Science.gov

Sample records for first-trimester fetal gender

  1. First trimester tricuspid regurgitation and fetal abnormalities.

    PubMed

    Wiechec, Marcin; Nocun, Agnieszka; Wiercinska, Ewa; Beithon, Jill; Knafel, Anna

    2015-09-01

    Tricuspid regurgitation (TR) is a common sonographic finding during the fetal life. It has been reported in 7% of normal fetuses. It may be associated with aneuploidy and with both cardiac and extracardiac defects. In this study, we have looked at the characteristics of fetuses with and without TR at 11+0 to 13+6 weeks' gestation. Groups were compared with respect to the following variables: prevalence of chromosomal defects; other markers of aneuploidy; fetal cardiac; and extracardiac anomalies. The study group included women, who underwent an ultrasound examination at 11-13+6 weeks' gestation between 2009 and 2012. The inclusion criteria were singleton pregnancies with crown-rump length measurements of 45-84 mm where the pregnancy outcome was known. Some 1075 patients met our inclusion criteria including 979 fetuses without TR and 96 with TR. There were 72 cases of aneuploidy diagnosed (6.7%). Isolated TR was found in 53 euploid fetuses (5.2%). All of the TR(+) aneuploid fetuses (n=40) had additional ultrasound markers present. Extracardiac anatomy showed a higher prevalence of abnormalities in the group of TR positives (12.5%) vs. TR negatives (1.6%). Abnormal cardiac findings were more frequent in the TR-positive group independently of chromosomal status and were found in 18.8% of fetuses with TR and in 1.9% with a normal tricuspid flow. TR in combination with other markers is the strongest predictor for aneuploidy. TR, as an isolated parameter, is a poor screening tool both for all and for each individual chromosomal abnormality and congenital cardiac defects.

  2. The impact of fetal gender on first trimester nuchal translucency and maternal serum free beta-hCG and PAPP-A MoM in normal and trisomy 21 pregnancies.

    PubMed

    Cowans, Nicholas J; Stamatopoulou, Anastasia; Maiz, Nerea; Spencer, Kevin; Nicolaides, Kypros H

    2009-06-01

    To investigate if fetal sex has an impact on 1st trimester combined screening for aenuploidy. We studied the first trimester PAPP-A, free beta-human chorionic gonadatropin (beta-hCG) and nuchal translucency levels in 56,024 normal, singleton pregnancies with known fetal sex at birth. We also examined the distributions in 722 pregnancies with trisomy 21 of known fetal sex. We have found a 14.74% increase in first trimester maternal serum (MS) median free beta-hCG MoM, 6.25% increase of PAPP-A and a 9.41% decrease in delta NT, when the fetus was female. Analysis of data has shown that women carrying a female fetus were 1.084 times more likely to be in the 'at risk' group than those carrying a male fetus. In examining data from 722 pregnancies in which the fetus was affected by trisomy 21, we observed a similar 20.8% increase in free beta-hCG MoM, 5.7% increase in PAPP-A and a 12% decrease in delta NT when the fetus was female. Amongst the trisomy 21 cases, 88.8% of male trisomy 21 cases were detected compared with 91.2% in female cases, this difference was not statistically significant. Correcting for fetal sex redressed the balance in screen-positive rate between the sexes and had a minimal impact on detection rate. Correcting for fetal sex may be a worthwhile consideration. A cost-benefit analysis would be required to determine if it is feasible to introduce fetal gender assignment into the routine first trimester scan for the purpose of marker correction and whether this would have any significant impact. (c) 2009 John Wiley & Sons, Ltd.

  3. First trimester increased nuchal translucency associated with fetal achondroplasia.

    PubMed

    Tonni, Gabriele; Ventura, Alessandro; De Felice, Claudio

    2005-04-01

    A 30-year-old woman, gravida 2, para 1, was referred for nuchal translucency, free beta-human chorionic gonadotropin (beta-hCG), and pregnancy-associated plasma protein A (PAPP-A) screening at 12 weeks gestation. The nuchal translucency was increased to 3.8 mm, resulting in a post-test result of 1:15 risk for Down syndrome by a combination of maternal age plus nuchal translucency, and 1:5 by a combination of maternal age plus nuchal translucency plus free beta-hCG plus PAPP-A. The patient underwent uncomplicated chorionic villus sampling that demonstrated a normal 46,XY fetus. The patient was then followed-up weekly by ultrasound. At 18 weeks gestation, generalized features of rhizomelic micromelia together with macrocrania and narrow thorax were seen. All fetal long bones were less than 2 standard deviations from the mean value. At that time, DNA analysis was performed on stored villi and a G380R mutation in the locus gene encoding for the fibroblast growth factor receptor 3 on chromosome 4p16.3 was found, leading to a prenatal diagnosis of achondroplasia. The couple opted for termination of pregnancy after counseling. Postmortem X-ray was done and confirmed the ultrasound diagnosis of achondroplasia. This is the second known case of increased nuchal translucency in the first trimester associated with prenatal confirmed diagnosis of fetal osteochondrodysplasia.

  4. [Sonographic fetal sex determination in the first trimester: study in 2314 pregnancies and literature review].

    PubMed

    González Ballano, Isabel; Savirón Cornudella, Ricardo; Puertas, Diego Lerma; Luis, Juan De León

    2015-04-01

    To evaluate the success rate and reliability of fetal sex determination in first trimester between 11-13+ 6 weeks and make a comparative study with other studies. A cohort study was performed. 2314 first trimester pregnancy ultrasounds were examined. For fetal sex estimation, the method of a sagittal section and the relation between the angle formed by the genital tubercle and spinal column was used. Diagnosis of fetal sex was issued in 1986 cases with 90.1% success rate. In 328 cases (14.2%) no gender assignment was achieved. A directly proportional relationship between success rate in fetal sex diagnosis and crown-rump length (CRL) (p < 0.001) was described; with CRL over 65 mm, the prediction of fetal sex is above 95% and from 77 mm is close to 100%. With CRL < 51 mm, the success rate is less than 80% in both sexes. The simplest and best performing technique is the relation between the angle formed by the genital tubercle and spinal column. Success rate below 60 mm is less than 90% overall, so it would have to be wary of establishing the fetal sex, especially if it involves a decision as to avoid an invasive test.

  5. Role of first-trimester sonography in the diagnosis of aneuploidy and structural fetal anomalies.

    PubMed

    Abu-Rustum, Reem S; Daou, Linda; Abu-Rustum, Sameer E

    2010-10-01

    We sought to determine the sensitivity of the first-trimester scan in the early diagnosis of aneuploidy and structural fetal anomalies in an unselected low-risk population. This was a retrospective chart review of all patients having first-trimester scans between 2002 and 2009. At our center, a survey of fetal anatomy is performed at the time of nuchal translucency assessment at 11 weeks to 13 weeks 6 days. A second-trimester scan is done at 20 to 23 weeks and a third-trimester scan at 32 to 35 weeks. Isolated sonographic findings of choroid plexus cysts and echogenic intracardiac foci were excluded. Lethal anomalies and those requiring immediate surgical intervention at birth were considered major structural anomalies. All scans were performed by a single sonologist certified by the Fetal Medicine Foundation. All neonates were examined at birth by a pediatrician. Our study included 1370 fetuses. Six cases of aneuploidy (0.4%) were detected. The first-trimester scan detected 5 of 6 cases of aneuploidy (83%), confirmed by karyotype. There were 36 cases of structural fetal anomalies (2.6%); 20 (1.5%) were major anomalies. The first-trimester scan detected 16 of 36 (44%); 20 (56%) were identified by second- or third-trimester scans. The first-trimester scan detection rate for major structural anomalies was 14 of 20 (70%). The 5 that were missed by the first-trimester scan were detected by a second-trimester scan. Our study emphasizes the importance of the first-trimester scan in the early detection of aneuploidy and structural fetal anomalies. In this small unselected low-risk population, the first-trimester scan detected 83% of aneuploidies and 70% of major structural anomalies. Our results are comparable to previously published studies from other centers and further exemplify the invaluable role of the first-trimester scan in the early detection of aneuploidy and structural anomalies in an unselected low-risk population.

  6. Maternal attitude towards first trimester screening for fetal abnormalities.

    PubMed

    Maiz, Nerea; Burgos, Jorge; Barbazán, Maria José; Recio, Virginia; Martínez-Astorquiza, Txanton

    2016-05-01

    To explore the maternal attitude towards the screening for structural abnormalities at the 11-13-week scan, according to the severity of the abnormality. A secondary aim was to analyse which maternal characteristics influence in the maternal response. This is a descriptive study based on the responses to 300 self-administrated questionnaires completed immediately before routine ultrasounds scan. A totally of 296 (98.7%) women participated in the study. If the baby had any abnormality 93.9% would prefer to know at 12 weeks, 96.6% if the abnormality was lethal, 95.3% if the abnormality involves severe handicap, 91.2% if the abnormality can only be suspected, but not confirmed until the pregnancy is more advanced (16 or 20 weeks), 77.0% if the abnormality was minor and 79.4% women would like to know at 12 weeks if the baby appeared normal. Maternal age, gestational age at the time of the questionnaire and maternal attitude towards termination of pregnancy were the only factors affecting maternal responses. Pregnant women prefer to be informed in the first trimester about any abnormality in their fetuses, even in cases of minor or only suspected abnormalities. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

  7. First-trimester fetal sex prediction by deoxyribonucleic acid analysis of maternal peripheral blood.

    PubMed

    Falcinelli, C; Battafarano, S; Neri, C; Mazza, V; Ranzi, A; Volpe, A; Forabosco, A

    1999-09-01

    We investigated whether the number of weeks of gestation influences the accuracy of first-trimester fetal sex prediction by analysis of deoxyribonucleic acid extracted from whole maternal blood. A comparison was also made to determine whether a difference exists between this approach and the deoxyribonucleic acid analysis of transcervical cells performed on the same group of subjects. Deoxyribonucleic acid was isolated from 50 maternal blood samples taken between gestational weeks 7 and 11. The sex of the fetus was assessed by nested polymerase chain reaction specific for the amelogenin gene. A receiver-operating characteristic curve analysis was used to correlate the accuracy of fetal gender prediction with the gestational age and also to compare the goodness of the 2 methods under investigation. Analysis of the receiver-operating characteristic curve provided a cutoff value of 9 weeks 4 days of gestation for both tests, indicating that a higher degree of accuracy in the sex assignment was obtained in those samples taken before or at this time. However, this difference was statistically significant only for analysis of deoxyribonucleic acid from maternal blood. The comparison between tests of deoxyribonucleic acid from maternal blood and from transcervical cells showed that the first approach is better, although a statistically significant difference was not found. Analysis of maternal blood deoxyribonucleic acid is a better approach than analysis of trans-cervical cell deoxyribonucleic acid in fetal sex prediction. The highest degree of accuracy is obtained when blood is drawn before 10 weeks of gestation. This can be important when sampling of chorionic villi should be avoided because of the risk of an X-linked disease when the fetal sex is female.

  8. Assessment of first-trimester thymus size and correlation with maternal diseases and fetal outcome.

    PubMed

    Borgelt, Judith M A; Möllers, Mareike; Falkenberg, Maria K; Amler, Susanne; Klockenbusch, Walter; Schmitz, Ralf

    2016-02-01

    We investigated the reliability of fetal thymus measurement during first-trimester screening, and associated fetal thymus size with crown-rump length, maternal diseases and fetal outcome. In a retrospective cohort of 971 normal singleton first-trimester fetuses, we measured the anterior-posterior diameter of the thymus in a midsagittal plane in 767 fetuses. The intra-observer and inter-observer reliabilities were tested by intra-class correlation coefficient. We correlated thymus size with fetal crown-rump length, and investigated its association with maternal diseases (diabetes mellitus, rheumatic disorders, hypertension and coagulation disorders) and fetal outcome (small for gestational age, preterm birth and umbilical artery pH) using regression analyses. The intra-observer and inter-observer reliabilities of fetal thymus measurement were excellent (intra-class correlation coefficient 0.926, 95% CI 0.745-0.981 and 0.945, 95% CI 0.886-0.993, respectively). A linear relationship was found between crown-rump length and thymus size (β = 0.023, p = 0.001). Pregnancies affected by maternal diabetes had a decreased fetal thymus size (β = -0.209, p = 0.001), whereas in pregnancies affected by maternal rheumatic disease the thymus size was increased (β = 0.285, p < 0.001). Fetal thymus size was not associated with maternal hypertension or maternal coagulation disorders. There was a positive association between preterm birth and fetal thymus size (p < 0.001). Measurement of first-trimester thymus size is reliable. Fetal thymus size has a linear correlation with crown-rump length. Maternal diabetes, rheumatic disease and preterm birth appear to have an association with fetal thymus size. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

  9. First-trimester fetal sex determination in maternal serum using real-time PCR.

    PubMed

    Costa, J M; Benachi, A; Gautier, E; Jouannic, J M; Ernault, P; Dumez, Y

    2001-12-01

    Fetal sex prediction can be achieved using PCR targeted at the SRY gene by analysing cell-free fetal DNA in maternal serum. Unfortunately, the results reported to date show a lack of sensitivity, especially during the first trimester of pregnancy. Therefore, determination of fetal sex by maternal serum analysis could not replace karyotype analysis following chorionic villus sampling. A new highly sensitive real-time PCR was developed to detect an SRY gene sequence in maternal serum. Analysis was performed on 121 pregnant women during the first trimester of pregnancy (mean gestational age: 11.8 weeks). Among them, 51 had at least one previous male-bearing pregnancy. Results were compared with fetal sex. SRY PCR analysis of maternal serum was in complete concordance with fetal sex. Among the 121 pregnant women, 61 were bearing a male fetus and 60 a female fetus. No false-negative results were observed. Furthermore, no false-positive results occurred, even though 27 women carrying a female fetus during the current pregnancy had at least one previous male-bearing pregnancy. This study demonstrates that a reliable, non-invasive sex determination can be achieved by PCR analysis of maternal serum during the first trimester of pregnancy. This non-invasive approach for fetal sex prediction should have great implications in the management of pregnant women who are carriers of an X-linked genetic disorder. Prenatal diagnosis might thus be performed for male fetuses only, avoiding invasive procedures and the risk of the loss of female fetuses.

  10. The significance of fetal maxillary length in the first trimester screening for trisomy 21.

    PubMed

    Unsal, Naim; Ozat, Mustafa; Kanat-Pektas, Mine; Gungor, Tayfun; Danisman, Nuri

    2011-06-01

    The present study aims to specify the significance of fetal maxillary length by establishing a nomogram for a Turkish population and by investigating its relationship with the ultrasonographic and biochemical parameters which are commonly used to screen trisomy 21 in the first trimester of pregnancy. The present observational study investigates 1,308 Turkish women who had 11- to 14-week-old singleton healthy pregnancies. Fetal crown-rump length (CRL), nuchal translucency (NT), nasal bone length (NBL) and maxillary length are measured by ultrasonography and maternal serum concentrations of pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (HCG) are determined. A positive and significant correlation was detected between the fetal maxillary length and gestational age (r = 0.309, P < 0.001) as was the case with fetal CRL (r = 0.357, P < 0.001) and NBL (r = 0.487, P < 0.001). Although there was a significant and positive correlation between fetal maxillary length and maternal serum PAPP-A levels (r = 0.201, P < 0.001), a significant and negative correlation was found between fetal maxillary length and the maternal serum concentrations of free beta-HCG (r = -0.238, P < 0.001). Fetal maxillary length increased in accordance with the advancing gestational age and increasing CRL. Maternal serum PAPP-A concentrations and fetal CRL and NBL were addressed as independent predictors of fetal maxillary length. The length of fetal maxillary bone is a promising biometrical parameter which can be reliably and efficiently used to screen trisomy 21 in first trimester. Fetal maxillary length is also found to correlate with gestational age, CRL, NBL and PAPP-A significantly. It would be rational to use a combination of nasal and maxillary bone length measurements in case serum concentrations of PAPP-A or beta-HCG cannot be assessed.

  11. Fetal akinesia deformation sequence presenting with increased nuchal translucency in the first trimester of pregnancy.

    PubMed

    Makrydimas, George; Sotiriadis, Alexandros; Papapanagiotou, George; Tsopelas, Antonios; Lolis, Dimitrios

    2004-01-01

    Prenatal sonographic diagnosis of fetal akinesia deformation sequence (FADS) is usually achieved during the second and third trimester of pregnancy and relies on the demonstration of contractures of multiple joints, paucity of fetal movements and nuchal edema or generalized hydrops. We present the early diagnosis of FADS in a 13-week fetus presenting with nuchal translucency thickness (NT) of 5.1 mm, bilateral talipes and fixed flexion deformity of the fingers and wrists. We also review cases of this condition diagnosed during the first trimester and discuss the role of increased NT in the early diagnosis of FADS even in cases without previous history of an affected child.

  12. First-trimester adiponectin and subsequent development of preeclampsia or fetal growth restriction.

    PubMed

    Valdés, Enrique R; Lattes, Karinna A; Muñoz, Hernán S; Barja, Pilar Y; Papapietro, Karin V

    2011-01-01

    The evidence regarding the utility of assessing first-trimester adiponectin (ApN) serum levels in early prediction of preeclampsia (PE) and fetal growth restriction (FGR) is contradictory. This study aims to determine the role of maternal serum ApN levels as an early predictor of PE and FGR. A prospective case-control study among a pregnant population who attended their 11- to 14-week ultrasound scan at the University of Chile's Clinical Hospital's Fetal Medicine Unit. We included patients who developed PE or FGR (10 cases per group) and 35 healthy controls. We determined ApN levels in blood samples from these 55 patients using a commercial ELISA kit and assessed the relationship of ApN levels with variables like development of PE, FGR, weight at birth and maternal BMI. There were no significant differences among first-trimester ApN serum levels in the groups. Average concentrations were 8, 6.8 and 10.8 ng/ml for the control, PE and FGR groups, respectively. In our study, maternal serum ApN levels were not useful in predicting subsequent development of PE and FGR. However, maternal serum ApN concentration adjusted by BMI was significantly higher during the first trimester in women who later developed FGR. Copyright © 2011 S. Karger AG, Basel.

  13. Sonographic spectrum of first-trimester fetal cephalocele: review of 35 cases.

    PubMed

    Sepulveda, W; Wong, A E; Andreeva, E; Odegova, N; Martinez-Ten, P; Meagher, S

    2015-07-01

    To describe the sonographic features of fetal cephalocele diagnosed at the time of first-trimester ultrasound screening for aneuploidy. This was a retrospective review of cases of cephalocele diagnosed in the first trimester at four fetal medicine referral centers. Once diagnosis was suspected, a transvaginal ultrasound examination was offered to improve depiction of the cranial defect and enhance examination of fetal anatomy, with special attention given to the location, size and content of defects. To assure consistency in diagnosis, representative pictures and videoclip sequences of the cranial defect were obtained and reviewed by at least two authors. Cases were classified and compared with the assessment made at diagnosis. Of the 35 affected fetuses identified, 33 were of a singleton pregnancy and two were of twin pregnancies in which the other fetus was unaffected. The lesion was classified as a cranial meningocele in 13 (37%) cases and as an encephalocele in 22 (63%). The bone defect was occipital in 27 (77%), frontal in three (9%), parietal in three (9%) and non-classifiable in two (6%). Twelve (34%) were considered as small in size, 11 (31%) as medium and 12 (34%) as large. There were no reported cases of aneuploidy; however, four (11%) cases were associated with Meckel-Gruber syndrome, two (6%) with a disruptive syndrome and one (3%) with skeletal dysplasia. Eight (23%) pregnancies were lost to follow-up. Parents opted for termination of pregnancy in 21 of the 27 remaining cases and, of the six ongoing pregnancies, four patients miscarried or the fetus died in utero during the second trimester, one liveborn infant died shortly after delivery and one underwent neonatal surgery for an isolated cranial meningocele and is currently doing well. First-trimester sonographic diagnosis of cephalocele is accomplished easily with a detailed examination of the skull contour at the time of routine assessment of the axial and sagittal views of the head for measurement

  14. Diagnostic accuracy of fetal rhesus D genotyping using cell-free fetal DNA during the first trimester of pregnancy.

    PubMed

    Vivanti, Alexandre; Benachi, Alexandra; Huchet, François-Xavier; Ville, Yves; Cohen, Henri; Costa, Jean-Marc

    2016-11-01

    Rhesus D genotyping with cell-free fetal DNA currently is used throughout the world. Although this technique has spread rapidly, its optimal use is still a matter of debate. This screening test has been introduced mainly for the treatment of RhD-negative pregnant women during the third trimester of pregnancy, thereby avoiding systematic anti-D prophylaxis, yet such a strategy has proved cost-ineffective. Publications reporting on fetal RHD genotyping with cell-free DNA in maternal plasma, specifically during the first trimester of pregnancy, are scarce in the scientific literature. This study sought to assess the performance of noninvasive fetal Rhesus D genotyping in the first trimester of pregnancy with a single-exon real-time polymerase chain reaction assay. This was a retrospective observational multicenter study. Cell-free fetal DNA was extracted from maternal blood of both nonimmunized and immunized women at 10-14 weeks of gestation. RHD sequence was determined by quantitative polymerase chain reaction, with amplification of exon 10. Results were compared with RhD phenotype data that were obtained by cord blood sampling of neonates. In total, 416 serum samples from RhD-negative pregnant women were collected during the first trimester of pregnancy. The test's overall sensitivity and specificity were 100% (95% confidence interval, 96.9-100.0) and 95.2% (95% confidence interval, 90.5-97.6), respectively. The negative and positive predictive values were 99.8% (95% confidence interval, 94.9-100.0) and 97.1% (95% confidence interval, 94.2-98.6), respectively. Fetal RHD status was inconclusive in 9 cases (2.2%). Noninvasive fetal RHD determination by single-exon quantitative polymerase chain reaction during the first trimester of pregnancy exhibits high accuracy. Copyright © 2016 Elsevier Inc. All rights reserved.

  15. Accuracy of fetal sex determination on ultrasound examination in the first trimester of pregnancy.

    PubMed

    Manzanares, Sebastián; Benítez, Adara; Naveiro-Fuentes, Mariña; López-Criado, María Setefilla; Sánchez-Gila, Mar

    2016-06-01

    The aim of this study was to evaluate the feasibility and success rate of sex determination on transabdominal sonographic examination at 11-13 weeks' gestation and to identify factors influencing accuracy. In this prospective observational evaluation of 672 fetuses between 11 weeks' and 13 weeks + 6 days' gestational age (GA), we determined fetal sex according to the angle of the genital tubercle viewed on the midsagittal plane. We also analyzed maternal, fetal, and operator factors possibly influencing the accuracy of the determination. Fetal sex determination was feasible in 608 of the 672 fetuses (90.5%), and the prediction was correct in 532 of those 608 cases (87.5%). Fetal sex was more accurately predicted as the fetal crown-rump length (CRL), and GA increased and was less accurately predicted as the maternal body mass index increased. A CRL greater than 55.7 mm, a GA more than 12 weeks + 2 days, and a body mass index below 23.8 were identified as the best cutoff values for sex prediction. None of the other analyzed factors influenced the feasibility or accuracy of sex determination. The sex of a fetus can be accurately determined on sonographic examination in the first trimester of pregnancy; the accuracy of this prediction is influenced by the fetal CRL and GA and by the maternal body mass index. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:272-277, 2016. © 2015 Wiley Periodicals, Inc.

  16. First trimester fetal heart rate as a predictor of newborn sex.

    PubMed

    Bracero, L A; Seybold, D J; Witsberger, S; Rincon, L; Modak, A; Baxi, L V

    2016-03-01

    To predict the sex of newborns using first trimester fetal heart rate (FHR). This was a retrospective review of medical records and ultrasounds performed between 8 and 13 weeks of gestation. Continuous variables were compared using Student's t-tests while categorical variables were compared using Chi-square test. We found no significant differences between 332 (50.7%) female and 323 (49.3%) male FHRs during the first trimester. The mean FHR for female fetuses was 167.0 ± 9.1 bpm and for male fetuses 167.3 ± 10.1 bpm (p = 0.62). There was no significant difference in crown rump length between female and male fetuses (4.01 ± 1.7 versus 3.98 ± 1.7 cm; p = 0.78) or in gestational age at birth (38.01 ± 2.1 versus 38.08 ± 2.1 weeks; p = 0.67). The males were significantly heavier than females (3305.3 ± 568.3 versus 3127.5 ± 579.8 g; p < 0.0001) but there were no differences in the proportion of small for gestational age (SGA), average for gestational age (AGA) and large for gestational age (LGA) infants. We found no significant difference between the female and male FHR during the first trimester in contrast to the prevailing lay view of females having a faster FHR. The only statistically significant difference was that males weighed more than female newborns.

  17. First trimester fetal heart rate as a predictor of newborn sex*

    PubMed Central

    Bracero, L. A.; Seybold, D. J.; Witsberger, S.; Rincon, L.; Modak, A.; Baxi, L. V.

    2015-01-01

    Objective To predict the sex of newborns using first trimester fetal heart rate (FHR). Methods This was a retrospective review of medical records and ultrasounds performed between 8 and 13 weeks of gestation. Continuous variables were compared using Student's t-tests while categorical variables were compared using Chi-square test. Results We found no significant differences between 332 (50.7%) female and 323 (49.3%) male FHRs during the first trimester. The mean FHR for female fetuses was 167.0 ± 9.1 bpm and for male fetuses 167.3 ± 10.1 bpm (p = 0.62). There was no significant difference in crown rump length between female and male fetuses (4.01 ± 1.7 versus 3.98 ± 1.7 cm; p = 0.78) or in gestational age at birth (38.01 ± 2.1 versus 38.08 ± 2.1 weeks; p = 0.67). The males were significantly heavier than females (3305.3 ± 568.3 versus 3127.5 ± 579.8 g; p < 50.0001) but there were no differences in the proportion of small for gestational age (SGA), average for gestational age (AGA) and large for gestational age (LGA) infants. Conclusions We found no significant difference between the female and male FHR during the first trimester in contrast to the prevailing lay view of females having a faster FHR. The only statistically significant difference was that males weighed more than female newborns. PMID:25754210

  18. Systematic review of first-trimester ultrasound screening for detection of fetal structural anomalies and factors that affect screening performance.

    PubMed

    Karim, J N; Roberts, N W; Salomon, L J; Papageorghiou, A T

    2017-10-01

    To determine the sensitivity and specificity of first-trimester ultrasound for the detection of fetal abnormalities and to establish which factors might impact on screening performance. A systematic review and meta-analysis of all relevant publications was performed to assess the diagnostic accuracy of two-dimensional transabdominal and transvaginal ultrasound in the detection of congenital fetal anomalies prior to 14 weeks' gestation. The reference standard was detection of abnormalities at birth or postmortem. Factors that may impact on detection rates were evaluated, including population characteristics, gestational age, healthcare setting, ultrasound modality, use of an anatomical checklist for detection of first-trimester anomalies and type of malformation included in the study. In an effort to reduce the impact of study heterogeneity on the results of the meta-analysis, data from the studies were analyzed within subgroups of major anomalies vs all types of anomaly and low-risk/unselected populations vs high-risk populations. An electronic search (until 29 July 2015) identified 2225 relevant citations, from which a total of 30 studies, published between 1991 and 2014, were selected for inclusion. The pooled estimate for the detection of major abnormalities in low-risk or unselected populations (19 studies, 115 731 fetuses) was 46.10% (95% CI, 36.88-55.46%). The detection rate for all abnormalities in low-risk or unselected populations (14 studies, 97 976 fetuses) was 32.35% (95% CI, 22.45-43.12%), whereas in high-risk populations (six studies, 2841 fetuses) it was 61.18% (95% CI, 37.71-82.19%). Of the factors examined for their impact on detection rate, there was a statistically significant relationship (P < 0.0001) between the use of a standardized anatomical protocol during first-trimester anomaly screening and its sensitivity for the detection of fetal anomalies in all subgroups. Detection rates of first-trimester fetal anomalies ranged from 32

  19. Fetal cells in cervical mucus in the first trimester of pregnancy.

    PubMed

    Cioni, Riccardo; Bussani, Cecilia; Scarselli, Benedetta; Bucciantini, Sandra; Barciulli, Francesco; Scarselli, Gianfranco

    2003-02-01

    The aim of this study was to first evaluate the presence of fetal cells in cervical mucus samples collected in the first trimester of pregnancy and then to compare different laboratory methods for the detection of these cells. Mucus samples were collected by using a cytobrush before termination of pregnancy (TOP) from 143 pregnant women between 7 and 12 weeks of gestation. None of the women had undergone an invasive diagnostic procedure prior to cervical mucus sampling. Samples of placental tissue were collected from each patient at TOP. Slides from each sample were first observed under an inverted microscope to detect possible sperm contamination. In the first part of our experiments, 40 mucus samples were treated with a mucolytic solution containing N-acetylcysteine (AC) and were analysed by a polymerase chain reaction (PCR) assay. The second series, consisting of 71 mucus samples, was treated with a mucolytic solution containing dithiothreitol (DTT): all 71 samples were analysed by a PCR-based assay, and an aliquot for fluorescent in situ hybridisation (FISH) analysis was also obtained from 48 out of 71 samples. In the third part of our experiments, performed on 32 mucus samples, mucus trapped on the cytobrush was directly spread on two slides for FISH analysis without any mucolytic treatment. All placental tissue samples obtained at termination were analysed by FISH for fetal sexing. Overall, the use of PCR-based or FISH analyses on 143 mucus samples resulted in correct sex prediction in 92/143 (64.3%) samples [20/66 (30.3%) cases from known male pregnancies and 72/77 (93.5%) cases from known female pregnancies]. In the AC group, Y-derived sequences were found in 7/23 samples (30.4%) from known male pregnancies and in 1/17 cases from known female pregnancies, with an overall correct sex prediction in 23/40 cases (57.5%). In the DTT group, Y-derived sequences could be amplified in 10/30 samples (33.3%) from known male pregnancies and in 4/41 cases from known

  20. Comparison of Prenatal Risk Calculation (PRC) with PIA Fetal Database software in first-trimester screening for fetal aneuploidy.

    PubMed

    Hörmansdörfer, C; Scharf, A; Golatta, M; Vaske, B; Corral, A; Hillemanns, P; Schmidt, P

    2009-02-01

    In February 2007 new software, Prenatal Risk Calculation (PRC), for calculating the risk of fetal aneuploidy was introduced in Germany. Our aim was to investigate its test performance and compare it with that of the PIA Fetal Database (PIA) software developed and used by The Fetal Medicine Foundation. Between 31 August 1999 and 30 June 2004 at the Women's Hospital of the Medical University of Hanover in Germany, 3120 singleton pregnancies underwent combined first-trimester screening at 11 + 0 to 13 + 6 weeks of gestation. Calculation of risk for fetal aneuploidy was computed prospectively using the PIA software. In a subsequent retrospective analysis, we recalculated risks for the 2653 of these datasets with known fetal outcome using the PRC software and compared the results. Of the 2653 datasets analyzed, 17 were cases of aneuploidy. At a cut-off of 1 : 230, for the detection of fetal aneuploidy, the respective sensitivity, false-positive rate and positive predictive value were 70.6%, 4.1% and 9.9% for PRC and 76.5%, 2.9% and 14.6% for PIA. At a cut-off of 1 : 300, the equivalent values were 70.6%, 5.6% and 7.5% for PRC and 76.5%, 4.0% and 11.0% for PIA. The differences in test performance between the two types of software were highly significant (P < 0.0001). The test performance of PRC was inferior to that of PIA, the sensitivity for detection of fetal aneuploidy being lower and the false-positive rate higher. Had PRC been employed prospectively in our study, 40% more women examined would have been offered unnecessarily an invasive procedure for fetal karyotyping.

  1. Auditing fetal nasal bone images in the first trimester of pregnancy: results from a peer review program.

    PubMed

    Palermo, Fernanda Gasparin; Albuquerque, Débora de Paula Soares de Medeiros; Martins, Wellington P; Araujo Júnior, Edward; Bruns, Rafael Frederico

    2016-09-01

    To establish a structured review process to facilitate the identification of the fetal nasal bone (NB) in the first trimester ultrasound scan to improve the quality images. We conducted a retrospective observational study in fetal NB images obtained during ultrasound exams of singleton pregnancies that underwent first trimester screening (crown-rump length 45-84 mm). When the images were obtained the examiner was not aware of the study. Audit was conducted by an examiner according criteria established by the Fetal Medicine Foundation. Fetal NB images were assessed regarding adequate magnification, mid-sagittal view and transducer held parallel to the direction of the nose. The transvaginal and transabdominal as well as anterior and posterior fetal back groups were compared using χ(2) test. We considered 874 fetal NB images for auditing. Fetal NB was considered present in 865 images (99%). During the audit process, we identified 72 (8.2%) cases of disagreement between examiner and auditor assessments. Disagreement was higher when image quality was poor (62 cases = 7%). Transvaginal approach performed better in the following criteria: adequate magnification (p < 0.001), midline (p < 0.001) and completely adequate (p < 0.001). A peer reviewed audit program for fetal NB is feasible in a clinical scenario. Image quality appears to play an important role in compliance to image standards audited and in agreement between examiner and auditor.

  2. Standardization of the first-trimester fetal cardiac examination using spatiotemporal image correlation with tomographic ultrasound and color Doppler imaging.

    PubMed

    Turan, S; Turan, O M; Ty-Torredes, K; Harman, C R; Baschat, A A

    2009-06-01

    The challenges of the first-trimester examination of the fetal heart may in part be overcome by technical advances in three-dimensional (3D) ultrasound techniques. Our aim was to standardize the first-trimester 3D imaging approach to the cardiac examination to provide the most consistent and accurate display of anatomy. Low-risk women with normal findings on first-trimester screening at 11 to 13 + 6 weeks had cardiac ultrasound using the following sequence: (1) identification of the four-chamber view; (2) four-dimensional (4D) volume acquisition with spatiotemporal image correlation (STIC) and color Doppler imaging (angle = 20 degrees, sweep 10 s); (3) offline, tomographic ultrasound imaging (TUI) analysis with standardized starting plane (four-chamber view), slice number and thickness; (4) assessment of fetal cardiac anatomy (four-chamber view, cardiac axis, size and symmetry, atrioventricular valves, great arteries and descending aorta) with and without color Doppler. 107 consecutive women (age, 16-42 years, body mass index 17.2-50.2 kg/m(2)) were studied. A minimum of three 3D volumes were obtained for each patient, transabdominally in 91.6%. Fetal motion artifact required acquisition of more than three volumes in 20%. The median time for TUI offline analysis was 100 (range, 60-240) s. Individual anatomic landmarks were identified in 89.7-99.1%. Visualization of all structures in one panel was observed in 91 patients (85%). Starting from a simple two-dimensional cardiac landmark-the four-chamber view-the standardized STIC-TUI technique enables detailed segmental cardiac evaluation of the normal fetal heart in the first trimester. (c) 2009 ISUOG.

  3. Screening for fetal spina bifida by ultrasound examination in the first trimester of pregnancy using fetal biparietal diameter.

    PubMed

    Bernard, Jean-Pierre; Cuckle, Howard S; Stirnemann, Julien J; Salomon, Laurent J; Ville, Yves

    2012-10-01

    Prenatal screening for aneuploidies is best achieved in the first trimester when there is no reliable screening test for spina bifida. Early ultrasound features may be too complex for routine screening. We assessed screening potential of simple and reproducible fetal biometric measurements at 11-14 weeks of gestation. A total of 34,951 unselected consecutive pregnancies included 18 with spina bifida. Another 28 cases were referred for assessment. Biometric measurements were expressed in multiples of the median for crown-rump length. Biparietal diameter (BPD) was smaller in spina bifida (P < .0001). In all, 22 of 44 (50%) cases with spina bifida aperta had a BPD <5th centile. BPD was independent of maternal adiposity and smoking status. Simple and reproducible BPD at 11-14 weeks of gestation could detect half the cases of open fetal spina bifida by identifying 5% of pregnancies for expert scanning in first- and second-trimester examinations of the fetal spine and cranium. Copyright © 2012 Mosby, Inc. All rights reserved.

  4. Cell-free total and fetal DNA in first trimester maternal serum and subsequent development of preeclampsia

    PubMed Central

    Silver, Robert; Clifton, Rebecca G.; Myatt, Leslie; Hauth, John C.; Leveno, Kenneth J.; Reddy, Uma M.; Peaceman, Alan M.; Ramin, Susan M.; Samuels, Philip; Saade, George; Sorokin, Yoram

    2017-01-01

    Objective To assess the relationship between first trimester cell-free total and fetal DNA in maternal plasma and the subsequent development of preeclampsia. Study Design Nested case-control study of patients enrolled in the Combined Antioxidant and Preeclampsia Prediction Studies (CAPPS) prediction study of 175 women who did and 175 women who did not develop preeclampsia. The predictive values of cell-free total and fetal DNA and the subsequent development of preeclampsia were measured using ROC curves. Results Cell-free total DNA was higher in African American (median; 25 – 75%; 6.15; 0.14 – 28.73; p = 0.02) and Hispanic (4.95; 0.20 – 26.82; p = 0.037) compared to white women (2.33; 0.03 – 13.10). Levels of cell-free total DNA was also associated with maternal BMI (p = 0.02). Cell-free total DNA levels were similar between women who later developed preeclampsia (3.52; 0.11 – 25.3) and controls (3.74; 0.12 – 21.14, p=0.96). Conclusions There is no significant difference in levels of cell-free total DNA in the first trimester in women who subsequently develop preeclampsia. Levels of cell-free total DNA in the first trimester are increased in African American and Hispanic compared to white women, and levels increase with increasing BMI. PMID:27398706

  5. Human chorionic gonadotropin (hCG) concentrations during the late first trimester are associated with fetal growth in a fetal sex-specific manner.

    PubMed

    Barjaktarovic, Mirjana; Korevaar, Tim I M; Jaddoe, Vincent W V; de Rijke, Yolanda B; Visser, Theo J; Peeters, Robin P; Steegers, Eric A P

    2017-02-01

    Human chorionic gonadotropin (hCG) is a pregnancy-specific hormone that regulates placental development. hCG concentrations vary widely throughout gestation and differ based on fetal sex. Abnormal hCG concentrations are associated with adverse pregnancy outcomes including fetal growth restriction. We studied the association of hCG concentrations with fetal growth and birth weight. In addition, we investigated effect modification by gestational age of hCG measurement and fetal sex. Total serum hCG (median 14.4 weeks, 95 % range 10.1-26.2), estimated fetal weight (measured by ultrasound during 18-25th weeks and >25th weeks) and birth weight were measured in 7987 mother-child pairs from the Generation R cohort and used to establish fetal growth. Small for gestational age (SGA) was defined as a standardized birth weight lower than the 10th percentile of the study population. There was a non-linear association of hCG with birth weight (P = 0.009). However, only low hCG concentrations measured during the late first trimester (11th and 12th week) were associated with birth weight and SGA. Low hCG concentrations measured in the late first trimester were also associated with decreased fetal growth (P = 0.0002). This was the case for both male and female fetuses. In contrast, high hCG concentrations during the late first trimester were associated with increased fetal growth amongst female, but not male fetuses. Low hCG in the late first trimester is associated with lower birth weight due to a decrease in fetal growth. Fetal sex differences exist in the association of hCG concentrations with fetal growth.

  6. The use of cffDNA in fetal sex determination during the first trimester of pregnancy of female DMD carriers.

    PubMed

    Wu, Dong; Hou, Qiaofang; Li, Tao; Chu, Yan; Guo, Qiannan; Kang, Bing; Liao, Shixiu

    2012-11-01

    Chorionic villus sampling (CVS) or amniocentesis for fetal sex determination is generally the first step in the prenatal diagnosis of X-linked genetic disorders such as Duchenne muscular dystrophy (DMD). However, non-invasive prenatal diagnostic (NIPD) techniques such as measurement of cell-free fetal DNA (cffDNA) in maternal plasma are preferable given the procedure-related miscarriage rate of CVS. We determined fetal sex during the first trimester using a quantitative real-time polymerase chain reaction (PCR) assay of cffDNA in pregnant carriers of DMD. The fetal sex was confirmed by amniocentesis karyotype analysis and multiplex ligation-dependent probe amplification (MLPA) at 16 weeks. This procedure may avoid unnecessary CVS or amniocentesis of female fetuses.

  7. Acute Fetal Demise with First Trimester Maternal Infection Resulting from Listeria monocytogenes in a Nonhuman Primate Model.

    PubMed

    Wolfe, Bryce; Wiepz, Gregory J; Schotzko, Michele; Bondarenko, Gennadiy I; Durning, Maureen; Simmons, Heather A; Mejia, Andres; Faith, Nancy G; Sampene, Emmanuel; Suresh, Marulasiddappa; Kathariou, Sophia; Czuprynski, Charles J; Golos, Thaddeus G

    2017-02-21

    Infection with Listeria monocytogenes during pregnancy is associated with miscarriage, preterm birth, and neonatal complications, including sepsis and meningitis. While the risk of these conditions is thought to be greatest during the third trimester of pregnancy, the determinants of fetoplacental susceptibility to infection, the contribution of gestational age, and the in vivo progression of disease at the maternal-fetal interface are poorly understood. We developed a nonhuman primate model of listeriosis to better understand antecedents of adverse pregnancy outcomes in early pregnancy. Four pregnant cynomolgus macaques (Macaca fascicularis) received a single intragastric inoculation between days 36 and 46 of gestation with 10(7) CFU of an L. monocytogenes strain isolated from a previous cluster of human listeriosis cases that resulted in adverse pregnancy outcomes. Fecal shedding, maternal bacteremia, and fetal demise were consistently noted within 7 to 13 days. Biopsy specimens of maternal liver, spleen, and lymph node displayed variable inflammation and relatively low bacterial burden. In comparison, we observed greater bacterial burden in the decidua and placenta and the highest burden in fetal tissues. Histopathology indicated vasculitis, fibrinoid necrosis, and thrombosis of the decidual spiral arteries, acute chorioamnionitis and villitis in the placenta, and hematogenous infection of the fetus. Vascular pathology suggests early impact of L. monocytogenes infection on spiral arteries in the decidua, which we hypothesize precipitates subsequent placentitis and fetal demise. These results demonstrate that L. monocytogenes tropism for the maternal reproductive tract results in infection of the decidua, placenta, and the fetus itself during the first trimester of pregnancy.IMPORTANCE Although listeriosis is known to cause significant fetal morbidity and mortality, it is typically recognized in the third trimester of human pregnancy. Its impact on early

  8. The role of cytokines in first trimester pregnancy losses with fetal chromosomal anomaly.

    PubMed

    Kasap, Esin; Karaarslan, Serap; Gene, Mine; Gur, Esra B; Sahin, Nur; Guclu, Serkan

    2015-11-01

    The contribution of local inflammation to the pathophysiology of abnormal choromosomally miscarriages remains unclear The objective of this study was to investigate the inflammatory response at the maternofetal interface of women presenting with first trimester miscarriage with abnormal choromosomally Level of TNF-α , IL-6 ve IL-17 were asseyed using immunohistochemistry technique at decidual and placental bed biopsy samples from 23 women with elective termination of pregnancy 21 euploid and 18 aneuploid missed miscarriages. Immunostainig for TNF-α, IL-6 ve IL-17 has been evaluated semi-quantitatively by 'quickscore' method. We found that the intensity of TNF-α staining was high in the miscarriage group, and this has been found in previous studies. Unlike some previous studies, the intensity of IL-6 staining was higher in the miscarriage groups only in decidual glandular epithelium. The intensity of IL-6 staining was found to be higher in the miscarriage group with chromosome anomaly than in the miscarriage group without chromosome anomaly. There was no significant difference in IL-17 levels between any of the groups. Cytokines are considered to play an important role in the maintenance of pregnancy but the exact mechanism between them and the mutual regulation relationship were not been fully understood, which need our further study.

  9. [Prenatal screening for anueploidies in the first trimester: Audit to a Fetal Medicine Centre with specialized Laboratory in Mexico].

    PubMed

    Oviedo-Cruz, Héctor; Hernández-Paredez, Javier; Ruíz-Ramírez, Areysha Vanessa

    2015-05-01

    Screening for aneuploidies using ultrasound and biochemical first trimester markers has an expected performance if the qualification requirements are fulfilled. To describe the first trimester markers in Mexico through the audit to a Fetal Medicine Centre and Laboratory. Descriptive study conducted with the audit method of ultrasound and biochemical markers in pregnancies that prenatal screening tests in the first quarter were made between 11 + 1 and 14 + 1 weeks pregnant patients who came to the Laboratorio del Centro Médico para Atención Fetal Especializada. In 17 months n=1020 pregnancies, 962 (94.3%) single, 55 (5.4%) doubles, and 3 (0.3%) triplets. Median maternal age of 33.8 years (16-52), 413 (40.5%) > or = 35 years. 1080 foetuses with 1009 valid measurements of nuchal translucency (29.8% at external cabinets), 54% >p50; 7.3% >p95, and 1.6% > p99. Out of 1555 sera processed at the Laboratory (f-beta-hCG and PAPP-A, Roche), 641 (41.2%) were interpreted at external centres. In 914 sera the f-beta-hCG MoM were p50 = 0.72, 3.2% >p95; for PAPP-A, p50 = 0.89, 9.0% < p5. There were 850 combined tests, and in 745 an additional marker was added; the IP ductus venosus median was 0.99 MoM. A risk > or =1 in 100 resulted in 50 foetuses (4.6%); 27 underwent invasive procedure at our Centre, 19 normal karyotypes, and 8 abnormal as: 3 trisomy 21 and 5 diverse aneuploidies. The qualification requirements are fulfilled for nuchal translucency, ductus venosus, and the combined test; 1 out of 3 invasive procedures resulted an aneuploidy; the estimated false positive rate is 3.9%. The Laboratory will adjust the median values of the biochemical markers. A cohort study has begun.

  10. Enhanced First Trimester Screening for Trisomy 21 with Contingent Cell-Free Fetal DNA: A Comparative Performance and Cost Analysis.

    PubMed

    Huang, Tianhua; Meschino, Wendy S; Teitelbaum, Mari; Dougan, Shelley; Okun, Nan

    2017-09-01

    Prenatal screening for trisomy 21 is a standard of care. Emerging cell-free fetal DNA (cffDNA) technologies can improve screening performance, but they are expensive. This study was conducted to propose a contingent screening model that would incorporate cffDNA technology, would remain affordable, and could be applied equitably in a publically funded system. Using performance and cost parameters from published literature, four prenatal screening strategies were compared. Scenario 1 modelled integrated prenatal screening (first trimester nuchal translucency and biochemical markers from both the first and second trimesters) with no cffDNA. Scenarios 2 and 3 modelled first trimester combined screening (FTS) and "enhanced FTS" (adding serum placental growth factor and alpha fetoprotein to FTS), respectively, with contingent cffDNA following a positive result. Scenario 4 modelled cffDNA as the primary screening test. Scenario 1 provides a known detection rate (DR) of 88%, with a false positive rate (FPR) of 3.3%. Scenarios 2 and 3 result in a DR of 94% and overall FPR of 0.59% and 0.33%, respectively, comparable to the DR of 96% and FPR of 0.1% with primary cffDNA (assuming the published test failure rate of 3%). The total cost, cost per woman screened, and cost per case of trisomy 21 detected were lower with scenario 3 (enhanced FTS with contingent cffDNA) compared with primary cffDNA or scenario 2 (FTS with contingent cffDNA). Enhanced FTS with contingent cffDNA following a positive result provides a similar performance to that of primary cffDNA at a substantially lower cost. Copyright © 2017 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  11. Acute Fetal Demise with First Trimester Maternal Infection Resulting from Listeria monocytogenes in a Nonhuman Primate Model

    PubMed Central

    Wolfe, Bryce; Wiepz, Gregory J.; Schotzko, Michele; Bondarenko, Gennadiy I.; Durning, Maureen; Simmons, Heather A.; Mejia, Andres; Faith, Nancy G.; Sampene, Emmanuel; Suresh, Marulasiddappa; Kathariou, Sophia; Czuprynski, Charles J.

    2017-01-01

    ABSTRACT Infection with Listeria monocytogenes during pregnancy is associated with miscarriage, preterm birth, and neonatal complications, including sepsis and meningitis. While the risk of these conditions is thought to be greatest during the third trimester of pregnancy, the determinants of fetoplacental susceptibility to infection, the contribution of gestational age, and the in vivo progression of disease at the maternal-fetal interface are poorly understood. We developed a nonhuman primate model of listeriosis to better understand antecedents of adverse pregnancy outcomes in early pregnancy. Four pregnant cynomolgus macaques (Macaca fascicularis) received a single intragastric inoculation between days 36 and 46 of gestation with 107 CFU of an L. monocytogenes strain isolated from a previous cluster of human listeriosis cases that resulted in adverse pregnancy outcomes. Fecal shedding, maternal bacteremia, and fetal demise were consistently noted within 7 to 13 days. Biopsy specimens of maternal liver, spleen, and lymph node displayed variable inflammation and relatively low bacterial burden. In comparison, we observed greater bacterial burden in the decidua and placenta and the highest burden in fetal tissues. Histopathology indicated vasculitis, fibrinoid necrosis, and thrombosis of the decidual spiral arteries, acute chorioamnionitis and villitis in the placenta, and hematogenous infection of the fetus. Vascular pathology suggests early impact of L. monocytogenes infection on spiral arteries in the decidua, which we hypothesize precipitates subsequent placentitis and fetal demise. These results demonstrate that L. monocytogenes tropism for the maternal reproductive tract results in infection of the decidua, placenta, and the fetus itself during the first trimester of pregnancy. PMID:28223455

  12. First trimester fetal diagnosis of genetic disorders: clinical evaluation of 250 cases.

    PubMed Central

    Brambati, B; Simoni, G; Danesino, C; Oldrini, A; Ferrazzi, E; Romitti, L; Terzoli, G; Rossella, F; Ferrari, M; Fraccaro, M

    1985-01-01

    Chromosome and enzyme determinations were performed in 250 pregnancies between the 7th and the 12th week of gestation. The majority of the tests were performed for risk of chromosomal abnormalities and 75% of the women were 35 years old or more. We describe a chorionic villi sampling (CVS) technique which proved to be highly efficient, with a diagnostic success rate of 97.7%. In the light of our experience we suggest that CVS is best performed between the 9th and 10th weeks of pregnancy. The average weight of the aspirated specimen was 20 mg with a lower limit of 5 mg which proved sufficient for diagnostic purposes. No major maternal complications were encountered and the slight bleeding observed in 14% of the cases during the days following the CVS should be considered a harmless effect of the aspiration technique. The proportion of fetal losses may lie between 4 and 7%. Paediatric monitoring of the 93 infants born so far and ultrasound examination of the pregnancies still in progress at the time of writing did not reveal any negative effect of CVS. Fetal-maternal transfusion and intrauterine infection are problems which need further basic investigations. PMID:3989840

  13. Acoustic output measured by thermal and mechanical indices during fetal echocardiography at the time of the first trimester scan.

    PubMed

    Nemescu, Dragos; Berescu, Anca

    2015-01-01

    We measured acoustic output, expressed as the thermal index (TI) and mechanical index (MI), during fetal echocardiography at the time of the first trimester scan. TI and MI were retrieved from the saved displays during gray-mode, high-definition color flow Doppler and pulsed-wave Doppler (tricuspid flow) ultrasound examinations of the fetal heart and from the ductus venosus assessment. A total of 399 fetal cardiac examinations were evaluated. There was a significant increase in TI values from B-mode studies (0.07 ± 0.04 [mean ± SD]) to color flow mapping (0.2 ± 0.0) and pulsed-wave Doppler studies (0.36 ± 0.05). The TI from ductus venosus assessment (0.1 ± 0.01) was significantly lower than those from Doppler examinations of the heart. MI values from B-mode scans (0.65 ± 0.12) and color flow mapping (0.71 ± 0.11) were comparable, although different, and both values were higher than those from pulsed-wave Doppler tricuspid evaluation (0.39 ± 0.03). There were no differences in MI values from power Doppler assessment between the tricuspid flow and ductus venosus. Safety indices were remarkably stable and were largely constant, especially for color Doppler (TI), tricuspid flow (MI) and ductus venosus assessment (TI, MI). We acquired satisfactory Doppler images and/or signals at acoustic levels that were lower than the actual recommendations and never reached a TI of 0.5.

  14. Fetal Nasal Bone Length as a Novel Marker for Prediction of Adverse Perinatal Outcomes in the First-Trimester of Pregnancy.

    PubMed

    Canda, Mehmet Tunç; Demir, Namık; Sezer, Orçun

    2017-04-05

    Adverse outcomes of pregnancy are a challenging health-care problem. Prediction of adverse pregnancy outcomes is important to prevent the morbidities of the foetus and the mother. To study the clinical interest of fetal nasal bone length in predicting adverse pregnancy outcomes in the first trimester of pregnancy. A population-based retrospective cohort study. Data from 868 women with first-trimester fetal nasal bone length and birth records available were enrolled. Fetal nasal bone length percentiles were determined and evaluated for their ability to predict adverse pregnancy outcomes such as preterm birth, preterm labour, preterm premature rupture of membranes, early preterm birth, gestational diabetes mellitus, gestational hypertension-preeclampsia, small-for-gestational age foetuses, macrosomia, oligohydramnios, polyhydramnios and fetal distress. Fetal nasal bone length >95th percentile was significantly associated with preterm labor and preterm premature rupture of membranes (p=0.02, accuracy 0.91 and p=0.001, accuracy 0.94, respectively), whereas nasal bone length >99th percentile was significantly associated with preterm labor and oligohydramnios (p=0.006, accuracy 0.95 and p=0.014, accuracy 0.97). Fetal nasal bone length at high percentiles in the first trimester of pregnancy may aid in the prediction of adverse outcomes such as preterm labour, preterm premature rupture of membranes and oligohydramnios.

  15. Fetal hemoglobin, α1-microglobulin and hemopexin are potential predictive first trimester biomarkers for preeclampsia.

    PubMed

    Anderson, Ulrik Dolberg; Gram, Magnus; Ranstam, Jonas; Thilaganathan, Basky; Kerström, Bo; Hansson, Stefan R

    2016-04-01

    Overproduction of cell-free fetal hemoglobin (HbF) in the preeclamptic placenta has been recently implicated as a new etiological factor of preeclampsia. In this study, maternal serum levels of HbF and the endogenous hemoglobin/heme scavenging systems were evaluated as predictive biomarkers for preeclampsia in combination with uterine artery Doppler ultrasound. Case-control study including 433 women in early pregnancy (mean 13.7weeks of gestation) of which 86 subsequently developed preeclampsia. The serum concentrations of HbF, total cell-free hemoglobin, hemopexin, haptoglobin and α1-microglobulin were measured in maternal serum. All patients were examined with uterine artery Doppler ultrasound. Logistic regression models were developed, which included the biomarkers, ultrasound indices, and maternal risk factors. There were significantly higher serum concentrations of HbF and α1-microglobulin and significantly lower serum concentrations of hemopexin in patients who later developed preeclampsia. The uterine artery Doppler ultrasound results showed significantly higher pulsatility index values in the preeclampsia group. The optimal prediction model was obtained by combining HbF, α1-microglobulin and hemopexin in combination with the maternal characteristics parity, diabetes and pre-pregnancy hypertension. The optimal sensitivity for all preeclampsia was 60% at 95% specificity. Overproduction of placentally derived HbF and depletion of hemoglobin/heme scavenging mechanisms are involved in the pathogenesis of preeclampsia. The combination of HbF and α1-microglobulin and/or hemopexin may serve as a prediction model for preeclampsia in combination with maternal risk factors and/or uterine artery Doppler ultrasound. Copyright © 2016 International Society for the Study of Hypertension in Pregnancy. Published by Elsevier B.V. All rights reserved.

  16. Quantitation of fetal DNA in maternal serum during the first trimester of pregnancy by the use of a DAZ repetitive probe.

    PubMed

    Stanghellini, I; Bertorelli, R; Capone, L; Mazza, V; Neri, C; Percesepe, A; Forabosco, A

    2006-09-01

    Cell-free fetal DNA in maternal plasma or serum is at present widely investigated as a source of fetal genetic material, both in studies of pregnancy-related disorders and in planning strategies for non-invasive prenatal diagnosis. Despite the number of trials already performed on the quantitation of fetal DNA, data about the amount of DNA at the beginning of pregnancy, in particular in the first trimester, remain limited. A new probe mapping on the deleted in azoospermia (DAZ) repetitive region of the Yq chromosome was designed for an early assessment of fetal DNA concentration in maternal serum. Among 57 pregnant women prospectively studied in their first trimester, fetal DNA was detected already by the 5th gestational week, with the analysis becoming reliable by the 8th week of gestation when a 100% accuracy in fetal sex determination was achieved. Moreover, in the three cases of pregnancy ending in fetal loss, the amount of fetal DNA apparently decreased before the abortion was diagnosed, whereas it consistently showed an increasing trend in normal pregnancies. Real-time PCR with the use of DAZ multilocus probe can efficiently quantitate free fetal DNA in the maternal serum at the beginning of pregnancy.

  17. Analysis of first-trimester combined test results in preparation for a cell-free fetal DNA era.

    PubMed

    Kose, Semir; Cımrın, Dilek; Yıldırım, Nuri; Aksel, Ozge; Keskinoglu, Pembe; Bora, Elcin; Cankaya, Tufan; Altunyurt, Sabahattin

    2016-11-01

    To survey experience with the first-trimester combined test (FCT) for trisomy 21 (T21) in different risk score groups to determine the most useful clinical application of cell-free fetal DNA (cffDNA) screening. In a retrospective study, the records of FCT results obtained at a center in Turkey between January 2009 and January 2014 were reviewed. The FCT results and rates of uptake of invasive diagnostic testing were compared among different risk score groups. FCT results were available for 4804 pregnancies; 276 (5.7%) had IDT results. Ten (72.7%) of 11 cases of T21 had a risk score of 1:300 or more. The IDT uptake rates were 54.5%, 51.9%, and 47.4% at risk scores of 1:100 or more, 1:200 or more, and 1:300 or more, respectively. In the group at intermediate risk (1:1001-1:3000), no pregnancy had an FCT result of both low pregnancy-associated plasma protein A and high free β-human chorionic gonadotropin, but 30 (3.9%) of 766 pregnancies had both advanced maternal age and high β-human chorionic gonadotropin. cffDNA screening should be used to optimize IDT uptake in pregnancies with a risk score of 1:101-1:1000. The selective power of the FCT diminishes beyond the 1:1001 score and cffDNA screening cannot yet be recommended routinely. Copyright © 2016 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  18. First-trimester diagnosis of Meckel-Gruber syndrome by fetal ultrasound with molecular identification of CC2D2A mutations by next-generation sequencing.

    PubMed

    Jones, D; Fiozzo, F; Waters, B; McKnight, D; Brown, S

    2014-12-01

    We describe a first-trimester ultrasound examination in which the finding of fetal encephalocele and the cystic appearance of the kidneys raised suspicion of Meckel-Gruber syndrome (MKS). On the basis of sonographic findings, the patient elected termination of pregnancy, and post-termination studies using next-generation sequencing of a gene panel revealed two mutations (one previously described and the other novel) in the gene CC2D2A. Mutations in CC2D2A are known to cause MKS and Joubert syndrome, thus providing molecular confirmation of the clinical suspicion of MKS and opening the possibility for future prenatal diagnosis. This case highlights the ability to detect important anomalies in the first trimester using ultrasound, even in low-risk situations. It also demonstrates the growing role of new sequencing technologies in fetal testing. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  19. First trimester alcohol exposure alters placental perfusion and fetal oxygen availability affecting fetal growth and development in a non-human primate model.

    PubMed

    Lo, Jamie O; Schabel, Matthias C; Roberts, Victoria H J; Wang, Xiaojie; Lewandowski, Katherine S; Grant, Kathleen A; Frias, Antonio E; Kroenke, Christopher D

    2017-03-01

    Prenatal alcohol exposure leads to impaired fetal growth, brain development, and stillbirth. Placental impairment likely contributes to these adverse outcomes, but the mechanisms and specific vasoactive effects of alcohol that links altered placental function to impaired fetal development remain areas of active research. Recently, we developed magnetic resonance imaging techniques in nonhuman primates to characterize placental blood oxygenation through measurements of T2* and perfusion using dynamic contrast-enhanced magnetic resonance imaging. The objective of this study was to evaluate the effects of first-trimester alcohol exposure on macaque placental function and to characterize fetal brain development in vivo. Timed-pregnant Rhesus macaques (n=12) were divided into 2 groups: control (n=6) and ethanol exposed (n=6). Animals were trained to self-administer orally either 1.5 g/kg/d of a 4% ethanol solution (equivalent to 6 drinks/d) or an isocaloric control fluid from preconception until gestational day 60 (term is G168). All animals underwent Doppler ultrasound scanning followed by magnetic resonance imaging that consisted of T2* and dynamic contrast-enhanced measurements. Doppler ultrasound scanning was used to measure uterine artery and umbilical vein velocimetry and diameter to calculate uterine artery volume blood flow and placental volume blood flow. After noninvasive imaging, animals underwent cesarean delivery for placenta collection and fetal necropsy at gestational day 110 (n=6) or 135 (n=6). Fetal weight and biparietal diameter were significantly smaller in ethanol-exposed animals compared with control animals at gestational day 110. By Doppler ultrasound scanning, placental volume blood flow was significantly lower (P=.04) at gestational day 110 in ethanol-exposed vs control animals. A significant reduction in placental blood flow was evident by dynamic contrast-enhanced magnetic resonance imaging. As we demonstrated recently, T2* values vary

  20. Diagnosis of sirenomelia in the first trimester.

    PubMed

    Singh, Chanchal; Lodha, Pooja; Arora, Deepshikha; Prabhu Sharma, Akshatha; Kaul, Anita

    2014-01-01

    Sirenomelia or "mermaid syndrome" is a rare congenital abnormality with an incidence of 1 in 60,000. We report a case diagnosed in the first trimester using two-dimensional, three-dimensional, and color Doppler ultrasound. With increasing emphasis on early diagnosis of fetal abnormalities, this case highlights the importance of looking for anomalies in the first trimester itself. In fact, the diagnosis of sirenomelia should be easier in the first trimester as severe oligohydramnios in later gestation hampers vision.

  1. Fetal Nasal Bone Status In Iranian Women Undergoing First-Trimester Screening For Trisomy 21: A Review and an Observational Study.

    PubMed Central

    Poureisa, Masoud; Daghighi, Mohammad Hossein; Mazaheri Khameneh, Ramin; Salehi Majd, Sanaz

    2015-01-01

    Background: Failed visualization of the fetal nasal bone (NB) by ultrasound at 11 - 14 weeks of gestation is strongly associated with chromosomal abnormalities. Meanwhile, the incidence of the absent fetal NB in normal fetuses in the first trimester in mothers of different ethnic origins differs significantly. It is, therefore, important to assess ethnic variations in the first-trimester visualization of the fetal NB before introducing this marker into routine screening programs for aneuploidy. Objectives: The objectives of this study were to determine the NB length and the prevalence of the NB absence as well as calculating the likelihood ratio (LR) for the absence of the NB in normal fetuses of Iranian women undergoing first-trimester screening for trisomy 21. Patients and Methods: In 767 normal fetuses, the fetal profile was examined by ultrasound for the absence/presence of the NB. The NB length was also measured, and the LR for the NB absence was also determined. Results: The NB was absent in 2/767 (0.26%) of the fetuses. The mean length of the NB was 3.6 ± 0.69 mm for the fetuses of 11 - 14 weeks gestational age. The LR value of the absent NB was equal to 250 in the normal fetuses of the Iranian population living in the North-West provinces. Conclusion: The low prevalence of the NB absence in normal fetuses in the present study is compatible with the larger size of the NB in Iranian people compared to other communities. Meanwhile, the reference range of the NB length in normal Iranian fetuses was established so that basic data could be recorded for further studies regarding the absence or presence of the NB in screening for chromosomal abnormalities (Down syndrome) within the Iranian population. PMID:26715977

  2. Applicability of first-trimester combined screening for fetal trisomy 21 in a resource-limited setting in mainland China.

    PubMed

    Li, B; Sahota, D S; Lao, T T; Xu, J; Hu, S Q; Zhang, L; Liu, Q Y; Sun, Q; Tang, D; Ma, R M

    2016-09-01

    To assess the feasibility and performance of the first-trimester combined screening test for trisomy 21 in a resource-limited setting in mainland China. Prospective observational cohort study. First Affiliated Hospital of Kunming Medical University, China. Ten thousand four hundred and forty-two pregnant women requesting first-trimester screening. The combined screening test was performed from May 2012 to December 2014. Women with a high-risk result (≥1:600) were offered further confirmatory tests after counselling. The threshold for high risk was determined by Monte Carlo simulation to achieve a 5% false-positive rate according to the local age distribution. Pregnancy outcome and screening results were recorded for all women and monthly audits were conducted. Sensitivity, screen positive rate, cost per case of Down syndrome detected. Six hundred and ten women (5.8% of the total screened) had a high-risk screening test, of whom 274 (44.9%) underwent a diagnostic test and 169 (27.7%) opted for a noninvasive prenatal screening test (NIPT); 160 (26.2%) declined further testing after counselling. The pregnancy outcome was available for 10 174 (97.4%) of the women. The observed incidence of Down syndrome was 0.13% (1/750). All 14 women with a trisomy 21 pregnancy had a high-risk screening test result. The cost per Down syndrome detected was RMB596 686 compared with RMB1.79 million if all had been screened by NIPT. The combined screening test appears to be a more cost-effective strategy in mainland China. Screening performance in China would be improved by adopting Chinese-specific models, external quality control and assurance, and establishing risk thresholds appropriate for the age distribution of the population. Combined first-trimester Downs screening in China was improved by adopting Chinese-specific models and external QC. © 2016 Royal College of Obstetricians and Gynaecologists.

  3. First-trimester ultrasound screening for trisomy 21 based on maternal age, fetal nuchal translucency, and different methods of ductus venosus assessment.

    PubMed

    Wagner, Philipp; Sonek, Jiri; Klein, Jessika; Hoopmann, Markus; Abele, Harald; Kagan, Karl Oliver

    2017-07-01

    To examine whether combining the dichotomous assessment of the a-wave and the ductus venosus (DV) pulsatility index for veins (PIV) measurement improves first-trimester screening performance. Retrospective study performed at the University Hospital of Tuebingen based on singleton pregnancies that underwent first-trimester screening including DV flow assessment. In each case, the risk of trisomy 21 was calculated based on maternal age, fetal nuchal translucency, and DV flow either as dichotomous classification of the a-wave, as measurement of the DV PIV, or both. There were 5280 euploid fetuses and 127 fetuses with trisomy 21. The DV a-wave was reversed in 2.3% and 66.1% in the euploid and trisomy 21 cases, respectively. The DV PIV measurements were above the 95th percentile in 8.3% and 77.2% the euploid and trisomy 21 cases, respectively. For a false positive rate of 3%, the detection rate for trisomy 21 based on maternal age, fetal NT, and DV flow is about 87% irrespective of whether DV is examined as a continuous or dichotomous variable. The combination of both resulted in a small decrease at 3% false positive rate. Assessment of the DV a-wave and the DV PIV result in similar DRs. Combining these two approaches does not appear to improve their individual screening performance. © 2017 John Wiley & Sons, Ltd. © 2017 John Wiley & Sons, Ltd.

  4. Low PAPP-A in the first trimester is associated with reduced fetal growth rate prior to gestational week 20.

    PubMed

    Salvig, J D; Kirkegaard, I; Winding, T N; Henriksen, T B; Tørring, N; Uldbjerg, N

    2010-06-01

    To evaluate the association between maternal pregnancy-associated plasma protein-A (PAPP-A) and fetal growth from the first to the second trimester. A prospective cohort study including 8347 pregnant women attending prenatal care at Aarhus University Hospital were conducted. PAPP-A was measured during 8 to 14 gestational weeks. Fetal growth between the two scans in the first and second trimesters was estimated by (GA(20)- GA(12))/Days(calendar), where GA(12) reflects gestational age in days calculated from crown-rump length at a 12-week scan, GA(20) reflects gestational age in days calculated from biparietal diameter at a 20-week scan, and Days(calendar) reflects the number of calendar days between the two scans. Fetal growth rate from the first to the second trimester was correlated with PAPP-A, with a regression coefficient of 0.009 (95% CI, 0.007-0.012, P < 0.001). PAPP-A below 0.30 MoM was associated with a fetal growth rate below the tenth centile, with an adjusted OR of 2.05 (95% CI, 1.24-3.38). Low levels of PAPP-A are associated not only with low birth weight at term but also with slower fetal growth prior to 20 weeks of gestation.

  5. Regional development of the human epidermis in the first trimester embryo and the second trimester fetus (ages related to the timing of amniocentesis and fetal biopsy).

    PubMed

    Holbrook, K A; Odland, G F

    1980-03-01

    The epidermis was sampled from multiple body sites of whole human embryos and fetuses of 45- and 65-days, 16- and 21-weeks estimated gestation age to determine whether a regionally dependent, variable rate of interfollicular epidermal development exists. Surface characteristics and thickness of the epidermis were evaluated by scanning electron and light microscopy, respectively. It was concluded that all epidermal development proceeded simultaneously during the first trimester with the exception of the foot which was more advanced in both thickness and state of differentiation. During the second trimester the epidermis of both the head and the foot showed more precocious development, particularly in relation to the special sense organs and to the plantar surface. The interfollicular epidermis of the majority of the body, however, was approximately equivalent in the state of development. These data have potential relevance to prenatal diagnosis of inherited skin disease from amniocentesis and/or fetal biopsy specimens; the present survey of the total epidermal surface will allow one to predict the types of skin-derived cells that should be present in the amniotic fluid at a given age, and to evaluate a fetal biopsy from one region and be confident that it is an accurate index of fetal skin development, age and status in general.

  6. Assessment of free fetal DNA concentration in maternal plasma during the first trimester of pregnancy: comparative study between EDTA and PPT tubes - pilot study.

    PubMed

    Chadud, Carolina Schneider; Araujo Júnior, Edward; Martinhago, Ciro Dresh; Andari, Viviane Cristina Mello; Tedesco, Giselle Darahem; Bussamra, Luiz Claudio Silva; Aoki, Tsutomu

    2015-01-01

    To compare ethylenediamine tetraacetic acid (EDTA) tubes and plasma preparation tubes (PPT) for evaluating maternal plasma during the first trimester of pregnancy. A cross-sectional study was conducted on 24 male fetuses in women between 6 and 14 weeks of pregnancy. Blood samples (10 mL) were collected and stored in EDTA and PPT tubes. Subsequently, the samples were centrifuged and sent for free fetal DNA extraction by means of the polymerase chain reaction (PCR) technique. The reactions were performed in a real time PCR machine for detecting the amplification products. The genome region chosen for performing the PCR reactions was a target specific for the Y chromosome, in which the DYS-14 marker was amplified only when the DNA was of male sex. The free fetal DNA concentration was given by the threshold cycle (TC). To compare the tubes, the paired Student t-test was used. The mean gestational age was 11.08 ± 2.30 weeks (range: 6-14). The mean TC for PPT was 30.08 ± 1.05 (range: 27.08-32.61) and for EDTA, 30.23 ± 0.96 (range: 28.01-32.09), but without statistical significance (p=0.357). We did not observe any statistically significant difference in free fetal DNA concentration between the EDTA and PPT tubes.

  7. Measuring fetal volume during late first trimester by three-dimensional ultrasonography using virtual organ computer-aided analysis.

    PubMed

    Barra, Daniela A; Lima, Jailson C; Mauad Filho, Francisco; Araujo Júnior, Edward; Martins, Wellington P

    2013-09-01

    Our aim was to determine whether rotating the fetus over its largest axis and reducing the rotational step angle can improve reliability/agreement of fetal volume measurements obtained with three-dimensional ultrasonography (3-DUS). Two observers acquired three 3-DUS data sets for a fetus with a crown-rump length between 45 and 84 mm. These observers determined the fetal volume using virtual organ computer-aided analysis (VOCAL), by three different methods, with a rotational step angle of 30°: (1) minimal manipulation of the 3-DUS data set, fetus rotated over any axis; (2) manipulation of the 3-DUS data set until the fetus could be seen in a standardized manner, fetus rotated over its anteroposterior axis; (3) same 3-DUS data set manipulation, fetus rotated over its longitudinal axis. Intra- and inter-observer reliability/agreement was determined with intra-class correlation coefficients and limits of agreement. In addition, we tested the method that provided the best reliability/agreement results using 15° and 9° of rotational step angles. The time taken to manipulate 3-DUS and determine fetal volume was recorded. The best intra- and inter-observer reliability/agreement results were observed when the fetus was rotated over its longitudinal axis. Reducing rotational step angle to 15° or 9° did not further improve reliability/agreement. The observer took approximately 1 min to determine fetal volume using this method. Our findings indicate that fetal volume should be determined by rotating the fetus over its longitudinal axis, at a rotational step angle of 30°, which is relatively fast and allows analysis of fetal volume with good reliability and agreement.

  8. Early Detection of Fetal Malformation, a Long Distance Yet to Cover! Present Status and Potential of First Trimester Ultrasonography in Detection of Fetal Congenital Malformation in a Developing Country: Experience at a Tertiary Care Centre in India.

    PubMed

    Kashyap, Namrata; Pradhan, Mandakini; Singh, Neeta; Yadav, Sangeeta

    2015-01-01

    Early detection of malformation is tremendously improved with improvement in imaging technology. Yet in a developing country like India majority of pregnant women are not privileged to get timely diagnosis. To assess the present status and potential of first trimester ultrasonography in detection of fetal congenital structural malformations. This was a retrospective observational study conducted at Sanjay Gandhi Postgraduate Institute of Medical Sciences. All pregnant women had anomaly scan and women with fetal structural malformations were included. Out of 4080 pregnant women undergoing ultrasound, 312 (7.6%) had fetal structural malformation. Out of 139 patients who were diagnosed after 20 weeks, 47 (33.8%) had fetal structural anomalies which could have been diagnosed before 12 weeks and 92 (66.1%) had fetal malformations which could have been diagnosed between 12 and 20 weeks. The first trimester ultrasonography could have identified 50% of major structural defects compared to 1.6% in the present scenario. This focuses on the immense need of the hour to gear up for early diagnosis and timely intervention in the field of prenatal detection of congenital malformation.

  9. Early Detection of Fetal Malformation, a Long Distance Yet to Cover! Present Status and Potential of First Trimester Ultrasonography in Detection of Fetal Congenital Malformation in a Developing Country: Experience at a Tertiary Care Centre in India

    PubMed Central

    Kashyap, Namrata; Pradhan, Mandakini; Singh, Neeta; Yadav, Sangeeta

    2015-01-01

    Background. Early detection of malformation is tremendously improved with improvement in imaging technology. Yet in a developing country like India majority of pregnant women are not privileged to get timely diagnosis. Aims and Objectives. To assess the present status and potential of first trimester ultrasonography in detection of fetal congenital structural malformations. Methodology. This was a retrospective observational study conducted at Sanjay Gandhi Postgraduate Institute of Medical Sciences. All pregnant women had anomaly scan and women with fetal structural malformations were included. Results. Out of 4080 pregnant women undergoing ultrasound, 312 (7.6%) had fetal structural malformation. Out of 139 patients who were diagnosed after 20 weeks, 47 (33.8%) had fetal structural anomalies which could have been diagnosed before 12 weeks and 92 (66.1%) had fetal malformations which could have been diagnosed between 12 and 20 weeks. Conclusion. The first trimester ultrasonography could have identified 50% of major structural defects compared to 1.6% in the present scenario. This focuses on the immense need of the hour to gear up for early diagnosis and timely intervention in the field of prenatal detection of congenital malformation. PMID:26759727

  10. First-trimester fetal growth restriction and the occurrence of miscarriage in rural Bangladesh: A prospective cohort study

    PubMed Central

    Rashid, Harunor; Ma, Enbo; Ferdous, Farzana; Ekström, Eva-Charlotte

    2017-01-01

    Fetal growth restriction in early pregnancy increases the risk of adverse pregnancy outcome, which has a significant social and psychological impact on women. There is limited information related to community-based study to evaluate early indicators related to miscarriage. The aim of this study is to examine the relationship between fetal growth restriction, measured by ultrasound crown-rump length (CRL), and subsequent occurrence of miscarriage in pregnant women in rural Bangladesh. The study was conducted within the Maternal and Infant Nutrition Interventions Trial in Matlab (MINIMat study), Bangladesh. A total of 4436 pregnant women were enrolled in the study when they were at less than 14 gestational weeks. The expected CRL was determined based on an established growth curve of gestational age and CRL, and deviation from this curve of CRL was expressed as a z-score. After identifying related covariates, the multiple Poisson regression model was used to determine the independent contribution from the CRL to miscarriage. A total of 3058 singleton pregnant women were included in analyses, with 92 miscarriages and 2966 continued pregnancies. The occurrence of miscarriages was significantly higher in the smaller categories of CRL z-score after adjustments for maternal age, parity, early pregnancy BMI, gestational age at CRL measurement and socioeconomic status (adjusted relative risk [95% confidence interval]: 1.03 [1.02–1.05] for less than -2 z-score). In a rural Bangladesh population, smaller than expected CRL for the gestational age was related to subsequent miscarriage. Ultrasound biometry information together with careful clinical assessment should provide much needed attention and care for pregnant women. PMID:28732073

  11. International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown–rump length in the first trimester of pregnancy

    PubMed Central

    Papageorghiou, A T; Kennedy, S H; Salomon, L J; Ohuma, E O; Cheikh Ismail, L; Barros, F C; Lambert, A; Carvalho, M; Jaffer, Y A; Bertino, E; Gravett, M G; Altman, D G; Purwar, M; Noble, J A; Pang, R; Victora, C G; Bhutta, Z A; Villar, J

    2014-01-01

    CRL); and SD of GA = 2.39102 + (0.0193474 × CRL). Conclusions We have produced international prescriptive standards for early fetal linear size and ultrasound dating of pregnancy in the first trimester that can be used throughout the world. © 2014 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology. PMID:25044000

  12. A Cost-Effectiveness Analysis of First Trimester Non-Invasive Prenatal Screening for Fetal Trisomies in the United States

    PubMed Central

    Walker, Brandon S.; Nelson, Richard E.; Jackson, Brian R.; Grenache, David G.; Ashwood, Edward R.; Schmidt, Robert L.

    2015-01-01

    Background Non-invasive prenatal testing (NIPT) is a relatively new technology for diagnosis of fetal aneuploidies. NIPT is more accurate than conventional maternal serum screening (MSS) but is also more costly. Contingent NIPT may provide a cost-effective alternative to universal NIPT screening. Contingent screening used a two-stage process in which risk is assessed by MSS in the first stage and, based on a risk cutoff, high-risk pregnancies are referred for NIPT. The objective of this study was to (1) determine the optimum MSS risk cutoff for contingent NIPT and (2) compare the cost effectiveness of optimized contingent NIPT to universal NIPT and conventional MSS. Study Design Decision-analytic model using micro-simulation and probabilistic sensitivity analysis. We evaluated cost effectiveness from three perspectives: societal, governmental, and payer. Results From a societal perspective, universal NIPT dominated both contingent NIPT and MSS. From a government and payer perspective, contingent NIPT dominated MSS. Compared to contingent NIPT, adopting a universal NIPT would cost $203,088 for each additional case detected from a government perspective and $263,922 for each additional case detected from a payer perspective. Conclusions From a societal perspective, universal NIPT is a cost-effective alternative to MSS and contingent NIPT. When viewed from narrower perspectives, contingent NIPT is less costly than universal NIPT and provides a cost-effective alternative to MSS. PMID:26133556

  13. First trimester fetal volume and crown-rump length: comparison between singletons and twins conceived by in vitro fertilization.

    PubMed

    Martins, Wellington P; Ferriani, Rui A; Nastri, Carolina O; Filho, Francisco Mauad

    2008-09-01

    The aim of this study was to compare the crown-rump length (CRL) and the fetal head and trunk (HT) volume between singletons and twins conceived after in vitro fertilization. Thirty pregnant patients submitted to embryo transfer were enrolled in this research. Ten conceived twins (20 dichorionic fetuses) while other 20 conceived singletons. The gestational age was calculated by adding 14 d to the number of days between the oocyte retrieval and the scheduled ultrasound. Three-dimensional ultrasound scans were performed weekly from 73 d (10 wk and 3 d) to 101 d (14 wk and 3 d) of gestational age. HT volume was assessed by VOCAL using 15 degrees step rotation on the manual mode. The measurement of CRL was performed by using the longitudinal plane of the fetus in the multiplanar view. The CRL and HT volume weekly relative increase were evaluated to compare the growth between singletons and twins. No significant difference was identified, in any analyzed week, when comparing the mean of CRL and HT volume between singletons and twins. Additionally, no significant difference between singletons and twins was noticed when comparing the weekly relative increase, both for CRL and HT volume. However, the weekly relative increase was significantly higher for HT volume than for CRL in every week studied for both singletons and twins. The total relative increase observed between 73 and 101 d was much higher for HT volume than for CRL: 679 +/- 39% versus 138 +/- 18% in singletons and 689 +/- 58% versus 139 +/- 21% in twins (HT volume and CRL, respectively), suggesting that HT volume could more accurately determine the gestational age.

  14. A first trimester trisomy 13/trisomy 18 risk algorithm combining fetal nuchal translucency thickness, maternal serum free beta-hCG and PAPP-A.

    PubMed

    Spencer, Kevin; Nicolaides, Kypros H

    2002-10-01

    This study examines 45 cases of trisomy 13 and 59 cases of trisomy 18 and reports an algorithm to identify pregnancies with a fetus affected by trisomy 13 or 18 by a combination of maternal age fetal nuchal translucency (NT) thickness, and maternal serum free beta-hCG and PAPP-A at 11-14 weeks of gestation. In this mixed trisomy group the median MoM NT was increased at 2.819, whilst the median MoMs for free beta-hCG and PAPP-A were reduced at 0.375 and 0.201 respectively. We predict that with the use of the combined trisomy 13 and 18 algorithm and a risk cut-off of 1 in 150 will for a 0.3% false positive rate allow 95% of these chromosomal defects to be identified at 11-14 weeks. Such algorithms will enhance existing first trimester screening algorithms for trisomy 21. Copyright 2002 John Wiley & Sons, Ltd.

  15. First trimester maternal serum placenta growth factor (PIGF)concentrations in pregnancies with fetal trisomy 21 or trisomy 18.

    PubMed

    Spencer, K; Liao, A W; Ong, C Y; Geerts, L; Nicolaides, K H

    2001-09-01

    Placenta growth factor (PIGF), an angiogenic factor belonging to the vascular endothelial growth factor family, pregnancy-associated plasma protein A (PAPP-A) and free beta-human chorionic gonadotrophin (beta-hCG) were measured in maternal serum from 45 pregnancies with trisomy 21, 45 with trisomy 18 and 493 normal controls at 10-13 completed weeks of gestation. In the normal pregnancies maternal serum PIGF levels increased exponentially with gestation. The median multiple of the median (MoM) PIGF concentration in the trisomy 21 group (1.26 MoM) was significantly higher (p<0.0001) than in the control group (1.00 MoM). In the trisomy 18 group the median PIGF was lower (0.889 MoM) but this did not quite reach significance (p=0.064). The corresponding median MoM values for PAPP-A were 1.00 MoM for the controls, 0.49 MoM for trisomy 21 and 0.16 MoM for trisomy 18. The median MoM values for free beta-hCG were 1.00 MoM for the controls, 2.05 MoM for trisomy 21 and 0.38 MoM for trisomy 18. In the control group there was a small but significant correlation of PIGF with free beta-hCG (r=+0.1024) and PAPP-A (r=+0.2288). In the trisomy 18 group there was a significant association between PIGF and free beta-hCG (r=+0.2629) but not with PAPP-A (r=+0.0038). In the trisomy 21 group there was a small but significant association with PAPP-A (r=+0.1028) but not with free beta-hCG (r=+0.0339). The separation of affected and unaffected pregnancies in maternal serum PIGF is small, and therefore it is unlikely that measurement of PIGF would improve screening for these abnormalities provided by the combination of fetal nuchal translucency and maternal serum PAPP-A and free beta-hCG. Copyright 2001 John Wiley & Sons, Ltd.

  16. First-trimester umbilical vein blood flow in pregnancies with low serum pregnancy-associated plasma protein-A levels: an early predictor of fetal growth restriction.

    PubMed

    Rizzo, G; Capponi, A; Pietrolucci, M E; Capece, A; Arduini, D

    2010-10-01

    To investigate umbilical vein blood flow (UVBF) during the first trimester in pregnancies with low serum pregnancy-associated plasma protein-A (PAPP-A) levels and to relate umbilical vein (UV) diameter, time-averaged maximum velocity (TAMXV) and UVBF values to the subsequent development of fetal intrauterine growth restriction (IUGR). UVBF assessment was performed at 11 + 0 to 13 + 6 weeks' gestation in 102 singleton pregnancies with PAPP-A concentrations of < 0.3 multiples of the median. UV diameter, UV-TAMXV and UVBF were calculated and analyzed in relation to pregnancy outcome. Pregnancy outcomes were: 51 pregnancies with birth weight ≥ 10(th) centile (Group A), 30 pregnancies with birth weight < 10(th) centile with normal Doppler in the umbilical artery throughout gestation (Group B) and 21 pregnancies with birth weight < 10(th) centile and abnormal umbilical artery Doppler later in gestation (Group C). No differences were found in PAPP-A levels between groups. Group C fetuses exhibited significantly lower values of UV-TAMXV (z-score - 1.99 SDs, t = 8.527, P ≤ 0.0001) and UVBF (z-score - 0.97 SDs, t = 7.420, P ≤ 0.0001) in comparison with normal reference ranges, while no differences were found in Groups A or B. Decreased UV-TAMXV and UVBF at 11 + 0 to 13 + 6 weeks' gestation identify fetuses at risk of developing IUGR among pregnancies with low levels of PAPP-A. Copyright © 2010 ISUOG. Published by John Wiley & Sons, Ltd.

  17. First-trimester emergencies: a radiologist's perspective.

    PubMed

    Phillips, Catherine H; Wortman, Jeremy R; Ginsburg, Elizabeth S; Sodickson, Aaron D; Doubilet, Peter M; Khurana, Bharti

    2017-09-25

    The purpose of this article is to help the practitioner ensure early diagnosis and response to emergencies in the first trimester by reviewing anatomy of the developing embryo, highlighting the sonographic appearance of common first-trimester emergencies, and discussing key management pathways for treating emergent cases. First-trimester fetal development is a stepwise process that can be challenging to evaluate in the emergency department (ED) setting. This is due, in part, to the complex anatomy of early pregnancy, subtlety of the sonographic findings, and the fact that fewer than half of patients with ectopic pregnancy present with the classic clinical findings of a positive pregnancy test, vaginal bleeding, pelvic pain, and tender adnexa. Ultrasound (US) has been the primary approach to diagnostic imaging of first-trimester emergencies, with magnetic resonance imaging (MRI) and computed tomography (CT) playing a supportive role in a small minority of cases. Familiarity with the sonographic findings diagnostic of and suspicious for early pregnancy failure, ectopic pregnancy, retained products of conception, gestational trophoblastic disease, failed intrauterine devices, and complications associated with assisted reproductive technology (ART) is critical for any emergency radiologist. Evaluation of first-trimester emergencies is challenging, and knowledge of key imaging findings and familiarity with management pathways are needed to ensure early diagnosis and response.

  18. Clinical implementation of routine screening for fetal trisomies in the UK NHS: cell-free DNA test contingent on results from first-trimester combined test.

    PubMed

    Gil, M M; Revello, R; Poon, L C; Akolekar, R; Nicolaides, K H

    2016-01-01

    Cell-free DNA (cfDNA) analysis of maternal blood for detection of trisomies 21, 18 and 13 is superior to other methods of screening but is expensive. One strategy to maximize performance at reduced cost is to offer cfDNA testing contingent on the results of the first-trimester combined test that is used currently. The objectives of this study were to report the feasibility of implementing such screening, to examine the factors affecting patient decisions concerning their options for screening and decisions on the management of affected pregnancies and to report the prenatal diagnosis of fetal trisomies and outcome of affected pregnancies following the introduction of contingent screening. We examined routine clinical implementation of contingent screening in 11,692 singleton pregnancies in two National Health Service (NHS) hospitals in the UK. Women with a risk ≥ 1 in 100 (high-risk group) were offered options of invasive testing, cfDNA testing or no further testing, and those with a risk between 1 in 101 and 1 in 2500 (intermediate-risk group) were offered cfDNA testing or no further testing. The trisomic status of the pregnancies was determined by prenatal or postnatal karyotyping or by examination of the neonates. In the study population of 11,692 pregnancies, there were 47 cases of trisomy 21 and 28 of trisomies 18 or 13. Screening with the combined test followed by invasive testing for all patients in the high-risk group potentially could have detected 87% of trisomy 21 and 93% of trisomies 18 or 13, at a false-positive rate of 3.4%; the respective values for cfDNA testing in the high- and intermediate-risk groups were 98%, 82% and 0.25%. However, in the high-risk group, 38% of women chose invasive testing and 60% chose cfDNA testing; in the intermediate-risk group 92% opted for cfDNA testing. A prenatal diagnosis was made in 43 (91.5%) pregnancies with trisomy 21 and all pregnancies with trisomies 18 or 13. In many affected pregnancies the parents chose

  19. Reproducibility study of fetal 3-D volumetry in the first trimester: effect of fetal size and rotational angle of VOCAL software.

    PubMed

    Papastefanou, Ioannis; Kappou, Dimitra; Souka, Athena P; Pilalis, Athanasios; Chrelias, Charalambos; Siristatidis, Charalambos; Kassanos, Dimitrios

    2014-05-01

    Intra- and inter-observer reproducibility of fetal volume measurement by 3-D ultrasound scan (using VOCAL [Virtual Organ Computer-Aided Analysis] software) in 27 fetuses at 7 to 13 wk was studied. For intra-observer variability, the mean difference (MD) and 95% limits of agreement (95% LOA) at 12°, 18° and 30° were MD(12) = 0.097, 95% LOA(12) = -0.87 to +1.06; MD(18) = 0.07, 95% LOA(18) = -1.31 to +1.45; and MD(30) = -0.07, 95% LOA(30) = -1.55 to +1.41. The standard deviation of the differences (SD(DIF)) increased with crown-rump length at 12° (p = 0.0016), 18° (p = 0.0011) and 30° (p = 0.02). For inter-observer variability, MD(12) = 0.15, 95% LOA(12) = -1.65 to +1.95; MD(18) = 0.042, 95% LOA(18) = -1.79 to +1.87; and MD(30) = 0.19, 95% LOA(30) = -1.24 to +1.62. SDDIF increased with crown-rump length at 18° (p = 0.0084) and 30° (p = 0.0073). The accuracy of fetal volume measurement was not influenced by rotational angle or fetal size. Precision deteriorated for wider rotational angles and larger fetuses.

  20. Accuracy of sonographic fetal gender determination: predictions made by sonographers during routine obstetric ultrasound scans

    PubMed Central

    Pollard, Karen; Garbett, Ian

    2015-01-01

    Abstract Objectives: The purpose of this study was to determine the accuracy of sonographer predictions of fetal gender during routine ultrasounds. Primarily, the study sought to investigate the accuracy of predictions made in the first trimester, as requests from parents wanting to know the gender of their fetus at this early scan are becoming increasingly common. Second and third trimester fetuses were included in the study to confirm the accuracy of later predictions. In addition, the mother's decision to know the gender was recorded to determine the prevalence of women wanting prenatal predictions. Methods: A prospective, cross sectional study was conducted in a specialist private obstetric practice in the Illawarra, NSW. A total of 640 fetuses across three trimesters were examined collectively by seven sonographers. Fetal gender was predicted using the sagittal plane only in the first trimester and either the sagittal or transverse plane in later trimesters. Phenotypic gender confirmation was obtained from hospital records or direct telephone contact with women postnatally. Results: Results confirmed 100% accuracy in predictions made after 14 weeks gestation. The overall success rate in the first trimester group (11–14 weeks) was 75%. When excluding those scans where a prediction could not be made, success rates increased to 91%. Results were less accurate for fetuses younger than 12 weeks, with an overall success rate of 54%. Male fetuses under 13 weeks were more likely to have gender incorrectly or unable to be assigned. After 13 weeks, success rates for correctly predicting males exceeded that of female fetuses. Statistical differences were noted in the success rates of individual sonographers. Sixty seven percent of women were in favour of knowing fetal gender from ultrasound. Publicly insured women were more likely to request gender disclosure than privately insured women. Conclusions: Sonographic gender determination provides high success rates in the

  1. First-trimester fetal cardiac examination using spatiotemporal image correlation, tomographic ultrasound and color Doppler imaging for the diagnosis of complex congenital heart disease in high-risk patients.

    PubMed

    Turan, S; Turan, O M; Desai, A; Harman, C R; Baschat, A A

    2014-11-01

    A four-dimensional (4D) fetal echocardiographic technique utilizing spatiotemporal image correlation, tomographic ultrasound imaging display (STIC-TUI echo) and color Doppler has previously been shown to be effective in displaying the examination planes constituting the extended cardiac examination. The aim of this study was to evaluate the performance of this first-trimester STIC-TUI echo technique in identifying complex congenital heart disease (CHD) in high-risk pregnancies. This was a prospective study of patients presenting at first-trimester screening who were at high risk for CHD owing to pregestational diabetes, in-vitro fertilization (IVF), increased nuchal translucency (NT) thickness, first-trimester tricuspid regurgitation or reversed ductus venosus (DV) a-wave, a previous child with CHD or who were on anticonvulsant medication. First-trimester STIC-TUI echo was performed, and the findings were correlated with second-trimester echocardiography and post-delivery echo findings in survivors. One hundred and sixty-four fetuses from 152 patients were enrolled (77 diabetics, 38 IVF, 14 with increased NT, 23 cases of tricuspid regurgitation or reversed a-wave in the DV, 22 with prior CHD and two on anticonvulsants). STIC-TUI echo was abnormal in 20 (12%), showing atrioventricular canal defect (n = 9), hypoplastic left heart (n = 2), pulmonary stenosis (n = 2), right aortic arch (n = 1), interrupted aortic arch (n = 1), tricuspid atresia (n = 1), heterotaxy (n = 1), persistent truncus arteriosus (n = 1), double outlet right ventricle and ventricular septal defect (n = 1) and double inlet ventricle with transposition of the great arteries (n = 1). 85% of these anomalies were evident in the four-chamber view plane of the TUI display, and the remainder were diagnosed in the outflow tract planes with color Doppler imaging. In 13, CHD was isolated while seven had extracardiac anomalies. Thirteen fetuses had aneuploidy and all

  2. First-trimester septated cystic hygroma and cavum velum interpositum cyst.

    PubMed

    Sherer, David M; Dalloul, Mudar; Miller, Michelle J; Kheyman, Mila; Zinn, Harry L; Abulafia, Ovadia

    2011-07-01

    First-trimester septated cystic hygroma, frequently noted during general obstetric first-trimester screening, is strongly associated with fetal aneuploidy and structural anomalies and is considered an ominous finding. We present the case of a fetus with a first-trimester septated cystic hygroma and cavum velum interpositum cyst.

  3. Fetal Tricuspid Regurgitation in the First Trimester as a Screening Marker for Congenital Heart Defects: Systematic Review and Meta-Analysis.

    PubMed

    Scala, Carolina; Morlando, Maddalena; Familiari, Alessandra; Leone Roberti Maggiore, Umberto; Ferrero, Simone; D'Antonio, Francesco; Khalil, Asma

    2017-01-01

    Assessment of tricuspid flow has been reported to improve the performance of screening for aneuploidies and congenital heart defects (CHD). However, the performance of tricuspid regurgitation (TR) as a screening marker for CHD in euploid fetuses is yet to be established. The main aim of this meta-analysis was to establish the predictive accuracy of TR for CHD. MEDLINE, Embase, and the Cochrane Library were searched electronically utilizing combinations of the relevant medical subject heading for "fetus," "tricuspid regurgitation," and "first trimester." The outcomes explored were prevalence of TR in an euploid population, strength of association between TR and CHD, and predictive accuracy of TR for CHD in euploid fetuses. Summary estimates of sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio for the overall predictive accuracy of TR for the detection of CHD were computed using the hierarchical summary receiver-operating characteristics model. A total of 452 articles were identified; 60 were assessed with respect to their eligibility for inclusion and a total of 4 studies were included in the study. TR was associated with an increased risk of CHD (RR: 9.6, 95% CI 2.8-33.5; I2: 92.7%). The strength of association between TR and CHD persisted when considering fetuses at risk for CHD, such as those with increased nuchal translucency (RR: 7.2, 95% CI 5.2-9.8; I2: 0%), while TR did not show any association with CHD when detected in a population at low risk for cardiac defects (RR: 9.3, 95% CI 0.8-111.8; I2: 93%). The overall diagnostic performance of TR in detecting CHD was poor in detecting CHD (sROC: 0.684, SE: 0.61) with a sensitivity of 35.2% (95% CI 26.9-44.1) and a specificity of 98.6% (95% CI 98.5-98.7). Detection of TR at the 11-14 weeks' scan showed a positive likelihood ratio of 7.2 (95% CI 5.3-9.8) in detecting CHD when applied to a population at risk for CHD such as fetuses with an increased nuchal translucency. The

  4. First Trimester Diagnosis of VACTERL Association

    PubMed Central

    Santos, Joana; Nogueira, Rosete; Pinto, Rita; Cerveira, Isabel; Pereira, Susana

    2013-01-01

    VACTERL association (OMIM 192350) is a non-random combination of multiple congenital malformations including vertebral, anal, cardiac, tracheoesophageal, renal and limb anomalies. The wide spectrum of defects suggests the occurrence of defective development during early embryogenesis. The authors report a case of a complex polymalformative association detected by ultrasound in the first trimester of pregnancy. The ensuing fetal study revealed the presence of vertebral, anorectal, renal and limb anomalies and therefore was considered a case of VACTERL association. This complex association generally entails a poor prognosis. Its early detection allows discussion of management options, including medical termination of pregnancy. PMID:24765498

  5. Visualization and quantitation of fetal movements by real-time three-dimensional ultrasound with live xPlane imaging in the first trimester of pregnancy.

    PubMed

    Lu, Ye; Yang, Taizhu; Luo, Hong; Deng, Feng; Cai, Qianyun; Sun, Weiwei; Song, Hao

    2016-10-31

    To prove whether real-time three-dimensional (3D) ultrasound with live xPlane imaging is better in observing fetal movements than standard ultrasound imaging. 50 healthy women with singleton pregnancies (22-43 years old) at 11 to 14 weeks of gestation underwent real-time 3D ultrasound examination with live xPlane imaging from July 2014 to February 2015. The incidence and frequency of 10 fetal movement patterns in 10 minutes were evaluated, including general movements (GMs), isolated arm movements, isolated leg movements, hiccup, stretching, breathing, startle, jaw opening, isolated head retroflexion, and isolated head anteflexion. The correlation between gestational age and frequency of each fetal movement pattern was analyzed. GM had the highest incidence (100%), followed by startle (84%) and isolated arm movements (68%). Their median frequency was 5 (IQR 3-6), 5 (IQR 1.75-11.5), and 1 (IQR 0-2), respectively. GM (Z=5.875, P<0.001) and startle (Z=5.302, P<0.001) had significantly higher frequency than isolated arm movements. The other 7 fetal movement patterns had much lower incidence and frequency. The frequency of GM was positively correlated with gestational age (r=0.360, P=0.010). Real-time 3D ultrasound with live x Plane imaging was shown to be a feasible tool for observing fetal movements.

  6. Visualization and quantitation of fetal movements by real-time three-dimensional ultrasound with live xPlane imaging in the first trimester of pregnancy

    PubMed Central

    Lu, Ye; Yang, Taizhu; Luo, Hong; Deng, Feng; Cai, Qianyun; Sun, Weiwei; Song, Hao

    2016-01-01

    Aim To prove whether real-time three-dimensional (3D) ultrasound with live xPlane imaging is better in observing fetal movements than standard ultrasound imaging. Methods 50 healthy women with singleton pregnancies (22-43 years old) at 11 to 14 weeks of gestation underwent real-time 3D ultrasound examination with live xPlane imaging from July 2014 to February 2015. The incidence and frequency of 10 fetal movement patterns in 10 minutes were evaluated, including general movements (GMs), isolated arm movements, isolated leg movements, hiccup, stretching, breathing, startle, jaw opening, isolated head retroflexion, and isolated head anteflexion. The correlation between gestational age and frequency of each fetal movement pattern was analyzed. Results GM had the highest incidence (100%), followed by startle (84%) and isolated arm movements (68%). Their median frequency was 5 (IQR 3-6), 5 (IQR 1.75-11.5), and 1 (IQR 0-2), respectively. GM (Z = 5.875, P < 0.001) and startle (Z = 5.302, P < 0.001) had significantly higher frequency than isolated arm movements. The other 7 fetal movement patterns had much lower incidence and frequency. The frequency of GM was positively correlated with gestational age (r = 0.360, P = 0.010). Conclusion Real-time 3D ultrasound with live x Plane imaging was shown to be a feasible tool for observing fetal movements. PMID:27815938

  7. The Performance of First Trimester Anatomy Scan: A Decision Analysis

    PubMed Central

    Harper, Lorie M.; Wood, S. Lindsay; Jenkins, Sheri M.; Owen, John; Biggio, Joseph R.

    2016-01-01

    Introduction First trimester ultrasound (US) for anatomy assessment may improve anomaly detection but may also increase overall US utilization. We sought to assess the utility of first trimester US for evaluation of fetal anatomy. Materials and Methods A decision analytic model was created to compare first plus second trimester anatomy scans to second trimester anatomy scan alone in 4 populations: general, normal weight women, obese women, and diabetics. Probability estimates were obtained from the literature. Outcomes considered were number of: major structural anomalies detected, number of US performed, and false positive US. Multivariable sensitivity analyses were performed to evaluate the consistency of the model with varying assumptions. Results A strategy of first trimester US detected the highest number of anomalies but required more US examinations per anomaly detected. The addition of a first trimester anatomy US was associated with a small increase in false positive US (<10/10,000). In populations with higher anomaly prevalence and lower second trimester US sensitivity (i.e. diabetes, obese), the number of additional US performed per anomaly detected with the first trimester US was fewer than 60. Discussion In high-risk populations, a first trimester US in addition to a second trimester US may be a beneficial approach to detecting anomalies. PMID:27105290

  8. First trimester predictors of adverse pregnancy outcomes.

    PubMed

    Brameld, Kate J; Dickinson, Jan E; O'Leary, Peter; Bower, Carol; Goldblatt, Jack; Hewitt, Beverley; Murch, Ashleigh; Stock, Rosanne

    2008-12-01

    To identify first trimester indicators of adverse pregnancy outcomes. Data were obtained from the statewide evaluation of first trimester screening for Down syndrome in Western Australia which included 22,695 pregnancies screened between August 2001 and October 2003. Screening data were linked with pregnancy outcome information from the Hospital Morbidity Database and the Birth Defects Registry. The odds ratios (OR) of adverse outcomes were analysed for combined risk incorporating maternal age, nuchal translucency (NT) and biochemical parameters and then separately for each parameter (pregnancy-associated plasma protein-A (PAPP-A), free beta human chorionic gonadotropin (beta-hCG) and NT). Risk assessments for first trimester combined screening are derived from maternal age, ultrasound measurement of fetal NT, maternal serum free beta-hCG and PAPP-A. Increased combined risk for Down syndrome was significantly (P < 0.01) associated with spontaneous loss at or before 24 weeks gestation (OR 13.51), birth defects (OR 6.58) and preterm birth at or before 32 weeks gestation (OR 3.2). Maternal serum PAPP-A below the 5th centile was associated with Down syndrome (OR 8.43), spontaneous loss before 24 weeks (OR 5.04) and later than 24 weeks (OR 4.50), preterm delivery before 32 weeks (OR 3.11) and before 37 weeks (OR 2.24). NT above the 95th centile was associated with Down syndrome (OR 43.91), birth defects (OR 4.02) and spontaneous loss before 24 weeks (OR 6.24). Low levels of free beta-hCG and increased NT were less consistently associated with adverse outcomes and high levels of free beta-hCG showed limited use as an indicator. The detection rates for all outcomes other than Down syndrome were less than 40%. Biochemical indicators and NT that are measured during first trimester screening for Down syndrome show a number of associations with adverse outcomes, but do not show appropriate performance characteristics for screening tests. These data are consistent with the

  9. Nasal bone in first-trimester screening for trisomy 21.

    PubMed

    Cicero, Simona; Avgidou, Kyriaki; Rembouskos, Georgios; Kagan, Karl Oliver; Nicolaides, Kypros H

    2006-07-01

    This study was undertaken to investigate the impact of incorporating assessment of the nasal bone into first-trimester combined screening by fetal nuchal translucency (NT) thickness and maternal serum biochemistry. In this prospective combined screening study for trisomy 21, the fetal nasal bone was also examined and classified as present or absent. A multivariate approach was used to calculate patient-specific risks for trisomy 21 and the detection rate (DR) and false-positive rate (FPR) were estimated. We examined 2 screening strategies; first, integrated first-trimester screening in all patients and second, first-stage screening of all patients using fetal NT and maternal serum free beta-hCG and PAPP-A, followed by second-stage assessment of nasal bone only in those with an intermediate risk of 1 in 101 to 1 in 1000 after the first-stage. The nasal bone was absent in 113 (0.6%) of the 20,165 chromosomally or phenotypically normal fetuses and in 87 (62.1%) of the 140 fetuses with trisomy 21. With combined first-trimester NT and serum screening, the DR of 90% was achieved at a FPR of 5%. Inclusion of the nasal bone, either in all cases or in about 10% of the total in the 2-stage approach, halved the FPR to 2.5%. Inclusion of the nasal bone in first-trimester combined screening for trisomy 21 achieves a DR of 90% for a FPR of 2.5%.

  10. Non-invasive prenatal determination of fetal gender using QF-PCR analysis of cell-free fetal DNA in maternal plasma.

    PubMed

    Kim, Shin Young; Lim, Ji Hyae; Park, So Yeon; Kim, Moon Young; Choi, June Seek; Ryu, Hyun Mee

    2012-03-22

    Detection of cell-free fetal DNA (cffDNA) in maternal plasma has given rise to the possibility of new non-invasive approaches for early prenatal diagnoses. We evaluated the feasibility and accuracy of non-invasive fetal gender determination using quantitative fluorescent-polymerase chain reaction (QF-PCR) analysis of circulating cffDNA in the first-trimester maternal plasma. Plasma samples were prospectively collected from 202 singleton pregnancies at 4 to 13 weeks of gestation. Fetal gender was determined by QF-PCR with the sex-determining region Y (SRY) and amelogenin X/Y (AMELX/Y) genes. The result was confirmed by fetal karyotyping or phenotype at birth. Of the 202 pregnancies, 162 had pregnancy outcomes available and could be included in our evaluation. The accuracies of AMELX/Y, SRY, and combined AMELX/Y+SRY analysis for fetal gender determination were 83.3%, 82.1%, and 97.5%, respectively, compared with those of the invasive approach and the fetal gender outcome at birth (82 males and 80 females). Combined AMELX/Y+SRY analysis had the highest sensitivity (98.8%) for fetal gender determination with a specificity of 96.3%. Moreover, fetal gender detection by the combined AMELX/Y+SRY analysis at 11 to 13 weeks of gestation was 100% correct. Fetal gender determination could be accurately determined from maternal cffDNA in the first-trimester using QF-PCR analysis of combined AMELX/Y+SRY. Copyright © 2011 Elsevier B.V. All rights reserved.

  11. Women as moral pioneers? Experiences of first trimester antenatal screening.

    PubMed

    Williams, Clare; Sandall, Jane; Lewando-Hundt, Gillian; Heyman, Bob; Spencer, Kevin; Grellier, Rachel

    2005-11-01

    The implementation of innovative medical technologies can raise unprecedented ethical, legal and social dilemmas. This is particularly so in the area of antenatal screening, which is dominated by the language of risk and probabilities. Second trimester serum screening for Down's syndrome and neural tube defects has a well-established place in antenatal care. Increasingly, first trimester screening with biochemical and ultrasound markers is being proposed as advance on this, yielding higher detection rates of Down's syndrome at an earlier gestational age. This article explores the experiences of 14 women offered innovative first trimester screening, which takes place within the context of a detailed ultrasound scan. The study is set within the UK, where recent policy changes mean that the offer of screening for fetal anomalies, particularly Down's syndrome, will become a routine part of antenatal care and offered to all pregnant women. This paper focuses on the significance of the scan in first trimester screening, and some of the potential dilemmas for women that can result from this. It then discusses the ways in which women made their decisions about screening, in particular, their work as 'moral pioneers'. We found that the part played by the ultrasound scan in first trimester screening, particularly in relation to the higher-quality images now being obtained, has the potential to introduce new and novel ethical dilemmas for pregnant women. Although concerns have been raised about pregnant women viewing ultrasound scans as benign, many of the women reported having thought carefully through their own moral beliefs and values prior to screening. It seems that whatever other implications they may have, first trimester screening technologies will continue the tradition of pregnant women acting as 'moral pioneers' in increasingly complex settings.

  12. First-trimester uterine scar assessment by transvaginal ultrasound.

    PubMed

    Stirnemann, Julien J; Chalouhi, Gihad E; Forner, Sylvana; Saidji, Yasmine; Salomon, Laurent J; Bernard, Jean-Pierre; Ville, Yves

    2011-12-01

    The objective of the study was to describe the assessment of lower segment uterine scar (LSCS) by transvaginal ultrasound (TVUS) during a first-trimester scan. Patients with a history of LSCS were prospectively enrolled over a 6 month period. Four groups were defined: type 1A, thin scar within cervicoisthmic canal (CIC); type 1B, thin above the internal os (IO); type 2A, dehiscent within the CIC; type 2B, dehiscent above the IO. Accuracy of first-trimester TVUS was investigated by blind testing a panel of 14 operators over a web-based dataset. The scar was visualized in 122 of 123 patients enrolled. Types 1A, 1B, 2A, and 2B occurred in 49.2%, 3.3%, 38.3%, and 9.2%, respectively. When blind tested, fetal medicine specialists achieved a median sensitivity of 82% and specificity of 100% for the detection of a scar. These were 83% and 87% for nonspecialists. First-trimester uterine scar assessment may become a valuable tool in early recognition of patients at risk of subsequent perinatal complications. Copyright © 2011 Mosby, Inc. All rights reserved.

  13. The influence of parity and gravidity on first trimester markers of chromosomal abnormality.

    PubMed

    Spencer, K; Ong, C Y; Liao, A W; Nicolaides, K H

    2000-10-01

    We have studied changes in first trimester fetal nuchal translucency (NT) and maternal serum free beta-hCG and PAPP-A with gravidity and parity in 3252 singleton pregnancies unaffected by chromosomal abnormality or major pregnancy complications. We have shown that gravidity and parity is associated with a small but progressive decrease in fetal NT and a small but progressive increase in free beta-hCG and PAPP-A. None of these small changes with increasing gravidity or parity are statistically significant and hence correction for these variables is not necessary when considering first trimester screening for chromosomal abnormalities. Copyright 2000 John Wiley & Sons, Ltd.

  14. First Trimester Ultrasound in Prenatal Diagnosis-Part of the Turning Pyramid of Prenatal Care.

    PubMed

    Neiger, Ran

    2014-09-05

    First-trimester sonographic assessment of the risk of chromosomal abnormalities is routinely performed throughout the world, primarily by measuring fetal nuchal translucency thickness between 11-13 weeks' gestation, combined with assessment of serum markers. The development of high-frequency transvaginal transducers has led to improved ultrasound resolution and better visualization of fetal anatomy during the first-trimester. Continuous improvement in ultrasound technology allows a thorough detailed assessment of fetal anatomy at the time of the nuchal translucency study. Using transabdominal or transvaginal sonography, or a combination of both approaches, it is now possible to diagnose a wide range of fetal anomalies during the first trimester. Multiple studies reported early diagnosis of major fetal anomalies after demonstrating the association of increased nuchal translucency thickness with structural defect in chromosomally normal and abnormal fetuses. Normal sonographic findings provide reassurance for women at high risk while detection of fetal malformation during the first trimester enables discussion and decisions about possible treatments and interventions, including termination of pregnancy, during an early stage of pregnancy.

  15. First Trimester Ultrasound in Prenatal Diagnosis—Part of the Turning Pyramid of Prenatal Care

    PubMed Central

    Neiger, Ran

    2014-01-01

    First-trimester sonographic assessment of the risk of chromosomal abnormalities is routinely performed throughout the world, primarily by measuring fetal nuchal translucency thickness between 11–13 weeks’ gestation, combined with assessment of serum markers. The development of high-frequency transvaginal transducers has led to improved ultrasound resolution and better visualization of fetal anatomy during the first-trimester. Continuous improvement in ultrasound technology allows a thorough detailed assessment of fetal anatomy at the time of the nuchal translucency study. Using transabdominal or transvaginal sonography, or a combination of both approaches, it is now possible to diagnose a wide range of fetal anomalies during the first trimester. Multiple studies reported early diagnosis of major fetal anomalies after demonstrating the association of increased nuchal translucency thickness with structural defect in chromosomally normal and abnormal fetuses. Normal sonographic findings provide reassurance for women at high risk while detection of fetal malformation during the first trimester enables discussion and decisions about possible treatments and interventions, including termination of pregnancy, during an early stage of pregnancy. PMID:26237489

  16. First-trimester surgical abortion technique.

    PubMed

    Yonke, Nicole; Leeman, Lawrence M

    2013-12-01

    New data have emerged to support changes in first-trimester abortion practice in regard to antibiotic prophylaxis, cervical ripening, the use of manual vacuum aspiration, and pain management. This article addresses these new recommendations and reviews techniques in performing manual and electric vacuum uterine aspiration procedures before 14 weeks' gestation, including very early abortion (<7 weeks' gestation), technically difficult abortions, management of complications, and postabortal contraception. The information discussed also applies to miscarriage management. Copyright © 2013 Elsevier Inc. All rights reserved.

  17. Supporting patients after disclosure of abnormal first trimester screening results.

    PubMed

    Fisher, Jane

    2012-03-01

    The clinical value of first trimester aneuploidy screening is well established internationally. The implementation of a more effective testing protocol has led to an increase in 'abnormal' or worrying findings that are disclosed to women relatively early in their pregnancy. It is timely, therefore, to explore the support needs of women who are told during the first trimester that their screening result has increased their risk of fetal anomaly. A Medline search uncovered numerous papers in the review period on first trimester screening regimens, and the efficacy of particular screening markers, but very little on the psychosocial sequelae for women receiving abnormal results. Therefore, this study takes what can be gleaned from the available literature, augmented by the author's experience in an independent UK charity providing nondirective support and information to parents through prenatal screening and its consequences. [Antenatal Results and Choices (ARC) was established as a UK charity in 1988. The organization provides nondirective information and specialized support to parents throughout antenatal testing and its consequences, dealing with approximately 8000 contacts a year. ARC also provides training programmes for providers in communication skills and supporting decision-making. www.arc-uk.org.] With the shift in timing of screening programmes, there has been an emphasis in the literature on concerns about the provision of pretest information and counselling rather than what women find beneficial when dealing with results. The emotional impact of worrying news will always be significant and the ensuing decisions complex. The challenge for providers is to have a flexibility of approach that enables women and couples to be supported to understand the possible clinical implications of a screening result and what this might mean to them in the context of their individual lives.

  18. [Severe hydrops fetalis in a first trimester pregnancy with Ulrich-Turner syndrome].

    PubMed

    Klare, P; Sydow, P; Körner, H

    1992-01-01

    We report about a case of abundant hydropic evolution of a fetus in the first trimester of gestation. Already in the 8th week of gestation we diagnosed the first references of failure with transvaginal ultrasound. In the following three weeks we observed the progression of the hydrops. The genetic research of fetal tissue after induced abortion show the karyotype 45 X0.

  19. First-Trimester Detection of Surface Abnormalities

    PubMed Central

    Rousian, Melek; Koning, Anton H. J.; Bonsel, Gouke J.; Eggink, Alex J.; Cornette, Jérôme M. J.; Schoonderwaldt, Ernst M.; Husen-Ebbinge, Margreet; Teunissen, Katinka K.; van der Spek, Peter J.; Steegers, Eric A. P.; Exalto, Niek

    2014-01-01

    The aim was to determine the diagnostic performance of 3-dimensional virtual reality ultrasound (3D_VR_US) and conventional 2- and 3-dimensional ultrasound (2D/3D_US) for first-trimester detection of structural abnormalities. Forty-eight first trimester cases (gold standard available, 22 normal, 26 abnormal) were evaluated offline using both techniques by 5 experienced, blinded sonographers. In each case, we analyzed whether each organ category was correctly indicated as normal or abnormal and whether the specific diagnosis was correctly made. Sensitivity in terms of normal or abnormal was comparable for both techniques (P = .24). The general sensitivity for specific diagnoses was 62.6% using 3D_VR_US and 52.2% using 2D/3D_US (P = .075). The 3D_VR_US more often correctly diagnosed skeleton/limb malformations (36.7% vs 10%; P = .013). Mean evaluation time in 3D_VR_US was 4:24 minutes and in 2D/3D_US 2:53 minutes (P < .001). General diagnostic performance of 3D_VR_US and 2D/3D_US apparently is comparable. Malformations of skeleton and limbs are more often detected using 3D_VR_US. Evaluation time is longer in 3D_VR_US. PMID:24440996

  20. First trimester sonographic diagnosis of ectopia cordis: a case report and review of the literature.

    PubMed

    Hannoun, Antoine; Usta, Ihab M; Sawaya, Fadi; Nassar, Anwar H

    2011-06-01

    A case of ectopia cordis (EC) with gastroschisis in a 27-year-old primigravida was diagnosed at 10(3/7) weeks of gestation. The pregnancy was terminated by suction dilatation and curettage. With the increasing use of first trimester ultrasonography, early detection of fetal abnormalities is becoming more frequent. We review other published cases of EC detected in the first trimester and discuss the possible advantages of early diagnosis including options of termination at earlier gestational ages which might decrease the physical and psychological trauma on some patients.

  1. ZIKA virus reveals broad tissue and cell tropism during the first trimester of pregnancy

    PubMed Central

    El Costa, Hicham; Gouilly, Jordi; Mansuy, Jean-Michel; Chen, Qian; Levy, Claude; Cartron, Géraldine; Veas, Francisco; Al-Daccak, Reem; Izopet, Jacques; Jabrane-Ferrat, Nabila

    2016-01-01

    The outbreak of the Zika Virus (ZIKV) and its association with fetal abnormalities have raised worldwide concern. However, the cellular tropism and the mechanisms of ZIKV transmission to the fetus during early pregnancy are still largely unknown. Therefore, we ex vivo modeled the ZIKV transmission at the maternal-fetal interface using organ culture from first trimester pregnancy samples. Here, we provide evidence that ZIKV strain circulating in Brazil infects and damages tissue architecture of the maternal decidua basalis, the fetal placenta and umbilical cord. We also show that ZIKV replicates differentially in a wide range of maternal and fetal cells, including decidual fibroblasts and macrophages, trophoblasts, Hofbauer cells as well as umbilical cord mesenchymal stem cells. The striking cellular tropism of ZIKV and its cytopathic-induced tissue injury during the first trimester of pregnancy could provide an explanation for the irreversible congenital damages. PMID:27759009

  2. Evaluation of nuchal translucency measurement in first trimester pregnancy.

    PubMed

    Barati, Mojgan; Zargar, Mahvash; Masihi, Sara; Taherpour, Sima

    2011-04-01

    A significant number of pregnancies, particularly in women with previous histories of infertility, are associated with fetal abnormalities. Methods such as the nuchal translucency (NT) measurement enable us to identify more pregnancies with chromosomal abnormalities. This analytic cross-sectional study was performed in 446 pregnant women at 11-14 weeks gestation, from 2009 to 2010 in the Fetal Medicine Unit of Imam Khomeini Hospital, Ahvaz Jundishapur University of Medical Sciences. All NT measurements were performed by a certified sonographer using the Fetal Medicine Foundation (FMF) recommended protocol. FMF first trimester software was used for primary and secondary (adjusted) risk calculation. The average maternal age was 28.5 years and 15% of mothers were ≥35 years of age. The average crown rump length (CRL), gestational age and NT thickness were 61.7, 12.4 weeks and 1.75 mm, respectively. There were 20 cases with increased adjusted risk (4.04%) and 4 cases of documented abnormal karyotype. In our study increased adjusted risk was 4.04%.Documented abnormal karyotype were 0.9% and 28% of total and high-risk groups who accepted amniocentesis, respectively. In this study, 50% of women with high-risk results and about half of those with abnormal karyotypes were seen in women under age 35. Knowing these risks is of utmost importance in pregnancy, particularly in patients with infertility histories.

  3. Cloned cattle fetuses with the same nuclear genetics are more variable than contemporary half-siblings resulting from artificial insemination and exhibit fetal and placental growth deregulation even in the first trimester.

    PubMed

    Lee, Rita S F; Peterson, A James; Donnison, Martyn J; Ravelich, Susan; Ledgard, Anita M; Li, Ning; Oliver, Jan E; Miller, Andria L; Tucker, Fleur C; Breier, Bernhard; Wells, David N

    2004-01-01

    The cloning of cattle by somatic cell nuclear transfer (NT) is associated with a high incidence of abnormal placentation, excessive fluid accumulation in the fetal sacs (hydrops syndrome), and fetal overgrowth. Fetal and placental development was investigated at Day 50, during placentome formation; at Day 100, when placentation was completed; and at Day 150, when the hydrops syndrome frequently develops. The NT fetuses were compared with contemporary half-siblings generated from in vitro-produced embryos or by artificial insemination (AI). Fetal cotyledon formation and vascularization of the chorioallantoic membranes was initiated normally in NT conceptuses, but fewer cotyledons successfully formed placentomes. By Day 100, the mean number of placentomes was significantly lower in surviving NT fetuses. Only those with normal placentome numbers were represented in surviving NT pregnancies at Day 150. The mean total caruncle tissue weight of the placentomes was significantly higher in the surviving NT groups at Days 100 and 150, irrespective of the placentome numbers, indicating that increased NT placental weight was caused by excessive uterine tissue growth. By Day 100, NT fetuses exhibited growth deregulation, and those that survived to Day 150 were 17% heavier than contemporary AI controls. Placentome, liver, and kidney overgrowth accompanied the hydrops syndrome at Day 150. The NT fetal overgrowth was not a consequence of in vitro embryo culture and showed no correlation with placental overgrowth. However, in vitro culture and incomplete reprogramming of the donor genome are epigenetic effects that may override genetic traits and contribute to the greater variability in placental and fetal development in the NT group compared with AI half-siblings.

  4. First trimester diclofenac exposure and pregnancy outcome.

    PubMed

    Cassina, Matteo; De Santis, Marco; Cesari, Elena; van Eijkeren, Marion; Berkovitch, Matitiahu; Eleftheriou, Giorgio; Raffagnato, Francesco; Di Gianantonio, Elena; Clementi, Maurizio

    2010-11-01

    To assess the safety of diclofenac during pregnancy. A prospective observational cohort study, evaluating follow-up data of women who contacted Teratology Information Services to get counseling. The exposed group included 145 pregnant women who were exposed to diclofenac between the 5th and the 14th gestational week. A contemporary control group (501 women) was randomly selected from among patients who contacted Teratology Information Services with regard to exposures to agents known not to be teratogenic during a similar period of pregnancy. Major birth malformations were not more common in the study group than in the control group (p=0.07). Our study suggests that the use of diclofenac is relatively safe during the first trimester of pregnancy and the studied sample size makes it possible to exclude a risk of congenital malformation higher than 3.3, with a power of 80%. Copyright © 2010 Elsevier Inc. All rights reserved.

  5. First trimester maternal serum alpha-fetoprotein is not raised in pregnancies with open spina bifida.

    PubMed

    Spencer, Kevin; Khalil, Asma; Brown, Louise; Mills, Ian; Horne, Hannah

    2014-02-01

    Two recent studies have suggested that maternal serum alpha fetoprotein (AFP) levels are increased in the first trimester of pregnancies in which the fetus has an open spina bifida. This is contrary to previously published studies. This study assesses further whether maternal serum AFP is elevated in the first trimester in cases with open spina bifida. Cases with open spina bifida were identified from our fetal database, and corresponding first trimester screening samples were retrieved and analysed for maternal serum AFP. A control group was selected by taking three samples matched for gestational age (exact day), ethnicity and smoking status and received in the laboratory on the same day. AFP was measured with the Kryptor platform and free β-hCG and pregnancy-associated plasma protein A results were available from the fetal database. Thirty-nine open spina bifida cases were identified with a control group of 126 cases. The median multiple of the median AFP in the cases were not significantly different from the controls (0.92 vs 1.06 p = 0.3511) as was the case for free β-hCG (0.87 vs 0.95 p = 0.7146) and pregnancy-associated plasma protein A (1.04 vs 1.04 p = 0.261). Our results confirm that maternal serum biochemical markers in the first trimester are unable to distinguish cases in which the fetus has open spina bifida. © 2013 John Wiley & Sons, Ltd.

  6. First trimester risk assessment for trisomy 21 in twin pregnancies combining nuchal translucency and first trimester biochemical markers.

    PubMed

    Prats, Pilar; Rodríguez, Ignacio; Comas, Carmina; Puerto, Bienvenido

    2012-10-01

    The aim is to describe the performance of first-trimester combined risk assessment in twin pregnancies. Maternal serum free beta-human chorionic gonadotrophin and pregnancy-associated plasma protein A (PAPP-A) were determined at 8 to 12 weeks and fetal nuchal translucency (NT) was measured at 11 to 13+6 weeks. The individual risk was estimated for each fetus using the combined test in dichorionic twins. In monochorionic twins, the mean risk assessment of the two fetuses was used. An invasive diagnostic procedure was offered when the risk was ≥ 1 : 270 in either one of the fetuses. From February 2007 to June 2011, 447 twin pregnancies were enrolled in this study. There were 402 (89.9%) dichorionic and 45 (10.1%) monochorionic twins. In dichorionic twins, mean crown-rump length (CRL) was 63.9 mm; median NT multiples of the median (MoM) was 0.97; median Β-hCG was MoM 1.74; median PAPP-A was 1.72. In monochorionic twins, mean CRL was 61.9 mm; median NT MoM was 0. 98; median Β-hCG MoM was 1.44; and median PAPP-A was 1.51. Two pregnancies with Down syndrome were detected by first trimester screening, both in dichorionic twins. The false positive rate was 5.7% (95% confidence interval 4.1-7.3) and 4.4% (95% confidence interval 0.1-8.8%) in dichorionic and monochorionic twins, respectively. The combined test in twins appears to be a good method for Down syndrome screening with a high detection rate and an acceptable false-positive rate. © 2012 John Wiley & Sons, Ltd.

  7. Medical methods for first trimester abortion.

    PubMed

    Kulier, Regina; Kapp, Nathalie; Gülmezoglu, A Metin; Hofmeyr, G Justus; Cheng, Linan; Campana, Aldo

    2011-11-09

    Surgical abortion by vacuum aspiration or dilatation and curettage has been the method of choice for early pregnancy termination since the 1960s. Medical abortion became an alternative method of first trimester pregnancy termination with the availability of prostaglandins in the early 1970s and anti-progesterones in the 1980s. The most widely researched drugs are prostaglandins (PGs) alone, mifepristone alone, methotrexate alone, mifepristone with prostaglandins and methotrexate with prostaglandins. To compare different medical methods for first trimester abortion. The Cochrane Controlled Trials Register, MEDLINE and Popline were systematically searched. Reference lists of retrieved papers were also searched. Experts in WHO/HRP were contacted. Types of studies Randomised controlled trials comparing different medical methods for abortion during first trimester (e.g. single drug, combination) were considered. Trials were assessed and included if they had adequate concealment of allocation, randomisation procedure and follow-up. Women, pregnant during the first trimester, undergoing medical abortion were the participants. The outcomes were mortality, failure to achieve complete abortion, surgical evacuation, ongoing pregnancy at follow-up, time until passing of conceptus, blood transfusion, side effects and women's dissatisfaction with the procedure. Two reviewers independently selected trials for inclusion from the results of the search strategy described previously.The selection of trials for inclusion in the review was performed independently by two reviewers after employing the search strategy described previously. Trials under consideration were evaluated for appropriateness for inclusion and methodological quality without consideration of their results. Data were processed using Revman software. Fifty-eight trials were included in the review. The effectiveness outcomes below refer to 'failure to achieve complete abortion' with the intended method unless

  8. Early fetal gender determination using real-time PCR analysis of cell-free fetal DNA during 6th-10th weeks of gestation.

    PubMed

    Khorram Khorshid, Hamid Reza; Zargari, Maryam; Sadeghi, Mohammad Reza; Edallatkhah, Haleh; Shahhosseiny, Mohammad Hassan; Kamali, Koorosh

    2013-05-07

    Nowadays, new advances in the use of cell free fetal DNA (cffDNA) in maternal plasma of pregnant women has provided the possibility of applying cffDNA in prenatal diagnosis as a non-invasive method. In contrary to the risks of invasive methods that affect both mother and fetus, applying cffDNA is proven to be highly effective with lower risk. One of the applications of prenatal diagnosis is fetal gender determination, which is important in fetuses at risk of sex-linked genetic diseases. In such cases by obtaining the basic information of the gender, necessary time management can be taken in therapeutic to significantly reduce the necessity of applying the invasive methods. Therefore in this study, the probability of detecting sequences on the human Y-chromosome in pregnant women has been evaluated to identify the gender of fetuses. Peripheral blood samples were obtained from 80 pregnant women with gestational age between 6th to 10th weeks and the fetal DNA was extracted from the plasma. Identification of SRY, DYS14 & DAZ sequences, which are not presentin the maternal genome, was performed using Real-Time PCR. All the obtained results were compared with the actual gender of the newborns to calculate the test accuracy. Considerable 97.3% sensitivity and 97.3% specificity were obtained in fetal gender determination which is significant in the first trimester of pregnancy. Only in one case, false positive result was obtained. Using non-invasive method of cffDNAs in the shortest time possible, as well as avoiding invasive tests for early determination of fetal gender, provides the opportunity of deciding and employing early treatment for fetuses at risk of genetic diseases.

  9. First-trimester features of Fowler syndrome (hydrocephaly-hydranencephaly proliferative vasculopathy).

    PubMed

    Laurichesse-Delmas, H; Beaufrère, A M; Martin, A; Kaemmerlen, A G; Déchelotte, P; Lémery, D

    2002-12-01

    We describe the features of Fowler syndrome (proliferative vasculopathy and hydrocephaly-hydranencephaly) diagnosed in the first trimester. The pregnancy with no significant family history was referred for karyotyping and ultrasound examination after a cystic hygroma was seen at 12 weeks. At 13 weeks, ultrasound examination revealed hydrocephaly-hydranencephaly, fetal akinesia, and arthrogryposis associated with increased nuchal translucency. The parents opted for termination of pregnancy and the diagnosis of Fowler syndrome was confirmed by pathological examination of the fetus. Calcified necrotic lesions and proliferative vasculopathy were observed in the entire central nervous system including the brainstem and spinal cord. Cases previously reported in siblings suggest an autosomal recessive transmission but specific genetic antenatal diagnosis is not yet available. The diagnosis of proliferative vasculopathy and hydrocephaly-hydranencephaly (Fowler syndrome) should be considered whenever hydrocephaly-hydranencephaly associated with a fetal akinetic sequence are encountered at the end of the first trimester. Genetic counseling is recommended.

  10. First trimester depression scores predict development of gestational diabetes mellitus in pregnant rural Appalachian women.

    PubMed

    Morrison, Chelsea; McCook, Judy G; Bailey, Beth A

    2016-01-01

    Gestational diabetes (GDM) occurs in up to 9% of pregnancies. Perinatal depression affects up to 20% of women during pregnancy, and can extend into the postpartum period. A number of studies have linked depression and diabetes, however, whether this applies to GDM or which might come first is less understood. The purpose of this study was to examine the potential relationship between depression identified in the first trimester of pregnancy and the subsequent development of GDM. Women without pre-existing Type I/II diabetes (n = 1021) were evaluated for depression during the first trimester of pregnancy, and medical records were reviewed to identify a positive history of diabetes. Women identified as depressed during the first trimester were more likely to have GDM compared to those not depressed. After controlling for demographic factors and weight-related variables level of depression in the first trimester still predicted later GDM development. Depression identified in early pregnancy may predict increased risk of subsequent GDM development. Due to the numerous maternal, fetal and neonatal complications associated with GDM, early recognition is essential to promote the best possible outcomes for mother and infant. Recognizing depression as a possible risk factor for GDM development could lead to earlier screening and preventative measures.

  11. Dealing with Pheochromocytoma during the First Trimester of Pregnancy

    PubMed Central

    Kiroplastis, Konstantinos; Kambaroudis, Apostolos; Andronikou, Apostolos; Reklou, Andromachi; Kokkonis, Dimitris; Petras, Panagiotis; Mamopoulos, Apostolos; Anagnostara, Eudokia; Spyridis, Charalampos

    2015-01-01

    Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment. PMID:25838955

  12. Dealing with Pheochromocytoma during the First Trimester of Pregnancy.

    PubMed

    Kiroplastis, Konstantinos; Kambaroudis, Apostolos; Andronikou, Apostolos; Reklou, Andromachi; Kokkonis, Dimitris; Petras, Panagiotis; Mamopoulos, Apostolos; Anagnostara, Eudokia; Spyridis, Charalampos

    2015-01-01

    Purpose. Pheochromocytoma in association with pregnancy is a very rare, without specific symptoms, life-threatening condition, increasing both maternal and fetal mortality up to 50%. The present paper illustrates the case of a pregnant woman, diagnosed with pheochromocytoma, aiming to demonstrate and discuss the difficulties that arouse during the diagnosis and the problems concerning the treatment. Patient. A 34-year-old woman, in the 9th week of pregnancy, complained for headache, sweating, and a feeling of heavy weight on the right renal area. A tumor of 10 cm diameter at the site of the right adrenal was found. Twenty-four-hour urine catecholamine and VMA excretion levels were well raised. Results. Multidisciplinary approach treated the patient conservatively. Surgical resection of the tumor was performed after the 14th week of pregnancy at the completion of organogenesis. Neither postoperative complications occurred nor hypertension relapse was recorded. The fetus was delivered without complications at the 36th week. Conclusions. There are no consensus and guidelines for treating pheochromocytoma during pregnancy, especially when it is diagnosed in the first trimester. The week of pregnancy and a multidisciplinary approach will determine whether the pregnancy should be continued or not, as well as the time and the approach of surgical treatment.

  13. Effect of oxygen on multidrug resistance in the first trimester human placenta.

    PubMed

    Lye, P; Bloise, E; Dunk, C; Javam, M; Gibb, W; Lye, S J; Matthews, S G

    2013-09-01

    The multidrug resistance proteins, P-glycoprotein (P-gp, encoded by the ABCB1 gene) and breast cancer resistance protein (BCRP, encoded by ABCG2) are highly expressed in the first trimester placenta. These transporters protect the fetus from exposure to maternally derived toxins and xenobiotics. Since oxygen is a regulator of multidrug resistance in various tissues, we hypothesized that changes in oxygen tension alter placental ABCB1/P-gp and ABCG2/BCRP expression in the first trimester. Placental specimens were collected from first (n = 7), second (n = 5) and term pregnancies (n = 5). First trimester placental villous explants were incubated (24 or 48 h) in different oxygen tension (3-20%). ABCB1, ABCG2 and VEGFA mRNA expression levels were assessed by RT-PCR and protein was localized by IHC. ABCB1 is expressed most highly in the first trimester placenta (p < 0.05), whereas ABCG2 expression does not change significantly over pregnancy. P-gp and BCRP staining is present in the syncytiotrophoblast and in cytotrophoblasts. ABCG2 mRNA is increased in hyperoxic (20%) conditions after 48 h (p < 0.05). In contrast, hypoxia (3%) did not change ABCB1 mRNA expression but significantly increased VEGFA mRNA (p < 0.05). Hypoxia resulted in increased BCRP staining in cytotrophoblasts and in the microvillous membrane of the syncytium. Whereas, hypoxia resulted in increased P-gp staining in proliferating cytotrophoblasts. We conclude that placental multidrug resistance expression, specifically ABCG2, is regulated by oxygen tension in the first trimester. It is possible that changes in placental oxygen supply are capable of altering fetal drug exposure especially during early pregnancy. Copyright © 2013 Elsevier Ltd. All rights reserved.

  14. Obesity during pregnancy affects sex steroid concentrations depending on fetal gender.

    PubMed

    Maliqueo, M; Cruz, G; Espina, C; Contreras, I; García, M; Echiburú, B; Crisosto, N

    2017-07-05

    It is not clear whether maternal obesity along with fetal gender affect sex steroid metabolism during pregnancy. Therefore, we compared sex steroid concentrations and placental expression of steroidogenic enzymes between non-obese and obese pregnant women with non-pathological pregnancies, and investigated the influence of fetal gender on these parameters. In 35 normal weight (body mass index (BMI) 20-24.9 kg m(-)(2)) (controls) and 36 obese women (BMI 30-36 kg m(-)(2)) (obese), a fasting blood sample was obtained at first and at third trimester of gestation to measure progesterone, dehydroepiandrosterone (DHEA), DHEA sulfate, androstenedione, testosterone and estradiol by liquid chromatography-tandem mass spectrometry and estrone by radioimmunoassay. In a subset of women, placental mRNA and protein expression of steroidogenic enzymes was measured by quantitative PCR and western blot, respectively. The comparisons were primarily made between controls and obese, and then separately according to fetal gender. At first and third trimesters of gestation serum progesterone was lower whereas testosterone was higher in obese women (P<0.05, respectively). Upon analyzing according to fetal gender, lower progesterone levels were present in obese pregnant women with male fetuses at first trimester and with female fetuses at third trimester (P<0.05, respectively). Testosterone was higher in obese women with male fetuses compared to control women with male fetuses (P<0.05). The placental protein expression of P450scc was higher in obese women compared to controls (P<0.05). P450 aromatase was higher in obese women with female fetuses (P=0.009), whereas in obese women with male fetuses P450 aromatase was lower compared to control women (P=0.026). Obesity in non-pathological pregnancies alters the maternal serum progesterone and testosterone concentrations depending on fetal gender. These changes can be attributed to gender-related placental adaptations, as the expression

  15. First-trimester combined screening for trisomy 21 in women at risk for α-thalassemia.

    PubMed

    Zhen, Li; Pan, Min; Han, Jin; Yang, Xin; Liao, Can; Li, Dong-Zhi

    2016-01-01

    To report the strategy of first-trimester aneuploidy screening in pregnancies at risk for homozygous α(0)-thalassemian. Women at risk of homozygous α(0)-thalassemia were given an ultrasound examination at 11-14 weeks' gestation to exclude an affected pregnancy. Fetal cardiothoracic ratio (CTR) and nuchal translucence (NT) were measured. If cardiomegaly was found, chorionic villus sampling (CVS) was offered for α-thalassemia; otherwise the first-trimester combined screening test was performed on the pregnancy. The invasive testing for karyotyping was only followed in those cases with a positive aneuploidy screening test. In total, 69 of 288 pregnancies were found to be affected by homozygous α(0)-thalassemia using ultrasound, and the findings were confirmed by invasive testing. In the remaining 219 pregnancies, invasive testing was not performed for α-thalassemia because of a normal fetal CTR, and the women received the first-trimester combined screening. Nine CVS procedures were performed for karyotyping because of a positive aneuploidy screening. Totally three pregnancies with aneuploidy were diagnosed and terminated. Our strategy can selectively detect aneuploidy pregnancies not affected by homozygous α-thalassemia, and, meanwhile, save on the cost of unnecessary aneuploidy screening or karyotyping in pregnancies with an affected fetus of homozygous α(0)-thalassemia.

  16. Spontaneous pregnancy reaches viability after low first trimester serum progesterone: a case report.

    PubMed

    Crochet, John R; Peavey, Mary C; Price, Thomas M; Behera, Millie A

    2012-01-01

    Progesterone is produced by the corpus luteum until completion of the luteal-placental shift at approximately 6-10 weeks following last menstruation. Studies have shown that first trimester progesterone levels are predictive of pregnancy viability, and some authors support a level of 5 ng/mL as an absolute threshold to indicate viability. A 47-year-old woman with recurrent pregnancy loss was noted to have a very low first trimester progesterone level (1.2 ng/mL), but the pregnancy progressed to viability. She unfortunately delivered an intrauterine fetal demise at 27 weeks and 3 days' gestation. A single serum progesterone level of < 5 ng/mL is suggestive, but not diagnostic, of a nonviable pregnancy. Routine uterine curettage during the evaluation of a pregnancy of unknown location using this level as an absolute cutoff may result in the interruption of a desired, viable pregnancy.

  17. Novel application of three-dimensional HDlive imaging in prenatal diagnosis from the first trimester.

    PubMed

    Pooh, Ritsuko Kimata; Kurjak, Asim

    2015-03-01

    Recent development of three-dimensional (3D) high definition (HD) ultrasound has resulted in remarkable progress in visualization of early embryos and fetuses in sonoembryology. The new technology of HDlive assesses both structural and functional developments in the first trimester with greater reliably than two-dimensional (2D) ultrasound. The ability to visualize not only fetal face, hands, fingers, feet, and toes, but also amniotic membranes, is better with volumetric ultrasound than 2D ultrasound. In this article, detailed and comprehensive structures of normal and abnormal fetuses depicted by 3D HDlive are presented, including various faces of Down's syndrome and holoprosencephaly, as well as low-set ear and finger/toe abnormalities from the first trimester. Three-dimensional HDlive further "humanizes" the fetus, enables detailed observation of the fetal face in the first trimester as shown in this article, and reveals that a small fetus is not more a fetus but a "person" from the first trimester. There has been an immense acceleration in understanding of early human development. The anatomy and physiology of embryonic development is a field where medicine exerts greatest impact on early pregnancy at present, and it opens fascinating aspects of embryonic differentiation. Clinical assessment of those stages of growth relies heavily on 3D/four-dimensional (4D) HDlive, one of the most promising forms of noninvasive diagnostics and embryological phenomena, once matters for textbooks are now routinely recorded with outstanding clarity. New advances deserve the adjective "breathtaking", including 4D parallel study of the structural and functional early human development.

  18. Prenatal Diagnosis of Cardiac Diverticulum with Pericardial Effusion in the First Trimester of Pregnancy with Resolution after Early Pericardiocentesis

    PubMed Central

    Garcia Rodriguez, Raquel; Rodriguez Guedes, Azahara; Garcia Delgado, Raquel; Roldan Gutierrez, Lourdes; Medina Castellano, Margarita; Garcia Hernandez, Jose Angel

    2015-01-01

    Cardiac diverticulum is a rare anomaly, which may present in association with pericardial effusion. Only few cases diagnosed during fetal life have been published and only in 12 cases pericardiocentesis was made with good postnatal outcomes in 83% of the cases. In the first trimester of pregnancy only 6 cases were reported. We described the largest series of cases published. We describe a case of cardiac diverticulum complicated with pericardial effusion during the first trimester of pregnancy and resolved by intrauterine pericardiocentesis at 17 weeks of pregnancy. We made a systematic review of the literature with the cases reported of cardiac diverticulum, management, and outcomes. PMID:26558121

  19. First-trimester combined screening for trisomy 21 in a predominantly Chinese population.

    PubMed

    Leung, T Y; Chan, L W; Leung, T N; Fung, T Y; Sahota, D S; Spencer, K; Lau, T K

    2007-01-01

    To examine the effectiveness of first-trimester fetal trisomy 21 screening using a combination of maternal age, nuchal translucency thickness (NT) and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A) levels in a predominantly Chinese population in Hong Kong. This was a prospective study over a 1.5-year period of 2990 women who underwent combined screening for trisomy 21 between 11+0 and 13+6 weeks of gestation in a university fetal medicine unit. NT was measured according to the criteria set by The Fetal Medicine Foundation (FMF), maternal serum free beta-hCG and PAPP-A levels were measured, and the risk of trisomy 21 was calculated using The FMF's algorithm. Fetal karyotyping was advised when the risk was 1 : 300 or above. All subjects were followed up for pregnancy and fetal outcome. Of the 2990 women who underwent the screening program, 99% were Chinese. There were 57 twin pregnancies, giving a total of 3047 fetuses. Thirty-one percent of the women were 35 years old or above. One hundred and eighty-five (6.1%) fetuses were screen-positive; this included 14 cases of trisomy 21 and 17 cases of other chromosomal abnormalities. The positive predictive value was 16.7%. Among the 2862 screen-negative fetuses, only 18 (0.6%) cases had an unknown fetal outcome. There were no cases in which trisomy 21 was missed and the infant was liveborn. First-trimester combined screening for fetal trisomy 21 is highly effective among Chinese subjects. Copyright (c) 2006 ISUOG.

  20. First trimester uric acid and adverse pregnancy outcomes

    PubMed Central

    Laughon, S.K.; Catov, J.; Powers, R.W.; Roberts, J.M.; Gandley, R.E.

    2011-01-01

    BACKGROUND The association of elevated serum uric acid with the development of hypertension is established outside of pregnancy. We investigated whether first trimester uric acid was associated with the development of the following: gestational hypertension or preeclampsia, these outcomes stratified by presence of hyperuricemia at delivery since this denotes more severe disease, preterm birth or small for gestational age (SGA). METHODS Uric acid was measured in 1541 banked maternal plasma samples from a prior prospective cohort study that were collected at a mean gestational age of 9.0 (± 2.5) weeks. Polytomous regressions were performed and adjusted for parity and pre-pregnancy body mass index. RESULTS First trimester uric acid in the highest quartile (>3.56 mg/dL) compared to lowest three quartiles was associated with an increased risk of developing preeclampsia (adjusted OR = 1.82; 95% CI, 1.03–3.21) but not gestational hypertension. In women with hypertensive disease complicated by hyperuricemia at delivery, high first trimester uric acid was associated with a 3.22-fold increased risk of hyperuricemic gestational hypertension and a 3.65-fold increased risk of hyperuricemic preeclampsia. High first trimester uric acid was not associated with gestational hypertension or preeclampsia without hyperuricemia at delivery, preterm birth, or SGA. In women who developed hypertensive disease, elevated uric acid at delivery was only partly explained by elevated uric acid in the first trimester (r2 = .23). CONCLUSIONS First trimester elevated uric acid was associated with later preeclampsia and more strongly with preeclampsia and gestational hypertension with hyperuricemia. PMID:21252861

  1. Teratogenic effects of first-trimester cyclophosphamide therapy.

    PubMed

    Kirshon, B; Wasserstrum, N; Willis, R; Herman, G E; McCabe, E R

    1988-09-01

    Intravenous cyclophosphamide was administered for severe exacerbation of systemic lupus erythematosus to a patient not known to be in the first trimester of pregnancy. The patient received no other medication except prednisone. Her neonate was born with multiple anomalies, including absent thumbs, cleft palate, low-set ears, and multiple eye abnormalities. These anomalies probably reflect teratogenic effects of cyclophosphamide, and indicate that judgment is required before its use in the first trimester. Furthermore, this case illustrates the need for effective contraception and repetitive pregnancy testing when potentially teratogenic agents are administered to presumably nonpregnant women in the reproductive age group.

  2. Prediction of preeclampsia utilizing the first trimester screening examination.

    PubMed

    Baschat, Ahmet A; Magder, Laurence S; Doyle, Lauren E; Atlas, Robert O; Jenkins, Chuka B; Blitzer, Miriam G

    2014-11-01

    To derive a prediction rule for preeclampsia and early onset preeclampsia requiring delivery <34 weeks using first trimester maternal, ultrasound, and serum markers. Prospective cohort study of women enrolled at first trimester screening. Maternal history, demographics, anthropometry, ultrasound parameters, and serum analytes were compared between women with preeclampsia and normal outcome. The prediction rule was derived by Lasso logistic regression analysis. In 2441 women, 108 (4.4%) women developed preeclampsia, and 18 (0.7%) early preeclampsia. Nulliparity, prior hypertension, diabetes, prior preeclampsia, mean arterial pressure, and the log pregnancy-associate pregnancy protein-A multiples of the median were primary risk factors. Prediction rules for preeclampsia/early preeclampsia had an area under the curve of 0.82/0.83 respectively. Preeclampsia was predicted with 49% sensitivity and early preeclampsia with 55% sensitivity for a 10% false positive rate. First trimester prediction rules using parameters currently available at first trimester screening identify a significant proportion of women with subsequent preeclampsia. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. Are early first trimester weights valid proxies for preconception weight?

    USDA-ARS?s Scientific Manuscript database

    An accurate estimate of preconception weight is necessary for providing a gestational weight gain range based on the Institute of Medicine’s guidelines; however, an accurate and proximal preconception weight is not available for most women. We examined the validity of first trimester weights for est...

  4. Spontaneous superfetation diagnosed in the first trimester with successful outcome.

    PubMed

    Tuppen, G D; Fairs, C; de Chazal, R C; Konje, J C

    1999-09-01

    We report a twin pregnancy in which a 4-week discordance in size between the fetuses was identified in the first trimester. The discordance was maintained throughout the pregnancy, which was otherwise uneventful and resulted in the delivery of a live girl and boy.

  5. Variation of papp-a level in the first trimester of pregnancy and its clinical outcome.

    PubMed

    Patil, Mithil; Panchanadikar, T M; Wagh, Girija

    2014-04-01

    Abnormalities in maternal serum marker levels and fetal measurements obtained during the first trimester screening can be a marker not only for certain chromosomal disorders and anomalies in the fetus but also for specific pregnancy complications. In particular, low maternal serum pregnancy-associated plasma protein-A (PAPP-A), at 11-13 weeks of gestation, is associated with stillbirth, infant death, intrauterine growth restriction, preterm birth, and pre-eclampsia in chromosomally normal fetuses, while a raised nuchal translucency is associated with specific structural abnormalities and genetic syndromes. We have studied the serum Papp-A level in 560 pregnant patients (11-13 weeks gestation) registered at Bharati Hospital and Research Centre, Pune. All patients undergoing testing were followed till the delivery and their neonatal outcome was also taken into consideration. Our aim is to study the pregnancy outcome in relation to the variations of Papp-A level in the first trimester of pregnancy. Every patient visiting the antenatal OPD was counseled for testing of First Trimester Screening to assess fetal well-being. Patients who were registered for delivery at our hospital were taken into the trial. Blood samples were taken at 11-13 weeks of pregnancy and sent to the PerkinElmer lab for analysis. Results were expressed in Multiple of Median and patients having MOM value less than 0.5 were carefully observed till the delivery, and a thorough neonatal examination was done by a pediatrician. 524 patients were included in the trial out of which 452 patients were found to have a normal Papp-A level of >0.5 MOM. All these patients were followed further during the antenatal period where 18 patients developed preterm labor and few patients developed pregnancy-induced hypertension. The obstetric outcome of patients with a normal Papp-A level was fairly uneventful as compared to others with a low Papp-A level. Though Papp-A level in the first trimester of pregnancy (11

  6. First-trimester screening for trisomy 21 using alpha-fetoprotein.

    PubMed

    Bredaki, Foteini E; Wright, David; Matos, Pedro; Syngelaki, Argyro; Nicolaides, Kypros H

    2011-01-01

    To investigate the potential value of adding maternal serum alpha-fetoprotein (AFP) to free β-human chorionic gonadotropin (β-hCG) and PAPP-A and fetal nuchal translucency (NT) thickness in first-trimester screening for trisomy 21. In this case control study, serum AFP was measured in 100 trisomy 21 and 1,500 euploid pregnancies in which screening for trisomy 21 had been performed by a combination of serum free β-hCG and PAPP-A and fetal NT at 11-13 weeks' gestation. We examined the effect of adding AFP on the performance of screening by the combined test. In the trisomy 21 pregnancies, the median multiple of the normal median AFP, adjusted for gestational age, maternal weight, racial origin, smoking status and method of conception, was significantly reduced (0.7037, 95% CI: 0.6398-0.7739). Adding AFP to the combined test improved the performance of screening and for a risk cut-off of 1 in 100, the false-positive rate was reduced from 2.8 by 0.4% (95% CI: 0.13-0.77%) without a significant change in detection rate. Inclusion of serum AFP improves the performance of the first-trimester combined test in screening for trisomy 21. Copyright © 2011 S. Karger AG, Basel.

  7. Prospective first-trimester screening for trisomy 21 in 30,564 pregnancies.

    PubMed

    Avgidou, Kyriaki; Papageorghiou, Aris; Bindra, Renu; Spencer, Kevin; Nicolaides, Kypros H

    2005-06-01

    This study was undertaken to evaluate the performance of a 1-stop clinic for first-trimester assessment of risk (OSCAR) for trisomy 21 by a combination of maternal age, fetal nuchal translucency (NT) thickness, and maternal serum-free ss- human chorionic gonadotrophin (hCG) and pregnancy-associated plasma protein-A (PAPP-A). OSCAR was carried out in 30,564 pregnancies at 11 to 13 + 6 weeks. Patient-specific risks for trisomy 21 and detection and false-positive rates were calculated. The median maternal age was 34 (range 15-49) years. Chromosomal abnormalities were identified in 330 pregnancies, including 196 cases of trisomy 21. The estimated risk for trisomy 21 was 1 in 300 or greater in 7.5% of the normal pregnancies, in 93.4% of those with trisomy 21 and in 88.8% of those with other chromosomal defects. The most effective method of screening for chromosomal defects is by first-trimester fetal NT and maternal serum biochemistry.

  8. Efficacy of first-trimester ultrasound parameters for prediction of early spontaneous abortion.

    PubMed

    Datta, Mamta Rath; Raut, Ankush

    2017-09-01

    To assess first-trimester ultrasound measurements for the prediction of early spontaneous abortion. In a prospective observational study in Jamshedpur, India, women with singleton pregnancies of 42-76 days were enrolled between November 2014 and April 2016. Inclusion criteria were spontaneous conception, embryonic cardiac activity, and regular menstrual cycle. Fetal crown-to-rump length (CRL), gestational sac diameter (GSD), yolk sac diameter (YSD), and fetal heart rate (FHR) were measured by transvaginal ultrasonography. Ultrasonography was repeated at 12 weeks and beyond to determine pregnancy continuation. Among 800 women, 140 (17.5%) experienced early spontaneous abortion. CRL, GSD, and FHR values below the 5th percentile (odds ratio [OR] 26.48, 26.94, and 100.63, respectively), and YSD above the 95th percentile (OR 1.04) were predictors of early abortion. Normal YSD did not reduce the risk of abortion if the other three parameters were below the 5th percentile (OR 34.27). For every 10-bpm decrease in FHR below 130, there was 26.7% increased risk of abortion. GSD-CRL difference of less than 5 mm was associated with a higher likelihood of abortion (OR 4.88). First-trimester ultrasound measurements are predictors of early abortion. Risk assessment tables based on combinations of abnormal measures might improve prediction rates. © 2017 International Federation of Gynecology and Obstetrics.

  9. First trimester prenatal diagnosis: earlier is not necessarily better.

    PubMed

    Boss, J A

    1994-09-01

    In the past few years considerable attention has been given to a relatively new method of prenatal diagnosis known as chorionic villus sampling (CVS). Because CVS can be performed in the first trimester it is hailed by many as a significant advance over amniocentesis. What has not been as publicized, however, are the disadvantages of CVS and earlier prenatal diagnosis. The emotional costs of CVS in terms of the greater number of both spontaneous and selective abortions following CVS, the use of CVS for sex selection and, because of the greater social acceptability of first trimester abortion, the possibility of increased pressure on women to undergo prenatal diagnosis by health insurance companies, medical professionals and government agencies, all need to be weighed against the advantages of early prenatal diagnosis.

  10. Retrospective study evaluating the performance of a first-trimester combined screening for trisomy 21 in an Italian unselected population

    PubMed Central

    Padula, Francesco; Cignini, Pietro; Giannarelli, Diana; Brizzi, Cristiana; Coco, Claudio; D’Emidio, Laura; Giorgio, Elsa; Giorlandino, Maurizio; Mangiafico, Lucia; Mastrandrea, Marialuisa; Milite, Vincenzo; Mobili, Luisa; Nanni, Cinzia; Raffio, Raffaella; Taramanni, Cinzia; Vigna, Roberto; Mesoraca, Alvaro; Bizzoco, Domenico; Gabrielli, Ivan; Di Giacomo, Gianluca; Barone, Maria Antonietta; Cima, Antonella; Giorlandino, Francesca Romana; Emili, Sabrina; Cupellaro, Marina; Giorlandino, Claudio

    2014-01-01

    Objectives to assess the performance of a combined first-trimester screening for trisomy 21 in an unselected Italian population referred to a specialized private center for prenatal medicine. Methods a retrospective validation of first-trimester screening algorithms [risk calculation based on maternal age and nuchal translucency (NT) alone, maternal age and serum parameters (free β-hCG and PAPP-A) alone and a combination of both] for fetal aneuploidies evaluated in an unselected Italian population at Artemisia Fetal-Maternal Medical Centre in Rome. All measurements were performed between 11+0 and 13+6 weeks of gestation, between April 2007 and December 2008. Results of 3,610 single fetuses included in the study, we had a complete follow-up on 2,984. Fourteen of 17 cases of trisomy 21 were detected when a cut-off of 1:300 was applied [detection rate (DR) 82.4%, 95% confidence interval (CI) 64.2–100; false-positive rate (FPR) 4.7%, 95% CI 3.9–5.4; false-negative rate (FNR) 17.6%, 95% CI 0–35.8%]. Conclusion in our study population the detection rate for trisomy 21, using the combined risk calculation based on maternal age, fetal NT, maternal PAPP-A and free β-hCG levels, was superior to the application of either parameter alone. The algorithm has been validated for first trimester screening in the Italian population. PMID:26266002

  11. Retrospective study evaluating the performance of a first-trimester combined screening for trisomy 21 in an Italian unselected population.

    PubMed

    Padula, Francesco; Cignini, Pietro; Giannarelli, Diana; Brizzi, Cristiana; Coco, Claudio; D'Emidio, Laura; Giorgio, Elsa; Giorlandino, Maurizio; Mangiafico, Lucia; Mastrandrea, Marialuisa; Milite, Vincenzo; Mobili, Luisa; Nanni, Cinzia; Raffio, Raffaella; Taramanni, Cinzia; Vigna, Roberto; Mesoraca, Alvaro; Bizzoco, Domenico; Gabrielli, Ivan; Di Giacomo, Gianluca; Barone, Maria Antonietta; Cima, Antonella; Giorlandino, Francesca Romana; Emili, Sabrina; Cupellaro, Marina; Giorlandino, Claudio

    2014-01-01

    to assess the performance of a combined first-trimester screening for trisomy 21 in an unselected Italian population referred to a specialized private center for prenatal medicine. a retrospective validation of first-trimester screening algorithms [risk calculation based on maternal age and nuchal translucency (NT) alone, maternal age and serum parameters (free β-hCG and PAPP-A) alone and a combination of both] for fetal aneuploidies evaluated in an unselected Italian population at Artemisia Fetal-Maternal Medical Centre in Rome. All measurements were performed between 11(+0) and 13(+6) weeks of gestation, between April 2007 and December 2008. of 3,610 single fetuses included in the study, we had a complete follow-up on 2,984. Fourteen of 17 cases of trisomy 21 were detected when a cut-off of 1:300 was applied [detection rate (DR) 82.4%, 95% confidence interval (CI) 64.2-100; false-positive rate (FPR) 4.7%, 95% CI 3.9-5.4; false-negative rate (FNR) 17.6%, 95% CI 0-35.8%]. in our study population the detection rate for trisomy 21, using the combined risk calculation based on maternal age, fetal NT, maternal PAPP-A and free β-hCG levels, was superior to the application of either parameter alone. The algorithm has been validated for first trimester screening in the Italian population.

  12. First-trimester medical abortion practices in Canada

    PubMed Central

    Guilbert, Edith R.; Hayden, Althea S.; Jones, Heidi E.; White, Katharine O’Connell; Steven Lichtenberg, E.; Paul, Maureen; Norman, Wendy V.

    2016-01-01

    Abstract Objective To understand the current availability and practice of first-trimester medical abortion (MA) in Canada. Design Using public sources and professional networks, abortion facilities across Canada were identified for a cross-sectional survey on medical and surgical abortion. English and French surveys were distributed by surface or electronic mail between July and November 2013. Setting Canada. Participants A total of 94 abortion facilities were identified. Main outcome measures Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using χ2 and t tests. Results A total of 78 of 94 (83.0%) facilities responded. Medical abortion represented 3.8% of first-trimester abortions reported (2706 of 70 860) in 2012. Among the facilities offering MA, 45.0% performed fewer than 500 first-trimester abortions a year, while 35.0% performed more than 1000. More MAs were performed in private offices or ambulatory health centres than in hospitals. Sixty-two physicians from 28 of 78 facilities reported providing first-trimester MA; 87.1% also provided surgical abortion. More than three-quarters of MA physicians were female and 56.5% were family physicians. A preponderance (85.2%) of providers offered methotrexate with misoprostol. Nearly all physicians (90.3%) required patients to have an ultrasound before MA, and 72.6% assessed the completion of the abortion with ultrasonography. Most physicians (74.2%) offered MA through 49 days after the onset of the last menstrual period, and 21.0% offered MA through 50 to 56 days; 37.1% reported providing MA to patients who lived more than 2 hours away. Four physicians from 1 site provided MA via telemedicine. Conclusion In Canada, MA provision using methotrexate and misoprostol is consistent with best-practice guidelines, but MA is rare and its availability is unevenly distributed. PMID:28192275

  13. First-trimester medical abortion practices in Canada: National survey.

    PubMed

    Guilbert, Edith R; Hayden, Althea S; Jones, Heidi E; White, Katharine O'Connell; Steven Lichtenberg, E; Paul, Maureen; Norman, Wendy V

    2016-04-01

    To understand the current availability and practice of first-trimester medical abortion (MA) in Canada. Using public sources and professional networks, abortion facilities across Canada were identified for a cross-sectional survey on medical and surgical abortion. English and French surveys were distributed by surface or electronic mail between July and November 2013. Canada. A total of 94 abortion facilities were identified. Descriptive statistics on MA practice and facility and provider characteristics, as well as comparisons of MA practice by facility and provider characteristics using χ(2) and t tests. A total of 78 of 94 (83.0%) facilities responded. Medical abortion represented 3.8% of first-trimester abortions reported (2706 of 70 860) in 2012. Among the facilities offering MA, 45.0% performed fewer than 500 first-trimester abortions a year, while 35.0% performed more than 1000. More MAs were performed in private offices or ambulatory health centres than in hospitals. Sixty-two physicians from 28 of 78 facilities reported providing first-trimester MA; 87.1% also provided surgical abortion. More than three-quarters of MA physicians were female and 56.5% were family physicians. A preponderance (85.2%) of providers offered methotrexate with misoprostol. Nearly all physicians (90.3%) required patients to have an ultrasound before MA, and 72.6% assessed the completion of the abortion with ultrasonography. Most physicians (74.2%) offered MA through 49 days after the onset of the last menstrual period, and 21.0% offered MA through 50 to 56 days; 37.1% reported providing MA to patients who lived more than 2 hours away. Four physicians from 1 site provided MA via telemedicine. In Canada, MA provision using methotrexate and misoprostol is consistent with best-practice guidelines, but MA is rare and its availability is unevenly distributed. Copyright© the College of Family Physicians of Canada.

  14. Two-stage first-trimester screening for trisomy 21 by ultrasound assessment and biochemical testing.

    PubMed

    Kagan, K O; Staboulidou, I; Cruz, J; Wright, D; Nicolaides, K H

    2010-11-01

    This study was carried out to examine the performance of a contingent policy in first-trimester screening for trisomy 21, in which the estimated risk was first derived by a combination of maternal age, fetal nuchal translucency (NT) thickness, presence/absence of the nasal bone, blood flow in the ductus venosus or flow across the tricuspid valve, and biochemical testing was carried out only in those who were found to have an intermediate risk. We also examined the performance of a policy in which the estimated risk was first derived by a combination of maternal age and biochemical testing, and ultrasound examination was carried out only in those with an intermediate risk. The data for this study were derived from prospective screening for trisomy 21 in singleton pregnancies, using, as markers, a combination of maternal age, fetal NT thickness and maternal-serum free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A), in a one-stop clinic for first-trimester assessment of risk at 11 + 0 to 13 + 6 weeks of gestation. Assessment of the fetal nasal bone, ductus venosus flow and tricuspid flow were also routinely performed by appropriately trained sonographers. The performance of different screening policies was examined. The study population consisted of 19 614 pregnancies with a normal karyotype or delivery of a phenotypically normal baby (euploid group) and 122 cases of trisomy 21. The best performance was achieved by a contingent policy in which first-stage screening was based on maternal age, fetal NT thickness and either tricuspid valve or ductus venosus blood flow, followed by biochemical testing only those with an intermediate risk, of 1 in 51 to 1 in 1000 (which constituted about 20% of the total). The performance of contingent screening in which first-stage testing relies on biochemistry was poorer than when first-stage screening was performed by ultrasound examination because, in order to achieve the same detection

  15. Association between previously unknown connective tissue disease and subclinical hypothyroidism diagnosed during first trimester of pregnancy.

    PubMed

    Beneventi, Fausta; Locatelli, Elena; Alpini, Claudia; Lovati, Elisabetta; Ramoni, Véronique; Simonetta, Margherita; Cavagnoli, Chiara; Spinillo, Arsenio

    2015-11-01

    To investigate the presence of autoimmune rheumatic disorders among women with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy and subsequent pregnancy outcomes. Case-control study. Tertiary obstetric and gynecologic center. Pregnant women in the first trimester of pregnancy. Clinical, laboratory, ultrasonographic evaluations. Thyroid-stimulating hormone (TSH) level; antibodies against thyroperoxidase, thyroid globulin and TSH receptor detection; screening for rheumatic symptoms and antinuclear antibodies (ANA); uterine artery pulsatility index evaluation; pregnancy complication onset. Out of 3,450 women enrolled, 106 (3%) were diagnosed with autoimmune thyroid disorders. ANA were present in 18 (16.9%) of 106 cases and 26 (12.6%) of 206 controls. Of the cases, 28 (26.4%) of 106 reported rheumatic symptoms, 5 of these were diagnosed with Sjögren syndrome or with undefined connective tissue disease. Autoimmune thyroid diseases are statistically significantly associated with a higher risk of preeclampsia, fetal growth restriction, and overall pregnancy complications compared with controls, with a higher uterine artery pulsatility index, suggesting a defective placentation in thyroid disorders. The effect of ANA-positivity on moderate/severe adverse pregnancy outcomes was statistically significant among the patients with thyroid disorders (9 of 18 as compared to 8 of 88, odds ratio 9.65; 95% confidence interval, 2.613-7.81). Connective tissue diseases are frequently associated with autoimmune thyroid disorders diagnosed during the first trimester of pregnancy. Thyroid autoimmunity and ANA positivity independently increased the risk of adverse pregnancy outcomes. Copyright © 2015 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  16. Absolute first trimester cell-free DNA levels and their associations with adverse pregnancy outcomes.

    PubMed

    Thurik, Florentine F; Lamain-de Ruiter, Marije; Javadi, Ahmad; Kwee, Anneke; Woortmeijer, Heleen; Page-Christiaens, Godelieve C M L; Franx, Arie; van der Schoot, C Ellen; Koster, Maria P H

    2016-12-01

    To study associations of first trimester cell-free fetal DNA levels (in this paper referred to as cell-free placental DNA (cfpDNA) levels) and preeclampsia (PE), pregnancy-induced hypertension (PIH), gestational diabetes (GDM) and spontaneous preterm birth (sPB). A nested case-control study was conducted in first trimester samples (gestational age 8(+0) -13(+6)  weeks). A total of 226 cases and 301 controls were included. CfpDNA levels were quantified in male-bearing pregnancies using real-time DYS14-PCRs on DNA isolated from maternal serum. CfpDNA multiples of the median (MoMs) were calculated based on associations with patient characteristics (body mass index, parity, ethnicity and smoking). Associations between MoMs and adverse outcomes were studied. Cell-free placental DNA levels were negatively associated with body mass index (β = -0.297, p < 0.001) and smoking (β = -0.163, p = 0.006). MoMs were lower in women who later developed PIH (n = 84, p = 0.009) or GDM (n = 56, p = 0.037). There was no association between cfpDNA MoMs and PE (n = 37, p = 0.15) or sPB (n = 49, p = 0.19). CfpDNA was positively correlated with pregnancy-associated plasma protein A (r = 0.426, p < 0.001) but not with placental growth factor (r = 0.059, p = 0.179). Adjusted first trimester cfpDNA levels are associated with PIH and GDM but probably not with PE or sPB. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

  17. COMPARISON BETWEEN SUBLINGUAL AND VAGINAL ROUTE OF MISOPROSTOL IN MANAGEMENT OF FIRST TRIMESTER MISCARRIAGE MISSING

    PubMed Central

    Dehbashi, Zahra; Moosazadeh, Mahmood; Afshari, Mahdi

    2016-01-01

    Background: Each year, more than forty million abortions are occurred whole of the world. Misoprostol is a prostaglandin analogue with a strong uterotonic effect. The present study aimed to compare the efficacy of Misoprostol in first trimester abortion through two sublingual and vaginal routes of administration. Methods: This randomized clinical trial was conducted on 52 consecutive women in first trimester candidate for pregnancy termination because of fetal IUFD or missed abortion in sonography reports. The patients were hospitalized and then randomly assigned to receive sublingual Misoprostol (400 µg, n 27) or vaginal Misoprostol (400 µg placed in posterior fornix, n = 25). Findings: None of the pregnant in the sublingual group developed complete abortion at the end of follow-up time, while 36% of women inducted with vaginal misoprostol experienced complete abortion indicating a intergroup significant difference (p = 0.001). Compared with vaginal group, those women in sublingual group experienced more complications including diarrhea (22.2% versus 20.0%), nausea and vomiting (22.2% versus 0.0%), and abdominal pain (3.7% versus 0.0%). Conclusion: The use of Misoprostol in vaginal route results in more abortion completeness as well as lower complication rate as compared to sublingual prescription of the drug. PMID:27698600

  18. First Trimester Phthalate Exposure and Infant Birth Weight in the Infant Development and Environment Study

    PubMed Central

    Sathyanarayana, Sheela; Barrett, Emily; Nguyen, Ruby; Redmon, Bruce; Haaland, Wren; Swan, Shanna H.

    2016-01-01

    Phthalate exposure is widespread among pregnant women but whether it is related to fetal growth and birth weight remains to be determined. We examined whether first trimester prenatal phthalate exposure was associated with birth weight in a pregnancy cohort study. We recruited first trimester pregnant women from 2010–2012 from four centers and analyzed mother/infant dyads who had complete urinary phthalate and birth record data (N = 753). We conducted multiple linear regression to examine if prenatal log specific gravity adjusted urinary phthalate exposure was related to birthweight in term and preterm (≤37 weeks) infants, stratified by sex. We observed a significant association between mono carboxy-isononyl phthalate (MCOP) exposure and increased birthweight in term males, 0.13 kg (95% CI 0.03, 0.23). In preterm infants, we observed a 0.49 kg (95% CI 0.09, 0.89) increase in birthweight in relation to a one log unit change in the sum of di-ethylhexyl phthalate (DEHP) metabolite concentrations in females (N = 33). In summary, we observed few associations between prenatal phthalate exposure and birthweight. Positive associations may be attributable to unresolved confounding in term infants and limited sample size in preterm infants. PMID:27669283

  19. TNF-α alters the inflammatory secretion profile of human first trimester placenta.

    PubMed

    Siwetz, Monika; Blaschitz, Astrid; El-Heliebi, Amin; Hiden, Ursula; Desoye, Gernot; Huppertz, Berthold; Gauster, Martin

    2016-04-01

    Implantation and subsequent placental development depend on a well-orchestrated interaction between fetal and maternal tissues, involving a fine balanced synergistic cross-talk of inflammatory and immune-modulating factors. Tumor necrosis factor (TNF)-α has been increasingly recognized as pivotal factor for successful pregnancy, although high maternal TNF-α levels are associated with a number of adverse pregnancy conditions including gestational hypertension and gestational diabetes mellitus. This study describes effects of exogenously applied TNF-α, mimicking increased maternal TNF-α levels, on the secretion profile of inflammation associated factors in human first trimester villous placenta. Conditioned culture media from first trimester villous placental explants were analyzed by inflammation antibody arrays and ELISA after 48 h culture in the presence or absence of TNF-α. Inflammation antibody arrays identified interleukin (IL)-6, IL-8, chemokine (C-C motif) ligand 2 (CCL2), CCL4, and granulocyte-macrophage colony-stimulating factor (GM-CSF) as the most abundantly secreted inflammation-associated factors under basal culture conditions. In the presence of TNF-α, secretion of GM-CSF, CCL5, and IL-10 increased, whereas IL-4 and macrophage CSF levels decreased compared with controls. ELISA analysis verified antibody arrays by showing significantly increased synthesis and release of GM-CSF and CCL5 by placental explants in response to TNF-α. Immunohistochemistry localized GM-CSF in the villous trophoblast compartment, whereas CCL5 was detected in maternal platelets adhering to perivillous fibrin deposits on the villous surface. mRNA-based in situ padlock probe approach localized GM-CSF and CCL5 transcripts in the villous trophoblast layer and the villous stroma. Results from this study suggest that the inflammatory secretion profile of human first trimester placenta shifts towards increased levels of GM-CSF, CCL5, and IL10 in response to elevated maternal

  20. First-trimester diagnosis of Meckel-Gruber syndrome by transabdominal sonography in a low-risk case.

    PubMed

    Braithwaite, J M; Economides, D L

    1995-12-01

    Meckel-Gruber syndrome is a rare autosomal recessive disorder often resulting in neonatal death within a few hours of life. The condition is usually diagnosed ultrasonographically in the second trimester and earlier diagnosis has been mainly confined to high recurrence risk pregnancies. We describe the earliest non-invasive diagnosis of this condition at 12+2 weeks' gestation in a patient with no previous history using transabdominal ultrasound. Pregnancy termination was declined. Subsequent development of anhydramnios in the mid-trimester resulted in poor fetal visualization. We propose that first-trimester diagnosis of this condition is not only possible but preferable, as normal liquor volume facilitates visualization of fetal anatomy.

  1. Three-dimensional ultrasonography by means of HDlive rendering in the first trimester of pregnancy: A pictorial review.

    PubMed

    Tonni, Gabriele; Castigliego, Anna Pia; Grisolia, Gianpaolo; Lituania, Mario; Meagher, Simon; Da Silva Costa, Fabrício; Araujo Júnior, Edward

    2016-01-01

    Our objective was to describe early embryo/fetus anatomy and abnormalities provided by three and four-dimensional (3D/4D) ultrasound using HDlive rendering technology in the first trimester of pregnancy. Normal and pathologic embryonic and fetal volume data set with postprocessing using HDlive rendering mode. Virtual fetoscopic imaging of the normal and pathologic fetus even at early stage of development with increasing maternal-fetal bonding process. HDlive represents a novel and valuable lightening system for 3D/4D ultrasound application that may aid the prenatal interpretation of early congenital malformations although limitations and cautions are still needed for inclusion in obstetric clinical practice.

  2. Three-dimensional ultrasonography by means of HDlive rendering in the first trimester of pregnancy: A pictorial review

    PubMed Central

    Tonni, Gabriele; Castigliego, Anna Pia; Grisolia, Gianpaolo; Lituania, Mario; Meagher, Simon; Da Silva Costa, Fabrício; Araujo, Edward

    2016-01-01

    Our objective was to describe early embryo/fetus anatomy and abnormalities provided by three and four-dimensional (3D/4D) ultrasound using HDlive rendering technology in the first trimester of pregnancy. Normal and pathologic embryonic and fetal volume data set with postprocessing using HDlive rendering mode. Virtual fetoscopic imaging of the normal and pathologic fetus even at early stage of development with increasing maternal-fetal bonding process. HDlive represents a novel and valuable lightening system for 3D/4D ultrasound application that may aid the prenatal interpretation of early congenital malformations although limitations and cautions are still needed for inclusion in obstetric clinical practice. PMID:27403079

  3. Maternal Continuing Folic Acid Supplementation after the First Trimester of Pregnancy Increased the Risk of Large-for-Gestational-Age Birth: A Population-Based Birth Cohort Study

    PubMed Central

    Wang, Sufang; Ge, Xing; Zhu, Beibei; Xuan, Yujie; Huang, Kun; Rutayisire, Erigene; Mao, Leijing; Huang, Sanhuan; Yan, Shuangqin; Tao, Fangbiao

    2016-01-01

    Supplementation with folic acid (FA) was proven to prevent neural tube defects (NTDs) and was recommended worldwide before and during early pregnancy. However, much less is known regarding the role of FA after the 12th gestational week (GW). This study aimed to investigate the related effects of continued FA supplementation after the first trimester of pregnancy on fetal growth. The study subjects came from the Ma’anshan-Anhui Birth Cohort Study (MABC) that recruited 3474 pregnant women from the city of Ma’anshan in Anhui Province in China during the period of May 2013 to September 2014. The information on use of vitamin and mineral supplements was recorded in different periods (the first/second/third trimester of pregnancy). Small-for-gestational-age (SGA) births were live-born infants that were <10th percentile of birth weight, and large-for-gestational-age (LGA) births were live-born infants that were ≥90th percentile of birth weight according to nomograms based on gender and gestational age from the latest standards. We used multivariable logistic regression to evaluate the effects of FA supplement consumption in the second/third trimester of pregnancy on the risk of LGA and SGA. In addition, propensity score analysis was also performed to examine the effects. In this prospective birth cohort study conducted in Chinese women who had taken FA in the first trimester of pregnancy, we found that continued FA supplementation with 400 micrograms/day in the second and third trimesters of pregnancy significantly increased the risk of LGA (RR = 1.98 (1.29, 3.04)). This relation was strong or monotonic after adjusting for maternal age, newborn’s gender, maternal pre-pregnancy BMI, maternal education level, smoking, alcohol consumption and calcium supplementation. We did not observe that continuing FA supplementation after the first trimester of pregnancy remarkably decreased the risk of SGA. The propensity score analysis showed similar results. To confirm these

  4. Simultaneous monitoring of maternal and fetal heart rate variability during labor in relation with fetal gender.

    PubMed

    Gonçalves, Hernâni; Fernandes, Diana; Pinto, Paula; Ayres-de-Campos, Diogo; Bernardes, João

    2017-08-21

    Male gender is considered a risk factor for several adverse perinatal outcomes. Fetal gender effect on fetal heart rate (FHR) has been subject of several studies with contradictory results. The importance of maternal heart rate (MHR) monitoring during labor has also been investigated, but less is known about the effect of fetal gender on MHR. The aim of this study is to simultaneously assess maternal and FHR variability during labor in relation with fetal gender. Simultaneous MHR and FHR recordings were obtained from 44 singleton term pregnancies during the last 2 hr of labor (H1, H2 ). Heart rate tracings were analyzed using linear (time- and frequency-domain) and nonlinear indices. Both linear and nonlinear components were considered in assessing FHR and MHR interaction, including cross-sample entropy (cross-SampEn). Mothers carrying male fetuses (n = 22) had significantly higher values for linear indices related with MHR average and variability and sympatho-vagal balance, while the opposite occurred in the high-frequency component and most nonlinear indices. Significant differences in FHR were only observed in H1 with higher entropy values in female fetuses. Assessing the differences between FHR and MHR, statistically significant differences were obtained in most nonlinear indices between genders. A significantly higher cross-SampEn was observed in mothers carrying female fetuses (n = 22), denoting lower synchrony or similarity between MHR and FHR. The variability of MHR and the synchrony/similarity between MHR and FHR vary with respect to fetal gender during labor. These findings suggest that fetal gender needs to be taken into account when simultaneously monitoring MHR and FHR. © 2017 Wiley Periodicals, Inc.

  5. Multicenter study of first-trimester screening for trisomy 21 in 75 821 pregnancies: results and estimation of the potential impact of individual risk-orientated two-stage first-trimester screening.

    PubMed

    Nicolaides, K H; Spencer, K; Avgidou, K; Faiola, S; Falcon, O

    2005-03-01

    To evaluate the performance of first-trimester screening for trisomy 21 by a combination of maternal age, fetal nuchal translucency (NT) and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A). In addition, the potential impact of a new individual risk-orientated two-stage approach to first-trimester screening was examined. First-trimester combined screening for trisomy 21 was carried out in 75 821 singleton pregnancies with live fetuses at 11 + 0 to 13 + 6 gestational weeks. The detection and false-positive rates for different risk cut-offs were calculated. To examine the potential impact of an individual risk-orientated two-stage approach to first-trimester screening it was assumed that, after first-trimester combined screening, chorionic villus sampling (CVS) would be performed in all patients with a risk estimate of 1 in 100 or more and in none of those with a risk estimate of less than 1 in 1000. Those in the intermediate-risk category, with a risk estimate of between 1 in 101 and 1 in 1000, would have further assessment of risk by first-trimester ultrasound examination to determine presence/absence of the nasal bone, presence/absence of tricuspid regurgitation or normal/abnormal Doppler velocity waveform in the ductus venosus, and CVS would be performed if their adjusted risk became 1 in 100 or more. Fetal NT and maternal serum free beta-hCG and PAPP-A were successfully measured in all cases. The median maternal age was 31 (range, 13-49) years, the median gestation at screening was 12 (range, 11 + 0 to 13 + 6) weeks and the median fetal crown-rump length was 62 (range, 45-84) mm. Chromosomal abnormalities were identified in 544 pregnancies, including 325 cases of trisomy 21. The estimated risk for trisomy 21 was 1 in 300 or greater in 5.2% of normal pregnancies, in 92.6% of those with trisomy 21, in 88.5% of those with trisomy 18 or 13 and in 85.6% of those with other chromosomal defects. The

  6. Pancytopenia in the first trimester: An indicator of hidden hyperthyroidism.

    PubMed

    Imai, Ken; Ohkuchi, Akihide; Nagayama, Shiho; Saito, Shinsuke; Matsubara, Shigeki; Suzuki, Mitsuaki

    2015-12-01

    Pancytopenia in the first trimester is very rare. A 33-year-old multiparous woman presented with nausea, loss of appetite, and bodyweight loss of 7.4 kg at 9(1/7) weeks of gestation due to hyperemesis gravidarum. Her laboratory data demonstrated pancytopenia involving white blood cell count of 3500/μL, a hemoglobin level of 9.8 g/dL, and a platelet count of 10.5 × 10(4)/μL. An extensive investigation into the causes of the pancytopenia detected true hyperthyroidism: thyroid-stimulating hormone, <0.02 μU/mL; free triiodothyronine, 11.25 pg/mL; free thyroxine, 4.74 ng/dL; and anti-thyroid-stimulating hormone receptor antibodies, 12.2 IU/L. Propylthiouracil was started at a dose of 300 mg/day at 10(5/7) weeks of gestation, which resulted in the normalization of her blood parameters and concomitant improvements in her free triiodothyronine and free thyroxine levels at 12(0/7) weeks of gestation. Pancytopenia in the first trimester might be indicative of hidden hyperthyroidism. © 2015 Japan Society of Obstetrics and Gynecology.

  7. Comparison of paracervical block techniques during first trimester pregnancy termination.

    PubMed

    Glantz, J C; Shomento, S

    2001-02-01

    To determine whether variations in chloroprocaine placement in paracervical blocks influence effectiveness, whether chloroprocaine is superior to saline, and what factors influence pain perception. Eighty-two women undergoing first trimester aspiration abortions were randomized to receive 1% chloroprocaine or saline at 3-5-7-9 or 4-8 o'clock positions. Using a 0--10 scale, women rated anxiety, dysmenorrhea, and pain associated with laminaria insertion, paracervical block, and aspiration. All four groups were similar in medical and demographic characteristics. Injection position did not influence pain ratings, but women who received chloroprocaine had less pain than those who received saline (6.3+/-2.3 vs. 7.8+/-2.0, P=0.002). Paracervical pain and dysmenorrhea were independently associated with aspiration pain scores (respective regression coefficients 0.49 and 0.26, P<0.008). There is no advantage to using a four-site paracervical block over a two-site technique, but chloroprocaine is superior to saline. Paracervical block may not provide adequate anesthesia during first trimester abortion, especially for women with significant dysmenorrhea.

  8. Expectant management of incomplete abortion in the first trimester.

    PubMed

    Pauleta, Joana R; Clode, Nuno; Graça, Luís M

    2009-07-01

    To evaluate the effectiveness and acceptability of expectant management of induced and spontaneous first trimester incomplete abortion. A prospective observational trial, conducted between June 2006 and November 2007, of 2 groups of patients diagnosed with an incomplete abortion: 66 patients who had received misoprostol for an induced abortion (group 1) and 30 patients who had had a spontaneous abortion (group 2). Transvaginal ultrasound was performed weekly. The success rate (complete abortion without surgery), time to resolution, duration of bleeding and pelvic pain, rate of infection, number of unscheduled hospital visits, and level of satisfaction with expectant management were recorded. The incidence of complete abortion was 86.4% and 82.1% in groups 1 and 2 respectively at day 14 after diagnosis, and 100% in both groups at day 30 (two group 2 patients underwent curettage and were excluded from the analysis). Both groups reported 100% satisfaction with expectant management, although over 90% of the women reported feeling anxious. Expectant management for incomplete abortion in the first trimester after use of misoprostol or after spontaneous abortion may be practical and feasible, although it may increase anxiety associated with the impending abortion.

  9. Relationships among Constitution, Stress, and Discomfort in the First Trimester

    PubMed Central

    Wang, Hsiao-Ling; Lee, Tzu-Chi; Kuo, Shih-Hsien; Chou, Fan-Hao; Chen, Li-Li; Su, Yi-Chang; Chen, Lih-Mih

    2012-01-01

    The purpose of this study was to explore correlations among constitution, stress, and discomfort symptoms during the first trimester of pregnancy. We adopted a descriptive and correlational research design and collected data from 261 pregnant women during their first trimester in southern Taiwan using structured questionnaires. Results showed that (1) stress was significantly and positively correlated with Yang-Xu, Yin-Xu, and Tan-Shi-Yu-Zhi constitutions, respectively; (2) Yin-Xu and Tan-Shi-Yu-Zhi constitutions had significant correlations with all symptoms of discomfort, while Yang-Xu had significant correlations with all symptoms of discomfort except for “running nose”; (3) Tan-Shi-Yu-Zhi constitution and stress were two indicators for “fatigue”; Tan-Shi-Yu-Zhi was the indicator for “nausea”; Yang-Xu and Yin-Xu were indicators for “frequent urination.” Our findings also indicate that stress level affects constitutional changes and that stress and constitutional change affect the incidence of discomfort. This research can help healthcare professionals observe these discomforts and provide individualized care for pregnant women, to nurture pregnant women into neutral-type constitution, minimize their levels of discomfort, and promote the health of the fetus and the mother. PMID:21860652

  10. Relationships among Constitution, Stress, and Discomfort in the First Trimester.

    PubMed

    Wang, Hsiao-Ling; Lee, Tzu-Chi; Kuo, Shih-Hsien; Chou, Fan-Hao; Chen, Li-Li; Su, Yi-Chang; Chen, Lih-Mih

    2012-01-01

    The purpose of this study was to explore correlations among constitution, stress, and discomfort symptoms during the first trimester of pregnancy. We adopted a descriptive and correlational research design and collected data from 261 pregnant women during their first trimester in southern Taiwan using structured questionnaires. Results showed that (1) stress was significantly and positively correlated with Yang-Xu, Yin-Xu, and Tan-Shi-Yu-Zhi constitutions, respectively; (2) Yin-Xu and Tan-Shi-Yu-Zhi constitutions had significant correlations with all symptoms of discomfort, while Yang-Xu had significant correlations with all symptoms of discomfort except for "running nose"; (3) Tan-Shi-Yu-Zhi constitution and stress were two indicators for "fatigue"; Tan-Shi-Yu-Zhi was the indicator for "nausea"; Yang-Xu and Yin-Xu were indicators for "frequent urination." Our findings also indicate that stress level affects constitutional changes and that stress and constitutional change affect the incidence of discomfort. This research can help healthcare professionals observe these discomforts and provide individualized care for pregnant women, to nurture pregnant women into neutral-type constitution, minimize their levels of discomfort, and promote the health of the fetus and the mother.

  11. First trimester caesarean scar ectopic pregnancy evaluation using MRI.

    PubMed

    Peng, K-W; Lei, Z; Xiao, T-H; Jia, F-G; Zhong, W-X; Gao, Y; Shen, B-X; Xie, J-W

    2014-02-01

    To determine the features of caesarean scar ectopic pregnancy (CSP) by using magnetic resonance imaging (MRI) in the first trimester. Thirty-nine women with CSP in the first trimester were initially selected and underwent transvaginal ultrasound and MRI examinations. Thirty-five patients with CSP were finally included in this study. The CSPs were categorized into three groups: type I, in which a thin-walled diverticulum is present at the caesarean section scar (CSS) defect and the gestational sac (GS) is embedded in the diverticulum; type II, in which a thin-walled diverticulum is present at the CSS defect and the GS is partially embedded in the diverticulum; type III, in which a niche is present in the CSS defect and the GS is mainly embedded in the isthmus. Types I, II, and III CSP occurred in 40, 46, and 14% of the women, respectively. There was no significant difference between the three types in the minimum thickness of the CSS defect. In types I and II, there was a positive correlation in the maximum inlet diameter of the CSS defect and the approximate area of the GS. Using MRI, most CSPs present as a diverticulum at the CSS defect, and the CSS defect becomes weaker with the growth of the GS. MRI showed detailed features of the CSP. Copyright © 2013 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  12. Observational Cohort Study of Pregnancy Outcome after First-Trimester Exposure to Fluoroquinolones

    PubMed Central

    Wacker, Evelin; Meister, Reinhard; Panse, Mary; Weber-Schoendorfer, Corinna; Oppermann, Marc; Schaefer, Christof

    2014-01-01

    Fluoroquinolones are avoided during pregnancy due to developmental toxicity in animals. The aim of this study was to assess the fetal risk after intrauterine fluoroquinolone exposure. We performed an observational study of a prospectively ascertained cohort of pregnant women exposed to a fluoroquinolone during the first trimester. Pregnancy outcomes were compared to those of a cohort exposed to neither fluoroquinolones nor teratogenic or fetotoxic drugs. The outcomes evaluated were major birth defects (structural abnormalities of medical, surgical, or cosmetic relevance), spontaneous abortion, and elective termination of pregnancy. Pregnancy outcomes of 949 women with fluoroquinolone treatment were compared with those of 3,796 nonexposed controls. Neither the rate of major birth defects (2.4%; adjusted odds ratio [ORadj], 0.91; 95% confidence interval [CI], 0.6 to 1.5) nor the risk of spontaneous abortion (adjusted hazard ratio [HRadj], 1.01; 95% CI, 0.8 to 1.3) was increased. However, there was a nonsignificant increase in major birth defects after exposure to moxifloxacin (6/93, 6.5%; crude odds ratio [ORcrude], 2.40; 95% CI, 0.8 to 5.6). Neither a critical exposure time window within the first trimester nor a specific pattern of birth defects was demonstrated for any of the fluoroquinolones. The rate of electively terminated pregnancies was increased among the fluoroquinolone-exposed women (HRadj, 1.32; 95% CI, 1.03 to 1.7). The gestational ages at delivery and birth weights did not differ between groups. Our study did not detect an increased risk of spontaneous abortion or major birth defects. These reassuring findings support the recommendation to allow fluoroquinolone use in early pregnancy in selected cases. After the use of moxifloxacin, a detailed fetal ultrasound examination should be considered. PMID:24841264

  13. Accuracy of emergency physician performed bedside ultrasound in determining gestational age in first trimester pregnancy

    PubMed Central

    2012-01-01

    Background Patient reported menstrual history, physician clinical evaluation, and ultrasonography are used to determine gestational age in the pregnant female. Previous studies have shown that pregnancy dating by last menstrual period (LMP) and physical examination findings can be inaccurate. An ultrasound performed in the radiology department is considered the standard for determining an accurate gestational age. The aim of this study is to determine the accuracy of emergency physician performed bedside ultrasound as an estimation of gestational age (EDUGA) as compared to the radiology department standard. Methods A prospective convenience sample of ED patients presenting in the first trimester of pregnancy (based upon self-reported LMP) regardless of their presenting complaint were enrolled. EDUGA was compared to gestational age estimated by ultrasound performed in the department of radiology (RGA) as the gold standard. Pearson’s product moment correlation coefficient was used to determine the correlation between EDUGA compared to RGA. Results Sixty-eight pregnant patients presumed to be in the 1st trimester of pregnancy based upon self-reported LMP consented to enrollment. When excluding the cases with no fetal pole, the median discrepancy of EDUGA versus RGA was 2 days (interquartile range (IQR) 1 to 3.25). The correlation coefficient of EDUGA with RGA was 0.978. When including the six cases without a fetal pole in the data analysis, the median discrepancy of EDUGA compared with RGA was 3 days (IQR 1 to 4). The correlation coefficient of EDUGA with RGA was 0.945. Conclusion Based on our comparison of EDUGA to RGA in patients presenting to the ED in the first trimester of pregnancy, we conclude that emergency physicians are capable of accurately performing this measurement. Emergency physicians should consider using ultrasound to estimate gestational age as it may be useful for the future care of that pregnant patient. PMID:23216683

  14. Observational cohort study of pregnancy outcome after first-trimester exposure to fluoroquinolones.

    PubMed

    Padberg, Stephanie; Wacker, Evelin; Meister, Reinhard; Panse, Mary; Weber-Schoendorfer, Corinna; Oppermann, Marc; Schaefer, Christof

    2014-08-01

    Fluoroquinolones are avoided during pregnancy due to developmental toxicity in animals. The aim of this study was to assess the fetal risk after intrauterine fluoroquinolone exposure. We performed an observational study of a prospectively ascertained cohort of pregnant women exposed to a fluoroquinolone during the first trimester. Pregnancy outcomes were compared to those of a cohort exposed to neither fluoroquinolones nor teratogenic or fetotoxic drugs. The outcomes evaluated were major birth defects (structural abnormalities of medical, surgical, or cosmetic relevance), spontaneous abortion, and elective termination of pregnancy. Pregnancy outcomes of 949 women with fluoroquinolone treatment were compared with those of 3,796 nonexposed controls. Neither the rate of major birth defects (2.4%; adjusted odds ratio [OR(adj)], 0.91; 95% confidence interval [CI], 0.6 to 1.5) nor the risk of spontaneous abortion (adjusted hazard ratio [HR(adj)], 1.01; 95% CI, 0.8 to 1.3) was increased. However, there was a nonsignificant increase in major birth defects after exposure to moxifloxacin (6/93, 6.5%; crude odds ratio [OR(crude)], 2.40; 95% CI, 0.8 to 5.6). Neither a critical exposure time window within the first trimester nor a specific pattern of birth defects was demonstrated for any of the fluoroquinolones. The rate of electively terminated pregnancies was increased among the fluoroquinolone-exposed women (HR(adj), 1.32; 95% CI, 1.03 to 1.7). The gestational ages at delivery and birth weights did not differ between groups. Our study did not detect an increased risk of spontaneous abortion or major birth defects. These reassuring findings support the recommendation to allow fluoroquinolone use in early pregnancy in selected cases. After the use of moxifloxacin, a detailed fetal ultrasound examination should be considered.

  15. First trimester phthalate exposure and anogenital distance in newborns

    PubMed Central

    Swan, S.H.; Sathyanarayana, S.; Barrett, E.S.; Janssen, S.; Liu, F.; Nguyen, R.H.N.; Redmon, J.B.; Liu, Fan; Scher, Erica; Stasenko, Marina; Ayash, Erin; Schirmer, Melissa; Farrell, Jason; Thiet, Mari-Paule; Baskin, Laurence; Gray Chelsea Georgesen, Heather L.; Rody, Brooke J.; Terrell, Carrie A.; Kaur, Kapilmeet; Brantley, Erin; Fiore, Heather; Kochman, Lynda; Parlett, Lauren; Marino, Jessica; Hulbert, William; Mevorach, Robert; Pressman, Eva; Ivicek, Kristy; Salveson, Bobbie; Alcedo, Garry

    2015-01-01

    STUDY QUESTION Is first trimester phthalate exposure associated with anogenital distance (AGD), a biomarker of prenatal androgen exposure, in newborns? SUMMARY ANSWER Concentrations of diethylhexyl phthalate (DEHP) metabolites in first trimester maternal urine samples are inversely associated with AGD in male, but not female, newborns. WHAT IS KNOWN ALREADY AGD is a sexually dimorphic measure reflecting prenatal androgen exposure. Prenatal phthalate exposure has been associated with shorter male AGD in multiple animal studies. Prior human studies, which have been limited by small sample size and imprecise timing of exposure and/or outcome, have reported conflicting results. STUDY DESIGN, SIZE, DURATION The Infant Development and the Environment Study (TIDES) is a prospective cohort study of pregnant women recruited in prenatal clinics in San Francisco, CA, Minneapolis, MN, Rochester, NY and Seattle, WA in 2010–2012. Participants delivered 787 infants; 753 with complete data are included in this analysis. PARTICIPANTS/MATERIALS, SETTING, METHODS Any woman over 18 years old who was able to read and write English (or Spanish in CA), who was <13 weeks pregnant, whose pregnancy was not medically threatened and who planned to deliver in a study hospital was eligible to participate. Analyses include all infants whose mothers provided a first trimester urine sample and who were examined at or shortly after birth. Specific gravity (SpG) adjusted concentrations of phthalate metabolites in first trimester urine samples were examined in relation to genital measurements. In boys (N = 366), we obtained two measures of anogenital distance (AGD) (anoscrotal distance, or AGDAS and anopenile distance, AGDAP) as well as penile width (PW). In girls (N = 373), we measured anofourchette distance (AGDAF) and anoclitoral distance (AGDAC). We used multivariable regression models that adjusted for the infant's age at exam, gestational age, weight-for-length Z-score, time of day of urine

  16. Observational study comparing the performance of first-trimester screening protocols for detecting trisomy 21 in a North Indian population.

    PubMed

    Kaul, Anita; Singh, Chanchal; Gupta, Rachna; Arora, Nidhi; Gupta, Abha

    2017-04-01

    To evaluate first-trimester screening protocols for detecting trisomy 21 in an Indian population. The present prospective study collected data from women with singleton pregnancies and a crown-to-rump length of 45-84 mm who presented at the fetal medicine unit of a tertiary care center in North India between June 1, 2006, and December 31, 2015, for combined first-trimester screening. Maternal age, nuchal translucency, nasal bone, and maternal serum levels of free beta human chorionic gonadotropin and pregnancy-associated plasma protein A were assessed for calculating the risk of trisomy 21. Tricuspid regurgitation and qualitative analysis of ductus venosus data were available from June 2010, and were included where available. Trisomy-21 detection rates were calculated for various screening protocols and were compared. There were 4523 women screened and 24 records of trisomy 21. Combined screening with maternal age, nuchal translucency, nasal bone, tricuspid regurgitation, and ductus venosus demonstrated optimal detection and false-positive rates of 93.8% and 1.9%, respectively. Screening using only maternal age yielded a detection rate of 37.5%; using fixed nuchal translucency cut-off values of 2.5 and 3 mm resulted in detection rates of 66.7% and 37.5%, respectively. Combined first-trimester screening performed well in an Indian population; combining maternal age, nuchal translucency, nasal bone, ductus venosus, and tricuspid regurgitation yielded the most accurate screening. © 2016 International Federation of Gynecology and Obstetrics.

  17. Endovaginal US and Doppler findings after first-trimester abortion.

    PubMed

    Dillon, E H; Case, C Q; Ramos, I M; Holland, C K; Taylor, K J

    1993-01-01

    Endovaginal ultrasound (US) imaging and color Doppler flow imaging techniques were used to evaluate the uterus and its contents and to establish characteristics of a normal post-abortion appearance in 19 women who underwent elective first-trimester abortions. Twenty-two examinations were performed between 2 and 17 days after the procedure. Thirteen of the 22 examinations (59%) showed different amounts of intrauterine material of varying echogenicity. Seven of the 22 examinations (32%) showed a thick endometrial stripe, and only two showed a normal stripe. Color Doppler flow imaging demonstrated typical peritrophoblastic flow in four of eight patients on the second and third days after the abortions were performed. After the third day, flow was observed in only two of 11 patients, and intrauterine material was also seen. These results indicate that intrauterine material and low-impedance flow are frequently observed after an abortion and do not necessarily indicate clinically important retained products of conception.

  18. Sonographic features of placenta accreta after first-trimester abortion.

    PubMed

    Li, Ping; Zheng, Qichao; Xiong, Bin; Cai, Hongbing

    2013-08-01

    We assessed 5 patients with histologically/clinically confirmed placenta accreta after first-trimester abortion. In 4 patients, sonography showed an unclear endometrium, absence of an endometrium-myometrium interface, a well-vascularized hyperechoic lesion in the uterine body with a low resistive index, and myometrial thinning near the lesion. In 2 patients, contrast-enhanced sonography showed rapid irregular lesion enhancement. Chemotherapy reduced the lesions in 3 patients, and a decreased blood supply increased the resistive index in all lesions. Two patients each underwent hysterectomy and uterine curettage. The fifth patient had a cervical pregnancy; sonography showed a well-vascularized hyperechoic lesion in an enlarged cervix. Methotrexate gradually reduced this lesion. Sonography, especially contrast-enhanced sonography, can detect placenta accreta and guide treatment.

  19. Effect of pregestational diabetes mellitus on first trimester placental characteristics: three-dimensional placental volume and power Doppler indices.

    PubMed

    Gonzalez Gonzalez, N L; Gonzalez Davila, E; Castro, A; Padron, E; Plasencia, W

    2014-03-01

    To investigate whether pregestational diabetes mellitus (DM) induces changes in vascular placental development detectable at first trimester. This was a prospective case-control study in 69 women with pregestational DM and 94 controls undergoing first-trimester combined screening for aneuploidies. Maternal characteristics, fetal nuchal translucency thickness, maternal serum pregnancy-associated plasma protein A (PAPP-A) and free β human chorionic gonadotrophin (β-hCG) were evaluated. Three-dimensional ultrasound was used to measure placental volume and three dimensional power Doppler (3D-PD) placental vascular indices including: vascularization index (VI), flow index (FI) and vascularization flow index (VFI). Pregnancy-associated hypertensive complications (PAHC) and perinatal outcomes were analyzed. The total group of diabetic women and the group of diabetic women without PAHC were compared separately with the control group. 3D-PD placental vascular indexes were significantly lower in women with DM than in controls (VI p = 0.007, FI p = 0.003 and VFI p = 0.04). These differences remained on excluding cases with PAHC in the DM group. No differences were found in placental volumes between the DM group and controls. Serum PAPP-A levels were also lower in diabetic women (p < 0.02) and negatively correlated with the degree of maternal metabolic control at first trimester. Pregestational DM induces demonstrable alterations in first trimester placental development, with significantly reduced placental vascularization indices and PAPP-A values. This effect is independent of the later development of PAHC. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Iodine nutritional status of women in their first trimester of pregnancy in Catalonia.

    PubMed

    Torres, Maria Teresa; Francés, Lidia; Vila, Lluis; Manresa, Josep María; Falguera, Gemma; Prieto, Gemma; Casamitjana, Roser; Toran, Pere

    2017-07-26

    Sufficient iodine intake is needed during pregnancy to ensure proper fetal development. The iodine levels of women in their first trimester of pregnancy in Catalonia are currently unknown. This data would help to determine whether our public health services should establish recommendations or interventions in this line. The aim of this study was to investigate the iodine nutritional status, prevalence of urinary iodine <150 μg/L, and tobacco use in the first trimester of pregnancy in our setting. Cross-sectional study. Data were collected during 2008-2009 from women in their first trimester at the primary care centers of the province of Barcelona (Spain). Pregnant women included in the study completed a questionnaire on eating habits and underwent urinary iodine concentration (UIC) assessment. Nine hundred forty five women completed the dietary questionnaire and urinary iodine testing. Median UIC was 172 μg/L, with 407 participants (43.1%) showing levels <150 μg/L. On multivariate logistic regression analysis, intake of 1-2 glasses of milk per day, OR = 0.636 95% CI (0.45-0.90) or >2 glasses, OR = 0.593 95% CI (0.37-0.95); iodized salt consumption, OR = 0.678 95% CI (0.51-0. 90); and use of iodine supplementation, OR = 0.410 95% CI (0.31-0.54), protected against the risk of UIC <150 μg/L. Simultaneous consumption of iodized salt and milk (≥1 glass/day) showed a larger protective effect: OR = 0.427, 95% CI (0.31-0.54). The median UIC of the pregnant women surveyed indicated an acceptable iodine nutritional status according to the criteria established by the WHO and ICCIDD. The risk of urinary iodine <150 μg/L decreased with simultaneous consumption of milk and iodized salt, similar to the decrease seen with iodine supplementation.

  1. Medians and correction factors for biochemical and ultrasound markers in Chinese women undergoing first-trimester screening for trisomy 21.

    PubMed

    Sahota, D S; Leung, T Y; Fung, T Y; Chan, L W; Law, L W; Lau, T K

    2009-04-01

    To establish normative values and distribution parameters of first-trimester maternal serum free beta-human chorionic gonadotropin (beta-hCG), pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency (NT) thickness in Chinese women and to examine the effects of covariates on their levels. Maternal serum free beta-hCG, PAPP-A and fetal NT were measured in 9762 women presenting for first-trimester combined screening for Down syndrome at 11 to 14 weeks of gestation. Individuals' markers were converted to multiples of the median (MoM) using expected medians estimated by performing a weighted regression analysis. Multivariate regression analysis was performed to assess the influence of maternal weight, parity, ethnicity, chorionicity in twin pregnancies, smoking, insulin-dependent diabetes and mode of conception on individual marker MoM levels. Both free beta-hCG and PAPP-A median values demonstrated an exponential relationship with gestational age in days. Multivariate regression analysis indicated that free beta-hCG MoM was statistically significantly dependent on maternal weight (P < 0.0001) and chorionicity in twin pregnancy (both monochorionic and dichorionic P < 0.0001), that PAPP-A MoM was dependent on maternal weight (P < 0.0001), parity (P < 0.0001), chorionicity in twin pregnancy (both monochorionic and dichorionic P < 0.0001) and mode of conception (P = 0.002), and that fetal NT-MoM was dependent on maternal weight (P = 0.0006) and mode of conception (P = 0.012). Normative values have been generated to allow conversion of NT, free beta-hCG and PAPP-A to their MoM equivalents and correction factors have been determined to adjust for maternal and pregnancy characteristics for use in ethnic Chinese women undergoing first-trimester screening for aneuploidy. (c) 2009 ISUOG. Published by John Wiley & Sons, Ltd.

  2. Screening for chromosomal abnormalities using combined test in the first trimester of pregnancy

    PubMed Central

    Park, Soo Yeon; Jang, In Ae; Lee, Min Ah; Kim, Young Ju; Chun, Sun Hee

    2016-01-01

    Objective This study was designed to review the screening performance of combined test at the Ewha Womans University Mokdong hospital. Methods All women admitted for routine antenatal care between January 1st 2008 and December 31st 2012 with a known pregnancy outcome were included in this study, totaling 1,156 women with singleton pregnancies presenting at 10 to 13 weeks of gestation. Women were offered screening using a combination of maternal serum pregnancy-associated plasma protein-A, free β-human chorionic gonadotropin and fetal nuchal translucency thickness. Those with an estimated risk of ≥1 in 250 of carrying a fetus with trisomy 21 or ≥1 in 300 risk of trisomy 18 were offered genetic counseling with the option of an invasive diagnostic test. Results The median of gestational age was 11+3 weeks, the median of crown-rump length was 47.1 mm, and the median age of the women was 31 years. The detection rate was 80% for trisomy 21 (4 of 5) and 100% for trisomy 13 and 18 (all 2). The false-positive rate was 7.73% for trisomy 21 and 1.21% for trisomy 18. Conclusion This study was the first large population study performed with the aim of analyzing the performance of the combined test in Korea. This study demonstrated that the detection rates and other figures of the first trimester combined test are comparable to the results reported in other papers worldwide. Consequently, if strict conditions for good screening outcomes are achieved, the first trimester combined test might well be the earliest detectable screening, improving detection rates without increasing karyotyping or economic and other implications that inevitably ensue. PMID:27668198

  3. Association of Elevated first Trimester Serum Uric Acid Levels with Development of GDM

    PubMed Central

    C, Rasika; Ghose, Seetesh

    2014-01-01

    Background: Early intervention and appropriate treatment in patients with GDM will help in preventing the adverse maternal and fetal outcome and protect them from long term complications. Several studies have shown the association of hyperuricemia with GDM. This study was undertaken to find out the association of elevated first trimester uric acid with development of GDM. Materials and Methods: This prospective observational study was conducted in Mahatma Gandhi Medical Collage and Research Institute, Pondicherry, India, between November 2010 and May 2012. A total of 70 pregnant women were included and parameters like age, parity, BMI, history of DM, serum uric acid at <15 weeks and at 24 to 28 weeks and one step test at 24 to 28 weeks were noted and compared. Results: There was no significant correlation between the demographic variables and GDM, but a moderate significance noted between the family history of DM and one step test (p=0.048). Though there is a proportional increase in the serum uric acid with increase in the BMI, it was not statistically significant. A significant correlation was seen between BMI and risk of development of GDM (p= 0.001). Though there is a significant correlation between serum uric acid at <15 weeks and at 24 to 28 weeks, serum uric acid at <15 weeks of gestation is a better predictor of GGI and GDM (Pearson’s correlation = 0.735). Conclusion: There is increase in the risk of development of GDM with increased levels of serum uric acid in the first trimester. Uric acid levels at <15 weeks of gestation is more significantly associated with risk of development of GDM than it’s levels at 24 to 28 weeks of gestation. PMID:25653992

  4. Association of Elevated first Trimester Serum Uric Acid Levels with Development of GDM.

    PubMed

    C, Rasika; Samal, Sunita; Ghose, Seetesh

    2014-12-01

    Early intervention and appropriate treatment in patients with GDM will help in preventing the adverse maternal and fetal outcome and protect them from long term complications. Several studies have shown the association of hyperuricemia with GDM. This study was undertaken to find out the association of elevated first trimester uric acid with development of GDM. This prospective observational study was conducted in Mahatma Gandhi Medical Collage and Research Institute, Pondicherry, India, between November 2010 and May 2012. A total of 70 pregnant women were included and parameters like age, parity, BMI, history of DM, serum uric acid at <15 weeks and at 24 to 28 weeks and one step test at 24 to 28 weeks were noted and compared. There was no significant correlation between the demographic variables and GDM, but a moderate significance noted between the family history of DM and one step test (p=0.048). Though there is a proportional increase in the serum uric acid with increase in the BMI, it was not statistically significant. A significant correlation was seen between BMI and risk of development of GDM (p= 0.001). Though there is a significant correlation between serum uric acid at <15 weeks and at 24 to 28 weeks, serum uric acid at <15 weeks of gestation is a better predictor of GGI and GDM (Pearson's correlation = 0.735). There is increase in the risk of development of GDM with increased levels of serum uric acid in the first trimester. Uric acid levels at <15 weeks of gestation is more significantly associated with risk of development of GDM than it's levels at 24 to 28 weeks of gestation.

  5. Accuracy of first-trimester combined test in screening for trisomies 21, 18 and 13.

    PubMed

    Santorum, M; Wright, D; Syngelaki, A; Karagioti, N; Nicolaides, K H

    2017-06-01

    To examine the diagnostic accuracy of a previously developed model for the first-trimester combined test in screening for trisomies 21, 18 and 13. This was a prospective validation study of screening for trisomies 21, 18 and 13 by assessment of a combination of maternal age, fetal nuchal translucency, fetal heart rate and serum free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11 + 0 to 13 + 6 weeks' gestation in 108 982 singleton pregnancies undergoing routine care in three maternity hospitals. A previously published algorithm was used to calculate patient-specific risks for trisomy 21, 18 and 13 in each patient. The detection rate (DR) and false-positive rate (FPR) at estimated risk cut-offs from 1 in 2 to 1 in 1000 were determined. The proportions of trisomies detected were compared to their expected values in different risk groups. In the study population, there were 108 112 (99.2%) cases with normal fetal karyotype or birth of a phenotypically normal neonate and 870 (0.8%) cases with abnormal karyotype, including trisomy 21 (n = 432), trisomy 18 (n = 166), trisomy 13 (n = 56), monosomy X (n = 63), triploidy (n = 35) or other aneuploidy (n = 118). The screen-positive rates, standardized according to the maternal age distribution in England and Wales in 2011, of fetuses with abnormal or normal karyotype were compatible with those predicted from the previous model; at a risk cut-off of 1 in 100, the FPR was about 4% and the DRs for trisomies 21, 18 and 13 were 90%, 97% and 92%, respectively. There was evidence that the algorithm overestimated risk. This could, to some degree, reflect under-ascertainment in pregnancies ending in miscarriage or stillbirth. In a prospective validation study, the first-trimester combined test detected 90%, 97% and 92% of trisomies 21, 18 and 13, respectively, as well as > 95% of cases of monosomy X and triploidies and > 50% of other

  6. 2014 First-trimester ultrasound forum from the Korean Society of Ultrasound in Obstetrics and Gynecology.

    PubMed

    Oh, Soo-Young; Hong, Joon Seok; Seol, Hyun-Joo; Hwang, Han Sung; Park, Hyun Soo; Kim, Kunwoo; Ko, Hyun Sun; Kwak, Dong-Wook; Kim, Moon Young; Park, Mi Hye; Oh, Min Jeong; Park, Joong Shin; Kim, Sa Jin

    2015-01-01

    A first-trimester ultrasound scan has become an essential part of antenatal care. The Korean Society of Ultrasound in Obstetrics and Gynecology held a first-trimester ultrasound forum on April 5, 2014. The forum aimed to present an updated review of the literature on the topic of first-trimester ultrasound in specific lectures and to host a panel discussion on several important issues regarding first-trimester scans. The forum provided evidence- and consensus-based best practice patterns for obstetricians in Korea. Here, we report the review and checklists presented from the forum.

  7. 2014 First-trimester ultrasound forum from the Korean Society of Ultrasound in Obstetrics and Gynecology

    PubMed Central

    Oh, Soo-Young; Hong, Joon Seok; Seol, Hyun-Joo; Hwang, Han Sung; Park, Hyun Soo; Kim, Kunwoo; Ko, Hyun Sun; Kwak, Dong-Wook; Kim, Moon Young; Park, Mi Hye; Oh, Min Jeong; Park, Joong Shin

    2015-01-01

    A first-trimester ultrasound scan has become an essential part of antenatal care. The Korean Society of Ultrasound in Obstetrics and Gynecology held a first-trimester ultrasound forum on April 5, 2014. The forum aimed to present an updated review of the literature on the topic of first-trimester ultrasound in specific lectures and to host a panel discussion on several important issues regarding first-trimester scans. The forum provided evidence- and consensus-based best practice patterns for obstetricians in Korea. Here, we report the review and checklists presented from the forum. PMID:25629012

  8. The introduction of first trimester medical abortion in Armenia.

    PubMed

    Louie, Karmen S; Chong, Erica; Tsereteli, Tamar; Avagyan, Gayane; Vardanyan, Susanna; Winikoff, Beverly

    2015-02-01

    In Armenia, abortion is the main means of fertility regulation; however, before research activities were initiated only surgical methods were available and the quality of services was low in some areas. Our clinical study from 2008-2011 aimed to show that early medical abortion is an acceptable and feasible option. A total of 700 eligible women with pregnancies up to 63 days LMP presenting for abortion were recruited for the study in five locations. Participants took 200 mg mifepristone and 800 μg buccal misoprostol 24-48 hours later. They returned for a follow-up visit two weeks after mifepristone administration. 95% of the women had successful abortions and 95% were satisfied with the method. In 2012-2013, we conducted a follow-up assessment to examine the ongoing provision and quality of medical abortion services at the former research sites. Medical record reviews, interviews and observations were carried out three times approximately six months apart. The assessment found that all five sites had continued providing medical abortion, with about half of eligible women choosing the medical method. Four of the five sites were achieving high success rates. Staff turnover and the lack of trained providers likely contributed to the higher failure rate at the fifth site. These findings provide evidence that first trimester medical abortion is an acceptable and feasible option for Armenian women and providers, and that high quality services are being delivered.

  9. Ultrasound Evaluation of First Trimester Complications of Pregnancy.

    PubMed

    Morin, Lucie; Cargill, Yvonne M; Glanc, Phyllis

    2016-10-01

    OUTCOMES:: EVIDENCE: A MEDLINE search and review of bibliographies identified articles was conducted. The evidence collected was reviewed by the Diagnostic Imaging Committee of the Society of Obstetricians and Gynaecologists of Canada. The recommendations were made according to the guidelines developed by The Canadian Task Force on Preventive Health Care (Table 1). Women presenting with first trimester bleeding may be incorrectly diagnosed with a missed abortion, may have an ectopic pregnancy overlooked, or may be inappropriately reassured about viability. Improvement in the identification of the sonographic landmarks of normal embryonic development and awareness of the sonographic risk factors of pregnancy failure may lead to more case-specific management strategies. Diagnosis of suspected ectopic pregnancy often involves an assessment of both hormonal markers and sonographic features. Maternal morbidity and mortality can be reduced with an early diagnosis of ectopic pregnancy. Copyright © 2016 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.

  10. Sequential triage in the first trimester may enhance advanced ultrasound scanning in population screening for trisomy 21.

    PubMed

    Gyselaers, W J A; Roets, E R A; Van Holsbeke, C D Y J; Vereecken, A J; Van Herck, E J H; Straetmans, D P L; Ombelet, W U A M; Nijhuis, J G

    2006-06-01

    To design a trisomy 21 screening protocol for sequential triage in the first trimester, and to evaluate whether it reduces the need for advanced ultrasound scanning to such an extent that this could be dealt with by a limited number of well-trained sonographers only. Screening results of 31 trisomy 21 affected pregnancies and 16 096 unaffected pregnancies from the first trimester screening program of Algemeen Medisch Laboratorium in Antwerp, Belgium, were used to define high-risk, intermediate-risk and low-risk groups. A serum screening result (age, pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotropin (beta-hCG)) of >or=1 : 30 and/or a nuchal translucency thickness (NT) measurement of >or= 3.5 mm were classified as high risk. A serum screening result of < 1 : 1000 together with an NT of < 3.5 mm were classified as low risk. Other results were considered intermediate risk, for which further advanced ultrasound screening would be indicated. This protocol was then evaluated prospectively in another population of 13 493 first-trimester pregnancies. Of the total population, 1.9% was identified as being high risk (14 trisomy 21 pregnancies and 222 unaffected pregnancies; prevalence, 1 : 17), 59.6% was identified as being low risk (three trisomy 21 pregnancies and 9615 unaffected pregnancies; prevalence, 1 : 3206) and 38.4% was identified as being intermediate risk (10 trisomy 21 pregnancies and 6190 unaffected pregnancies; prevalence, 1 : 620). A similar distribution was found in the prospective arm of the study. There was no reduction of overall screening performance compared with our current first-trimester combined screening program. The number of intermediate-risk pregnancies was sufficiently low as to enable advanced ultrasound scanning by well-trained sonographers only. In population screening for fetal trisomy 21, sequential triage in the first trimester can be achieved using very simple methods. Pregnancies at high or at low

  11. Laminaria in abortion. Use in 1368 patients in first trimester.

    PubMed

    Hern, W M

    1975-09-01

    Use of laminaria for dilatation in 1368 patients obtaining first trimester abortion in a private clinic, Boulder, Colorado is described. Median age of patients was 21 years, 39% had had previous pregnancies, and 18.1% had had previous abortions. For 68 (4.8%) this was the 2nd abortion within 1 year. 65% of gestations were 5-8 weeks, 10% under 5 weeks, 18.1% from 9 to 10 weeks, and 4.6% 11 weeks or more. 9.4% of laminaria procedures had secondary manual dilatation. This was related to experience. 20 cases occurred in the 1st 102 procedures while a substitute physician who performed 42 procedures had a rate of 28.5%. The remaining 1224 cases had a secondary dilatation rate of 8.3%. Techniques for adequate placement of the laminaria and procedures to follow in cases of uneven dilatation are described in detail. Most common complication was fever of 102 degrees F or less for less than 1 day (58 cases). In 4 cases severe cramps resulted, leading the patient to extract the laminaria at home. There was 1 serious complication, a pelvic abscess. Principal disadvantages include the necessity for 2 clinic visits, the risk of mild to severe overnight cramping, expense (laminaria used cost $2.75 each), and anxiety, generally unfounded, about whether the patient would return the next day. Advantages are reduced need for local anesthesia with decreased likelihood of anesthetic reaction, reduced risk of uterine perforation and cervical laceration due to decresed need for forceful dilatation, rapid procedure time, and reduced blood loss. Also it allows some careful preoperative evaluation of the patient's emotional state and her feelings about the abortion and pain. The complication rate in this series was 8.3%, most minor.

  12. Sex-specific effect of first-trimester maternal progesterone on birthweight.

    PubMed

    Hartwig, Isabel R V; Pincus, Maike K; Diemert, Anke; Hecher, Kurt; Arck, Petra C

    2013-01-01

    Are maternal progesterone levels in early pregnancy associated with fetal birthweight? Low levels of first-trimester maternal progesterone are significantly associated with a reduction in birthweight in girls, but not boys. Progesterone in the third trimester of pregnancy has previously been related to birthweight in humans. Pregnant women between gestational weeks 4 and 12 were recruited by 99 obstetricians in private practice and enrolled in a prospective cohort study. A follow-up took place at birth. Women younger than 18 years, who had undergone fertility treatments or were diagnosed with infectious diseases, were excluded from the study. A subgroup of 906 participants in whom progesterone had been measured was then selected retrospectively based on the following criteria: no miscarriages, elective abortions or pregnancy complications, infections or multiple births. Data from the follow-up were available for 623 women, who were included in the analyses. The study was coordinated at the Charité University Medicine in Berlin, Germany. Anthropometric, medical and psychosocial information were collected and serum progesterone and estradiol levels were measured in women during the first trimester of pregnancy, followed by the documentation of the pregnancy outcome at birth. Univariable and multivariable regression analyses were performed to identify maternal markers, among them progesterone, affecting birthweight and to determine environmental and maternal factors that are associated with maternal progesterone levels during pregnancy. In the multivariable regression model, each increase in maternal progesterone by 1 ng/ml during the first trimester increased girls' birthweight by 10.17 g (95% CI: 2.03-18.31 g). If the mother carried a boy, maternal smoking and perceived worries during early pregnancy predicted a reduced birthweight, irrespective of progesterone levels. Maternal body mass index over 25 and maternal age <21 years significantly correlated with the

  13. Impact of the maternal age-related risk in first-trimester combined screening for trisomy 21.

    PubMed

    Abele, H; Lüthgens, K; Hoopmann, M; Kagan, K O

    2011-01-01

    To examine the impact of the maternal age-related risk in first-trimester combined screening for trisomy 21. Prospective assessment of risk for trisomy 21 by a combination of maternal age, fetal NT thickness and maternal serum PAPP-A and free β-hCG at 11+0 to 13+6 weeks of gestation between April 2002 and February 2007. Screening for trisomy 21 by patient-specific risks based on the maternal and gestational age-related risk multiplied by a likelihood ratio for NT and for maternal serum biochemistry were compared with a screening policy that is only based on the combined likelihood ratio for fetal NT and maternal serum biochemistry. The study population consisted of 38,603 euploid pregnancies and 109 fetuses with trisomy 21. In screening for trisomy 21 by fetal NT and maternal serum biochemistry in combination with and without maternal age with a fixed false-positive rate of 3%, the detection rate was 82.6 and 79.8%, respectively. In the group of women with a maternal age of less than 30 years and between 30 and 35 years, there was no difference in the detection rate. For women with a maternal age of 35 years or older, the detection rate increased from 77.1% without maternal age to 94.3% with maternal age, respectively. The overall difference between first-trimester screening based on fetal NT and maternal serum biochemistry with and without maternal age is about 3%. In screening with a fixed cut-off, the maternal age-related risk keeps the false-positive rate low in younger women and increases the detection rate in older women. 2011 S. Karger AG, Basel.

  14. [Leflunomide: assessing teratogenic risk during the first trimester of pregnancy].

    PubMed

    Casanova Sorní, C; Romá Sánchez, E; Pelufo Pellicer, A; Poveda Andrés, J L

    2005-01-01

    To assess the teratogenic risk associated with leflunomide during the first quarter of pregnancy, and to establish guidelines to minimize said risk. Literature search using tertiary, secondary, and primary sources related to teratogenicity, including databases (MEDLINE and EMBASE) and specific webs. The information required for assessment, as well as for the establishment of criteria was collected. Leflunomide demonstrated an increased risk of fetal death and teratogenic effects in animals. No major or minor malformation cases have been reported in humans regarding leflunomide, which is classified within category X of fetal risk. A wash-out regimen may possibly reduce the risk for fetal harm. Conception scheduling or early pregnancy detection is required for better clinical counselling and the avoidance of unnecessary risk.

  15. The First Trimester Gravid Serum Regulates Procalcitonin Expression in Human Macrophages Skewing Their Phenotype In Vitro

    PubMed Central

    Radillo, Oriano

    2014-01-01

    Procalcitonin (PCT) is one of the best diagnostic and prognostic markers in clinical practice, widely used to evaluate the evolution of bacterial infections. Although it is mainly produced by thyroid, during sepsis almost all the peripheral tissues are involved in PCT production. Parenchymal cells have been suggested as the main source of PCT expression; however the contribution of macrophages is not clear yet. In response to environmental cues, tissue macrophages acquire distinct functional phenotypes, ranging from proinflammatory (M1) to anti-inflammatory (M2) phenotype. Macrophages at the fetal-maternal interface show immunosuppressive M2-like activities required for the maintenance of immunological homeostasis during pregnancy. This study aims to clarify the ability to synthesise PCT of fully differentiated (M0), polarized (M1/M2) macrophages and those cultured either in the presence of first trimester gravid serum (GS) or pregnancy hormones. We found out that M1 macrophages upregulate PCT expression following LPS stimulation compared to M0 and M2. The GS downregulates PCT expression in macrophages, skewing them towards an M2-like phenotype. This effect seems only partially mediated by the hormonal milieu. Our findings strengthen the key role of macrophages in counteracting inflammatory stimuli during pregnancy, suggesting PCT as a possible new marker of M1-like macrophages. PMID:24733960

  16. The first trimester gravid serum regulates procalcitonin expression in human macrophages skewing their phenotype in vitro.

    PubMed

    Rami, Damiano; La Bianca, Martina; Agostinis, Chiara; Zauli, Giorgio; Radillo, Oriano; Bulla, Roberta

    2014-01-01

    Procalcitonin (PCT) is one of the best diagnostic and prognostic markers in clinical practice, widely used to evaluate the evolution of bacterial infections. Although it is mainly produced by thyroid, during sepsis almost all the peripheral tissues are involved in PCT production. Parenchymal cells have been suggested as the main source of PCT expression; however the contribution of macrophages is not clear yet. In response to environmental cues, tissue macrophages acquire distinct functional phenotypes, ranging from proinflammatory (M1) to anti-inflammatory (M2) phenotype. Macrophages at the fetal-maternal interface show immunosuppressive M2-like activities required for the maintenance of immunological homeostasis during pregnancy. This study aims to clarify the ability to synthesise PCT of fully differentiated (M0), polarized (M1/M2) macrophages and those cultured either in the presence of first trimester gravid serum (GS) or pregnancy hormones. We found out that M1 macrophages upregulate PCT expression following LPS stimulation compared to M0 and M2. The GS downregulates PCT expression in macrophages, skewing them towards an M2-like phenotype. This effect seems only partially mediated by the hormonal milieu. Our findings strengthen the key role of macrophages in counteracting inflammatory stimuli during pregnancy, suggesting PCT as a possible new marker of M1-like macrophages.

  17. First trimester placental markers in oocyte donation pregnancies.

    PubMed

    Savasi, Valeria M; Mandia, Luca; Laoreti, Arianna; Ghisoni, Luciano; Duca, Piergiorgio; Cetin, Irene

    2015-08-01

    This study investigates the hypothesis that placenta works differently in oocyte donation (OD) compared to spontaneous pregnancies. To verify this hypothesis we examine the first trimester maternal serum levels of free β-hCG and pregnancy-associated plasma protein-A (PAPP-A). Then we evaluated for potential differences of Down syndrome screening between OD pregnancies, in vitro fertilization/intracytoplasmic sperm injection pregnancies with autologous oocytes (IVF/ICSI) and spontaneous pregnancies. We analyze 13624 spontaneously conceived pregnancies (Controls), 171 oocyte donation pregnancies (OD IVF/ICSI) and 76 IVF pregnancies with autologous oocytes (Autologous IVF/ICSI). Furthermore, we collect a cohort of 802 spontaneously conceived age-matched pregnancies, in order to evaluate how older uteri contribute to explain the changes in markers concentrations (Age-matched controls We compare the multiples of the median (MoM) of free β-hCG and PAPP-A and nuchal translucency. Free β-hCG levels are significantly higher both in OD IVF/ICSI pregnancies (1.44 ± 1.06 MoM) and Autologous IVF/ICSI (1.48 ± 1.02 MoM) compared to Controls (1.15 ± 0.84 MoM; p < 0.05) and Age-matched Controls (1.18 ± 0.98 MoM; p < 0.05). PAPP-A levels do not significantly differ among the four groups. Significantly lower nuchal translucency is detected in Controls (1.41 ± 0.36 mm) compared to OD IVF/ICSI (1.46 ± 0.44 mm; p < 0.05), in Autologous IVF/ICSI (1.51 ± 0.34 mm; p < 0.05) and Age-matched Controls (1.44 ± 0.42 mm; p < 0.05). Oocyte donation pregnancies (OD IVF/ICSI) are significantly related to altered maternal serum placenta marker levels. These alterations might be due to the IVF technique. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Detrimental effects of ethanol and its metabolite acetaldehyde, on first trimester human placental cell turnover and function.

    PubMed

    Lui, Sylvia; Jones, Rebecca L; Robinson, Nathalie J; Greenwood, Susan L; Aplin, John D; Tower, Clare L

    2014-01-01

    Fetal alcohol spectrum disorder (FASD) describes developmental issues from high maternal alcohol intake, which commonly results in fetal growth restriction and long term morbidity. We aimed to investigate the effect of alcohol and acetaldehyde, on the first trimester placenta, the period essential for normal fetal organogenesis. Normal invasion and establishment of the placenta during this time are essential for sustaining fetal viability to term. We hypothesise that alcohol (ethanol) and acetaldehyde have detrimental effects on cytotrophoblast invasion, turnover and placental function. Taurine is an important amino acid for neuronal and physiological development, and so, its uptake was assayed in cells and placental explants exposed to alcohol or acetaldehyde. First trimester villous explants and BeWo cells were treated with 0, 10, 20, 40 mM ethanol or 0, 10, 20, 40 µM acetaldehyde. The invasive capacity of SGHPL4, a first trimester extravillous cytotrophoblast cell line, was unaffected by ethanol or acetaldehyde (p>0.05; N = 6). The cells in-cycle were estimated using immunostaining for Ki67. Proliferating trophoblast cells treated with ethanol were decreased in both experiments (explants: 40% at 20 mM and 40 mM, p<0.05, N = 8-9) (cell line: 5% at 20 mM and 40 mM, p<0.05, N = 6). Acetaldehyde also reduced Ki67-positive cells in both experiments (explants at 40 µM p<0.05; N = 6) (cell line at 10 µM and 40 µM; p<0.05; N = 7). Only in the cell line at 20 µM acetaldehyde demonstrated increased apoptosis (p<0.05; N = 6). Alcohol inhibited taurine transport in BeWo cells at 10 mM and 40 mM (p<0.05; N = 6), and in placenta at 40 mM (p<0.05; N = 7). Acetaldehyde did not affect taurine transport in either model (P<0.05; N = 6). Interestingly, system A amino acid transport in placental explants was increased at 10 µM and 40 µM acetaldehyde exposure (p<0.05; N = 6). Our results demonstrate that exposure to both genotoxins may contribute to the pathogenesis of FASD by

  19. First-trimester combined screening for trisomy 21 at 7-14 weeks' gestation.

    PubMed

    Wright, D; Spencer, K; Kagan K, K; Tørring, N; Petersen, O B; Christou, A; Kallikas, J; Nicolaides, K H

    2010-10-01

    To establish an algorithm for first-trimester combined screening for trisomy 21 with biochemical testing from 7 to 14 weeks' gestation and ultrasound testing at 11-13 weeks. This was a multicenter study of 886 pregnancies with trisomy 21 and 222 475 unaffected pregnancies with measurements of free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 7-14 weeks' gestation. Multiple regression modeling of log-transformed marker values was used to produce log multiples of the median (MoM) values for PAPP-A and free β-hCG. The models included terms for the center attended and the machine used for biochemical analysis, gestational age, maternal racial origin, maternal weight, smoking status and method of conception. Bivariate Gaussian distributions were fitted to log MoM PAPP-A and log MoM free β-hCG in trisomy 21 and in unaffected pregnancies. In each case the patient-specific risk for trisomy 21 was estimated by multiplying the individual maternal age-related risk with the likelihood ratio (LR) for fetal nuchal translucency (NT) according to the mixture model and the combined LR for maternal serum free β-hCG and PAPP-A. Estimates of detection rates for trisomy 21 and false-positive rates were calculated for combined screening with measurements of NT at 12 weeks together with measurements of free β-hCG and PAPP-A from 8 to 13 weeks. In trisomy 21 pregnancies the mean log MoM free β-hCG increased linearly with gestation between 7 and 14 weeks, whereas the relation between log MoM PAPP-A and gestation was fitted by a quadratic equation such that the maximum separation between trisomy 21 and unaffected pregnancies occurs at 9-10 weeks. At a false-positive rate of 3% the detection rate of combined screening at 12 weeks was 86% and this increased to 90% by biochemical testing at 9 weeks and ultrasound scanning at 12 weeks. The detection rate increased to 92% by measuring PAPP-A at 9 weeks and free β-hCG at the time of the scan

  20. Fetal gender and pregnancy outcomes in Libya: a retrospective study.

    PubMed

    Khalil, Mounir M; Alzahra, Esgair

    2013-01-01

    The relationship between pregnancy outcomes and fetal gender is well reported from different areas in the world, but not from Africa. In this study, we try to understand whether the recorded phenomenon of association of adverse pregnancy outcomes with a male fetus applies to our population. A total of 29,140 patient records from 2009 and 2010 were retrieved from Aljalaa Maternity Hospital, Tripoli, Libya. Analysis was carried out to find the correlation between fetal gender and different pregnancy outcomes. A male fetus was associated with an increased incidence of gestational diabetes mellitus (odds risk 1.4), preterm delivery (6.7% for males, 5.5% for females, odds risk 1.24), cesarean section (23.9% for males, 20% for females, odds risk 1.25), and instrumental vaginal delivery (4.4% for males, 3.1% for females, odds risk 1.48), p<0.005. Preeclampsia was more frequent among preterm females and postterm males, p<0.005. It was also more frequent in male-bearing primigravids, p<0.01. We confirm the existence of an adverse effect of a male fetus on pregnancy and labor in our population. We recommend further research to understand the mechanisms and clinical implications of this phenomenon.

  1. Fetal gender and pregnancy outcomes in Libya: a retrospective study

    PubMed Central

    Khalil, Mounir M.; Alzahra, Esgair

    2013-01-01

    Objective The relationship between pregnancy outcomes and fetal gender is well reported from different areas in the world, but not from Africa. In this study, we try to understand whether the recorded phenomenon of association of adverse pregnancy outcomes with a male fetus applies to our population. Materials and methods A total of 29,140 patient records from 2009 and 2010 were retrieved from Aljalaa Maternity Hospital, Tripoli, Libya. Analysis was carried out to find the correlation between fetal gender and different pregnancy outcomes. Results A male fetus was associated with an increased incidence of gestational diabetes mellitus (odds risk 1.4), preterm delivery (6.7% for males, 5.5% for females, odds risk 1.24), cesarean section (23.9% for males, 20% for females, odds risk 1.25), and instrumental vaginal delivery (4.4% for males, 3.1% for females, odds risk 1.48), p<0.005. Preeclampsia was more frequent among preterm females and postterm males, p<0.005. It was also more frequent in male-bearing primigravids, p<0.01. Conclusion We confirm the existence of an adverse effect of a male fetus on pregnancy and labor in our population. We recommend further research to understand the mechanisms and clinical implications of this phenomenon. PMID:23308081

  2. First-trimester screening for trisomy 21 combining biochemistry and ultrasound at individually optimal gestational ages. An interventional study.

    PubMed

    Borrell, Antoni; Casals, Elena; Fortuny, Albert; Farre, M Teresa; Gonce, Anna; Sanchez, Aurora; Soler, Anna; Cararach, Vicençc; Vanrell, Joan A

    2004-07-01

    To assess the effectiveness of the Combined Test in the prenatal detection of trisomy 21 in the general pregnant population using a new timing for the screening approach. First-trimester maternal serum biochemical markers (pregnancy-associated plasma protein-A and free-beta hCG) were determined in maternal serum at 7 to 12 weeks. Fetal nuchal translucency and gestational age were assessed at the 10- to 14-week ultrasound scan. A combined risk was estimated and delivered to the women the same day. When the risk was 1:250 or above, chorionic villus sampling was offered. Mean gestational age at biochemistry was 9.4 weeks, being 12.3 at ultrasound. In the 2780 studied pregnancies with a complete follow-up, observed detection rates were 88% (7/8) for trisomy 21 and 75% (3/4) for trisomy 18, with a 3.3% (92/2765) false-positive rate. The Combined Test, assessing biochemistry and ultrasound at individually optimal ages in the first trimester, showed an 88% detection rate for trisomy 21 with a remarkably reduced false-positive rate (3.3%). Copyright 2004 John Wiley and Sons, Ltd.

  3. First-trimester uterine artery Doppler velocimetry in the prediction of birth weight in a low-risk population.

    PubMed

    Sarmiento, Andres; Casasbuenas, Alexandra; Rodriguez, Nadiezhda; Angarita, Ana M; Sarmiento, Piedad; Sepulveda, Waldo

    2013-01-01

    To study the relationship between first-trimester uterine artery (UtA) Doppler velocimetry and birth weight in an unselected, low-risk obstetric population. This is a prospective study of 415 low-risk pregnant women who underwent a first-trimester ultrasound evaluation between 11 and 13 weeks of gestation. Blood flow velocimetry waveforms from both UtAs were obtained and the pulsatility index (PI) measured and recorded. Clinical records were reviewed for pregnancy outcomes. Birth weight was expressed as z-scores, and the Spearman correlation coefficient (ρ) was used to calculate the relationship between the mean, delta, and lowest UtA PI values and birth weight. There was no correlation between the mean and delta UtA PI values and birth weight. However, a significant correlation between the lowest UtA PI value and birth weight (ρ = -0.121; p = 0.013) was noted. Our study found a clinically significant correlation between the lowest UtA PI value and birth weight in an unselected, low-risk pregnant population. Because fetal growth is a multifactorial process in which placentation is only one of the factors involved, the use of a single parameter such as Doppler velocimetry remote from the delivery to predict birth weight in a low-risk population seems to be less useful than in the high-risk population. © 2012 John Wiley & Sons, Ltd.

  4. Dysmorphogenic effects of first trimester equivalent ethanol exposure in mice: a magnetic resonance microscopy-based study

    PubMed Central

    Parnell, Scott E.; Holloway, Hunter E.; Baker, Lorinda K.; Styner, Martin A.; Sulik, Kathleen K.

    2014-01-01

    Background The first trimester of human development and the equivalent developmental period in animal models is a time when teratogenic ethanol exposure induces the major structural birth defects that fall within Fetal Alcohol Spectrum Disorder (FASD). Previous FASD research employing an acute high dose maternal intraperitoneal ethanol treatment paradigm has identified sensitive periods for a number of these defects. Extending this work, this investigation utilized high resolution magnetic resonance imaging (MRM)-based analyses to examine the dysmorphology resulting from maternal dietary ethanol intake occurring during selected first trimester-equivalent time periods. Methods Female C57Bl/6J mice were acclimated to a liquid 4.8% ethanol (v/v)-containing diet, then bred while on standard chow. Dams were again provided the ethanol-containing liquid diet for a period that extended either from the beginning of gestational day (GD) 7 to the end of GD 11 or from the beginning of GD 12 to the end of GD 16. On GD 17, a subset of fetuses was selected for MRM-based analyses. Group comparisons were made for litter characteristics and gross dysmorphology, as well as whole and regional brain volumes. Results Ethanol-induced stage of exposure-dependent structural brain abnormalities were observed. The GD 7–11 ethanol-exposed group presented with a significant decrease in cerebellar volume and an increase in septal volume, while GD 12–16 ethanol treatment resulted in a reduction in right hippocampal volume accompanied by enlarged pituitaries. Additionally, the GD 12–16 ethanol exposure caused a high incidence of edema/fetal hydrops. Conclusions These results illustrate the teratogenic impact of maternal dietary ethanol intake occurring at time periods approximately equivalent to weeks 3 through 6 (GD 7–11 in mice) and weeks 7 through 12 (GD 12–16 in mice) of human gestation, further documenting ethanol’s stage of exposure-dependent neuroteratogenic endpoints and

  5. Short-term clearance of cell-free nucleic acids after first-trimester termination of pregnancy.

    PubMed

    Jeong, Young-Ju; Borgatta, Lynn; Kapp, Nathalie; Peter, Inga; Bianchi, Diana W; Johnson, Kirby L

    2007-09-01

    To determine the kinetics of the short-term clearance of cell-free nucleic acids in maternal plasma, we conducted a prospective cohort study of 36 women who underwent first-trimester elective surgical termination. By using real-time polymerase chain reaction (PCR) amplification and measurement of the sex-determining region of the Y chromosome (SRY) gene (as a marker of fetal DNA), beta-hCG (a placental messenger RNA transcript), and glyceraldehyde phosphate dehydrogenase (GAPDH; as a marker of both total DNA and mitochondrial RNA), we found that cell-free nucleic acids in maternal plasma are not cleared within 90 minutes after the procedure, in contrast to the case of term delivery, in which levels decrease rapidly after birth.

  6. Computed tomography assessment of peripubertal craniofacial morphology in a sheep model of binge alcohol drinking in the first trimester.

    PubMed

    Birch, Sharla M; Lenox, Mark W; Kornegay, Joe N; Shen, Li; Ai, Huisi; Ren, Xiaowei; Goodlett, Charles R; Cudd, Tim A; Washburn, Shannon E

    2015-11-01

    Identification of facial dysmorphology is essential for the diagnosis of fetal alcohol syndrome (FAS); however, most children with fetal alcohol spectrum disorders (FASD) do not meet the dysmorphology criterion. Additional objective indicators are needed to help identify the broader spectrum of children affected by prenatal alcohol exposure. Computed tomography (CT) was used in a sheep model of prenatal binge alcohol exposure to test the hypothesis that quantitative measures of craniofacial bone volumes and linear distances could identify alcohol-exposed lambs. Pregnant sheep were randomly assigned to four groups: heavy binge alcohol, 2.5 g/kg/day (HBA); binge alcohol, 1.75 g/kg/day (BA); saline control (SC); and normal control (NC). Intravenous alcohol (BA; HBA) or saline (SC) infusions were given three consecutive days per week from gestation day 4-41, and a CT scan was performed on postnatal day 182. The volumes of eight skull bones, cranial circumference, and 19 linear measures of the face and skull were compared among treatment groups. Lambs from both alcohol groups showed significant reduction in seven of the eight skull bones and total skull bone volume, as well as cranial circumference. Alcohol exposure also decreased four of the 19 craniofacial measures. Discriminant analysis showed that alcohol-exposed and control lambs could be classified with high accuracy based on total skull bone volume, frontal, parietal, or mandibular bone volumes, cranial circumference, or interorbital distance. Total skull volume was significantly more sensitive than cranial circumference in identifying the alcohol-exposed lambs when alcohol-exposed lambs were classified using the typical FAS diagnostic cutoff of ≤10th percentile. This first demonstration of the usefulness of CT-derived craniofacial measures in a sheep model of FASD following binge-like alcohol exposure during the first trimester suggests that volumetric measurement of cranial bones may be a novel biomarker

  7. Computed tomography assessment of peripubertal craniofacial morphology in a sheep model of binge alcohol drinking in the first trimester

    PubMed Central

    Birch, Sharla M.; Lenox, Mark W.; Kornegay, Joe N.; Shen, Li; Ai, Huisi; Ren, Xiaowei; Goodlett, Charles R.; Cudd, Tim A.; Washburn, Shannon E.

    2015-01-01

    Identification of facial dysmorphology is essential for the diagnosis of fetal alcohol syndrome (FAS); however, most children with fetal alcohol spectrum disorders (FASD) do not meet the dysmorphology criterion. Additional objective indicators are needed to help identify the broader spectrum of children affected by prenatal alcohol exposure. Computed tomography (CT) was used in a sheep model of prenatal binge alcohol exposure to test the hypothesis that quantitative measures of craniofacial bone volumes and linear distances could identify alcohol-exposed lambs. Pregnant sheep were randomly assigned to four groups: heavy binge alcohol, 2.5 g/kg/day (HBA); binge alcohol, 1.75 g/kg/day (BA); saline control (SC); and normal control (NC). Intravenous alcohol (BA; HBA) or saline (SC) infusions were given three consecutive days per week from gestation day 4–41, and a CT scan was performed on postnatal day 182. The volumes of eight skull bones, cranial circumference, and 19 linear measures of the face and skull were compared among treatment groups. Lambs from both alcohol groups showed significant reduction in seven of the eight skull bones and total skull bone volume, as well as cranial circumference. Alcohol exposure also decreased four of the 19 craniofacial measures. Discriminant analysis showed that alcohol-exposed and control lambs could be classified with high accuracy based on total skull bone volume, frontal, parietal, or mandibular bone volumes, cranial circumference, or interorbital distance. Total skull volume was significantly more sensitive than cranial circumference in identifying the alcohol-exposed lambs when alcohol-exposed lambs were classified using the typical FAS diagnostic cutoff of ≤10th percentile. This first demonstration of the usefulness of CT-derived craniofacial measures in a sheep model of FASD following binge-like alcohol exposure during the first trimester suggests that volumetric measurement of cranial bones may be a novel biomarker

  8. Overweight increases risk of first trimester hypothyroxinaemia in iodine-deficient pregnant women.

    PubMed

    Gowachirapant, Sueppong; Melse-Boonstra, Alida; Winichagoon, Pattanee; Zimmermann, Michael B

    2014-01-01

    Hypothyroxinaemia early in pregnancy may impair fetal brain development. Increased body weight has been associated with low thyroxine concentrations in non-pregnant women. In pregnant women, morbid maternal obesity is a risk factor for thyroid dysfunction. But whether lesser degrees of overweight that are much more common could be a risk factor for hypothyroxinaemia in pregnancy is unclear. The objective of this study was to investigate if overweight increases risk for thyroid dysfunction, and specifically hypothyroxinaemia, in iodine-deficient pregnant women. We performed a cross-sectional study at first hospital visit among healthy Thai pregnant women. We measured weight and height, urinary iodine concentration (UIC), serum thyroid hormones and thyroglobulin. Pre-pregnancy weight and relevant dietary factors were determined by questionnaire, and body mass index (BMI) was used to classify weight status. Among 514 women (mean gestational age, 11 weeks) with a median UIC of 111 μg dL(-1) , indicating mild iodine deficiency, 12% had low free thyroxine (fT4) concentrations: 3% had overt hypothyroidism; 7% had subclinical hypothyroidism; and 8% had isolated hypothyroxinaemia. Based on pre-pregnancy BMI, 26% of women were overweight or obese. In a multiple regression model, BMI was a negative predictor of fT4 (β = -0.20, P < 0.001). Compared to normal weight women, the prevalence ratio (95% CI) of a low fT4 in overweight women was 3.64 (2.08-6.37) (P < 0.01). Iodine-deficient pregnant Thai women who are overweight have a 3.6-fold higher risk of hypothyroxinaemia in the first trimester compared to normal weight women. Targeted screening should consider overweight a potential risk factor for thyroid dysfunction in pregnant women in iodine-deficient areas. © 2013 John Wiley & Sons Ltd.

  9. Quality of first-trimester measurement of crown-rump length.

    PubMed

    Dhombres, Ferdinand; Khoshnood, Babak; Bessis, Roger; Fries, Nicolas; Senat, Marie-Victoire; Jouannic, Jean-Marie

    2014-12-01

    The purpose of this study was to evaluate the quality of crown-rump length (CRL) measurements in scans judged to be of high quality for the measurement of the nuchal translucency. We analyzed prospective data on 68,250 scans by 1913 sonographers that were collected by the French College of Fetal Echography (CFEF) national practice assessment program for the first-trimester scan. The scans were evaluated according to the CFEF image scoring method (CFEF-ISM), which includes items to measure the quality of the scan for both nuchal translucency and the CRL measurements. The scans were classified into 4 quality groups with the use of the full CFEF-ISM score and then a shortened version of the CFEF-ISM that excluded the item on quality of CRL measurement. The proportion of scans with an inaccurate CRL measurement was compared across the different quality groups. Overall, 21.67% of scans were of insufficient quality for CRL measurement. Among 23,764 "excellent" scans according to the full CFEF-ISM, 965 scans (4.06%) had insufficient CRL quality vs 9.24% of scans with "excellent" quality on the short CFEF-ISM (relative risk, 2.27; 95% confidence interval, 2.11-2.44; P < .001). High scores of the quality of nuchal translucency measurement do not guarantee accurate measurement of crown-rump length. Specific measures are needed to evaluate and to improve the quality of the measurement of crown-lump length. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Sequential pathways of testing after first-trimester screening for trisomy 21.

    PubMed

    Platt, Lawrence D; Greene, Naomi; Johnson, Anthony; Zachary, Julia; Thom, Elizabeth; Krantz, David; Simpson, Joe Leigh; Silver, Richard K; Snijders, Rosalinde J M; Goetzl, Laura; Pergament, Eugene; Filkins, Karen; Mahoney, Maurice J; Hogge, W Allen; Wilson, R Douglas; Mohide, Patrick; Hershey, Douglas; MacGregor, Scott; Bahado-Singh, Ray; Jackson, Laird G; Wapner, Ronald

    2004-10-01

    To evaluate the performance and use of second-trimester multiple-marker maternal serum screening for trisomy 21 by women who had previously undergone first-trimester combined screening (nuchal translucency, pregnancy-associated plasma protein A, and free beta-hCG), with disclosure of risk estimates. In a multicenter, first-trimester screening study sponsored by the National Institute of Child Health and Human Development, multiple-marker maternal serum screening with alpha-fetoprotein, unconjugated estriol, and total hCG was performed in 4,145 (7 with trisomy 21) of 7,392 (9 with trisomy 21) women who were first-trimester screen-negative and 180 (7 with trisomy 21) of 813 (52 with trisomy 21) who were first-trimester screen-positive. Second-trimester risks were calculated using multiples of the median and a standardized risk algorithm with a cutoff risk of 1:270. Among the first-trimester screen-negative cohort, 6 of 7 (86%) trisomy 21 cases were detected by second-trimester multiple-marker maternal serum screening with a false-positive rate of 8.9%. Among the first-trimester screen-positive cohort, all 7 trisomy 21 cases were also detected in the second trimester, albeit with a 38.7% false-positive rate. Our data demonstrate that a sequential screening program that provides patients with first-trimester results and offers the option for early invasive testing or additional serum screening in the second trimester can detect 98% of trisomy 21-affected pregnancies. However, such an approach will result in 17% of patients being considered at risk and, hence, potentially having an invasive test. II-2

  11. Assessment of thyroid function during first-trimester pregnancy: what is the rational upper limit of serum TSH during the first trimester in Chinese pregnant women?

    PubMed

    Li, Chenyan; Shan, Zhongyan; Mao, Jinyuan; Wang, Weiwei; Xie, Xiaochen; Zhou, Weiwei; Li, Chenyang; Xu, Bin; Bi, Lihua; Meng, Tao; Du, Jianling; Zhang, Shaowei; Gao, Zhengnan; Zhang, Xiaomei; Yang, Liu; Fan, Chenling; Teng, Weiping

    2014-01-01

    Guidelines of the American Thyroid Association (ATA) proposed that the upper limit of the TSH reference range should be 2.5 mIU/L in first trimester, but the reported ranges in China are significantly higher. Our objective was to establish a rational reference range of serum TSH for diagnosis of subclinical hypothyroidism in the first trimester of pregnant women in China. We screened 4800 pregnant women in the first trimester and 2000 women who planned to become pregnant and evaluated 535 pregnant women in follow-up visits during the second and third trimester. Median concentrations of serum TSH decreased significantly from the seventh week of gestation. The median of TSH from 4 to 6 weeks was significantly higher than from 7 to 12 weeks (2.15 [0.56-5.31] mIU/L vs 1.47 [0.10-4.34] mIU/L, P<.001); however, there was no significant difference compared with nonpregnant women (2.07 [0.69-5.64] mIU/L; P=.784). The median of free T4 was not significantly altered in the first trimester. The prevalence of subclinical hypothyroidism in the 4800 pregnant women was 27.8% on the diagnostic criteria of TSH>2.5 mIU/L and 4.0% using the reference interval derived by our laboratory (0.14-4.87 mIU/L).Additionally, of 118 pregnant women who had serum TSH>2.5 mIU/L in the first trimester, only 30.0% and 20.3% of them at the 20th and 30th week of gestation had TSH>3.0 mIU/L. The reference range for nonpregnant women can be used for the assessment of pregnant women at 4 to 6 weeks of gestation. The upper limit of serum TSH in the first trimester was much higher than 2.5 mIU/L in Chinese pregnant women.

  12. Platelet Count in First Trimester of Pregnancy as a Predictor of Perinatal Outcome

    PubMed Central

    Larroca, Santiago Garcia-Tizon; Arevalo-Serrano, Juan; Abad, Virginia Ortega; Recarte, Pilar Pintado; Carreras, Alejandro Garcia; Pastor, Gonzalo Nozaleda; Hernandez, Cesar Rodriguez; Pacheco, Ricardo Perez Fernandez; Luis, Juan De Leon

    2017-01-01

    AIM: To rule out maternal and pregnancy factors that may contribute to platelet count (PLT) changes in the first trimester of gestation and examine if there is any association between its levels and adverse perinatal outcome. METHODS: The study population included all patients from the first-trimester visit between 2013-2015 with pregnancy results. Linear multiple regression was constructed to rule out variables that may have a significant contribution to PLT. For each adverse outcome at birth, multiple logistic regression analysis was implemented to estimate the PLT effect. RESULTS: PLT was measured in 6092 patients. There was the significant contribution on PLT in the first trimester from maternal weight, the presence of rheumatologic disease, BHCG levels and MPV. There was a significant association between PLT and abnormal cardiotocography at delivery (OR 1.004; IC95% 1.001 to 1.007) and C-Section due to abnormal CTG (OR 1.005; IC95% 1.002 to 1.008). When adjusted for factors that interact with PLT there was also a significant association with pH at birth < 7.10 and gestational diabetes. CONCLUSIONS: Maternal and pregnancy factors can poorly predict relevant changes in PLT at the first trimester of gestation. PLT at first trimester of pregnancy might predict adverse perinatal outcome in combination with other markers. PMID:28293312

  13. Neuroimaging parameters in early open spina bifida detection. Further benefit in first trimester screening?

    PubMed

    Iliescu, D; Comănescu, A; Antsaklis, P; Tudorache, Stefania; Ghiluşi, Mirela; Comănescu, Violeta; Paulescu, Daniela; Ceauşu, Iuliana; Antsaklis, A; Novac, Liliana; Cernea, N

    2011-01-01

    Morphological investigation of the central nervous system (CNS) in fetuses with positive markers for open spina bifida (OSB) detection, visualized by ultrasound during the first trimester of pregnancy. Data from fetuses that underwent routine first trimester ultrasound scan in our center during September 2007-March 2011 and presented abnormal aspects of the fourth ventricle, also referred as intracranial translucency (IT), provided the morphological support to evaluate CNS features. A neuro-histological study of posterior cerebral fossa illustrated anatomical features of the structures involved in the sonographic first trimester detection of neural tube defects. Abnormal IT aspects were found in OSB cases examined in the first trimester, but also in other severe cerebral abnormalities. Brain stem antero-posterior diameter (BS) and brain stem to occipital bone (BSOB) ratio may be more specific for OSB detection. Correlations between histological aspects of posterior brain fossa and ultrasound standard assessment have been made; highlighting the anatomical features involved by the new techniques developed for OSB early detection. Preliminary results show that modern sonographic protocols are capable to detect abnormalities in the morphometry of the posterior brain. First trimester fourth ventricle abnormalities should be followed by careful CNS evaluation because are likely to appear in OSB affected fetuses, but also in other CNS severe anomalies; in such cases, normal BS and BSOB ratio may serve as indirect argument for spine integrity, if specificity is confirmed in large series of fetuses.

  14. First Trimester Influenza Vaccination and Risks for Major Structural Birth Defects in Offspring.

    PubMed

    Kharbanda, Elyse Olshen; Vazquez-Benitez, Gabriela; Romitti, Paul A; Naleway, Allison L; Cheetham, T Craig; Lipkind, Heather S; Klein, Nicola P; Lee, Grace; Jackson, Michael L; Hambidge, Simon J; McCarthy, Natalie; DeStefano, Frank; Nordin, James D

    2017-08-01

    To examine risks for major structural birth defects in infants after first trimester inactivated influenza vaccine (IIV) exposures. In this observational study, we used electronic health data from 7 Vaccine Safety Datalink sites to examine risks for selected major structural defects in infants after maternal IIV exposure. Vaccine exposures for women with continuous insurance enrollment through pregnancy who delivered singleton live births between 2004 and 2013 were identified from standardized files. Infants with continuous insurance enrollment were followed to 1 year of age. We excluded mother-infant pairs with other exposures that potentially increased their background risk for birth defects. Selected cardiac, orofacial or respiratory, neurologic, ophthalmologic or otologic, gastrointestinal, genitourinary and muscular or limb defects were identified from diagnostic codes in infant medical records using validated algorithms. Propensity score adjusted generalized estimating equations were used to estimate prevalence ratios (PRs). We identified 52 856 infants with maternal first trimester IIV exposure and 373 088 infants whose mothers were unexposed to IIV during first trimester. Prevalence (per 100 live births) for selected major structural birth defects was 1.6 among first trimester IIV exposed versus 1.5 among unexposed mothers. The adjusted PR was 1.02 (95% CI 0.94-1.10). Organ system-specific PRs were similar to the overall PR. First trimester maternal IIV exposure was not associated with an increased risk for selected major structural birth defects in this large cohort of singleton live births. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. First trimester screening for trisomy 21 in gestational week 8-10 by ADAM12-S as a maternal serum marker.

    PubMed

    Tørring, Niels; Ball, Susan; Wright, Dave; Sarkissian, Gaïané; Guitton, Marie; Darbouret, Bruno

    2010-10-29

    A disintegrin and metalloprotease 12 (ADAM12-S) has previously been reported to be significantly reduced in maternal serum from women with fetal aneuploidy early in the first trimester and to significantly improve the quality of risk assessment for fetal trisomy 21 in prenatal screening. The aim of this study was to determine whether ADAM12-S is a useful serum marker for fetal trisomy 21 using the mixture model. In this case control study ADAM12-S was measured by KRYPTOR ADAM12-S immunoassay in maternal serum from gestational weeks 8 to 11 in 46 samples of fetal trisomy 21 and in 645 controls. Comparison of sensitivity and specificity of first trimester screening for fetal trisomy 21 with or without ADAM12-S included in the risk assessment using the mixture model. The concentration of ADAM12-S increased from week 8 to 11 and was negatively correlated with maternal weight. Log MoM ADAM12-S was positively correlated with log MoM PAPP-A (r = 0.39, P < 0.001), and with log MoM free beta hCG (r = 0.21, P < 0.001). The median ADAM12-S MoM in cases of fetal trisomy 21 in gestational week 8 was 0.66 increasing to approx. 0.9 MoM in week 9 and 10. The use of ADAM12-S along with biochemical markers from the combined test (PAPP-A, free beta hCG) with or without nuchal translucency measurement did not affect the detection rate or false positive rate of fetal aneuploidy as compared to routine screening using PAPP-A and free β-hCG with or without nuchal translucency. The data show moderately decreased levels of ADAM12-S in cases of fetal aneuploidy in gestational weeks 8-11. However, including ADAM12-S in the routine risk does not improve the performance of first trimester screening for fetal trisomy 21.

  16. First trimester screening for trisomy 21 in gestational week 8-10 by ADAM12-S as a maternal serum marker

    PubMed Central

    2010-01-01

    Background A disintegrin and metalloprotease 12 (ADAM12-S) has previously been reported to be significantly reduced in maternal serum from women with fetal aneuploidy early in the first trimester and to significantly improve the quality of risk assessment for fetal trisomy 21 in prenatal screening. The aim of this study was to determine whether ADAM12-S is a useful serum marker for fetal trisomy 21 using the mixture model. Method In this case control study ADAM12-S was measured by KRYPTOR ADAM12-S immunoassay in maternal serum from gestational weeks 8 to 11 in 46 samples of fetal trisomy 21 and in 645 controls. Comparison of sensitivity and specificity of first trimester screening for fetal trisomy 21 with or without ADAM12-S included in the risk assessment using the mixture model. Results The concentration of ADAM12-S increased from week 8 to 11 and was negatively correlated with maternal weight. Log MoM ADAM12-S was positively correlated with log MoM PAPP-A (r = 0.39, P < 0.001), and with log MoM free beta hCG (r = 0.21, P < 0.001). The median ADAM12-S MoM in cases of fetal trisomy 21 in gestational week 8 was 0.66 increasing to approx. 0.9 MoM in week 9 and 10. The use of ADAM12-S along with biochemical markers from the combined test (PAPP-A, free beta hCG) with or without nuchal translucency measurement did not affect the detection rate or false positive rate of fetal aneuploidy as compared to routine screening using PAPP-A and free β-hCG with or without nuchal translucency. Conclusion The data show moderately decreased levels of ADAM12-S in cases of fetal aneuploidy in gestational weeks 8-11. However, including ADAM12-S in the routine risk does not improve the performance of first trimester screening for fetal trisomy 21. PMID:21034452

  17. Outcome for children infected with congenital toxoplasmosis in the first trimester and with normal ultrasound findings: a study of 36 cases.

    PubMed

    Berrebi, Alain; Bardou, Magali; Bessieres, Marie-Hélène; Nowakowska, Dorota; Castagno, Romina; Rolland, Michel; Wallon, Martine; Franck, Jacqueline; Bongain, André; Monnier-Barbarino, Patricia; Assouline, Corinne; Cassaing, Sophie

    2007-11-01

    We wished to investigate the prognosis of children infected with Toxoplasma gondii during the first trimester of pregnancy and whose ultrasound findings were entirely normal, in order to find out whether congenital toxoplasmosis did or did not justify termination of pregnancy if there was no fetal abnormality on ultrasound. A prospective and retrospective study was carried out by 12 French centers who enrolled 36 children infected with T. gondii during the first trimester of pregnancy and whose ultrasound examinations showed no anomaly. The outcome of these children after the age of 12 months (mean 50 months, range 12-144 months) was analyzed. Of the 36 infected children, 28 (78%) presented subclinical toxoplasmosis. Only specific IgG antibodies persisted after 1 year. The principal manifestation in 7 children (19%) was chorioretinitis without major vision loss. Their intellectual development was entirely normal. One child (3%) developed severe congenital toxoplasmosis. Since 97% of children infected with toxoplasmosis during the first trimester of pregnancy are asymptomatic or only slightly affected, we believe that in such circumstances termination of pregnancy is not indicated. However, appropriate treatment is essential and prenatal ultrasound examinations should be free of any anomaly.

  18. Fetal sex determination using circulating cell-free fetal DNA (ccffDNA) at 11 to 13 weeks of gestation.

    PubMed

    Akolekar, Ranjit; Farkas, Daniel H; VanAgtmael, Anna L; Bombard, Allan T; Nicolaides, Kypros H

    2010-10-01

    To examine the performance of a mass spectrometry-based detection platform using three Y-chromosome sequences for fetal sex determination from circulating cell-free fetal DNA (ccffDNA) in maternal blood in the first trimester of pregnancy. We extracted ccffDNA for the determination of fetal sex from stored maternal plasma obtained at 11 to 13 weeks' gestation from singleton pregnancies with documented fetal gender. Mass spectrometry was used to examine 236 specimens for the presence of three Y-chromosome sequences (SRY, DBY and TTTY2). The sample was classified as male, female or inconclusive depending on the detection of three, one/none and two sequences, respectively. Three (1.3%) of the 236 cases were classified as invalid due to the absence of a well-defined spectral peak for TGIF and 22 (9.3%) were reported as inconclusive. In the 211 cases with a valid result, the fetal sex was correctly identified in 90 of 91 male babies and 119 of 120 female babies giving an accuracy of 99.1% and sensitivity and specificity for prediction of male fetuses of 98.9 and 99.2%, respectively. Fetal sex determination can be accurately determined from maternal ccffDNA in the first trimester of pregnancy using mass spectrometry analysis. © 2010 John Wiley & Sons, Ltd.

  19. Prenatal diagnosis of absent pulmonary valve syndrome from first trimester onwards: novel insights into pathophysiology, associated conditions and outcome.

    PubMed

    Gottschalk, I; Jehle, C; Herberg, U; Breuer, J; Brockmeier, K; Bennink, G; Hellmund, A; Strizek, B; Gembruch, U; Geipel, A; Berg, C

    2017-05-01

    To assess the spectrum of associated anomalies, intrauterine course and outcome in fetuses with absent pulmonary valve syndrome (APVS). All cases with a prenatal diagnosis of APVS at two centers over a period of 13 years were analyzed retrospectively. APVS was diagnosed in the presence of rudimentary or dysplastic pulmonary valve leaflets with to-and-fro blood flow in the pulmonary trunk on color and pulsed-wave Doppler ultrasound. Data on demographic characteristics, presence of associated conditions, Doppler studies and pregnancy outcome were reviewed. During the study period, 40 cases of APVS were diagnosed prenatally. Thirty-seven (92.5%) cases were associated with tetralogy of Fallot (TOF) and three (7.5%) had an intact ventricular septum. Patency of the ductus arteriosus (DA) was found in 17/37 (45.9%) TOF cases and in all three cases with an intact ventricular septum. Mean gestational age at diagnosis was 19.7 (range, 12-34) weeks with 10 (25.0%) cases (all with TOF) diagnosed in the first trimester. TOF was an isolated finding in 15 (37.5%) cases. Chromosomal anomalies, cardiac defects and extracardiac anomalies were present in 18 (45.0%), four (10.0%) and three (7.5%) cases, respectively. Among the 40 cases, there were 19 (47.5%) terminations of pregnancy, six (15.0%) intrauterine deaths, four (10.0%) neonatal deaths and 11 (27.5%) survivors. Patency of the DA, reversed flow during atrial contraction in the ductus venosus, umbilical artery or fetal middle cerebral artery, and hydrops/increased nuchal translucency thickness were significantly associated with non-survival. All 10 cases diagnosed in the first trimester had a patent DA and abnormal Doppler parameters, eight had hydrops and/or increased nuchal translucency, six were associated with trisomy 13 or 18 and none survived. APVS diagnosed in the first trimester is significantly associated with TOF, patency of the DA, abnormal Doppler parameters, lethal trisomies and intrauterine mortality. Cases of

  20. Ectopia cordis in a first-trimester sonographic screening program for aneuploidy.

    PubMed

    Sepulveda, Waldo; Wong, Amy E; Simonetti, Luis; Gomez, Enrique; Dezerega, Victor; Gutierrez, Jorge

    2013-05-01

    We review the sonographic features, antenatal course, and perinatal outcomes in 7 cases of ectopia cordis diagnosed in the first trimester. Four cases were associated with a large omphalocele (pentalogy of Cantrell) and 2 with a body stalk anomaly. The remaining fetus had isolated thoracic ectopia cordis. Two pregnancies were terminated; 2 fetuses died in utero; 2 infants died after delivery; and 1 died at 3 months of age. We conclude that the diagnosis of ectopia cordis can easily be established during the first trimester. In agreement with the currently available literature, the prognosis of ectopia cordis in our series was uniformly poor.

  1. [Prenatal diagnosis of skeletal dysplasia in first trimester of pregnancy X-linked dominant chondrodysplasia punctata].

    PubMed

    Polák, P; Baxová, A; Křepelová, A; Balák, M

    2014-06-01

    Case report describes successful prenatal diagnosis of skeletal dysplasia in the first trimester of pregnancy in a female patient affected with X-linked dominat chondrodysplasia punctata (CDPX2). Her first pregnancy was terminated in the second trimester due to skeletal dysplasia of the foetus. The diagnosis in the following pregnancy was finished in the first trimester - before the end of the 13th gestational week. The diagnosis was established on the basis of ultrasonographic (US) examination and mutation analysis of the EBP gene in the material of chorionic villus sampling (CVS).

  2. Safety of artemisinins in first trimester of prospectively followed pregnancies: an observational study

    PubMed Central

    Moore, Kerryn A; Simpson, Julie A; Paw, Moo Kho; Pimanpanarak, MuPawJay; Wiladphaingern, Jacher; Rijken, Marcus J; Jittamala, Podjanee; White, Nicholas J; Fowkes, Freya J I; Nosten, François; McGready, Rose

    2016-01-01

    Summary Background Artemisinins, the most effective antimalarials available, are not recommended for falciparum malaria during the first trimester of pregnancy because of safety concerns. Therefore, quinine is used despite its poor effectiveness. Assessing artemisinin safety requires weighing the risks of malaria and its treatment. We aimed to assess the effect of first-trimester malaria and artemisinin treatment on miscarriage and major congenital malformations. Methods In this observational study, we assessed data from antenatal clinics on the Thai–Myanmar border between Jan 1, 1994, and Dec 31, 2013. We included women who presented to antenatal clinics during their first trimester with a viable fetus. Women were screened for malaria, and data on malaria, antimalarial treatment, and birth outcomes were collected. The relationship between artemisinin treatments (artesunate, dihydroartemisinin, or artemether) and miscarriage or malformation was assessed using Cox regression with left-truncation and time-varying exposures. Findings Of 55 636 pregnancies registered between 1994 and 2013, 25 485 pregnancies were analysed for first-trimester malaria and miscarriage, in which 2558 (10%) had first-trimester malaria. The hazard of miscarriage increased 1·61-fold after an initial first-trimester falciparum episode (95% CI 1·32–1·97; p<0·0001), 3·24-fold following falciparum recurrence (2·24–4·68; p<0·0001), and 2·44-fold (1·01–5·88; p=0·0473) following recurrent symptomatic vivax malaria. No difference was noted in miscarriage in first-line falciparum treatments with artemisinin (n=183) versus quinine (n=842; HR 0·78 [95% CI 0·45–1·34]; p=0·3645) or in risk of major congenital malformations (two [2%] of 109 [95% CI 0·22–6·47] versus eight (1%) of 641 [0·54–2·44], respectively). Interpretation First-trimester falciparum and vivax malaria both increase the risk of miscarriage. We noted no evidence of an increased risk of miscarriage or

  3. Macrophage colony-stimulating factor (M-CSF) in first trimester maternal serum: correlation with pathologic pregnancy outcome.

    PubMed

    Eckmann-Scholz, Christel; Wilke, Christina; Acil, Yahya; Alkatout, Ibrahim; Salmassi, Ali

    2016-06-01

    To determine correlations between macrophage colony-stimulating factor (MCSF) levels in maternal blood during first trimester screening with respect to normal and pathological pregnancies. This was a prospective single centre study. First trimester screening was performed according to FMF London certificates. Nuchal translucency, PAPP-A and free β-HCG were obtained as well as M-CSF serum levels in maternal blood. Fetal karyotyping was achieved by chorionic villi sampling. 125 patients were enrolled in this study. 21 pregnancies had confirmed aberrant karyotypes. Trisomy 21 cases showed significantly elevated M-CSF levels of 270 ± 91 pg/ml (p = 0.032), whereas cases of trisomy 13 (183 ± 68 pg/ml) and trisomy 18 (143 ± 40 pg/ml) had low M-CSF levels. Furthermore M-CSF levels tended to be low in preterm deliveries, placental insufficiency and nicotine consumption. In cases with gestational diabetes M-CSF tended to be elevated. Furthermore we found a positive correlation between high free β-human chorionic gonadotropin (hcg) and MCSF values. There was no correlation between pregnancy associated plasma protein (PAPP-A) and M-CSF. M-CSF is a cytokine promoting placental growth and differentiation. M-CSF is known to be involved in the process of implantation in pregnancy. The role of M-CSF with respect to disturbed pregnancy outcomes such as placental insufficiency in normal or aberrant karyotypes, for example, is yet subject to further research.

  4. First-trimester contingent screening for trisomy 21 by biomarkers and maternal blood cell-free DNA testing.

    PubMed

    Nicolaides, K H; Wright, D; Poon, L C; Syngelaki, A; Gil, M M

    2013-07-01

    To define risk cut-offs with corresponding detection rates (DR) and false-positive rates (FPR) in screening for trisomy 21 using maternal age and combinations of first-trimester biomarkers in order to determine which women should undergo contingent maternal blood cell-free (cf) DNA testing. From singleton pregnancies undergoing screening for aneuploidies at three UK hospitals between March 2006 and May 2012, we analyzed prospectively collected data on the following biomarkers: fetal nuchal translucency thickness (NT) and ductus venosus pulsatility index for veins (DV-PIV) at 11 + 0 to 13 + 6 weeks' gestation and serum free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PlGF) and alpha-fetoprotein (AFP) at 8 + 0 to 13 + 6 weeks. Estimates of risk cut-offs, DRs and FPRs were derived for combinations of biomarkers and these were used to define the best strategy for contingent cfDNA testing. In contingent screening, detection of 98% of fetuses with trisomy 21 at an overall invasive testing rate < 0.5% can be potentially achieved by offering cfDNA testing to about 36%, 21% and 11% of cases identified by first-line screening using the combined test alone, using the combined test with the addition of serum PlGF and AFP and using the combined test with the addition of PlGF, AFP and DV-PIV, respectively. Effective first-trimester screening for trisomy 21, with DR of 98% and invasive testing rate < 0.5%, can be potentially achieved by contingent screening incorporating biomarkers and cfDNA testing. Copyright © 2013 ISUOG. Published by John Wiley & Sons, Ltd.

  5. High prevalence of maternal hypothyroidism despite adequate iodine status in Indian pregnant women in the first trimester.

    PubMed

    Jaiswal, Nidhi; Melse-Boonstra, Alida; Thomas, Tinku; Basavaraj, Chetana; Sharma, Surjeet Kaur; Srinivasan, Krishnamachari; Zimmermann, Michael B

    2014-09-01

    Iodine requirements are increased during pregnancy to maintain maternal and fetal euthyroidism. There have been recent improvements in iodized salt coverage in India, but whether iodized salt is sufficient to sustain iodine requirements during pregnancy remains uncertain. Our aims were to measure thyroid status in first trimester pregnant women in southern India and assess potential determinants of thyroid function, including iodine status, thyroid autoimmunity, dietary patterns, body weight, and anemia. This was a cross-sectional study among 334 pregnant women of ≤ 14 weeks' gestation, in Bangalore, India. We measured anthropometrics, urinary iodine concentration (UIC), maternal thyroid volume (by ultrasound), and thyroid function. We applied a thyrotropin (TSH) upper limit of 2.5 mIU/L to classify thyroid insufficiency. Using a questionnaire, we obtained sociodemographic and dietary data, obstetric history, and use of iodized salt and iodine supplements. Among the women, the mean (standard deviation) gestational age was 10.3 (2.5) weeks, 67% were nulliparous, 21% were vegetarian, 19% were anemic, and 23% were overweight or obese. Iodized salt was used by 98% of women, and they were iodine sufficient: median UIC (range) was 184.2 μg/L (8.1-1152 μg/L) and all had a normal thyroid volume. However, 18% of the women had thyroid insufficiency: 3.7% had overt hypothyroidism (83% with positive TPO-Ab), 9.2% had subclinical hypothyroidism, and 5.2% had hypothyroxinemia. Women consuming vegetarian diets did not have significantly lower iodine intakes or higher risk of hypothyroidism than those consuming mixed diets, but overweight/obesity and anemia predicted thyroid insufficiency. In this urban population of southern India, pregnant women have adequate iodine status in the first trimester. Despite this, many have thyroid insufficiency, and the prevalence of overt hypothyroidism is more than fivefold higher than reported in other iodine sufficient populations of

  6. Effects of anti-β2-GPI antibodies on cytokine production in normal first-trimester trophoblast cells.

    PubMed

    Azuma, Hiromitsu; Yamamoto, Tatsuo; Chishima, Fumihisa

    2016-07-01

    The anti-β2-GPI antibody (aβ2-GPIAb) has been detected in recurrent fetal loss with strong pathogenic activity. The effects of aβ2-GPIAb on cytokine production and aβ2-GPIAb binding sites in first-trimester trophoblast cells were evaluated. First-trimester trophoblast cells were cultured in 24-well tissue culture plates with immunoglobulin G (IgG) obtained from aβ2-GPIAb-positive and aβ2-GPIAb-negative serum. Cytokines in the cultured supernatant were measured using the suspension array system and enzyme-linked immunosorbent assays. To identify potential binding sites for aβ2-GPIAb, such as toll-like receptors (TLR) 2 or TLR4, we used mouse monoclonal anti-TLR2 and/or anti-TLR4 antibodies to inhibit TLR and then measured cytokine production. The production of cytokines, such as interleukin-6 and interleukin-8, increased more in response to aβ2-GPIAb-positive IgG than to aβ2-GPIAb-negative IgG in trophoblast cells. The secretion of cytokines from trophoblast cells decreased when the TLR were blocked with mouse monoclonal anti-TLR2 and anti-TLR4 antibodies. We suspect that aβ2-GPIAb might increase cytokine production by binding to TLR2 or TLR4. The increased cytokine production in response to aβ2-GPIAb might play a role in the increased inflammatory response in the placenta. © 2016 Japan Society of Obstetrics and Gynecology.

  7. Human trophoblast cell during first trimester after IVF-ET differs from natural conceived pregnancy in development and function.

    PubMed

    Yang, Rui; Liu, Ying-Ying; Zhao, Liang; Wang, Ying; Li, Rong; Liu, Ping; Ma, Cai-Hong; Chen, Xin-Na; Qiao, Jie

    2017-03-01

    To explore the differences of the trophoblast cell function in first trimester between natural pregnancy and pregnancy after IVF-ET therapy. 102 cases with twin to singleton fetal reduction after IVF-ET treatment from July 2010 to August 2013 in Peking University Third Hospital were involved in analysis, and eight specimens were obtained from this group. 10 natural-pregnancy cases undergoing artificial abortion with unwanted pregnancy were recruited as control. Semi-quantitative immunohistochemical method was used to detect the expression of EGFR, Bcl-2, tubulin-α, metallothionein and AFP in villi in both groups. Of the 102 cases, 14 cases (13.73%) were aborted. Preterm birth occurred in seven cases (7.86%). Low birth weight occurred in three patients (3.37%), and extremely low birth weight occurred in four cases (4.49%). The expression of EGFR, tubulin-α, Bcl-2, and metallothionein in the IVF-ET group was significantly lower than that in the control group (P<0.05). However, AFP expression was significantly higher in IVF-ET group than in control group (P<0.05). In IVF-ET group, the miscarriage case had weaker EGFR, tubulin-α, and metallothionein expression than full-term pregnancy; the early preterm labor case had weaker Bcl-2, tubulin-α, and metallothionein expression; and velamentous cord insertion case had weaker tubulin-α expression. The trophoblast cell function of IVF-ET group in first trimester is different from control group in proliferation, invasion, apoptosis and vascular development, and optimal pregnancy outcome depends on the self-healing balance of trophoblast cells.

  8. Reliability of the first-trimester cardiac scan by ultrasound-trained obstetricians with high-frequency transabdominal probes in fetuses with increased nuchal translucency.

    PubMed

    Bellotti, M; Fesslova, V; De Gasperi, C; Rognoni, G; Bee, V; Zucca, I; Cappellini, A; Bulfamante, G; Lombardi, C M

    2010-09-01

    To examine prospectively the reliability of ultrasound-trained obstetricians performing a first-trimester fetal cardiac scan with high-frequency transabdominal probes, by confirming normal or abnormal heart anatomy, in pregnancies referred for increased nuchal translucency thickness (NT). Trained obstetric operators assessed the fetal heart in 133 fetuses with increased NT (> 95th centile) at 11-14 weeks of gestation. A high-frequency transabdominal probe was used to confirm or refute normal cardiac anatomy rather than to establish a specific diagnosis. Following this preliminary screening by the ultrasound-trained obstetrician, specialized fetal echocardiographers rescanned the fetal heart in order to confirm the accuracy of the obstetric operators' findings and to establish a diagnosis in abnormal cases. Fetal cardiologists repeated the examinations at 20 and 32 weeks of pregnancy. Postnatal follow-up lasted 2 years. Twelve fetuses with normal karyotype and normal anatomy were lost to follow-up. A total of 121 fetuses with increased NT between 11 and 14 weeks' gestation were studied. Congenital heart disease (CHD) was detected in 20/121 (16.5%) fetuses. In addition, there were three with mild ventricular disproportion, the right ventricle being larger than the left, considered as a minor non-specific cardiac abnormality. CHD was associated with chromosomal anomalies in 12/20 (60%) cases. Among the 121 fetuses, there was agreement between ultrasound-trained obstetricians and fetal cardiologists in 116 (95.9%) of the cases, and the ultrasound-trained obstetricians correctly identified 18 cases with major cardiac defects. However, there was disagreement in five cases: two with small ventricular septal defects and three with ventricular disproportion. Our results provide evidence that obstetricians, trained to study the heart in the second trimester, can also differentiate reliably between normal and abnormal heart findings in the first trimester, when using a high

  9. Ductus venosus in the first trimester: contribution to screening of chromosomal, cardiac defects and monochorionic twin complications.

    PubMed

    Maiz, Nerea; Nicolaides, Kypros H

    2010-01-01

    In the first trimester the ductus venosus can be easily identified with color Doppler and a ductus venosus waveform can be obtained by pulsed Doppler. At 11-13 weeks the prevalence of abnormal a-wave in the ductus venosus is inversely related to fetal crown-rump length and maternal serum pregnancy-associated plasma protein-A (PAPP-A), increases with fetal nuchal translucency (NT) thickness and is more common in women of Black racial origin and in fetuses with abnormal karyotype or cardiac defects. Ductus venosus flow provides an independent contribution in the prediction of chromosomal abnormalities when combined with NT and the maternal serum markers of PAPP-A and free beta-hCG, increasing the detection rate to 96% at a false-positive rate of 2.6%. Abnormal ductus venosus flow increases the risk of cardiac defects in fetuses with NT above the 95th centile, and it may increase the risk in fetuses with normal NT. In twin pregnancies, abnormal ductus venosus flow is associated with chromosomal abnormalities and cardiac defects. In monochorionic twins, abnormal flow in the ductus venosus in at least 1 of the fetuses increases the risk of developing twin-to-twin transfusion syndrome.

  10. First-trimester screening for trisomies 18 and 13, triploidy and Turner syndrome by detailed early anomaly scan.

    PubMed

    Wagner, P; Sonek, J; Hoopmann, M; Abele, H; Kagan, K O

    2016-10-01

    To examine the performance of first-trimester ultrasound screening for trisomies 18 and 13, triploidy and Turner syndrome based on fetal nuchal translucency thickness (NT), additional fetal ultrasound markers including anatomy of the nasal bone (NB), blood flow across the tricuspid valve (TV) and through the ductus venosus (DV) and a detailed fetal anomaly scan at 11-13 weeks' gestation. This was a retrospective case-matched study involving pregnant women at 11-13 weeks' gestation. The study population consisted of fetuses with trisomy 18, trisomy 13, triploidy or Turner syndrome. For each fetus with an abnormal karyotype, 50 randomly selected euploid fetuses were added to the study population. In all cases, the crown-rump length and NT were measured. In addition NB, TV flow and DV flow were examined. The summed risk for trisomies 21, 18 and 13 was computed based on: first, maternal age (MA); second, MA and fetal NT; third, MA, NT and one of the markers NB, TV flow or DV flow; fourth, MA, NT and all these markers combined; fifth, MA, NT and fetal anomalies; and, finally, MA, NT, all markers and fetal anomalies. The study population consisted of 4550 euploid and 91 aneuploid fetuses. Median NT was 1.8 mm in euploid fetuses and 4.8, 6.8, 1.8 and 10.0 mm in fetuses with trisomy 18, trisomy 13, triploidy and Turner syndrome, respectively. The NB, TV flow and DV flow were abnormal in 48 (1.1%), 34 (0.7%) and 99 (2.2%) euploid fetuses, respectively, and in 42 (46.2%), 31 (34.1%) and 62 (68.1%) aneuploid fetuses, respectively. At least one defect was found in 60 (1.3%) euploid and in 76 (83.5%) aneuploid fetuses. For a false-positive rate of 3%, the detection rate for screening based on MA and fetal NT was 75.8%. It increased to 84.6-86.8% when including one of the additional ultrasound markers and it was 90.1% when all three markers were included. When screening was based on MA, fetal NT and a detailed anomaly scan, the detection rate was 94.5% and increased to 95

  11. Screening for trisomy 21 in twins using first trimester ultrasound and maternal serum biochemistry in a one-stop clinic: a review of three years experience.

    PubMed

    Spencer, Kevin; Nicolaides, Kypros H

    2003-03-01

    To evaluate the performance of screening for fetal trisomy 21 in the first trimester of twin pregnancies by a combination of maternal serum biochemistry and ultrasonography. Three year retrospective review of screening performance. District General Hospital maternity unit. All women booked to receive routine antenatal care at Harold Wood Hospital between 1 June 1998 and 30th September 2001. The population included 13,940 women of all ages presenting with pregnancies between 10 weeks 3 days and 13 weeks 6 days gestation. Of these, 230 had a twin pregnancy. Women booked into the clinic were offered screening using a combination of maternal serum free beta-hCG and pregnancy-associated plasma protein-A (PAPP-A) and fetal nuchal translucency thickness. Women at increased risk of carrying a fetus with trisomy 21 or trisomy 13/18 (>/=1 in 300 at sampling) were offered counselling and an invasive diagnostic procedure. Follow up of the outcome of all pregnancies was carried out. For women who on examination were at 14 weeks of gestation or greater, or for women presenting as late bookers beyond 14 weeks, screening was performed in the same time frame using only maternal serum free beta-hCG and alpha-fetoprotein. The first trimester detection rate for trisomy 21 and all aneuploides, false positive rate, uptake of screening, uptake of invasive testing in women identified at increased risk and fetal loss rates after invasive testing. Overall, 97.4% of the women with twins (224/230) accepted first trimester screening. The rate of detection of trisomy 21 was 75% (3/4). Fetal death at presentation was found in 3.4% of fetuses (16/460). Of women who accepted screening, 4.3% (10/230) presented too late for fetal nuchal translucency measurement and 10.0% of women (23/230) presented too early. A risk for trisomy 21 was calculated for each fetus based on the individual fetal nuchal translucency thickness and the maternal biochemistry. The false positive rate among those eligible for

  12. Patient Experience with Karyotyping After First Trimester Miscarriage: A National Survey.

    PubMed

    McNally, Leah; Huynh, Diem; Keller, Jennifer; Dikan, Jennifer; Rabinowitz, Matthew; Lathi, Ruth B

    2016-01-01

    To assess the frequency of chromosome testing after first trimester miscarriage as well as to investigate patient experiences. An anonymous online questionnaire was developed and made available. Inclusion criteria were female, age ≥ 18, first trimester miscarriage, occurrence of miscarriage within the past year, miscarriage care provided in the United States, and survey completion. Of the 980 women who started the survey, 448 met inclusion criteria. Of those, 37 participants had chromosome testing on the miscarriage specimen. Of those who did not have testing, 66% said they wished they had done so at the time of miscarriage, and 67% said they would still want testing if it were available today. There was no correlation between patient age and chromosome testing. Chromosome testing increased in frequency with higher number of miscarriages, although the low number of women with chromosome testing limits our ability to draw definitive conclusions. On average, providers needed to spend 15-20 minutes with patients for them to feel like it was "enough time." In this national survey we found that chromosome testing is performed in approximately 8% of first trimester miscarriages. Our data indicate that the majority of patients experiencing first trimester miscarriage desire chromosome testing.

  13. First trimester maternal serum placental growth factor in trisomy 21 pregnancies.

    PubMed

    Cowans, N J; Stamatopoulou, A; Spencer, K

    2010-05-01

    To examine placental growth factor (PlGF) levels in first trimester maternal serum in trisomy 21 pregnancies and to investigate the potential value of PlGF in a first trimester screening test. First trimester maternal serum from 70 trisomy 21 cases and 375 euploid controls were retrospectively analyzed for PlGF using a DELFIA Xpress immunoassay platform. Results were expressed as multiples of medians (MoM) for comparison. PlGF levels were significantly decreased in pregnancies with trisomy 21, 0.76 MoM versus 0.98 MoM in controls. Inclusion of PlGF into the first trimester combined test [maternal age, pregnancy associated plasma protein-A (PAPP-A), free-beta human chorionic gonadotrophin (beta-hCG) and nuchal translucency] would increase the detection rate by 0.5% at a 5% false positive rate. PlGF at 11 weeks to 13 weeks 6 days has the potential to be included as a marker for the detection of pregnancies with trisomy 21.

  14. First trimester medical termination of pregnancy: an alternative for New Zealand women.

    PubMed

    Goodyear-Smith, Felicity; Knowles, Alison; Masters, Jonathan

    2006-06-01

    First trimester medical terminations of pregnancy (TOP) have been carried out in a private abortion clinic in Auckland from 1 July 2003 to 30 June 2005. To audit first trimester medical TOP outcomes over the first 2 years and to compare the demographics and complication rates of women opting for medical TOP with those choosing surgical TOP during this period. Retrospective, consecutive case audit of women presenting for a first trimester TOP. Anonymous audit included ethnicity, gestation at first appointment, pain relief requirements, blood loss, timing from the taking of misoprostol to expulsion of products of conception, complications and comparison of outcomes and characteristics between medical termination of pregnancy (MTOP) and surgical termination of pregnancy (STOP). A total of 3311 TOPs were performed over the 2-year study period, including 390 MTOPs (12%). No significant differences were found in age, ethnicity or history of previous TOP between women choosing MTOP or STOP. Gravida 1 and nulliparous women were significantly more likely to choose MTOP. Five per cent (21/390) of women taking mifepristone progressed to STOP. Complications involving hospitalisation occurred in six MTOPs (1.5%) and 18 STOPs (0.6%). First trimester MTOP is safe and effective and is a realistic alternative for women wanting choice of method in New Zealand.

  15. Value of histopathologic examination of uterine products after first-trimester miscarriage.

    PubMed

    Alsibiani, Sharifa Ali

    2014-01-01

    The main rationale of routine histopathologic examination of products after first-trimester miscarriages is to detect an ectopic pregnancy or a molar pregnancy, which require further management. An alternative approach is to examine the products only when there is a definite indication. As there is no agreement, we aimed to study whether routine histopathological examination of tissues obtained after first-trimester miscarriage is of any clinical value in our populations. Medical records of all (558) patients with a diagnosis of first-trimester miscarriage over 4 years (2007-2010) at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, were reviewed. Histopathologic examination confirmed products of conception in 537 (96.2%) patients, no products of conception in 17 (3%) patients, molar pregnancy in 2 (0.4%) patients, and decidual tissues without chorionic villi (Arias-Stella reaction) in 2 (0.4%) patients. After clinical correlation, only one unsuspected partial molar pregnancy was diagnosed by histopathology examination. Conclusion is that it does not appear reasonable to perform histopathological examination routinely after all first-trimester miscarriages in our studied population. We recommend that histopathological examination be performed in select instances: when the diagnosis is uncertain, when fewer tissues have been obtained during surgery, when unexpected pathology was seen, when ultrasound suggests a molar pregnancy, or when patients are considered at high risk for trophoblastic disease.

  16. First-trimester prenatal sonographic diagnosis of ectopia cordis in a twin gestation.

    PubMed

    Barbee, Kristen; Wax, Joseph R; Pinette, Michael G; Cartin, Angelina; Blackstone, Jacquelyn

    2009-01-01

    The 11-14-week ultrasound examination allows early pregnancy dating, detection of major anomalies and multiple gestations, and accurate chorionicity determination. We describe a rare case of first-trimester sonographic diagnosis of ectopia cordis in a dichorionic twin pregnancy, illustrating the benefits of early ultrasound in patient counseling and management. (c) 2009 Wiley Periodicals, Inc. J Clin Ultrasound, 2009.

  17. Adiposity and hyperleptinemia during the first trimester among pregnant women with preeclampsia.

    PubMed

    Yeboah, Francis Agyemang; Ngala, Robert Amadu; Bawah, Ahmed Tijani; Asare-Anane, Henry; Alidu, Huseini; Hamid, Abdul-Wahab Mawuko; Wumbee, Joshua Dokurugu Kwame

    2017-01-01

    Leptin levels start increasing from the early stages of pregnancy, irrespective of the maternal body mass index. Leptin levels are increased in pregnant women with preeclampsia (PE) and may precede the clinical onset of the disease, with peaks occurring around 28 weeks of gestation. This study was aimed at determining whether serum leptin concentration and body fat percentage are significantly altered during the first trimester in pregnancies that subsequently develop PE and whether such changes are useful in predicting the disease. This was a prospective longitudinal study conducted among pregnant women in Ho municipality. A cohort of 314 pregnant women was monitored from the first antenatal visit to delivery period at the Volta Regional Hospital, Ho, Ghana. Maternal serum leptin and lipid profile were analyzed and body fat percentage determined during first trimester. Body mass index was also calculated. First trimester serum leptin level (P<0.0001) and body fat percentage (P<0.0001) were significantly higher in those who developed PE than those who did not; while triglycerides (P=0.8600), total cholesterol (P=0.5620), high-density lipoprotein (P=0.5880), low-density lipoprotein (P=0.4870) and very low-density lipoprotein (P=0.6540) did not show any significant difference between those with PE and those without PE. Leptin levels are increased significantly during the first trimester of pregnancy in obese women with PE, and these increases precede the onset of PE.

  18. Effect of parity and fetal sex on placental and luteal hormones during early first trimester.

    PubMed

    Järvelä, Ilkka Y; Záčková, Tamara; Laitinen, Päivi; Ryynänen, Markku; Tekay, Aydin

    2012-02-01

    Earlier studies have shown that maternal hormone secretion during late first or second trimester may be affected by gravidity. We examined the luteoplacental hormone secretion during 5-11 weeks of gestation in relation to gravidity. Forty-one naturally conceived pregnancies underwent weekly assessment of serum human chorionic gonadotrophin, progesterone and 17-OH progesterone, estradiol, testosterone, and pregnancy-associated plasma protein A levels. In addition, the volume and the vasculature of the dominant ovary with corpus luteum were assessed with the use of a 3-dimensional power Doppler ultrasonography. Areas under the curve for hormonal and ultrasonographic parameters were calculated. Twenty-two out of the 41 women were pregnant for the first time. All the pregnancies were uncomplicated and resulted in term deliveries of appropriately grown newborns. During pregnancy weeks 5-11, the secretion (area under the curve) of human chorionic gonadotrophin (6.54 ± 0.03 vs 6.39 ± 0.05, p = 0.010), progesterone (3.49 ± 0.02 vs 3.36 ± 0.03, p = 0.003), and 17-OH progesterone (2.73 ± 0.03 vs 2.62 ± 0.03, p = 0.013) were higher in primigravid than in multigravid women. No other differences were detected between primigravid and multigravid women. The placental function already differs between primigravid and multigravid women during the first weeks of pregnancy, which reflects the corpus luteal function. © 2012 John Wiley & Sons, Ltd.

  19. The impact of introducing combined first-trimester trisomy 21 screening in the French population.

    PubMed

    Royère, Dominique

    2016-06-01

    French state health insurance has funded trisomy 21 prenatal screening for all pregnant women since decades. First-trimester combined screening was introduced nationally and funded in 2010. To evaluate the impact of the introduction, of a national policy of prenatal trisomy 21 first-trimester screening on the reduction of invasive prenatal diagnostic procedures. The results of all prenatal trisomy 21 screening and invasive diagnostic procedures were collected for the whole country over the period 2009-12. The screen-positive rates (risk cut-off 1 : 250, including isolated nuchal translucency ≥ 3.5 mm), positive predictive values and percentage of cases diagnosed prenatally were calculated. Over the study period the number of women undergoing serum screening (including first- and second-trimester screening tests) increased from 678 803 to 689 651 (83 to 85% of deliveries, P < 0.0001). By 2012, first-trimester combined screening accounted for 70% of all trisomy 21 screening. The screen-positive rate decreased from 9.5 to 4.8% (P < 0.001) resulting in a 37 478 (47%) drop (P < 0.001) in the number of invasive diagnostic procedures. The positive predictive value of screening increased from 2.6 to 6.1% from 2009 to 2012 (P < 0.001), due to the higher positive predictive value of first-trimester over second-trimester screening (9.1 vs. 1.8% over the period 2010-12, P < 0.001). The percentage of prenatally diagnosed cases remained high at around 80% between 2010 and 2012. The policy shift from second-trimester to first-trimester trisomy 21 screening allowed to reduce the number of invasive tests. The number of antenatal trisomy 21 diagnoses increased (+2.7%) over the study period. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

  20. First-Trimester Follistatin-Like-3 Levels in Pregnancies Complicated by Subsequent Gestational Diabetes Mellitus

    PubMed Central

    Thadhani, Ravi; Powe, Camille E.; Tjoa, May Lee; Khankin, Eliyahu; Ye, Jun; Ecker, Jeffrey; Schneyer, Alan; Karumanchi, S. Ananth

    2010-01-01

    OBJECTIVE To determine whether maternal levels of follistatin-like-3 (FSTL3), an inhibitor of activin and myostatin involved in glucose homeostasis, are altered in the first trimester of pregnancies complicated by subsequent gestational diabetes mellitus (GDM). RESEARCH DESIGN AND METHODS This was a nested case-control study of subjects enrolled in a prospective cohort of pregnant women with and without GDM (≥2 abnormal values on a 100-g glucose tolerance test at ∼28 weeks of gestation). We measured FSTL3 levels in serum collected during the first trimester of pregnancy. Logistic regression analyses were used to determine the risk of GDM. RESULTS Women who developed GDM (n = 37) had lower first-trimester serum levels of FSTL3 compared with women who did not (n = 127) (median 10,789 [interquartile range 7,013–18,939] vs. 30,670 [18,370–55,484] pg/ml, P < 0.001). When subjects were divided into tertiles based on FSTL3 levels, women with the lowest levels demonstrated a marked increase in risk for developing GDM in univariate (odds ratio 11.2 [95% CI 3.6–35.3]) and multivariate (14.0 [4.1–47.9]) analyses. There was a significant negative correlation between first-trimester FSTL3 levels and ∼28-week nonfasting glucose levels (r = −0.30, P < 0.001). CONCLUSIONS First-trimester FSTL3 levels are associated with glucose intolerance and GDM later in pregnancy. PMID:20007937

  1. First-trimester exposure to bupropion and risk of cardiac malformations.

    PubMed

    Louik, Carol; Kerr, Stephen; Mitchell, Allen A

    2014-10-01

    Bupropion is a drug uniquely used both to treat depression and as an aid to smoking cessation. We investigated previously reported associations between first-trimester exposure to bupropion and cardiac defects. Using data gathered since 2003 by the Slone Epidemiology Center's Case-control Birth Defects Study, we classified subjects with cardiac defects into subgroups. Exposure categories included first-trimester bupropion alone or in combination with other antidepressants, first-trimester antidepressants other than bupropion, and no exposure to any antidepressant at any time from 2 months prior to pregnancy through delivery. We calculated odds ratios and 95% confidence intervals, controlling for confounding using logistic regression. There were 8611 non-malformed infants and 7913 infants with cardiac defects. Eight cardiac subgroups had sufficient subjects (two or more exposed cases) for analysis. The adjusted odds ratio (aOR) for first-trimester bupropion use in relation to ventricular septal defect (VSD) was slightly elevated (1.6, 95% confidence interval 1.0-2.8); for exposure to bupropion alone, the aOR was 2.5 (95% confidence interval 1.3-5.0). Risks were not materially elevated for bupropion in relation to the other seven cardiac subgroups. We did not confirm previously reported associations for left-sided defects overall but had too few exposed cases to evaluate specific defects in this category. We did observe an elevated risk of VSD following first-trimester bupropion use, particularly when used without other antidepressants. This pattern for bupropion alone was observed in all our risk comparisons and was not explained by higher doses or gestational timing. Copyright © 2014 John Wiley & Sons, Ltd.

  2. Sex ratio at birth is associated with first-trimester maternal thyrotropin in women receiving levothyroxine.

    PubMed

    Miñambres, Donaire Inka; Ovejero Crespo, Diana; García-Paterson, Apolonia; Adelantado, Juan María; Corcoy Pla, Rosa

    2013-12-01

    The sex ratio at birth (male out of total alive newborns) is historically established at 0.515 and is influenced by numerous factors. It is not known, however, whether it is influenced by maternal thyroid conditions. Our aim was to analyze its association with maternal thyroid autoimmunity and first-trimester thyrotropin (TSH). We performed a retrospective cohort study at a tertiary care center. We studied 167 women who had received pregestational treatment with levothyroxine for hypothyroidism or differentiated thyroid carcinoma and gave birth to live infants. Women with secondary/tertiary hypothyroidism, pregestational diabetes mellitus, or multiple pregnancies were excluded. Autoimmunity was defined as present/absent, and mean first-trimester TSH was tested both as a quantitative variable and using six predefined categories. The outcome measure was sex ratio at birth. The sex ratio at birth was 0.485, not significantly different from expected. Maternal characteristics were similar in mothers of female and male newborns with the exception of mean first-trimester TSH, which was higher in pregnancies of female fetuses (3.27 vs. 2.52 mUI/L, p<0.025). Newborn sex differed across predefined TSH categories (p<0.021, with a sex ratio of 0.200 [95% confidence interval 0.00-0.402] for TSH ≥10 mUI/L). A multiple logistic regression analysis to predict newborn male sex confirmed maternal mean first-trimester TSH as the single predictor (odds ratio 0.900 [95% confidence interval 0.823-0.984], p<0.020). In women under pregestational treatment with levothyroxine, mean maternal first-trimester TSH is negatively associated with sex ratio at birth. This association has not been previously described.

  3. The effect of a 'vanishing twin' on biochemical and ultrasound first trimester screening markers for Down's syndrome in pregnancies conceived by assisted reproductive technology.

    PubMed

    Gjerris, A C; Loft, A; Pinborg, A; Christiansen, M; Tabor, A

    2009-01-01

    Previous studies have found that 1 in 10 in vitro fertilization (IVF) singletons originates from a twin gestation. First trimester Down's syndrome screening markers are altered in assisted reproductive techniques (ART) pregnancies compared with spontaneously conceived pregnancies. The presence of a perished embryo may further complicate prenatal screening among women pregnant after ART. The aim of this study was to assess the impact of a 'vanishing twin' on first trimester combined biochemical and ultrasound screening in pregnancies conceived after IVF and intracytoplasmatic sperm injection. From a national prospective cohort study concerning first trimester combined screening among women pregnant after ART, 56 cases of pregnancies with a vanishing twin were identified. As control group 897 cases of ART singleton pregnancies were used. All women completed a first trimester combined ultrasound and biochemical screening programme comprising serum PAPP-A and free beta-hCG together with nuchal translucency (NT) measurement. There were no significant differences in geometric mean MoM free beta-hCG and PAPP-A between pregnancies with an early (gestational week <9, EVT) or late vanishing twin (gestational week 9-13, LVT) or singleton pregnancies (0.98, 1.13 and 0.95 for free beta-hCG and 0.84, 0.80 and 0.74 for PAPP-A, respectively). Likewise, no difference was seen for NT measurements. The gestational age at the time of blood sampling and NT scan was similar for the three groups. The proportion of EVT pregnancies with a PAPP-A and free beta-hCG log(10)MoM value below the 5th%iles and above the 95th%iles of the value in the singleton pregnancies were 4.3%, 4.3%, 6.4% and 8.5%, respectively, which did not constitute a significant difference from singletons. The corresponding values for LVT pregnancies were 0%, 22.2%, 0% and 11.1%, respectively; however, these numbers were too small to allow for statistical calculations. First trimester biochemical screening markers in

  4. COMPARISON OF GESTATIONAL AGE AT BIRTH BASED ON LAST MENSTRUAL PERIOD AND ULTRASOUND DURING THE FIRST TRIMESTER

    EPA Science Inventory

    Reported last menstrual period (LMP) is commonly used to estimate gestational age (GA) but may be unreliable. Ultrasound in the first trimester is generally considered a highly accurate method of pregnancy dating. The authors compared first trimester report of LMP and first trime...

  5. COMPARISON OF GESTATIONAL AGE AT BIRTH BASED ON LAST MENSTRUAL PERIOD AND ULTRASOUND DURING THE FIRST TRIMESTER

    EPA Science Inventory

    Reported last menstrual period (LMP) is commonly used to estimate gestational age (GA) but may be unreliable. Ultrasound in the first trimester is generally considered a highly accurate method of pregnancy dating. The authors compared first trimester report of LMP and first trime...

  6. First-Trimester Maternal Serum Levels of sFLT1, PGF and ADMA Predict Preeclampsia.

    PubMed

    Bian, Zheng; Shixia, Chenzi; Duan, Tao

    2015-01-01

    Placental growth factor (PGF), soluble fms-like tyrosine kinase 1 (sFLT1) and asymmetric dimethylarginine (ADMA) are involved in the pathogenesis of preeclampsia. Abnormal maternal sFLT1, PGF and ADMA levels are detectable weeks before the onset of preeclampsia. To investigate sFLT1, PGF and ADMA in the first trimester of pregnancy as predictors of preeclampsia. In this prospective nested case-control study, 740 pregnant women enrolled at 12-16 weeks of gestation and followed up until 6 weeks after delivery at the Shanghai First Maternity and Infant Health Hospital of Tongji University between January 2010 and December 2012. Forty-four women developed preeclampsia. Urinary proteins were measured using 24-hour collection or dipsticks. sFLT1, PGF and ADMA were measured by ELISA in the first trimester. Pulsatility index (PI) was measured by Doppler ultrasound in the second trimester. First-trimester serum sFLT1 and ADMA levels of women who developed preeclampsia were significantly higher compared with women with normal pregnancies (sFLT1: 0.321 ± 0.023 vs. 0.308 ± 0.019 ng/ml, P = 0.001; ADMA: 0.86 ± 0.16 vs. 0.68 ± 0.20 μM, P < 0.001). First-trimester serum PGF levels of women who developed preeclampsia were significantly lower than in women with normal pregnancies (115.72 ± 32.55 vs. 217.30 ± 74.48 pg/ml, P < 0.001). Multiple logistic regression and receiver-operating characteristic curves identified first-trimester PGF and ADMA to be sensitive and selective predictors of preeclampsia (area under the curve [AUC]: 0.902), as well as second-trimester uterine artery pulse index (AUC: 0.836). In the first trimester, maternal serum sFLT1, PGF and ADMA levels, as well as second-trimester uterine artery PI, could predict preeclampsia.

  7. First-Trimester Maternal Serum Levels of sFLT1, PGF and ADMA Predict Preeclampsia

    PubMed Central

    Bian, Zheng; Shixia, Chenzi; Duan, Tao

    2015-01-01

    Background Placental growth factor (PGF), soluble fms-like tyrosine kinase 1 (sFLT1) and asymmetric dimethylarginine (ADMA) are involved in the pathogenesis of preeclampsia. Abnormal maternal sFLT1, PGF and ADMA levels are detectable weeks before the onset of preeclampsia. Objective To investigate sFLT1, PGF and ADMA in the first trimester of pregnancy as predictors of preeclampsia. Methods In this prospective nested case-control study, 740 pregnant women enrolled at 12–16 weeks of gestation and followed up until 6 weeks after delivery at the Shanghai First Maternity and Infant Health Hospital of Tongji University between January 2010 and December 2012. Forty-four women developed preeclampsia. Urinary proteins were measured using 24-hour collection or dipsticks. sFLT1, PGF and ADMA were measured by ELISA in the first trimester. Pulsatility index (PI) was measured by Doppler ultrasound in the second trimester. Results First-trimester serum sFLT1 and ADMA levels of women who developed preeclampsia were significantly higher compared with women with normal pregnancies (sFLT1: 0.321±0.023 vs. 0.308±0.019 ng/ml, P = 0.001; ADMA: 0.86±0.16 vs. 0.68±0.20 μM, P<0.001). First-trimester serum PGF levels of women who developed preeclampsia were significantly lower than in women with normal pregnancies (115.72±32.55 vs. 217.30±74.48 pg/ml, P<0.001). Multiple logistic regression and receiver-operating characteristic curves identified first-trimester PGF and ADMA to be sensitive and selective predictors of preeclampsia (area under the curve [AUC]: 0.902), as well as second-trimester uterine artery pulse index (AUC: 0.836). Conclusion In the first trimester, maternal serum sFLT1, PGF and ADMA levels, as well as second-trimester uterine artery PI, could predict preeclampsia. PMID:25906026

  8. Successful use of uterine artery embolisation to treat placenta increta in the first trimester.

    PubMed

    Soleymani Majd, Hooman; Srikantha, Maithili; Majumdar, Subrata; B-Lynch, Christopher; Choji, Kiyoshi; Canthaboo, Manivannan; Ismail, Lamiese

    2009-05-01

    A 39-year-old Asian woman was admitted to hospital with persistent, heavy vaginal bleeding following an uncomplicated first trimester surgical termination of pregnancy (STOP). Her heavy bleeding continued after the STOP and she had recurrent hospital admissions which included two procedures to evacuate presumed retained products of conception. She eventually had a MRI scan performed which suggested placental tissue in the fundal region, extended into the uterine wall. The findings were consistent with placenta increta and the patient had a bilateral uterine artery embolisation (UAE), following which her symptoms rapidly subsided. We describe the first successfully managed case of persistent vaginal bleeding secondary to abnormal placentation. It would seem to substantiate the efficacy of UAE as a therapeutic modality for the conservative management of invasive placentation in the first trimester of pregnancy.

  9. Changes in blood parameters in rhesus monkeys (Macaca mulatta) during the first trimester of gestation.

    PubMed

    Ibáñez-Contreras, Alejandra; Hernández-Godínez, Braulio; Reyes-Pantoja, Sergio A; Jiménez-García, Andrea; Solís-Chavéz, Salvador A; Suarez-Gutiérrez, Rodrigo; Gálvan-Montaño, Alfonso

    2013-08-01

    Regarding the good practice in the laboratory work, it is essential to have a broad spectrum of biochemical and hematological references in pregnant females to determine the health status of the colony. To establish reference values to reveal changes in hematology and blood chemistry in pregnant rhesus monkeys (Macaca mulatta) in their first trimester of pregnancy. Twenty-eight females in reproductive stage were used, divided into two groups: 14 pregnant macaques in their first trimester and 14 non-pregnant used as the control group. Blood samples were collected for the hematological test and blood chemistry. The results showed significant difference in the blood chemistry for the following parameters: glucose, total bilirubin, and total protein. The hematological evaluation revealed significant difference in leukocytes and neutrophils. These findings offer a reference range and provide a basis for improvement in techniques and refinement of clinical processes in these specimens. © 2013 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. A comparison of transvaginal and abdominal ultrasound in visualizing the first trimester conceptus.

    PubMed

    Cullen, M T; Green, J J; Reece, E A; Hobbins, J C

    1989-10-01

    Ultrasound visualization of the first trimester embryo was compared using abdominal and transvaginal sonography. The parameters evaluated included the ability to obtain biometry, the ability to visualize detailed internal anatomy, and a subjective assessment of the overall image clarity. In 120 patients studied, transvaginal sonography was superior to abdominal sonography in obtaining biometric measurements in 51 cases (43%) and for visualizing internal anatomy in 45 cases (38%); also the image clarity of transvaginal sonography was subjectively better in 75 cases (63%). Vaginal sonography was superior to abdominal sonography in gestations less than or equal to 10 weeks, in obese patients, and in patients with retroverted uteri. The major difficulty encountered with transvaginal sonography was the limited maneuverability of the probe to generate specific views. Vaginal sonography can be a valuable tool in imaging the first trimester fetus, complementing, not replacing, abdominal sonography.

  11. Body Stalk Anomaly Complicated by Ectopia Cordis in the First Trimester

    PubMed Central

    Y., Shibata; K., Terada; M., Igarashi

    2014-01-01

    The most serious conditions seen in body stalk anomaly may be the cases which are complicated by ectopia cordis, which is characterized by the abnormal location of the heart outside the thorax. We encountered four cases of body stalk anomaly, which were complicated by ectopia cordis, which were diagnosed in the first trimesters of pregnancy. In three of these cases, ultrasound scans revealed foetuses with large anterior abdominal wall defects, with their hearts extending outside their thoracic cavities. Their mothers, along with their husbands opted for termination of their pregnancies. In 1 other case, an ultrasound scan revealed a dead foetus, with gastroschisis. Based on the current cases, we suggest that the diagnosis of ectopia cordis caused by body stalk anomaly can be made during the first trimester of pregnancy. PMID:24995220

  12. Body stalk anomaly complicated by ectopia cordis in the first trimester.

    PubMed

    Y, Shibata; K, Terada; M, Igarashi; S, Suzuki

    2014-05-01

    The most serious conditions seen in body stalk anomaly may be the cases which are complicated by ectopia cordis, which is characterized by the abnormal location of the heart outside the thorax. We encountered four cases of body stalk anomaly, which were complicated by ectopia cordis, which were diagnosed in the first trimesters of pregnancy. In three of these cases, ultrasound scans revealed foetuses with large anterior abdominal wall defects, with their hearts extending outside their thoracic cavities. Their mothers, along with their husbands opted for termination of their pregnancies. In 1 other case, an ultrasound scan revealed a dead foetus, with gastroschisis. Based on the current cases, we suggest that the diagnosis of ectopia cordis caused by body stalk anomaly can be made during the first trimester of pregnancy.

  13. Simultaneous osseous metaplasia nodules of the submucosa and mesosalpinx after first trimester abortion: a case report.

    PubMed

    Feng, Zhou; Jiale, Qin; Xiaofei, Zhang; Qingyun, Guo; Lili, Huang

    2013-11-19

    Here, we report a case of simultaneous osseous metaplasia nodules of the submucosa and mesosalpinx after a first trimester abortion. A 36-year-old woman presented to the Women's Hospital, School of Medicine, Zhejiang University with vaginal bleeding and infertility resulting from osseous metaplasia nodules of the submucosa and mesosalpinx after a first trimester abortion. Diagnostic and operative hysteroscopy and laparoscope procedures were performed. The osseous metaplasia nodules disappeared after hysteroscopy and laparoscope interventions; 2 weeks postoperatively, the patient underwent a transvaginal ultrasound examination and the abnormal ultrasound appearance had resolved. Osseous metaplasia nodules in the submucosa and mesosalpinx can be a rare cause of vaginal bleeding and infertility. Autologous tissue, not persistent heterologous tissue, may be the true reason for metaplasia. Treatment is by ultrasound-guided curettage or by hysteroscopic and laparoscope removal.

  14. Simultaneous osseous metaplasia nodules of the submucosa and mesosalpinx after first trimester abortion: a case report

    PubMed Central

    2013-01-01

    Objectives Here, we report a case of simultaneous osseous metaplasia nodules of the submucosa and mesosalpinx after a first trimester abortion. Case presentation A 36-year-old woman presented to the Women’s Hospital, School of Medicine, Zhejiang University with vaginal bleeding and infertility resulting from osseous metaplasia nodules of the submucosa and mesosalpinx after a first trimester abortion. Diagnostic and operative hysteroscopy and laparoscope procedures were performed. The osseous metaplasia nodules disappeared after hysteroscopy and laparoscope interventions; 2 weeks postoperatively, the patient underwent a transvaginal ultrasound examination and the abnormal ultrasound appearance had resolved. Conclusions Osseous metaplasia nodules in the submucosa and mesosalpinx can be a rare cause of vaginal bleeding and infertility. Autologous tissue, not persistent heterologous tissue, may be the true reason for metaplasia. Treatment is by ultrasound-guided curettage or by hysteroscopic and laparoscope removal. PMID:24245923

  15. First-Trimester Serum Fatty Acid-Binding Protein 4 and Subsequent Gestational Diabetes Mellitus.

    PubMed

    Tu, Wen-Jun; Guo, Min; Shi, Xiao-Dong; Cai, Yan; Liu, Qiang; Fu, Chen-Wei

    2017-10-06

    To examine whether plasma fatty acid-binding protein 4 concentrations, measured in the first trimester, are associated with gestational diabetes mellitus (GDM). This prospective, multicenter cohort study was conducted at three maternity centers in two cities (Harbin and Beijing) in China from July 2015 to June 2016. Data for fasting plasma glucose and fatty acid-binding protein 4 concentrations in the first trimester and one-step GDM screening with a 75-g oral glucose tolerance test performed between 24 and 28 weeks of gestation were collected and analyzed. Plasma from women in the first trimester was available for 1,150 women, of whom 135 (11.7%) developed GDM. The GDM distribution across the fatty acid-binding protein 4 quartiles ranged from 3.8% (first quartile) to 21.6% (fourth quartile). In multivariate models comparing the second (quartile 2), third, and fourth quartiles against the first quartile of fatty acid-binding protein 4, concentrations of fatty acid-binding protein 4 in quartile 2, quartile 3, and quartile 4 were associated with the development of GDM with respective associated adjusted odds ratios (95% CIs) of 1.76 (1.21-2.58), 2.36 (1.55-4.29), and 3.57 (1.99-6.11). A significant difference in the area under receiver operating characteristic curve between established risk factors alone and the addition of fatty acid-binding protein 4 concentrations was observed (difference 0.042 [95% CI 0.028-0.055]; P=.03). Higher fatty acid-binding protein 4 concentrations in the first trimester visit were associated with increased risk of GDM and might be useful in identifying women at risk for GDM for early prevention strategies.

  16. A comparison of Lamicel tents and gemeprost (Cervagem) pessaries prior to first trimester abortion.

    PubMed

    Stornes, I; Rasmussen, K L

    1991-01-01

    In an open, randomized study 108 women were treated with either a Lamicel tent or a 1 mg gemeprost pessary (Cervagem) 4 h before first trimester abortion. Both treatments were effective in producing cervical dilatation, however further dilatation was significantly easier after Cervagem. Preoperative abdominal pain and gastrointestinal side-effects were significantly more frequent in the Cervagem group. The incidence of postoperative pain and blood loss were similar in the two groups. Advantages and disadvantages of the two treatments are mentioned.

  17. Sirenomelia apus after trimethoprim exposure: first-trimester ultrasound diagnosis-a case report.

    PubMed

    Dosedla, Erik; Kalafusová, Michaela; Calda, Pavel

    2012-01-01

    We report the early prenatal ultrasound diagnosis of sirenomelia apus at 12+4 weeks in a patient with trimethoprim exposure in the vulnerable period. First-trimester scan revealed a malformed fetus with one femur, one small tibia, no feet, intraabdominal unilocular cystic structure, and two-vessel umbilical cord with allantoic cyst. Ultrasound visualization with two/three/four-dimensions was helpful in the process of parental counseling. Copyright © 2012 Wiley Periodicals, Inc.

  18. Committee Opinion Summary No. 638: First-Trimester Risk Assessment for Early-Onset Preeclampsia.

    PubMed

    2015-09-01

    Hypertensive disorders with adverse sequelae (including preterm birth, maternal morbidity and mortality, and long-term risk of maternal cardiovascular disease) complicate 5-10% of pregnancies. Early identification of pregnant women at risk of developing early-onset preeclampsia would theoretically allow referral for more intensive surveillance or application of preventive therapies to reduce the risk of severe disease. In practice, however, the effectiveness of such triage would be hindered by the low positive predictive value for early-onset preeclampsia reported in the literature. In spite of the modest predictive value of first-trimester preeclampsia risk assessment and the lack of data demonstrating improved clinical outcomes, commercial tests are being marketed for the prediction of preeclampsia in the first trimester. Taking a detailed medical history to evaluate for risk factors is currently the best and only recommended screening approach for preeclampsia; it should remain the method of screening for preeclampsia until studies show that aspirin or other interventions reduce the incidence of preeclampsia for women at high risk based on first-trimester predictive tests.

  19. Point prevalence of abnormal thyroid-stimulating hormone during the first trimester of pregnancy in Israel.

    PubMed

    Zornitzki, Taiba; Froimovici, Miron; Amster, Rubi; Lurie, Samuel

    2014-09-01

    The prevalence of thyroid dysfunction in early pregnancy in Israel is not known. To assess the rate of abnormal thyroid-stimulating hormone (TSH) tests in low risk pregnant women attending a community clinic in Israel. We conducted a retrospective analysis of the charts of low risk pregnant women (n = 303) who had undergone a TSH screening during the first trimester of pregnancy at Clalit Health Services Women's Health Centers in Ashkelon and Tel Aviv. TSH of 0.1-2.5 mIU/L during the first trimester was considered to be normal. The TSH levels ranged from 0.04 to 13.3 mIU/L (median 1.73 mIU/L, mean 1.88 mIU/L).The rate of abnormal TSH was 25.6%, with low TSH 2.3% and high TSH 23.4%. The prevalence of abnormal TSH was not influenced by gravidity (primigravidas versus multigravidas) or place of residence (Ashkelon or Tel Aviv). In view of the high prevalence of abnormal TSH (25.6%) in pregnant women in Israel during the first trimester, a universal country-wide screening should be considered.

  20. Laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy

    PubMed Central

    Minig, Lucas; Otaño, Lucas; Cruz, Pilar; Patrono, María Guadalupe; Botazzi, Cecilia; Zapardiel, Ignacio

    2016-01-01

    OBJECTIVE: To evaluate the feasibility and safety of laparoscopic surgery for treating adnexal masses during the first trimester of pregnancy. STUDY DESIGN: An observational study of a prospective collection of data of all pregnant women who underwent laparoscopic surgery for adnexal masses during the first trimester of pregnancy between January 1999 and November 2012 at the Obstetrics and Gynecology Department of the Italian Hospital of Buenos Aires, Buenos Aires, Argentina was performed. RESULTS: A total of 13 women were included. The median (range) gestational age at the moment of surgical procedure was 7 weeks (range: 5-12 weeks). The main indication of surgery was cyst torsion in four cases (30.7%) and rupture of ovarian cysts in four cases (30.7%). Other indications included persistent ovarian cyst in three patients (23%) and heterotopic pregnancy in two cases (15.3%). Neither surgical complications nor spontaneous abortions occurred in any of the cases and the post-operative period was uneventful in all the cases. No cases of intrauterine growth retardation, preterm delivery, congenital defects, or neonatal complications were registered. CONCLUSION: The treatment of complicated adnexal masses by laparoscopic surgery during the first trimester of pregnancy appears to be a safe procedure both for the mother and for the foetus. Additional research on a larger number of cases is still needed to support these conclusions. PMID:26917915

  1. Obstetrical complications associated with first-trimester screening markers in twin pregnancies.

    PubMed

    Iskender, Cantekin; Tarım, Ebru; Çok, Tayfun; Yalcınkaya, Cem; Kalaycı, Hakan; Yanık, Filiz Bilgin

    2013-11-01

    The aim of this retrospective study was to investigate the relation between perinatal complications in twin pregnancies and the combination of first-trimester maternal serum pregnancy-associated plasma protein-A (PAPP-A) and free beta-human chorionic gonadotrophin (β-hCG) levels. The study was conducted at the Perinatology Department of Baskent University between January 2005 and December 2011. In total, 104 patients with twin pregnancies were recruited. The association of first-trimester maternal serum-screening markers with perinatal complications was investigated for small-for-gestational-age (SGA) fetuses or intrauterine growth restriction (IUGR), preterm delivery (before 34 weeks of gestation), pregnancy-induced hypertension (PIH), and growth discordance between fetuses. Low serum PAPP-A (below 10th percentile) levels were not correlated with preterm labor, PIH, or IUGR in twin gestations. Elevated free β-hCG levels (>90th percentile) were linked to increased rates of PIH and small-for-gestational-age fetuses or IUGR. Elevated first-trimester free β-hCG was related to adverse pregnancy outcomes in twin pregnancies, whereas low PAPP-A levels were not linked to adverse pregnancy outcomes. © 2013 The Authors. Journal of Obstetrics and Gynaecology Research © 2013 Japan Society of Obstetrics and Gynecology.

  2. Committee Opinion No. 638: First-Trimester Risk Assessment for Early-Onset Preeclampsia.

    PubMed

    2015-09-01

    Hypertensive disorders with adverse sequelae (including preterm birth, maternal morbidity and mortality, and long-term risk of maternal cardiovascular disease) complicate 5-10% of pregnancies. Early identification of pregnant women at risk of developing early-onset preeclampsia would theoretically allow referral for more intensive surveillance or application of preventive therapies to reduce the risk of severe disease. In practice, however, the effectiveness of such triage would be hindered by the low positive predictive value for early-onset preeclampsia reported in the literature. In spite of the modest predictive value of first-trimester preeclampsia risk assessment and the lack of data demonstrating improved clinical outcomes, commercial tests are being marketed for the prediction of preeclampsia in the first trimester. Taking a detailed medical history to evaluate for risk factors is currently the best and only recommended screening approach for preeclampsia; it should remain the method of screening for preeclampsia until studies show that aspirin or other interventions reduce the incidence of preeclampsia for women at high risk based on first-trimester predictive tests.

  3. First Trimester Maternal Serum PP13 in the Risk Assessment for Preeclampsia

    PubMed Central

    ROMERO, Roberto; KUSANOVIC, Juan Pedro; THAN, Nandor Gabor; EREZ, Offer; GOTSCH, Francesca; ESPINOZA, Jimmy; EDWIN, Samuel; CHEFETZ, Ilana; GOMEZ, Ricardo; NIEN, Jyh Kae; SAMMAR, Marei; PINELES, Beth; HASSAN, Sonia S.; MEIRI, Hamutal; TAL, Yossi; KUHNREICH, Ido; PAPP, Zoltan; CUCKLE, Howard S.

    2008-01-01

    Objective To determine whether first trimester maternal serum Placental Protein 13 (PP13) concentrations can be used in the risk assessment for preeclampsia. Study Design This case-control study included 50 patients with preeclampsia and 250 patients with normal pregnancies. Samples were collected between 8-13 weeks of gestation. Serum PP13 concentrations were measured by ELISA and expressed as medians and multiples of the median (MoM) for gestational age. Sensitivity and specificity were derived from receiver operating characteristic curve analysis. Results 1) Serum PP13 concentration in the first trimester was significantly lower in patients who developed preterm and early-onset preeclampsia than in those with normal pregnancies; and 2) At 80% specificity, a cutoff of 0.39 MoM had a sensitivity of 100% for early-onset preeclampsia and 85% for preterm preeclampsia. Conclusion Maternal serum first trimester PP13 appears to be a reasonable marker for risk assessment, but a weak marker for severe preeclampsia at term, and ineffective for identifying mild preeclampsia at term. PMID:18539259

  4. Dynamic collagen changes in cervix during the first trimester and decreased collagen content in cervical insufficiency.

    PubMed

    Gedikbasi, Asuman; Yücel, Burak; Arslan, Oguz; Giris, Murat; Gedikbasi, Ali; Abbasoglu, Semra Dogru

    2016-09-01

    To determine the changes in cervical collagen during the first trimester of pregnancy and to evaluate the collagen deficit in cases with a previous diagnosis of cervical insufficiency (CI). Cervical punch biopsies were obtained from 66 patients divided into three groups: patients with recurrent abortions due to CI (CI group; n = 8); first-trimester abortion group (study group; n = 37), subdivided into three groups according their gestational week (<7, 7-9 and 9-12 weeks), and patients with cervical biopsy due to gynecologic reasons (control group; n = 12). Collagen quantity was determined by a biochemical method that measured the levels of hydroxyproline (HOP) in dry cervix tissue. The HOP concentrations were significantly higher at lower gestational ages (p = 0.001). Collagen quantity was lowest in the CI group compared with other groups (p < 0.001). This study shows collagen component of cervix decreases as pregnancy advances through the first trimester. Cervical collagen concentration is lower in women with a history of CI compared to controls who has not a history of CI.

  5. Plasticity of marrow mesenchymal stem cells from human first-trimester fetus: from single-cell clone to neuronal differentiation.

    PubMed

    Zhang, Yihua; Shen, Wenzheng; Sun, Bingjie; Lv, Changrong; Dou, Zhongying

    2011-02-01

    Recent results have shown that bone marrow mesenchymal stem cells (BMSCs) from human first-trimester abortus (hfBMSCs) are closer to embryonic stem cells and perform greater telomerase activity and faster propagation than mid- and late-prophase fetal and adult BMSCs. However, no research has been done on the plasticity of hfBMSCs into neuronal cells using single-cell cloned strains without cell contamination. In this study, we isolated five single cells from hfBMSCs and obtained five single-cell cloned strains, and investigated their biological property and neuronal differentiation potential. We found that four of the five strains showed similar expression profile of surface antigen markers to hfBMSCs, and most of them differentiated into neuron-like cells expressing Nestin, Pax6, Sox1, β-III Tubulin, NF-L, and NSE under induction. One strain showed different expression profile of surface antigen markers from the four strains and hfBMSCs, and did not differentiate toward neuronal cells. We demonstrated for the first time that some of single-cell cloned strains from hfBMSCs can differentiate into nerve tissue-like cell clusters under induction in vitro, and that the plasticity of each single-cell cloned strain into neuronal cells is different.

  6. ADAM12 and PAPP-A: Candidate regulators of trophoblast invasion and first trimester markers of healthy trophoblasts.

    PubMed

    Christians, Julian K; Beristain, Alexander G

    2016-03-03

    Proper placental development and function is crucial for a healthy pregnancy, and there has been substantial research to identify markers of placental dysfunction for the early detection of pregnancy complications. Low first-trimester levels of a disintegrin and metalloproteinase 12 (ADAM12) and pregnancy-associated plasma protein-A (PAPP-A) have been consistently associated with the subsequent development of preeclampsia and fetal growth restriction. These molecules are both metalloproteinases secreted by the placenta that cleave insulin-like growth factor binding proteins (IGFBPs), although ADAM12 also has numerous other substrates. Recent work has identified ADAM12, and particularly its shorter variant, ADAM12S, as a regulator of the migration and invasion of trophoblasts into the lining of the uterus, a critical step in normal placental development. While the mechanisms underlying this regulation are not yet clear, they may involve the liberation of heparin-binding EGF-like growth factor (HB-EGF) and/or IGFs from IGFBPs. In contrast, there has been relatively little functional work examining PAPP-A or the IGFBP substrates of ADAM12 and PAPP-A. Understanding the functions of these markers and the mechanisms underlying their association with disease could improve screening strategies and enable the development of new therapeutic interventions.

  7. Identification of fetal mesenchymal stem cells in maternal blood: implications for non-invasive prenatal diagnosis.

    PubMed

    O'Donoghue, K; Choolani, M; Chan, J; de la Fuente, J; Kumar, S; Campagnoli, C; Bennett, P R; Roberts, I A G; Fisk, N M

    2003-08-01

    Strategies for genetic prenatal diagnosis on fetal cells in the maternal circulation have been limited by lack of a cell type present only in fetal blood. However, the recent identification of mesenchymal stem cells (MSC) in first trimester fetal blood offers the prospect of targeting MSC for non-invasive prenatal diagnosis. We developed protocols for fetal MSC enrichment from maternal blood and determined sensitivity and specificity in mixing experiments of male fetal MSC added to female blood, in dilutions from 1 in 10(5) to 10(8). We then used the optimal protocol to isolate fetal MSC from maternal blood in the first trimester, using blood taken after surgical termination of pregnancy as a model of increased feto-maternal haemorrhage. In model mixtures, we could amplify one male fetal MSC in 2.5 x 10(7) adult female nucleated cells, yielding a 100% pure population of fetal cells, but not one fetal MSC in 10(8) nucleated cells. Fetal MSC were identified in one of 20 post-termination maternal blood samples and confirmed as fetal MSC by XY fluorescence in-situ hybridization (FISH), immunophenotyping and osteogenic and adipogenic differentiation. We report the isolation of fetal MSC from maternal blood; however, their rarity in post-termination blood suggests they are unlikely to have a role in non-invasive prenatal diagnosis. Failure to locate these cells routinely may be attributed to their low frequency in maternal blood, to sensitivity limitations of enrichment technology, and/or to their engraftment in maternal tissues soon after transplacental passage. We speculate that gender microchimerism in post-reproductive maternal tissues might result from feto-maternal trafficking of MSC in early pregnancy.

  8. The maternal age-related first trimester risks for trisomy 21, 18 and 13 based on Danish first trimester data from 2005 to 2014.

    PubMed

    Hartwig, Tanja Schlaikjaer; Sørensen, Steen; Jørgensen, Finn Stener

    2016-07-01

    Most currently used age-related risks of T21, T18 and T13 are based on estimates of the live-birth prevalence, and describe an exponential increase of risk by increased maternal age. We investigated the first trimester prevalence of T21, T18 and T13 in a large population of Danish women. From the Danish Cytogenetic Central Registry we got the information of all pre- and postnatally diagnosed fetuses with T21, T18 or T13 between 2005 and 2014 in Denmark. Information on the total number of births and maternal age at birth were gathered from StatBank Denmark. The total number of included women was 605 853. The total number of T21 cases was 1564, T18 cases was 401 and T13 cases was 157. The overall first trimester prevalence per 10 000 pregnancies was 25.8 for T21, 6.6 for T18 and 2.6 for T13. Boltzmann sigmoidal model (Y = Bottom + (top-bottom / (1 - exp (V50 - X) / slope)) was found to best describe the age-related risk of T21, T18 and T13. We found that the age-related risks are better described by sigmoidal functions, contrary to the widely assumed exponential functions. Our results indicate a lower age-related a priori risk of T21, T18 and T13 compared to widely used risk models. © 2016 John Wiley & Sons, Ltd. © 2016 John Wiley & Sons, Ltd.

  9. Central nervous system development-related microRNAs levels increase in the serum of gestational diabetic women during the first trimester of pregnancy.

    PubMed

    Lamadrid-Romero, M; Solís, K H; Cruz-Reséndiz, M S; Pérez, J E; Díaz, N F; Flores-Herrera, H; García-López, G; Perichart, O; Reyes-Muñoz, E; Arenas-Huertero, F; Eguía-Aguilar, P; Molina-Hernández, A

    2017-08-10

    MicroRNAs are heterochronic molecules important during brain development, which could be altered by gestational diabetes mellitus (GDM). To explore these molecules in maternal serum, we performed an RT-qPCR analysis. Our results revealed the heterochronic character of some neural development-related microRNA in serum samples of pregnant women. In relation to the first trimester, higher levels of miR-183-5p, -200b-3p, and -125-5p in the second trimester, and higher levels of miR-137 in the third trimester, were found. Furthermore, an insult such as GDM led to higher levels of miR-183-5p, -200b-3p, -125-5p, and -1290 relative to the control in the first trimester, which might be related to changes in neurogenesis and cell proliferation. An in silico analysis suggested that increased microRNAs in the second trimester in the control contributed to cell proliferation and neuron differentiation and that the rise in miR-137 in the third trimester led to neuron maturation. In the diabetic, higher levels of the microRNAs in the first trimester suggested alterations in cell proliferation and neuron differentiation. In conclusion, we showed that fetal-related microRNAs can be detected in the serum of pregnant woman and exhibit temporary regulation during pregnancy and that microRNAs involved in cell proliferation and neuron differentiation are upregulated under GDM. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

  10. Safety of artemether-lumefantrine exposure in first trimester of pregnancy: an observational cohort

    PubMed Central

    2014-01-01

    Background There is limited data available regarding safety profile of artemisinins in early pregnancy. They are, therefore, not recommended by WHO as a first-line treatment for malaria in first trimester due to associated embryo-foetal toxicity in animal studies. The study assessed birth outcome among pregnant women inadvertently exposed to artemether-lumefantrine (AL) during first trimester in comparison to those of women exposed to other anti-malarial drugs or no drug at all during the same period of pregnancy. Methods Pregnant women with gestational age <20 weeks were recruited from Maternal Health clinics or from monthly house visits (demographic surveillance), and followed prospectively until delivery. Results 2167 pregnant women were recruited and 1783 (82.3%) completed the study until delivery. 319 (17.9%) used anti-malarials in first trimester, of whom 172 (53.9%) used (AL), 78 (24.4%) quinine, 66 (20.7%) sulphadoxine-pyrimethamine (SP) and 11 (3.4%) amodiaquine. Quinine exposure in first trimester was associated with an increased risk of miscarriage/stillbirth (OR 2.5; 1.3–5.1) and premature birth (OR 2.6; 1.3–5.3) as opposed to AL with (OR 1.4; 0.8–2.5) for miscarriage/stillbirth and (OR 0.9; 0.5–1.8) for preterm birth. Congenital anomalies were identified in 4 exposure groups namely AL only (1/164[0.6%]), quinine only (1/70[1.4%]), SP (2/66[3.0%]), and non-anti-malarial exposure group (19/1464[1.3%]). Conclusion Exposure to AL in first trimester was more common than to any other anti-malarial drugs. Quinine exposure was associated with adverse pregnancy outcomes which was not the case following other anti-malarial intake. Since AL and quinine were used according to their availability rather than to disease severity, it is likely that the effect observed was related to the drug and not to the disease itself. Even with this caveat, a change of policy from quinine to AL for the treatment of uncomplicated malaria during the whole pregnancy period

  11. The association between perchlorate and thiocyanate exposure and thyroid function in first-trimester pregnant Thai women.

    PubMed

    Charatcharoenwitthaya, Natthinee; Ongphiphadhanakul, Boonsong; Pearce, Elizabeth N; Somprasit, Charintip; Chanthasenanont, Athita; He, Xuemei; Chailurkit, Laor; Braverman, Lewis E

    2014-07-01

    Thyroid hormone is critical for fetal neurodevelopment. Perchlorate and thiocyanate decrease thyroidal iodine uptake by competitively inhibiting the sodium/iodide symporter. It is clear that perchlorate and thiocyanate anions can influence thyroid function. However, as pollutants in the environment, their impact is conflicting. The objective was to determine the effects of environmental perchlorate and/or thiocyanate exposure on thyroid function in first-trimester pregnant women. A cross-sectional study was conducted in 200 pregnant Thai women with a gestational age of 14 weeks or less. Urinary iodide, perchlorate, thiocyanate, and serum thyroid function tests were measured. The women were aged 28.6 ± 6.1 years and the mean gestational age was 9.6 ± 2.7 weeks. Median urinary iodide, perchlorate, and thiocyanate concentrations were 153.5 μg/L, 1.9 μg/L, and 510.5 μg/L, respectively. Using Spearman's rank correlation analyses, there were positive correlations between serum TSH and urine perchlorate to creatinine (r = 0.20, P = .005) and TSH and thiocyanate to creatinine ratios (r = 0.22, P = .001). There were negative correlations between free T4 and the perchlorate to creatinine ratio (r = -0.18, P = .01) and free T4 and the thiocyanate to creatinine ratio (r = -0.19, P = .008). In multivariate analyses adjusting for log thiocyanate to creatinine ratio, log iodide to creatinine ratio, and gestational age, log perchlorate to creatinine ratio was positively associated with log TSH (P = .002) and inversely associated with log free T4 (P = .002). Log thiocyanate to creatinine ratio was a significant positive predictor of log TSH (P = .02) in women with a urine iodide level of less than 100 μg/L. Low-level environmental exposure to perchlorate and thiocyanate is common in Thailand. Low-level exposure to perchlorate is positively associated with TSH and negatively associated with free T4 in first-trimester pregnant women using multivariate analyses. In multivariate

  12. Impact of bias in crown-rump length measurement at first-trimester screening for trisomy 21.

    PubMed

    Kagan, K O; Hoopmann, M; Baker, A; Huebner, M; Abele, H; Wright, D

    2012-08-01

    To assess the repeatability of crown-rump length (CRL) measurement and examine the effect of its over- and underestimation on first-trimester combined screening. Intra- and interoperator repeatability of CRL measurement at 11-13 weeks of gestation was assessed in 124 cases by two operators. Raw data were transformed into gestational age and intra- and interoperator repeatability was evaluated by within-operator standard deviation (SD) and the SD of differences in measurements between both operators. Modeling techniques were used to assess the impact of CRL measurement error on general population screening and on the operator-specific screening performance. The impact of errors in CRL measurement were investigated by simulating fetal nuchal translucency (NT) measurements and multiple of the median (MoM) values for pregnancy-associated plasma protein A (PAPP-A) and free β-human chorionic gonadotropin (β-hCG) for 500 000 euploid and 500 000 trisomy 21 pregnancies at 12 weeks and 9 weeks of gestation, and adding to or subtracting from each CRL value up to 10 mm and recalculating patient-specific risks. Within-operator SD of the CRL measurement was 1.27 days of gestation. The SD of the differences in CRL measurement between operators was 1.37 days of gestation. Both intra- and interoperator 95% limits of agreement were around ± 5 mm. In general population-based screening, a CRL measurement error SD of 5 mm accounts for an estimated 5% of the SD of log MoM PAPP-A and less than 1% of the SD of log MoM free β-hCG. Modeling the effect of removing this measurement error on overall screening performance showed a minimal impact. For a risk cut-off of 1 in 100, the benefit in terms of overall screening performance would be an increase in detection rate of about 1% and a reduction in false-positive rate of less than 0.1%. With regard to the operator-specific screening performance, a consistent 5-mm underestimation of CRL reduces the detection rate from 84% to 79% and the

  13. Pregnancy outcome of first trimester exposure to the vitamin K antagonist phenprocoumon depends on duration of treatment.

    PubMed

    Hüttel, Eleanor; Padberg, Stephanie; Meister, Reinhard; Beck, Evelin; Schaefer, Christof

    2017-02-23

    The aim of this observational cohort study was to specify the risk of the vitamin K antagonist (VKA) phenprocoumon during first trimester of pregnancy, in particular to estimate the risk of birth defects and spontaneous fetal loss. Four hundred eight pregnancies with phenprocoumon exposure were compared to 1,642 pregnancies neither exposed to VKA nor to other major teratogens or fetotoxicants. There was no typical warfarin embryopathy in our exposed cohort. However, the overall rate of major birth defects was significantly increased (7.4 % vs 2.3 %; adjusted odds ratio [ORadj] 2.14; 95 % confidence interval [CI] 1.4-3.4). With early cessation until five completed gestational weeks the birth defect risk was similar to the comparison cohort (2.4 % vs 2.3 %; ORadj 1.07; 95 % CI 0.2-3.6). With treatment duration exceeding seven gestational weeks the rate of major birth defects increased up to five-fold (10.8 % vs 2.3 %; ORadj 5.18; 95 % CI 2.0-11.6). The overall risk of spontaneous abortion (SAB) was 38.0 % vs 17.5 % in the comparison cohort (adjusted hazard ratio (HRadj) 2.9; 95 % CI 2.2-3.9). The treatment duration had a significant effect on the hazard of SAB (HRadj 1.12; 95 % CI 1.01-1.25 per each additional exposure week). Phenprocoumon and other VKA carry an embryotoxic risk. This risk seems to be time-dependent with a steep risk increase for birth defects and also for fetal loss after week 5. If maternal disease permits, VKA therapy should be switched to safer alternatives such as heparins immediately after early recognition of pregnancy.

  14. First-Trimester Combined Screening Is Effective for the Detection of Unbalanced Chromosomal Translocations at 11 to 12 Weeks of Gestation

    PubMed Central

    Huang, ShangYu; Chang, ChiaLin; Hsiao, ChingHua; Soong, YungKuei; Duan, Tao

    2014-01-01

    The first trimester combined screening, which analyzes fetal nuchal translucency and levels of free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein A (PAPP-A) in maternal serum, is routinely used to detect abnormal pregnancies associated with Down syndrome and other trisomy aneuploidies. Based on the hypothesis that major chromosomal translocations could lead to similar biochemical and developmental outcomes during early embryo development, we compared these markers among pregnancies with normal, balanced, or unbalanced fetal karyotypes. Among the parents, 71 (73%) carry balanced reciprocal translocation and 26 (27%) have Robertsonian translocation. Of the 97 pregnancies tested, 39 (40%), 37 (37%), and 22 (23%) fetuses had normal karyotype, balanced chromosomal translocations, and unbalanced chromosomal translocations, respectively. Importantly, we found that pregnancies with an unbalanced translocation had significantly higher free β-hCG multiple of the median (MoM) and larger nuchal translucency thickness than those with normal karyotype or balanced translocations. Analysis showed that the area under a receiver operating characteristic curve (AUC) is 0.716, 0.820, and 0.936 for free β-hCG MoM, PAPP-A MoM, and fetal nuchal translucency, respectively. When these 3 independent factors were combined, the AUC reached 0.976. In addition, logistic regression showed that the most optimal model for predicting an unbalanced chromosomal translocation is a combination of PAPP-A and nuchal translucency with an AUC of 0.980. Therefore, the first trimester combined screening is not only effective in the screening of Down syndrome and other trisomy abnormalities but also has high sensitivity for the detection of unbalanced chromosomal translocations in fetuses. PMID:24177714

  15. Kisspeptin Regulation of Genes Involved in Cell Invasion and Angiogenesis in First Trimester Human Trophoblast Cells

    PubMed Central

    Matjila, Mushi; Millar, Robert P.; Katz, Arieh A.

    2014-01-01

    The precise regulation of extravillous trophoblast invasion of the uterine wall is a key process in successful pregnancies. Kisspeptin (KP) has been shown to inhibit cancer cell metastasis and placental trophoblast cell migration. In this study primary cultures of first trimester human trophoblast cells have been utilized in order to study the regulation of invasion and angiogenesis-related genes by KP. Trophoblast cells were isolated from first trimester placenta and their identity was confirmed by immunostaining for cytokeratin-7. Real-time quantitative RT-PCR demonstrated that primary trophoblast cells express higher levels of GPR54 (KP receptor) and KP mRNA than the trophoblast cell line HTR8Svneo. Furthermore, trophoblast cells also expressed higher GPR54 and KP protein levels. Treating primary trophoblast cells with KP induced ERK1/2 phosphorylation, while co-treating the cells with a KP antagonist almost completely blocked the activation of ERK1/2 and demonstrated that KP through its cognate GPR54 receptor can activate ERK1/2 in trophoblast cells. KP reduced the migratory capability of trophoblast cells in a scratch-migration assay. Real-time quantitative RT-PCR demonstrated that KP treatment reduced the expression of matrix metalloproteinase 1, 2, 3, 7, 9, 10, 14 and VEGF-A, and increased the expression of tissue inhibitors of metalloproteinases 1 and 3. These results suggest that KP can inhibit first trimester trophoblast cells invasion via inhibition of cell migration and down regulation of the metalloproteinase system and VEGF-A. PMID:24923321

  16. Glycosylated fibronectin as a first-trimester biomarker for prediction of gestational diabetes.

    PubMed

    Rasanen, Juha P; Snyder, Caryn K; Rao, Paturi V; Mihalache, Raluca; Heinonen, Seppo; Gravett, Michael G; Roberts, Charles T; Nagalla, Srinivasa R

    2013-09-01

    To evaluate the potential clinical utility of serum biomarkers for first-trimester prediction of gestational diabetes mellitus (GDM). Maternal serum concentrations of glycosylated (Sambucus nigra lectin-reactive) fibronectin, adiponectin, sex hormone-binding globulin, placental lactogen, and high-sensitivity C-reactive protein (CRP) were measured at 5-13 weeks of gestation in a case-control study of 90 pregnant women with subsequent development of GDM and in 92 control group participants. Ability to detect GDM was assessed using logistic regression modeling and receiver operating characteristic (ROC) curves. Classification performance and positive and negative predictive values were reported at specific thresholds. Glycosylated fibronectin variation across trimesters was evaluated using a serial-measures analysis of 35 nondiabetic control group participants. First-trimester serum concentrations of glycosylated fibronectin, adiponectin, high-sensitivity CRP, and placental lactogen were significantly associated (P<.001) with GDM. After adjustment for maternal factors and other biomarkers, glycosylated fibronectin demonstrated an independent association with GDM (P<.001). Adiponectin, high-sensitivity CRP, and placental lactogen demonstrated modest classification performance compared with glycosylated fibronectin (respectively: area under the curve [AUC] 0.63; 95% confidence interval [CI] 0.53-0.71; AUC 0.68; 95% CI 0.60-0.76; and AUC 0.67, 95% CI 0.59-0.75; compared with AUC 0.91; 95% CI 0.87-0.96). Glycosylated fibronectin levels above a threshold of 120 mg/L correctly identified 57 GDM case group participants with a positive predictive value of 63% (95% CI 53-72%) and a negative predictive value of 95% (95% CI 94-95%) at a population prevalence of 12%. There was no association between sex hormone-binding globulin and GDM. First-trimester glycosylated fibronectin is a potential pregnancy-specific biomarker for early identification of women at risk for GDM. II.

  17. Immunomodulatory molecules are released from the first trimester and term placenta via exosomes

    PubMed Central

    Kshirsagar, S.K.; Alam, S.M.; Jasti, S.; Hodes, H.; Nauser, T.; Gilliam, M.; Billstrand, C.; Hunt, J.S.; Petroff, M.G.

    2012-01-01

    The semiallogenic fetus is tolerated by the maternal immune system through control of innate and adaptive immune responses. Trophoblast cells secrete nanometer scale membranous particles called exosomes, which have been implicated in modulation of the local and systemic maternal immune system. Here we investigate the possibility that exosomes secreted from the first trimester and term placenta carry HLA-G and B7 family immunomodulators. Confocal microscopy of placental sections revealed intracellular colocalization of B7-H1 with CD63, suggesting that B7-H1 associates with subcellular vesicles that give rise to exosomes. First trimester and term placental explants were then cultured for 24 hours. B7H-1 (CD274), B7-H3 (CD276) and HLA-G5 were abundant in pelleted supernatants of these cultures that contained microparticles and exosomes; the latter, however, was observed only in first trimester pellets and was nearly undetectable in term explant-derived pellets. Further purification of exosomes by sucrose density fractionation confirmed the association of these proteins specifically with exosomes. Finally, culture of purified trophoblast cells in the presence or absence of EGF suggested that despite the absence of HLA-G5 association with term explant-derived exosomes, it is present in exosomes secreted from mononuclear cytotrophoblast cells. Further, differentiation of cytotrophoblast cells reduced the presence of HLA-G5 in secreted exosomes. Together, the results suggest that the immunomodulatory proteins HLA-G5, B7-H1 and B7-H3, are secreted from early and term placenta, and have important implications in the mechanisms by which trophoblast immunomodulators modify the maternal immunological environment. PMID:23107341

  18. Immunomodulatory molecules are released from the first trimester and term placenta via exosomes.

    PubMed

    Kshirsagar, S K; Alam, S M; Jasti, S; Hodes, H; Nauser, T; Gilliam, M; Billstrand, C; Hunt, J S; Petroff, M G

    2012-12-01

    The semiallogenic fetus is tolerated by the maternal immune system through control of innate and adaptive immune responses. Trophoblast cells secrete nanometer scale membranous particles called exosomes, which have been implicated in modulation of the local and systemic maternal immune system. Here we investigate the possibility that exosomes secreted from the first trimester and term placenta carry HLA-G and B7 family immunomodulators. Confocal microscopy of placental sections revealed intracellular co-localization of B7-H1 with CD63, suggesting that B7-H1 associates with subcellular vesicles that give rise to exosomes. First trimester and term placental explants were then cultured for 24 h. B7H-1 (CD274), B7-H3 (CD276) and HLA-G5 were abundant in pelleted supernatants of these cultures that contained microparticles and exosomes; the latter, however, was observed only in first trimester pellets and was nearly undetectable in term explant-derived pellets. Further purification of exosomes by sucrose density fractionation confirmed the association of these proteins specifically with exosomes. Finally, culture of purified trophoblast cells in the presence or absence of EGF suggested that despite the absence of HLA-G5 association with term explant-derived exosomes, it is present in exosomes secreted from mononuclear cytotrophoblast cells. Further, differentiation of cytotrophoblast cells reduced the presence of HLA-G5 in secreted exosomes. Together, the results suggest that the immunomodulatory proteins HLA-G5, B7-H1 and B7-H3, are secreted from early and term placenta, and have important implications in the mechanisms by which trophoblast immunomodulators modify the maternal immunological environment. Copyright © 2012 Elsevier Ltd. All rights reserved.

  19. Trimethoprim-sulfonamide use during the first trimester of pregnancy and the risk of congenital anomalies.

    PubMed

    Hansen, Craig; Andrade, Susan E; Freiman, Heather; Dublin, Sascha; Haffenreffer, Katie; Cooper, William O; Cheetham, T Craig; Toh, Sengwee; Li, De-Kun; Raebel, Marsha A; Kuntz, Jennifer L; Perrin, Nancy; Rosales, A Gabriela; Carter, Shelley; Pawloski, Pamala A; Maloney, Elizabeth M; Graham, David J; Sahin, Leyla; Scott, Pamela E; Yap, John; Davis, Robert

    2016-02-01

    Sulfonamide antibacterials are widely used in pregnancy, but evidence about their safety is mixed. The objective of this study was to assess the association between first-trimester sulfonamide exposure and risk of specific congenital malformations. Mother-infant pairs were selected from a cohort of 1.2 million live-born deliveries (2001-2008) at 11 US health plans comprising the Medication Exposure in Pregnancy Risk Evaluation Program. Mothers with first-trimester trimethoprim-sulfonamide (TMP-SUL) exposures were randomly matched 1:1 to (i) a primary comparison group (mothers exposed to penicillins and/or cephalosporins) and (ii) a secondary comparison group (mothers with no dispensing of an antibacterial, antiprotozoal, or antimalarial medication during the same time period). The outcomes were cardiovascular abnormalities, cleft palate/lip, clubfoot, and urinary tract abnormalities. We first identified 7615 infants in the TMP-SUL exposure group, of which 7595 (99%) were exposed to a combination of TMP-SUL and the remaining 1% to sulfonamides alone. After matching (1:1) to the comparator groups and only including those with complete data on covariates, there were 20 064 (n = 6688 per group) in the primary analyses. Overall, cardiovascular defects (1.52%) were the most common and cleft lip/palate (0.10%) the least common that were evaluated. Compared with penicillin/cephalosporin exposure, and no antibacterial exposure, TMP-SUL exposure was not associated with statistically significant elevated risks for cardiovascular, cleft lip/palate, clubfoot, or urinary system defects. First-trimester TMP-SUL exposure was not associated with a higher risk of the congenital anomalies studied, compared with exposure to penicillins and/or cephalosporins, or no exposure to antibacterials. Copyright © 2015 John Wiley & Sons, Ltd.

  20. Pregnancy Outcome After First Trimester Use of Methyldopa: A Prospective Cohort Study.

    PubMed

    Hoeltzenbein, Maria; Beck, Evelin; Fietz, Anne-Katrin; Wernicke, Juliane; Zinke, Sandra; Kayser, Angela; Padberg, Stephanie; Weber-Schoendorfer, Corinna; Meister, Reinhard; Schaefer, Christof

    2017-07-01

    Published experience on first trimester exposure to methyldopa is still limited, although it is recommended as first-line treatment for hypertensive disorders in pregnancy in most countries. The primary aim of this prospective observational cohort study was to analyze the rate of major birth defects and spontaneous abortions in women with methyldopa therapy for chronic hypertension. Outcomes of 261 pregnancies with first trimester exposure to methyldopa and 526 comparison pregnancies without chronic hypertension reported to the German Embryotox pharmacovigilance institute were evaluated. The rate of major birth defects in the exposed cohort was not significantly increased compared with the comparison cohort (3.7% versus 2.5%; adjusted odds ratio, 1.24; 95% confidence interval, 0.4-4.0). There was a tendency toward a higher rate of spontaneous abortions in exposed women. The risk of preterm birth was significantly higher, and adjusted birth weight scores were significantly lower in the methyldopa group. Head circumferences were significantly reduced in exposed boys only. There was neither evidence for an increased risk for birth defects or increase in early pregnancy loss nor evidence for growth restriction or a reduced head circumference in a sensitivity analysis comparing monotherapies with methyldopa to metoprolol. However, the significantly increased risk of preterm birth in methyldopa-treated pregnancies was confirmed. In conclusion, our study does not indicate a teratogenic risk of methyldopa. Further studies are needed to confirm its safety in the first trimester and clarify the influence of hypertension and methyldopa on preterm birth and intrauterine growth. URL: https://drks-neu.uniklinik-freiburg.de/drks_web/. Unique identifier: DRKS00010502. © 2017 American Heart Association, Inc.

  1. Assessment of patient acceptability of medical treatment in case of non-viable first trimester pregnancy.

    PubMed

    Tomasik, Paweł; Zwierzchowska, Aneta; Barcz, Ewa

    2015-05-01

    The aim of the present study was to assess patient acceptability and satisfaction with medical treatment (vaginal misoprostol) of non-viable first trimester pregnancy. A total of 64 women, treated with vaginal misoprostol for non-viable first trimester pregnancy between October 2012 and December 2012 at the First Department of Obstetrics and Gynecology Medical University of Warsaw, were included in this questionnaire-based study. Questions pertaining to advantages and disadvantages of misoprostol treatment as compared to potential surgical intervention were used. The respondents also determined whether they would choose medical treatment if they were to decide again. The Visual Analogue Scale (VAS) was used to assess pain and bleeding intensity. Medical treatment was successful in 57 and surgical treatment was needed in 7 women. Average pain and bleeding intensity were 5.8 and 5.3, respectively. The most common side effects included diarrhea (27%), dizziness (22.2%), nausea (15.9%), and chills (15.6%). The most important advantages of misoprostol therapy were avoidance of the risk of uterine perforation (96.4%) and formation of intrauterine adhesions (74.6%), whereas the most significant disadvantages were prolonged bleeding (21.4%), pain (21.4%), and longer treatment duration (42.9%). Overall, 95.6% of the patients with successful treatment outcome declared they would choose this procedure if they were to decide again, as compared to 85.6% of women with treatment failure (p > 0.05). Medical treatment with vaginal misoprostol is acceptable and well-tolerated by the vast majority of women with non-viable first trimester pregnancy. Satisfaction is expressed by both, respondents with successful as well as unsuccessful treatment outcome.

  2. Women's experiences with doula support during first-trimester surgical abortion: a qualitative study.

    PubMed

    Chor, Julie; Lyman, Phoebe; Tusken, Megan; Patel, Ashlesha; Gilliam, Melissa

    2016-03-01

    To explore how doula support influences women's experiences with first-trimester surgical abortion. We conducted semistructured interviews with women given the option to receive doula support during first-trimester surgical abortion in a clinic that uses local anesthesia and does not routinely allow support people to be present during procedures. Dimensions explored included (a) reasons women did or did not choose doula support; (b) key aspects of the doula interaction; and (c) future directions for doula support in abortion care. Interviews were transcribed, and computer-assisted content analysis was performed; salient themes are presented. Thirty women were interviewed: 19 received and 11 did not receive doula support. Reasons to accept doula support included (a) wanting companionship during the procedure and (b) being concerned about the procedure. Reasons to decline doula support included (a) a sense of stoicism and desiring privacy or (b) not wanting to add emotion to this event. Women who received doula support universally reported positive experiences with the verbal and physical techniques used by doulas during the procedure, and most women who declined doula support subsequently regretted not having a doula. Many women endorsed additional roles for doulas in abortion care, including addressing informational and emotional needs before and after the procedure. Women receiving first-trimester surgical abortion in this setting value doula support at the time of the procedure. This intervention has the potential to be further developed to help women address pre- and postabortion informational and emotional needs. In a setting that does not allow family or friends to be present during the abortion procedure, women highly valued the presence of trained abortion doulas. This study speaks to the importance of providing support to women during abortion care. Developing a volunteer doula service is one approach to addressing this need, especially in clinics that

  3. Kisspeptin regulation of genes involved in cell invasion and angiogenesis in first trimester human trophoblast cells.

    PubMed

    Francis, Víctor A; Abera, Aron B; Matjila, Mushi; Millar, Robert P; Katz, Arieh A

    2014-01-01

    The precise regulation of extravillous trophoblast invasion of the uterine wall is a key process in successful pregnancies. Kisspeptin (KP) has been shown to inhibit cancer cell metastasis and placental trophoblast cell migration. In this study primary cultures of first trimester human trophoblast cells have been utilized in order to study the regulation of invasion and angiogenesis-related genes by KP. Trophoblast cells were isolated from first trimester placenta and their identity was confirmed by immunostaining for cytokeratin-7. Real-time quantitative RT-PCR demonstrated that primary trophoblast cells express higher levels of GPR54 (KP receptor) and KP mRNA than the trophoblast cell line HTR8Svneo. Furthermore, trophoblast cells also expressed higher GPR54 and KP protein levels. Treating primary trophoblast cells with KP induced ERK1/2 phosphorylation, while co-treating the cells with a KP antagonist almost completely blocked the activation of ERK1/2 and demonstrated that KP through its cognate GPR54 receptor can activate ERK1/2 in trophoblast cells. KP reduced the migratory capability of trophoblast cells in a scratch-migration assay. Real-time quantitative RT-PCR demonstrated that KP treatment reduced the expression of matrix metalloproteinase 1, 2, 3, 7, 9, 10, 14 and VEGF-A, and increased the expression of tissue inhibitors of metalloproteinases 1 and 3. These results suggest that KP can inhibit first trimester trophoblast cells invasion via inhibition of cell migration and down regulation of the metalloproteinase system and VEGF-A.

  4. Cost-effectiveness analysis of alternative first-trimester pregnancy termination strategies in Mexico City.

    PubMed

    Hu, D; Grossman, D; Levin, C; Blanchard, K; Goldie, S J

    2009-05-01

    To assess the comparative health and economic outcomes associated with three alternative first-trimester abortion techniques in Mexico City and to examine the policy implications of increasing access to safe abortion modalities within a restrictive setting. Cost-effectiveness analysis. Mexico City. Reproductive-aged women with unintended pregnancy seeking first-trimester abortion. Synthesising the best available data, a computer-based model simulates induced abortion and its potential complications and is used to assess the cost-effectiveness of alternative safe modalities for first-trimester pregnancy termination: (1) hospital-based dilatation and curettage (D&C), (2) hospital-based manual vacuum aspiration (MVA), (3) clinic-based MVA and (4) medical abortion using vaginal misoprostol. Number of complications, lifetime costs, life expectancy, quality-adjusted life expectancy. In comparison to the magnitude of health gains associated with all safe abortion modalities, the relative differences between strategies were more pronounced in terms of their economic costs. Assuming all options were equally available, clinic-based MVA was the least costly and most effective. Medical abortion with misoprostol provided comparable benefits to D&C, but cost substantially less. Enhanced access to safe abortion was always more influential than shifting between safe abortion modalities. This study demonstrates that the provision of safe abortion is cost-effective and will result in reduced complications, decreased mortality and substantial cost savings compared with unsafe abortion. In Mexico City, shifting from a practice of hospital-based D&C to clinic-based MVA and enhancing access to medical abortion will have the best chance to minimise abortion-related morbidity and mortality.

  5. Diagnosis of Pentalogy of Cantrell in the First Trimester Using Transvaginal Sonography and Color Doppler

    PubMed Central

    Türkçapar, Ayşe Figen; Sargın Oruc, Ayla; Öksüzoglu, Aysegül; Danışman, Nuri

    2015-01-01

    We report the prenatal diagnosis of Cantrell syndrome in the first trimester. During a routine transabdominal ultrasonographic examination, a midline supraumbilical abdominal wall defect including herniated liver and ectopia cordis with a large omphalocele containing the intestines and cystic hygroma was incidentally identified at the 12th week of gestation. A transvaginal sonography examination revealed a severe lumbosacral scoliosis in addition to the inability to visualize the abdominal aorta which was indicative of a severe intracardiac defect. The parents opted for pregnancy to be terminated. In this case report, we discuss the complementary role of transvaginal sonography and Doppler imaging in the diagnosis of Cantrell syndrome in early pregnancy. PMID:25802780

  6. A molar masquerading as an ectopic pregnancy in the early first trimester: a salutary lesson.

    PubMed

    Govind, Abha; Lakhi, Nisha

    2012-01-01

    The authors report a case in which a molar pregnancy was mistaken for an ectopic pregnancy in the early first trimester. This confusion delayed diagnosis and caused distress; follow-up led to the final diagnosis of complete hydatidiform mole. Correct preoperative diagnosis of molar pregnancy by ultrasound in early pregnancy may be tricky. It is important to obtain histological evidence to make the final diagnosis of gestational trophoblastic disease. While relatively rare, consideration of molar pregnancy in the differential diagnosis of early pregnancy loss may avoid unnecessary distress.

  7. A molar masquerading as an ectopic pregnancy in the early first trimester: a salutary lesson

    PubMed Central

    Govind, Abha; Lakhi, Nisha

    2012-01-01

    The authors report a case in which a molar pregnancy was mistaken for an ectopic pregnancy in the early first trimester. This confusion delayed diagnosis and caused distress; follow-up led to the final diagnosis of complete hydatidiform mole. Correct preoperative diagnosis of molar pregnancy by ultrasound in early pregnancy may be tricky. It is important to obtain histological evidence to make the final diagnosis of gestational trophoblastic disease. While relatively rare, consideration of molar pregnancy in the differential diagnosis of early pregnancy loss may avoid unnecessary distress. PMID:22956887

  8. Identification and localization of netrin-4 and neogenin in human first trimester and term placenta.

    PubMed

    Dakouane-Giudicelli, M; Duboucher, C; Fortemps, J; Salama, S; Brulé, A; Rozenberg, P; de Mazancourt, P

    2012-09-01

    We describe here for the first time the characterization of family member of netrins, netrin-4 and its receptor neogenin, during the development of the placenta. By using western blots and RT-PCR, we demonstrated the presence of netrin-4 and its receptor neogenin protein as well as their transcripts. Using immunohistochemistry, we studied the distribution of netrin-4 and neogenin in both the first trimester and term placenta. We observed staining of netrin-4 in villous and extravillous cytotrophoblasts, syncytiotrophoblast, and endothelial cells whereas staining in stromal cells was faint. In decidua, we observed netrin-4 labelling in glandular epithelial cells, perivascular decidualized cells, and endothelial cells. However, neogenin was absent in villous and extravillous cytotrophoblasts and was expressed only on syncytiotrophoblast and placental stromal cells in the first trimester and at term placenta. The pattern of distribution suggests that a functional netrin-4-neogenin pathway might be restricted to syncytiotrophoblasts, mesenchymal cells, and villous endothelial cells. This pathway function might vary with its localization in the placenta. It is possibly involved in angiogenesis, morphogenesis, and differentiation. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  9. Thyroid function tests during first-trimester of pregnancy: a review of literature.

    PubMed

    Mansourian, Azad R

    2010-07-15

    This literature review was conducted to summarize the main points of maternal thyroid function tests, with particular attention in the first trimester of pregnancy which accompanied with significant biochemical and metabolic alteration. The evaluation of thyroid function of either hyperthyroidism and hypothyroidism should be assessed by determination of serum Thyroid Stimulating Hormone (TSH), Thyroxine (T4), Triiodothyronine (T3), Iodine and Thyroid Autoantibodies. Glomerular filtration rate is increased during pregnancy; therefor iodine deficiency should be evaluated during the pregnancy to prevent hypothyroidism. The role which can be played by Human Chronic Gonadotropin (hCG) on stimulating the thyroid gland to become over-active was investigated. Serum level ofthyroglobulin (Tg) and Thyroxin Binding Globulin (TBG) should be assessed for proper assessments of thyroid gland during pregnancy. Thyroid function tests during first-trimester of pregnancy and particularly the reference interval for thyroid function tests for pregnant women in each region has to be established, to prevent mis-diagnosis and irreversible mental and physical adverse affect for growing fetus.

  10. Prenatal diagnosis of Cantrell pentalogy in first trimester screening: case report and review of literature

    PubMed Central

    Ergenoğlu, Mete Ahmet; Yeniel, A. Özgür; Peker, Nuri; Kazandı, Mert; Akercan, Fuat; Sağol, Sermet

    2012-01-01

    Pentalogy of Cantrell is a heterogeneous and rare thoraco-abdominal wall closure defect with the estimated prevalence of 1/65.000 to 1/200.000 births. Supraumbilical midline wall defect (generally omphalocele), deficiency of the anterior diaphragm and diaphragmatic peritoneum, defect of the lower sternum and several intracardiac defects are the components of Cantrell pentalogy. Etiology is unknown but a defect on the lateral mesoderm during the early stage of pregnancy is the most accepted hypothesis. Nowadays both 2- dimensional (2D) and 3-dimensional (3D) sonography are commonly used in diagnosis. In our case, a fetus with 11 weeks of gestation was reported as Cantrell pentalogy during first trimester screening. Additionally, unilateral limb defect and lumbar lordoscoliosis were detected through 3D sonography. Pregnancy was terminated according to parental desire. Karyotype was 46 XY. Early diagnosis is feasible in the first trimester if ectopia cordis and omphalocele exist. Additionally, development in ultrasound technology provides us with better visualization and early diagnosis. Prognosis seems to be poor in patients with complete Cantrell syndrome and patients with associated anomalies. Termination is the choice of treatment. Early diagnosis gives us a chance to reduce maternal morbidity and mortality related to termination. PMID:24592026

  11. Patterns and predictors of vaginal bleeding in the first trimester of pregnancy

    PubMed Central

    Hasan, Reem; Baird, Donna D.; Herring, Amy H.; Olshan, Andrew F.; Jonsson Funk, Michele L.; Hartmann, Katherine E.

    2010-01-01

    Purpose Although first-trimester vaginal bleeding is an alarming symptom, few studies have investigated the prevalence and predictors of early bleeding. This study characterizes first trimester bleeding, setting aside bleeding that occurs at time of miscarriage. Methods Participants (n=4539) were women ages 18–45 enrolled in Right From the Start, a community-based pregnancy study (2000–2008). Bleeding information included timing, heaviness, duration, color, and associated pain, as well as recurrence risk in subsequent pregnancies. Life table analyses were used to describe gestational timing of bleeding. Factors associated with bleeding were investigated using multiple logistic regression, with multiple imputation for missing data. Results Approximately one-fourth of participants (n=1207) reported bleeding (n=1656 episodes), but only 8% of women with bleeding reported heavy bleeding. Of the spotting and light bleeding episodes (n=1555), 28% were associated with pain. Among heavy episodes (n=100), 54% were associated with pain. Most episodes lasted less than 3 days, and most occurred between gestational weeks 5–8. Twelve percent of women with bleeding and 13% of those without experienced miscarriage. Maternal characteristics associated with bleeding included fibroids and prior miscarriage. Conclusions Consistent with the hypothesis that bleeding is a marker for placental dysfunction, bleeding is most likely to be seen around the time of the luteal-placental shift. PMID:20538195

  12. Synthetic Receptors Induce Anti Angiogenic and Stress Signaling on Human First Trimester Cytotrophoblast Cells.

    PubMed

    Pantho, Ahmed F; Price, Mason; Ashraf, Ahm Zuberi; Wajid, Umaima; Khansari, Maryam Emami; Jahan, Afsana; Afroze, Syeda H; Rhaman, Md Mhahabubur; Johnson, Corey R; Kuehl, Thomas J; Hossain, Md Alamgir; Uddin, Mohammad Nasir

    2017-05-11

    The cytotrophoblast (CTB) cells of the human placenta have membrane receptors that bind certain cardiotonic steroids (CTS) found in blood plasma. One of these, marinobufagenin, is a key factor in the etiology of preeclampsia. Herein, we used synthetic receptors (SR) to study their effectiveness on the angiogenic profile of human first trimester CTB cells. The humanextravillous CTB cells (Sw.71) used in this study were derived from first trimester chorionic villus tissue. Culture media of CTB cells treated with ≥1 nM SR level revealed sFlt-1 (Soluble fms-like tyrosine kinase-1) was significantly increased while VEGF (vascular endothelial growth factor) was significantly decreased in the culture media (* p < 0.05 for each) The AT₂ receptor (Angiotensin II receptor type 2) expression was significantly upregulated in ≥1 nM SR-treated CTB cells as compared to basal; however, the AT₁ (Angiotensin II receptor, type 1) and VEGFR-1 (vascular endothelial growth factor receptor 1) receptor expression was significantly downregulated (* p < 0.05 for each). Our results show that the anti-proliferative and anti-angiogenic effects of SR on CTB cells are similar to the effects of CTS. The observed anti angiogenic activity of SR on CTB cells demonstrates that the functionalized-urea/thiourea molecules may be useful as potent inhibitors to prevent CTS-induced impairment of CTB cells.

  13. First trimester placental volume and vascular indices in pregnancies complicated by preeclampsia.

    PubMed

    Plasencia, Walter; González-Dávila, Enrique; González Lorenzo, Alejandra; Armas-González, Marina; Padrón, Erika; González-González, Nieves L

    2015-12-01

    To analyze placental volume and vascularization at first trimester in women with pre-eclampsia, and secondarily, the effect of maternal characteristics on placental development and perinatal outcomes. This was a prospective cohort study including women seen between 11 and 14 weeks of pregnancy. Biophysical and biochemical markers included in the screening program for aneuploidy were recorded. Placental volume and vascularization indices were obtained using three-dimensional power-Doppler imaging and Virtual Organ Computer-aided Analysis (VOCAL) techniques. We compared 84 women with pre-eclampsia versus 904 non-affected. Placental volume and all vascular indices were lower in those with pre-eclampsia. Multivariate analysis showed that parity and maternal weight had a significant effect on placental volume and vascularization indices (p = 0.004 and p = 0.011). In women with pre-eclampsia, multiparity showed a negative effect on placental volume, gestational age, birth weight and Apgar test score. By contrast, in the non-affected group, multiparity had a protective effect. Low maternal weight had a significantly worse effect on placental vascularization and perinatal outcomes in women with pre-eclampsia. Women with pre-eclampsia showed significantly lower placental volume and vascularization indices at first trimester. Multiparity and low maternal weight independently exacerbated the negative effects of pre-eclampsia on placental characteristics and perinatal outcomes. © 2015 John Wiley & Sons, Ltd. © 2015 John Wiley & Sons, Ltd.

  14. [Application of ultrasonic monitoring in induced abortion during the first trimester].

    PubMed

    Peng, Ping; Liu, Xin-yan; Dai, Qing; Cui, Quan-cai; Lang, Jing-he; Liu, Shi-ping

    2010-10-01

    To evaluate the value of ultrasonic monitoring in induced abortion during the first trimester. Totally 110 healthy women with a singleton pregnancy between 9 and 11 gestational weeks were enrolled. All the procedures of induced abortion were performed routinely. Ultrasonography was performed when the procedure of induced abortion was completed. Patients with normal ultrasonographic results were assigned in the control group, while patients with abnormal ultrasonographic findings were enrolled in the study group,in which these patients underwent further operations until the ultrasonography showed clear endomembrane line. All the recurretaged tissue in the study group were sent for pathological examinations. Of these 110 patients, 28 (25.5%) entered study group and 82 (74.5%) entered control group. In the study group, trophoblastic cell or chorion was found in the recurretaged tissue in 11 patients (39.3%), in which 3 had trophoblastic cell embedded in smooth muscular tissue, 6 had pathologic deciduas, and 11 had pathologic secretory endometria. In this control group,1 patient (0.9%) had retained products of conception. The operation duration [(20.6∓2.1) min vs.(11.5∓3.5) min, P0.05]. Ultrasonic monitoring in induced abortion during the first trimester can decrease the incidence of retained products of conception and will not induce endometrial damage. It is especially useful for women whose fetuses were at older gestational ages.

  15. Comparison of gemeprost and vaginal misoprostol in first trimester mifepristone-induced abortion.

    PubMed

    Svendsen, Pernille Fog; Rørbye, Christina; Vejborg, Thomas; Nilas, Lisbeth

    2005-07-01

    The aim of this study was to compare efficacy and side effects of gemeprost and vaginal misoprostol in mifepristone-induced abortions in women up to 63 days of gestation. A retrospective study of 833 consecutive patients admitted for medical termination of first trimester pregnancy was conducted. Four-hundred ten patients received mifepristone 600 mg, followed 48 h later by gemeprost 1 mg (regimen I), and 423 patients received mifepristone 200 mg followed by vaginal misoprostol 800 microg (regimen II). Success rates were evaluated after 2 weeks and after 3 months. The severity of bleeding and side effects (pain, nausea, vomiting and diarrhea) was scored by the patients, and requests for supplementary analgesic treatment were recorded by the attending nurse. Success rates were 99% in both groups after 2 weeks of follow-up. At 3 months of follow-up, success rates had declined to 94% for regimen I and 96% for regimen II. The frequency of severe pain was higher in regimen I compared to regimen II (72% vs. 60%, p < .001), but the severity of bleeding and gastrointestinal side effects was similar in the two regimens. When combined with mifepristone, gemeprost and vaginal misoprostol are equally effective for termination of first trimester abortion, but may be associated with varying intensity of side effects.

  16. Practice bulletin no. 143: medical management of first-trimester abortion.

    PubMed

    2014-03-01

    Over the past three decades, medical methods of abortion have been developed throughout the world and are now a standard method of providing abortion care in the United States. Medical abortion, which involves the use of medications rather than a surgical procedure to induce an abortion, is an option for women who wish to terminate a first-trimester pregnancy. Although the method is most commonly used up to 63 days of gestation (calculated from the first day of the last menstrual period), the treatment also is effective after 63 days of gestation. The Centers for Disease Control and Prevention estimates that 64% of abortions are performed before 63 days of gestation (1). Medical abortions currently comprise 16.5% of all abortions in the United States and 25.2% of all abortions at or before 9 weeks of gestation (1). Mifepristone, combined with misoprostol, is the most commonly used medical abortion regimen in the United States and Western Europe; however, in parts of the world, mifepristone remains unavailable. This document presents evidence of the effectiveness, benefits, and risks of first-trimester medical abortion and provides a framework for counseling women who are considering medical abortion.

  17. Informed choice in women attending private clinics to undergo first-trimester screening for Down syndrome.

    PubMed

    Jaques, Alice M; Sheffield, Leslie J; Halliday, Jane L

    2005-08-01

    Informed choice for prenatal screening has long been considered an essential aspect of service provision, and has been researched extensively in the second trimester. This study aims at examining whether women having first-trimester screening in a private clinic had made an informed choice. A cross-sectional survey recruited women having first-trimester screening at specialist ultrasound practices. Two questionnaires containing a validated Multidimensional Measure of Informed Choice (MMIC) were self-administered pre- and post-screening. MMIC was completed by 81% (163/202) of women. Ninety-nine percent of women had a positive attitude towards screening, therefore informed choice was essentially measured on knowledge alone. Pre-screening, 68% made an informed choice, compared with 74% post-screening (chi2 = 1.6, p = 0.21 (McNemar)). Knowledge was associated with education level, information sources and perception of screening as routine or optional. The Australasian Guidelines on prenatal screening state that all women having testing should be provided with written information, and it should be ensured that they have appropriate understanding of the test(s). These guidelines are not being met, even in private clinical care. Health professionals should ensure that all women are provided with suitable information about prenatal screening that is tailored to their level of education and individual needs, and should emphasise that screening is optional. Copyright 2005 John Wiley & Sons, Ltd.

  18. Introduction of first trimester combined test increases uptake of Down's syndrome screening.

    PubMed

    Tringham, Gillian M; Nawaz, Tariq S; Holding, Stephen; Mcfarlane, Jane; Lindow, Stephen W

    2011-11-01

    To describe any trends in the uptake of antenatal screening for Down's syndrome since the addition of the earlier first trimester combined test. All antenatal screening tests for Down's syndrome were carried out and their results were recorded by the Clinical Biochemistry Department at the Hull Royal Infirmary (HRI) and reviewed against the antenatal booking data held at the Women and Children's Hospital at HRI. The uptake of antenatal Down's syndrome screening for 5 different age groups of women across a four-year-period from 2007 to 2010 was analysed. There was a significant increase in uptake of antenatal screening for Down's syndrome from 43.9% to 56.5% after the introduction of the combined test in 2010. This increase was apparent in all age groups. There was no change in the proportion of women opting for an invasive test following a positive screening test. Addition of the earlier first trimester combined test has increased uptake of antenatal screening for Down's syndrome in women of all ages. This is most likely due to the advantages this test gives women such as earlier decision making, earlier further invasive diagnostic testing and earlier termination, if necessary. Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

  19. [First-trimester screening for trisomies 18 and 13 with the combined use of the risk algorithms for trisomy 21, 18 and 13].

    PubMed

    Lüthgens, K; Hoopmann, M; Alkier, R; Abele, H; Yazdi, B; Kagan, K

    2012-12-01

    Assessment of first-trimester combined screening for trisomy 18 and 13 with the combined use of the risk algorithms for trisomy 21, 18 and 13. First-trimester combined screening based on maternal and gestational age, fetal NT, PAPP-A and free β-hCG was assessed in 39 ,004 pregnancies. Patient-specific risks for trisomy 21, 18, 13 were computed based on the current FMF London algorithm. The study population consisted of 38 ,751 singleton pregnancies including 39 cases with trisomy 18 or 13. In the aneuploid group, median delta NT was 0.72 mm, PAPP-A was 0.21 MoM and free β-hCG was 0.33 MoM. Although only 41 % of the NT measurements of fetuses with trisomy 18 or 13 were above the 95th percentile, the detection rates for trisomy 18 or 13 were 82 % with the trisomy 18/13 algorithm and 56.4 % with the trisomy 21 algorithm. The respective false-positive rates were 0.7 % and 4.7 %. The combination of the trisomy 18/13 and the trisomy 21 algorithm with the same cut-offs led to a detection rate of 94.9 % at an overall false-positive rate of 5.0 %. Despite a substantial underestimation of the fetal NT, the combined use of the trisomy 18/13 and the trisomy 21 algorithm of the FMF London leads to a detection rate for trisomy 18/13 of about 95 % for a false-positive rate of 5.0 %. © Georg Thieme Verlag KG Stuttgart · New York.

  20. The assessment of combined first trimester screening in women of advanced maternal age in an Asian cohort

    PubMed Central

    Li, Sarah Weiling; Barrett, Angela Natalie; Gole, Leena; Tan, Wei Ching; Biswas, Arijit; Tan, Hak Koon; Choolani, Mahesh

    2015-01-01

    INTRODUCTION First trimester screening (FTS) is a validated screening tool that has been shown to achieve detection rates of 84%–90% for trisomies 21, 18 and 13. However, its effectiveness for different maternal ages has not been assessed. The present study aimed to assess the performance of FTS in an Asian population, and to compare its effectiveness in older (≥ 35 years) and younger (< 35 years) women. The potential use of noninvasive prenatal test (NIPT) as a contingent screening test is also examined. METHODS Data on cases of FTS performed on singleton pregnancies over a six-year period was collated from two Singapore maternal centres, National University Hospital and Singapore General Hospital. Cases that had a 1:250 risk of trisomy were considered to be screen-positive. Pregnancy outcomes were obtained from birth records or karyotype test results. RESULTS From 10,289 FTS cases, we obtained a sensitivity of 87.8%, a specificity of 97.6%, a false positive rate of 2.4% and a false negative rate of 0.06% for the detection of aneuploidy. The overall detection rate for trisomy 21 was 86.5%–85.7% for older women and 87.5% for younger women. The mean number of invasive tests required per case of trisomy 21 was 9.3 in younger women, 8.6 in older women and 13.5 in women with intermediate risk (1:250–1,000). CONCLUSION While the performance of FTS was similar in younger and older women, more invasive procedures were required to diagnose trisomy 21 in women with intermediate risk. It may be advantageous to offer contingent NIPT to this group of women to reduce the risk of iatrogenic fetal loss. PMID:25640099

  1. A reassessment of biochemical marker distributions in trisomy 21-affected and unaffected twin pregnancies in the first trimester.

    PubMed

    Madsen, H N; Ball, S; Wright, D; Tørring, N; Petersen, O B; Nicolaides, K H; Spencer, K

    2011-01-01

    To estimate the difference between levels of the two biochemical markers pregnancy-associated plasma protein-A (PAPP-A) and maternal serum free β-human chorionic gonadotropin (free β-hCG) in twin pregnancies relative to singleton pregnancies and establish an improved screening procedure for chromosomal abnormalities such as trisomy 21 in twin pregnancies. 4843 unaffected and 47 trisomy 21-affected twin pregnancies were included in the study. Chorionicity-specific medians were generated for PAPP-A and free β-hCG from gestational ages 8 to 14 weeks. Multiple of the median values for each of the biochemical markers were calculated. Detection rates and false-positive rates were estimated for screening tests incorporating nuchal translucency and maternal age, with and without biochemistry. Medians for the two biochemical markers for monochorionic and dichorionic twins in unaffected pregnancies show a gestational age-specific increase relative to singleton medians. Allowing for gestation and chorionicity, twin pregnancies affected with trisomy 21 had higher levels of free β-hCG and lower levels of PAPP-A. Adding biochemistry into the risk assessment using a fixed risk cut-off of 1 in 100 increased the detection rate for fetal trisomy 21 in dizygotic twin pregnancies from 78 to 90%, and decreased the false-positive rate from 8.0 to 5.9%. Generation of chorionicity-specific medians for the biochemical markers and their use in risk assessment can improve the performance of first-trimester screening for chromosomal abnormalities in twins to a level comparable with that in singleton pregnancies.

  2. Evidence for the biosynthesis of DHEA from cholesterol by first-trimester human placental tissue: source of androgens.

    PubMed

    Loganath, A; Peh, K L; Wong, P C

    2002-03-01

    With a view to establishing whether first-trimester human placentas possess the ability to synthesize DHEA from cholesterol, homogenates of this tissue obtained from two groups of women undergoing elective termination of normally progressing pregnancy between 10 - 12 weeks gestation (n = 5, age 23 - 29 years and n = 5, age 21 - 27 years) were incubated separately with [26-(14)C]cholesterol for the generation of [14C]isocaproic acid + pregnenolone and [7n-3H]pregnenolone for the biosynthesis of [3H]DHEA. Controls consisted of homogenates heated in a boiling water bath for 10 min. Using the reverse-isotope dilution analysis, desmolase efficiency expressed as mean specific activity of [14C]isocaproic acid varied from 282 to 725 dpm/mmol, while that of 17 alpha-hydroxylase and steroid C-17,20-lyase, catalyzed conversion of [7n-3H]pregnenolone to [3H]DHEA varied from 3498 to 26 258 dpm/mmol. The corresponding efficiencies of enzymicconversion varied between 5.8 x 10( -2) and 1.5 x 10( -1) % for [14C]isocaproic acid, but between 5.5 x 10( -2) and 4.1 x 10( -1) % for [3H]DHEA. No such metabolite was evident in the controls of heat-denatured homogenates. These are the first study results to demonstrate that early placentas are capable of converting cholesterol to pregnenolone to DHEA, contrary to the widely held concept of DHEA production by fetal and maternal adrenal glands. This finding has important physiological implications and could provide a new dimension to the concept of fetoplacental steroidogenesis.

  3. Dosimetric data for the fetus derived from an anatomical model of its mother at the end of the first trimester

    SciTech Connect

    Davis, J.L.; Stabin, M.G.; Cristy, M.; Ryman, J.C.

    1986-01-01

    We discuss a study of the radiation transport of monoenergetic photons within a mathematical phantom of the pregnant female at the end of the first trimester. This phantom was developed from the adult female member of the ORNL phantom series with modifications reflecting anatomical changes at this stage of pregnancy. This geometry was incorporated into the ALGAMP Monte Carlo radiation transport code used at ORNL with the phantom series. For internal sources of radiation the emission of 60,000 monoenergetic photons at each of 12 energies within 30 organs of the body was simulated. Energy deposition within 158 regions of the body, including uterine wall, uterine contents, and 12 subregions within the contents, was tabulated. The results are presented in terms of the specific absorbed fraction, i.e., the fraction of the photon energy emitted within a source organ that is absorbed per unit mass of the target region. The specific absorbed fraction data are commonly used to evaluate the dose associated with internal emitters, e.g., from administered radiopharmaceuticals. Additional calculations have been performed for a uniform, isotropic field of photons incident on the surface of the phantom; these data provide information on the shielding of the fetus by the mother and are of interest in evaluation of doses from external radiation fields. In this study we have provided dosimetric information useful in making quantitative risk estimates for the developing fetus. Our investigations demonstrate that even at this early stage in pregnancy the effective dose equivalent to the mother cannot be used as an index of the dose equivalent to the fetus. Further efforts will be directed to consideration of later stages in fetal development and consideration of irradiation by external neutron fields.

  4. How should success be defined when attempting medical resolution of first-trimester missed abortion?

    PubMed

    Reynolds, A; Ayres-de-Campos, D; Costa, M A; Montenegro, N

    2005-01-10

    There is currently no consensus on how success should be defined after medical management of first-trimester missed abortion. The aim of this study was to determine the transvaginal ultrasound criterion associated with highest success rate and, at the same time, lowest long-term complications. Prospective observational study of consecutively enrolled patients. A tertiary care university hospital in northern Portugal. Forty-four women submitted to medical management of first-trimester missed abortion using a regimen of vaginal misoprostol, with histologically confirmed conception products passed vaginally. A transvaginal ultrasound scan was performed by an experienced sonographer in the morning after treatment, to characterise uterine content. Patients were provided with a chart for daily registration of axillary temperature, vaginal bleeding and lower abdominal pain. Transvaginal ultrasound was repeated 2-3 weeks later, and again after the following menses. Success rates of medical management when post-treatment transvaginal ultrasound criteria for subsequent expectant management were: absence of intra-uterine sac, largest anteroposterior diameter of hyperechogenic content, and maximum area of hyperechogenic intra-uterine content in a sagittal view. Self-reported duration of vaginal bleeding and abdominal pain after medical treatment. Success rate was 86% (38/44) when absence of gestational sac on the 12 h transvaginal ultrasound was used as the main criterion for subsequent expectant management and there was no need for further intervention. The success rate using the ultrasound criterion anteroposterior diameter < or = 15 mm was 51% (22/43), and with maximum sagittal plane area under 7.5 cm(2), 72% (31/43). Mean duration of vaginal haemorrhage was 9 days (minimum 2 days, maximum 14 days) and of lower abdominal pain 6 days (minimum 0 days, maximum 14 days). No patient recorded an axillary temperature exceeding 37 degrees C. No apparent relationship between the

  5. Women’s experiences with doula support during first-trimester surgical abortion: A qualitative study

    PubMed Central

    Chor, Julie; Lyman, Phoebe; Tusken, Megan; Patel, Ashlesha; Gilliam, Melissa

    2015-01-01

    Objective To explore how doula support influences women’s experiences with first-trimester surgical abortion. Study Design We conducted semi-structured interviews with women given the option to receive doula support during first-trimester surgical abortion in a clinic that uses local anesthesia and does not routinely allow support people to be present during procedures. Dimensions explored included: (1) reasons women did or did not choose doula support; (2) key aspects of the doula interaction; (3) future directions for doula support in abortion care. Interviews were transcribed and computer-assisted content analysis was performed; salient themes are presented. Results Thirty women were interviewed: 19 received and 11 did not receive doula support. Reasons to accept doula support included: (1) wanting companionship during the procedure; (2) being concerned about the procedure. Reasons to decline doula support included (1) a sense of stoicism and desiring privacy; or (2) not wanting to add emotion to this event. Women who received doula support universally reported positive experiences with the verbal and physical techniques used by doulas during the procedure and most women who declined doula support subsequently regretted not having a doula. Many women endorsed additional roles for doulas in abortion care, including addressing informational and emotional needs before and after the procedure. Conclusion Women receiving first-trimester surgical abortion in this setting value doula support at the time of the procedure. This intervention has the potential to be further developed to help women address pre- and post-abortion informational and emotional needs. Implications In a setting that does not allow family or friends to be present during the abortion procedure, women highly valued the presence of trained abortion doulas. This study speaks to the importance of providing support to women during abortion care. Developing a volunteer doula service is one approach to

  6. First trimester maternal serum AFP and total hCG in aneuploidies other than trisomy 21.

    PubMed

    Spencer, K; Heath, V; Flack, N; Ong, C; Nicolaides, K H

    2000-08-01

    Total human chorionic gonadotropin (hCG) and alpha-fetoprotein (AFP) were measured in maternal serum at 10-14 weeks of gestation from 53 pregnancies affected by trisomy 18, 42 cases with trisomy 13, 46 with Turner's syndrome and 13 with other sex aneuploides. The only significant association was the finding of reduced levels of total hCG in cases of trisomy 18 and 13. The association of increased levels of AFP in cases of trisomy 18 with ventral wall defects and the slight increase in AFP in cases of sex chromosomal anomalies other than Turner's syndrome was found. AFP and total hCG are not likely to replace the markers free beta-hCG and PAPP-A in first trimester screening for chromosomal anomalies. Copyright 2000 John Wiley & Sons, Ltd.

  7. Early first-trimester sibutramine exposure : pregnancy outcome and neonatal follow-up.

    PubMed

    De Santis, Marco; Straface, Gianluca; Cavaliere, Anna F; Carducci, Brigida; Caruso, Alessandro

    2006-01-01

    Sibutramine is a drug that is used in the treatment of obesity. There are currently no epidemiological studies relating to sibutramine exposure in pregnancy. The objective of our study was to determine whether sibutramine exposure during pregnancy constitutes a risk factor to the mother and developing fetus. Fifty-two pregnant women who were exposed to sibutramine in the first trimester of pregnancy, when they were unaware of being pregnant, contacted our Teratology Information Service. We recorded the prospective outcomes of this case series between May 2001 and September 2004 with a complete neonatal follow-up up to 1 month after delivery. Seven cases of hypertensive complications were observed during pregnancies. No cases of congenital anomalies in neonates were observed. Although many more cases are necessary to demonstrate that sibutramine is not teratogenic in pregnancy, our experience improves the counseling of pregnancies occurring involuntarily during sibutramine therapy.

  8. The transverse technique; a complementary approach to the measurement of first-trimester uterine artery Doppler.

    PubMed

    Drouin, Olivier; Johnson, Jo-Ann; Chaemsaithong, Piya; Metcalfe, Amy; Huber, Janie; Schwarzenberger, Jill; Winters, Erin; Stavness, Lesley; Tse, Ada W T; Lu, Jing; Lim, Wan Teng; Leung, Tak Yeung; Bujold, Emmanuel; Sahota, Daljit; Poon, Liona C

    2017-10-04

    The objectives of this study were to 1) define the protocol for the first-trimester assessment of the uterine artery pulsatility index (UtA-PI) using the new transverse technique, 2) evaluate UtA-PI measured by the transverse approach versus that obtained by the conventional sagittal approach, and 3) determine if accelerated onsite training (both methods) of inexperienced sonographers can achieve reproducible UtA-PI measurements compared to that measured by an experienced sonographer. The study consists of 2 parts conducted in 2 centers (Part 1, Calgary, Canada and Part 2, Hong Kong). Part 1 Prospective observational study of women with singleton pregnancies between 11-13+6 weeks' gestation. UtA-PI measurements were performed using the 2 techniques (4 sonographers trained in both methods, 10 cases each) and measurement indices (PI), time required and subjective difficulty to obtain satisfactory measurements were compared. One sample t-test and Wilcoxon rank sign test was used when appropriate. Bland-Altman difference plots were used to assess measurement agreement, and intra-class correlation (ICC) was used to evaluate measurement reliability. A target plot was used to assess measures of central tendency and dispersion. Part 2 One experienced and three inexperienced sonographers prospectively measured the UtA-PI at 11-13+6 weeks' gestation in two groups of women (42 and 35, respectively), with singleton pregnancies using both approaches. Inexperienced sonographers underwent accelerated on-site training by the experienced sonographer. Measurement approach and sonographer order were on a random basis. ICC, Bland-Altman and Passing-Bablok analyses were performed to assess measurement agreement, reliability and effect of accelerated training. Part 1 We observed no difference in the mean time to acquire the measurements (Sagittal: 118 seconds vs Transverse: 106 seconds, p=0.38). The 4 sonographers reported the transverse technique was subjectively easier to perform (p=0

  9. [FIRST-TRIMESTER ULTRASOUND AND BIOCHEMICAL MARKERS AND THEIR PREDICTIVE RATE IN PREECLAMPSIA DEVELOPMENT].

    PubMed

    Chalova, K; Pehlivanov, B

    2015-01-01

    Hypertensive disorders related to pregnancy and particularly preeclampsia are leading reasons for perinatal and maternal morbidity and mortality. The symptoms of preeclampsia are occurring during the second part of pregnancy, while the pathogenic processes start developing even in first trimester. This refers to the searching for the most reliable markers, that could prove those pathological processes happened and the combination of those markers in panel for early screening in order to predict the increased risk for developing of preeclampsia. Among multiple studied markers the most promising seam to be Doppler velosimetry of uterine arteries, PIGF, sFlt-1, sEndoglin, PAPP-A, PP-13. Their combined measurement increases the predictive rate and decreases the false positive results, but is also economically irrelevant. There are researches with different medications in order to argue their preventive effect in preeclampsia developing.

  10. Arterial Resistance in Late First Trimester as a Predictor of Subsequent Pregnancy-Related Hypertension

    PubMed Central

    Kushtagi, Pralhad; Emani, Anoosha

    2016-01-01

    Objectives This study aimed to examine the association between indicators of arterial resistance occurring late in the first trimester and the subsequent development of pregnancy-related hypertension. Methods This study took place between May 2014 and August 2015 and included 329 consecutive women with singleton pregnancies attending the antenatal clinics of a medical college in Karnataka, India, during this period. Pulse pressure (PP) and uterine artery Doppler parameters were recorded between 11–14 gestational weeks. Consequently, women were followed-up until after delivery for subsequent hypertension. Results Hypertension occurred more frequently if PP was high (17.6% versus 14.4% of pregnancies without high PP; P = 0.713), if a diastolic notch (DN) was present (15.1% versus 12.8% of pregnancies with an absent DN; P = 0.612) and if the resistive index (RI) was raised (22.2% versus 14.3% of pregnancies without raised RI; P = 0.366). A raised pulsatility index (PI) was significantly associated with hypertension (P = 0.013). The risk of hypertension was approximately seven-fold higher if two or more arterial resistance indicators were used, except with a present DN plus a raised RI or a present DN plus high PP. All arterial resistance indicators showed negative predictability (>85.6%) and good specificity (≥95.0%), except for the presence of a DN. A population-specific cut-off PI value of 1.72 had high negative predictability (92.8%) and good sensitivity (70.8%) and specificity (65.1%). Conclusion Raised PI in the late first trimester was a significant predictor of hypertension later in pregnancy. A combination of arterial resistance indicators may enhance prediction of subsequent hypertension. PMID:28003891

  11. Oxidative Stress Alters miRNA and Gene Expression Profiles in Villous First Trimester Trophoblasts

    PubMed Central

    Cross, Courtney E.; Tolba, Mai F.; Rondelli, Catherine M.; Xu, Meixiang; Abdel-Rahman, Sherif Z.

    2015-01-01

    The relationship between oxidative stress and miRNA changes in placenta as a potential mechanism involved in preeclampsia (PE) is not fully elucidated. We investigated the impact of oxidative stress on miRNAs and mRNA expression profiles of genes associated with PE in villous 3A first trimester trophoblast cells exposed to H2O2 at 12 different concentrations (0-1 mM) for 0.5, 4, 24, and 48 h. Cytotoxicity, determined using the SRB assay, was used to calculate the IC50 of H2O2. RNA was extracted after 4 h exposure to H2O2 for miRNA and gene expression profiling. H2O2 exerted a concentration- and time-dependent cytotoxicity on 3A trophoblast cells. Short-term exposure of 3A cells to low concentration of H2O2 (5% of IC50) significantly altered miRNA profile as evidenced by significant changes in 195 out of 595 evaluable miRNAs. Tool for annotations of microRNAs (TAM) analysis indicated that these altered miRNAs fall into 43 clusters and 34 families, with 41 functions identified. Exposure to H2O2 altered mRNA expression of 22 out of 84 key genes involved in dysregulation of placental development. In conclusion, short-term exposure of villous first trimester trophoblasts to low concentrations of H2O2 significantly alters miRNA profile and expression of genes implicated in placental development. PMID:26339600

  12. Hemangioblastic foci in human first trimester placenta: Distribution and gestational profile.

    PubMed

    Aplin, John D; Whittaker, Hannah; Jana Lim, Yu Ting; Swietlik, Stefanie; Charnock, Jayne; Jones, Carolyn J P

    2015-10-01

    The human placenta is a site of both hematopoiesis and vasculogenesis. There are reports of hemangioblastic foci (HAF) in the first trimester placenta, but little published information about their spatiotemporal incidence. We have used semi-thin sections and whole mount staining techniques on archival early pregnancy hysterectomy material as well as freshly-collected termination tissue. We report a description of the distribution of HAF, their gestational profile, and some characteristics of the constituent cells. We show crypt-shaped HAF are present in villi at different levels from 4 to 11 weeks and in the chorionic plate from 4 to 9 weeks. In the villous placenta, the foci often approach closely at one end to the trophoblast basement membrane. Morphologically they show remarkable similarity to those found in the yolk sac at similar stages. In some crypts, all cells are CD34+, but CD34 and nestin progressively segregate into the endothelial lineage. Brachyury is present in less differentiated cells. The erythroid lineage is dominant, as shown by the widespread expression of CD235a/glycophorin and characteristic erythroid morphologies, indicating various degrees of differentiation. However, CD41 is also present in non-endothelial cells. Initially a discontinuous UEA-1/CD31-positive endothelium forms at the periphery of the foci. These cells appear to become integrated into the developing vasculogenic/angiogenic vessel network. We also demonstrate that, independent of HAF, vasculogenesis occurs near the tips of growing villi during the first trimester. We suggest HAF interface with the developing vascular network, producing communication channels that allow erythrocytes to enter the placental-embryonic circulation. We speculate that the erythroid cells act as oxygen reservoirs during the period before flow of maternal blood through the intervillous space of the placenta, allowing a slow feed of oxygen-rich cells to the developing embryo. Copyright © 2015 Elsevier

  13. Use of specified critical periods of different congenital abnormalities instead of the first trimester concept.

    PubMed

    Czeizel, Andrew E; Puhó, Erzsébet H; Acs, Nándor; Bánhidy, Ferenc

    2008-03-01

    Previously the first trimester, later the 2nd and/or 3rd gestational months were evaluated at the analysis of different exposures in different congenital abnormalities. However, different congenital abnormalities have different critical periods. The objective of this study was to check the feasibility of a new approach to consider the specified critical periods of different congenital abnormalities separately. The potential teratogenic effect of oral ampicillin treatment and maternal influenza/fever during the study pregnancy regarding any time in pregnancy, during the first trimester, in the 2nd and/or 3rd gestational months, and finally in the specified critical periods of given congenital abnormalities were evaluated in the population-based large data set of the Hungarian Case-Control Surveillance System of Congenital Abnormalities. Of 22,843 cases, 1644 (7.2%) and 1328 (5.8%) were born to mothers who had oral ampicillin treatment or were affected with influenza/fever during the study pregnancy, while of 38,151 control newborns without any defect, 2631 (6.9 %) and 1838 (4.8%) had mothers with ampicillin treatment or influenza/fever, respectively. The analysis of different exposure time windows showed some difference in the risk for congenital abnormalities. The use of specified critical periods of different congenital abnormalities was feasible. The use of specified critical periods of different congenital abnormalities seems to be more scientific-based than the previously accepted methods for the evaluation of different exposure time windows. Thus this new and feasible approach is recommended for the controlled epidemiological studies in the future after an international consensus in the specified critical periods of different congenital abnormalities and other methodological issues. (c) 2008 Wiley-Liss, Inc.

  14. First-trimester multimarker prediction of gestational diabetes mellitus using targeted mass spectrometry.

    PubMed

    Ravnsborg, Tina; Andersen, Lise Lotte T; Trabjerg, Natacha D; Rasmussen, Lars M; Jensen, Dorte M; Overgaard, Martin

    2016-05-01

    Gestational diabetes mellitus (GDM) is associated with an increased risk of pre-eclampsia, macrosomia and the future development of type 2 diabetes mellitus in both mother and child. Although an early and accurate prediction of GDM is needed to allow intervention and improve perinatal outcome, no single protein biomarker has yet proven useful for this purpose. In the present study, we hypothesised that multimarker panels of serum proteins can improve first-trimester prediction of GDM among obese and non-obese women compared with single markers. A nested case-control study was performed on first-trimester serum samples from 199 GDM cases and 208 controls, each divided into an obese group (BMI ≥27 kg/m(2)) and a non-obese group (BMI <27 kg/m(2)). Based on their biological relevance to GDM or type 2 diabetes mellitus or on their previously reported potential as biomarkers for these diseases, a number of proteins were selected for targeted nano-flow liquid chromatography (LC) MS analysis. This resulted in the development and validation of a 25-plex multiple reaction monitoring (MRM) MS assay. After false discovery rate correction, six proteins remained significantly different (p<0.05) between obese GDM patients (n=135) and BMI-matched controls (n=139). These included adiponectin, apolipoprotein M and apolipoprotein D. Multimarker models combining protein levels and clinical data were then constructed and evaluated by receiver operating characteristic (ROC) analysis. For the obese, non-obese and all GDM groups, these models achieved marginally higher AUCs compared with adiponectin alone. Multimarker models combining protein markers and clinical data have the potential to predict women at a high risk of developing GDM.

  15. Insulin Exhibits an Antiproliferative and Hypertrophic Effect in First Trimester Human Extravillous Trophoblasts.

    PubMed

    Silva, Cláudia; Nunes, Catarina; Correia-Branco, Ana; Araújo, João R; Martel, Fátima

    2017-04-01

    Our aim was to investigate the effect of high levels of glucose, insulin, leptin, and tumor necrosis factor alpha, biomarkers of diabetes in pregnancy, in the process of placentation, using as a cell model a first trimester extravillous human trophoblast cell line (HTR8/SVneo cells). Exposure of HTR8/SVneo cells for 24 hours to either glucose (20 mmol/L) or leptin (25-100 ng/mL) did not cause significant changes in cell proliferation and viability. Tumor necrosis factor alpha (24 hours; 10-100 ng/L) caused a small decrease (10%) in cell proliferation and an increase (9%) in cell viability; however, both effects disappeared when exposure time was increased. Insulin (24 hours; 1-10 nmol/L) caused a concentration- and time-dependent decrease (10%-20%) in cell proliferation; the effect of insulin (10 nmol/L) was more pronounced after a 48 hours exposure (35%). In contrast, exposure to insulin (10 nmol/L; 48 hours) showed no significant effect on cell viability, apoptosis, and migration capacity. Insulin appears to cause hypertrophy of HTR8/SVneo cells as it reduces the cell mitotic index while increasing the culture protein content. The antiproliferative effect of insulin seems to involve activation of mammalian target of rapamycin, phosphoinositide 3-kinase, and p38 mitogen-activated protein kinase. Finally, simvastatin and the polyphenol quercetin potentiated the antiproliferative effect of insulin; on the contrary, the polyphenol resveratrol, the polyunsaturated fatty acids eicosapentaenoic and docosahexaenoic acids, and folic acid were not able to change it. In conclusion, we show that insulin has an antiproliferative and hypertrophic effect on a first trimester extravillous human trophoblast cell line. So insulin might affect the process of placentation.

  16. Continuation of pregnancy after first-trimester exposure to mifepristone: an observational prospective study.

    PubMed

    Bernard, N; Elefant, E; Carlier, P; Tebacher, M; Barjhoux, C E; Bos-Thompson, M A; Amar, E; Descotes, J; Vial, T

    2013-04-01

    To report the follow-up of continuing pregnancies after first-trimester exposure to mifepristone. Observational prospective study. France. Patients exposed to mifepristone during the first 12 weeks of pregnancy. Women were included in the study when they or their doctors asked a French pharmacovigilance centre or the Paris Teratogen Information Service about the risk of mifepristone exposure in early pregnancy. Exclusion criteria were requests received after 22 weeks of gestation or subsequent elective termination of pregnancy without a pathological examination of the fetus. Data on maternal history and drug exposure were collected on first contact, and pregnancy outcomes were documented at follow-up. Rate of major congenital malformations. A total of 105 pregnancies were included, with 46 exposed to mifepristone alone, and 59 exposed to both mifepristone and misoprostol. There were 94 live births (90.4%) and 10 (9.6%) miscarriages (including one with major malformation). Elective termination of pregnancy was performed after the subsequent diagnosis of trisomy 21 in one case. The overall rate of major congenital malformations was 4.2% (95% CI 1.2-10.4%), with two cases among 38 patients exposed to mifepristone alone, and two cases among 57 patients exposed to both mifepristone and misoprostol. This first prospective study found that the rate of major malformations after first-trimester exposure to mifepristone is only slightly higher than the expected 2-3% rate in the general population. Such findings provide reassuring data for risk evaluation for continuation of pregnancy after mifepristone exposure. © 2013 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2013 RCOG.

  17. Sustained Endocrine Gland-Derived Vascular Endothelial Growth Factor Levels Beyond the First Trimester of Pregnancy Display Phenotypic and Functional Changes Associated With the Pathogenesis of Pregnancy-Induced Hypertension.

    PubMed

    Sergent, Frédéric; Hoffmann, Pascale; Brouillet, Sophie; Garnier, Vanessa; Salomon, Aude; Murthi, Padma; Benharouga, Mohamed; Feige, Jean-Jacques; Alfaidy, Nadia

    2016-07-01

    Pregnancy-induced hypertension diseases are classified as gestational hypertension, preeclampsia, or eclampsia. The mechanisms of their development and prediction are still to be discovered. Endocrine gland-derived vascular endothelial growth factor (EG-VEGF) is an angiogenic factor secreted by the placenta during the first trimester of human pregnancy that was shown to control trophoblast invasion, to be upregulated by hypoxia, and to be abnormally elevated in pathological pregnancies complicated with preeclampsia and intrauterine growth restriction. These findings suggested that sustaining EG-VEGF levels beyond the first trimester of pregnancy may contribute to pregnancy-induced hypertension. To test this hypothesis, osmotic minipumps delivering EG-VEGF were implanted subcutaneously into gravid OF1 (Oncins France 1) mice on day 11.5 post coitus, which is equivalent to the end of the first trimester of human pregnancy. Mice were euthanized at 15.5 and 18.5 days post coitus to assess (1) litter size, placental, and fetal weights; (2) placental histology and function; (3) maternal blood pressure; (4) renal histology and function; and (5) circulating soluble fms-like tyrosine kinase 1 and soluble endoglin. Increased EG-VEGF levels caused significant defects in placental organization and function. Both increased hypoxia and decreased trophoblast invasion were observed. Treated mice had elevated circulating soluble fms-like tyrosine kinase 1 and soluble endoglin and developed gestational hypertension with dysregulated maternal kidney function. EG-VEGF effect on the kidney function was secondary to its effects on the placenta as similarly treated male mice had normal kidney functions. Altogether, these data provide a strong evidence to confirm that sustained EG-VEGF beyond the first trimester of pregnancy contributes to the development of pregnancy-induced hypertension.

  18. First trimester serum levels of the soluble transcobalamin receptor, holo-transcobalamin, and total transcobalamin in relation to preeclampsia risk.

    PubMed

    Abuyaman, Omar; Torring, Niels; Obeid, Rima; Nexo, Ebba

    2016-12-01

    Human placenta expresses CD320, a receptor that ensures the uptake of holo-transcobalamin (holoTC). Soluble CD320 (sCD320) is present in the circulation and its concentration increases during pregnancy. To investigate a possible association of sCD320, holoTC and total transcobalamin (TC) with the risk of subsequent preeclampsia using serum samples from asymptomatic first trimester pregnant women. Moreover, we aimed to establish reference intervals of the aforementioned biomarkers for first trimester pregnant women who remained healthy throughout pregnancy. This study was a retrospective case-control study that we performed on biobank serum samples. Cases (n = 50) and controls (n = 198) (matched for gestational age and date of sample collection) were asymptomatic women in early pregnancy [median (range) gestational age = 10 (8-12) weeks]. Cases developed preeclampsia while the controls remained normotensive throughout pregnancy. We measured the serum concentration of sCD320, holoTC, and total TC by using in-house ELISA methods. First trimester median concentrations of sCD320, holoTC and total TC were not significantly different between cases and controls. The odd ratio for developing preeclampsia based on exposure to low or high levels of sCD320, holoTC or total TC at first trimester was not significant. The reference intervals (2.5-97.5% percentiles (median)) derived from the controls were 50-170 (90) pmol\\L for sCD320, 20-140 (70) pmol\\L for holoTC and 560-1300 (810) pmol\\L for total TC. The risk of preeclampsia is not predicted by first trimester serum concentrations of sCD320, holoTC or total TC. The first trimester reference intervals for the three parameters is reported.

  19. Does gender of the fetus have any relation with fetal heart monitoring during the first and second stage of labor?

    PubMed

    Yohai, David; Baumfeld, Yael; Zilberstein, Tali; Yaniv Salem, Shimrit; Elharar, Debbie; Idan, Inbal; Mastrolia, Salvatore Andrea; Sheiner, Eyal

    2017-01-01

    To investigate fetal gender and its influences on neonatal outcomes, taking into consideration the available tools for the assessment of fetal well-being. We conducted a retrospective study comparing maternal, fetal and neonatal outcomes according to fetal gender, in women carrying a singleton gestation. A multivariate analysis was performed for the prediction of adverse neonatal outcomes according to fetal gender, after adjustment for gestational age, maternal age and fetal weight. A total of 682 pregnancies were included in the study, of them 56% (n = 383) were carrying a male fetus and 44% (n = 299) a females fetus. Male gender was associated with a significant higher rate of abnormal fetal heart tracing patterns during the first (67.7% versus 55.1, p = 0.001) and the second stage (77.6 versus 67.7, p = 0.01) of labor. Male gender was also significantly associated with lower Apgar scores at 1' (19.1% versus 10.7%, p < 0.01), as well as lower pH values (7.18 ± 0.15 versus 7.23 ± 0.18, p < 0.001), and significant differences in cord blood components (PCO2, PO2) compared with female fetuses. In the multivariate analysis, male gender was found to be significantly associated with first (OR 1.76, 95% CI 1.28-2.43, p = 0.001) and second stage (OR 1.73, 95% CI 1.20-2.50, p < 0.01) pathological fetal heart tracing patterns, pH < 7.1, and for Apgar scores at 1'< 7. The present study confirms the general trend of a lower clinical performance of male neonates compared with females. In addition, the relation between fetal heart rate patterns during all stages of labor and fetal gender showed an independent association between male fetal gender and abnormal fetal heart monitoring during labor.

  20. First trimester prediction of small- and large-for-gestation neonates by an integrated model incorporating ultrasound parameters, biochemical indices and maternal characteristics.

    PubMed

    Papastefanou, Ioannis; Souka, Athena P; Pilalis, Athanasios; Eleftheriades, Makarios; Michalitsi, Vasiliki; Kassanos, Demetrios

    2012-01-01

    To identify maternal/pregnancy characteristics, first trimester ultrasound parameters and biochemical indices which are significant independent predictors of small-for-gestational age (SGA) and large-for-gestational age (LGA) neonates. Retrospective cross-sectional study. Two fetal Medicine Units. 4 702 singleton pregnancies presenting for screening for chromosomal abnormalities by nuchal translucency and maternal serum biochemistry at 11-14 weeks. Reference ranges for birthweight applied to our population were constructed by the Royston and Wright method. Multiple logistic regression was applied to develop first trimester prediction models for SGA and LGA. Birth of SGA or LGA neonate. Maternal height, parity, smoking, assisted conception, delta crown-rump length, delta nuchal translucency, free beta human chorionic gonadotrophin and pregnancy-associated plasma protein-A were significant independent predictors of SGA. Maternal weight and height, smoking, delta crown-rump length and delta nuchal translucency were significant independent predictors of LGA. Models for SGA (AUC=0.7296, CI: 0.69-0.76, p<0.0001) and LGA (AUC=0.6901, CI: 0.65-0.72, p<0.0001) were derived, applicable to routine obstetric population at low risk for these conditions. For 20% screen positive rate the modeling achieves sensitivities of about 55% for SGA and 48% for LGA neonates. Prediction for birthweight deviations is feasible using data available at the routine 11-14 weeks' examination. Delta CRL and delta nuchal translucency were significant independent predictors for both SGA and LGA. © 2011 The Authors Acta Obstetricia et Gynecologica Scandinavica © 2011 Nordic Federation of Societies of Obstetrics and Gynecology.

  1. First-trimester inter- and intrafetal size discrepancies in bichorionic twins conceived by in vitro fertilization: can it predict pregnancy outcome?

    PubMed

    Bardin, Ron; Oron, Galia; Levy, Yael; Sapir, Onit; Meizner, Israel; Fisch, Benjamin; Wiznitzer, Arnon; Hadar, Eran

    2017-08-01

    To evaluate the association between first-trimester inter- and intrafetal size discrepancies and pregnancy outcome, among bichorionic-biamniotic twins conceived by IVF. A retrospective study design was used. Tertiary university-affiliated medical center. All women with a viable first-trimester bichorionic-biamniotic twin gestation, who conceived after IVF in 2007-2015. None. The association between fetal size differences and pregnancy outcome was analyzed. Intrafetal size discordance was defined as a difference between the actual gestational age calculated by ovum pickup (OPU) date and the evaluated gestational age by crown-rump length (CRL), for each twin. Intertwin size discrepancy was defined as a difference in CRL between the twins. The primary outcome was the number of live-born fetuses; the secondary outcome measures were gestational age at birth, birth weight percentile, and birth weight discordancy. A total of 277 women met the study criteria and were divided into three groups by outcome: 218 (78.7%) live-born twins, 41 (14.8%) live-born singleton, and 19 (6.5%) non-live-born pregnancy. Among the smaller than expected twin, the association of CRL-OPU differences with the primary outcome was significant for twin live-born delivery (-1.43 day), singleton live-born delivery (-4.12 days), and non-live-born pregnancy (-6.72 days). For the relatively larger twin, the association was significant for non-live-born pregnancy (-4.33 days) compared with any live-born delivery, either singleton (-0.95 days) or twin (-0.21 days). Among IVF conceived twin gestations, a CRL-OPU gap was associated with an increased risk of a negative pregnancy outcome. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  2. Metabolic syndrome and selenium in fetal programming: gender differences.

    PubMed

    Ojeda, M Luisa; Nogales, Fátima; Muñoz Del Valle, Paulina; Díaz-Castro, Javier; Murillo, M Luisa; Carreras, Olimpia

    2016-07-13

    Since Selenium (Se) forms part of glutathione peroxidase (GPx), which appears to have a dual role in Metabolic Syndrome (MS), this study evaluates the implication of Se in the transmission of this pathology to the progeny. Se body distribution, glucose, triglycerides, cholesterol, insulin and metabolic hormones [glucagon, leptin, gastric inhibitory polypeptide (GIP), and triiodothyronine (T3)], growth factors, receptor activator of nuclear factor kappa-B ligand (RANK-L) and osteopontin, as well as oxidative hepatic balance in the offspring of dams exposed to a fructose-rich diet (65%) with normal Se content (0.01 ppm) during gestation and lactation, were measured according to sex. Fructose pups had lower body weight; however, male pups had a lower body mass index and growth indicators in serum. Fructose pups, especially females, had lower levels of serum insulin and HOMA-IR. With regard to Se homeostasis, fructose pups presented a depletion of Se in heart and muscle, and repletion in kidneys, pancreas and thyroid, although only female pups showed a repletion of Se in the liver. Fructose pups presented lower superoxide dismutase activity and only female fructose pups had higher GPx activity, which provoked hepatic oxidation. Se balance and Se tissue deposits in MS pups during lactation are altered by gender. This difference is focused on hepatic Se deposits that affect GPx activity, which could be related to a disruption in the insulin-signaling cascade in females. Furthermore, although female fructose pups had greater metabolic disorders, only the males' growth and development were affected. Particularly relevant is the depletion of Se found in the heart of fructose pups, as this element is essential for correct heart function.

  3. [Assessment of efficacy and safety of medical treatment of non-viable first trimester pregnancy].

    PubMed

    Zwierzchowska, Aneta; Głuszak, Michał; Jabiry-Zieniewicz, Zoulikha; Banaszek-Wysoczańska, Agnieszka; Dziadecki, Wojciech; Barcz, Ewa

    2012-10-01

    The aim of our study was to assess the efficacy and safety of medical treatment of non-viable first trimester pregnancy. We analyzed 50 cases of women diagnosed with non-viable first trimester pregnancy: missed abortion (79.6%) or anembryonic pregnancy (20.4%), who were admitted and treated at the First Clinic of Obstetrics and Gynecology Medical University of Warsaw, between June 2011 and February 2012. The diagnosis was made after two ultrasound examinations, performed at least one week apart. None of the patients manifested symptoms of imminent miscarriage. All women received medical treatment - misoprostol administered vaginally or in cases of excessive bleeding in the course of the procedure, sublingually - according to our own scheme. The patients were informed that any moment they could decide to discontinue medical treatment and ask for surgery Initially, 4 tablets containing misoprostol (800 mcg) were administered vaginally A control ultrasound examination was performed 6 hours later. If expulsion of the gestational sac was completed, the patient was discharged. If the gestational sac was still present in the uterus, an additional dose of misoprostol was administered: 4 tablets vaginally or if excessive bleeding occurred, 3 tablets (600 mcg) sublingually. Another ultrasound examination was performed after 6 hours from the second dose and the patient was discharged if the expulsion of the gestational sac was completed. If the procedure failed, it was repeated in the same manner the next day. D&C was performed in cases of excessive bleeding, failure of medical treatment after 48 hours, patient decision to discontinue medical treatment or suspected incomplete abortion after menstrual bleeding. For women who completed the medical treatment, control visits were scheduled 14 days after hospital discharge and after menstrual bleeding, if incomplete abortion was suspected. D&C was performed in 12% of patients because of failure of medical treatment after 48 hours

  4. Doula support during first trimester surgical abortion: A randomized controlled trial

    PubMed Central

    Chor, Julie; Hill, Brandon; Martins, Summer; Mistretta, Stephanie; Patel, Ashlesha; Gilliam, Melissa

    2014-01-01

    Objectives To evaluate the impact of doula support on first trimester abortion care. Study Design Women were randomized to receive doula support or routine care during first trimester surgical abortion. We examined the effect of doula support on pain during abortion using a 100-mm visual analog scale. The study had statistical power to detect 20% difference in mean pain scores. Secondary measures included satisfaction, procedure duration, and patient recommendations regarding doula support. Results Two hundred and fourteen women completed the study: 106 received doula support, 108 received routine care. The groups did not differ regarding demographics, gestational age, or medical history. Pain scores in the doula and control groups did not differ at speculum insertion (38.6mm [±26.3mm] vs. 43.6mm [±25.9mm], p=0.18) or procedure completion (68.2mm [±28.0mm] vs. 70.6mm [±23.5mm], p=0.52). Procedure duration (3.39min [±2.83min] vs. 3.18min [±2.36min], p=0.55) and patient satisfaction (75.2mm [±28.6mm] vs. 74.6mm [±27.4mm], p=0.89) did not differ between doula and control groups. Among women who received doula support, 96.2% recommended routine doula support for abortion and 60.4% indicated interest in training as doulas. Among women who did not receive doula support, 71.6% of women would have wanted it. Additional clinical staff was needed to provide support for 2.9% of women in the doula group and 14.7% of controls (p<0.01). Conclusions Although doula support did not have a measurable effect on pain or satisfaction, women overwhelmingly recommended it for routine care. Women receiving doula support were less likely to require additional clinic support resources. Doula support, therefore, may address patient psychosocial needs. PMID:24983679

  5. Noise exposure during the first trimester and the risk of gestational diabetes mellitus

    NASA Astrophysics Data System (ADS)

    Min, Kyoung-Bok; Min, Jin-Young

    2017-07-01

    Gestational diabetes mellitus (GDM) is a form of diabetes that affects pregnant women. GDM tends to resolve after delivery, but has an impact on the health of the mother and her offspring. Considering the potential association between noise and diabetes and the susceptibility of the pregnant state to diabetogenesis, noise pollution may be associated with the risk of GDM; however, there is no evidence of the effect of noise pollution on GDM. In this study, we investigated the association between residential exposure to noise during the first trimester and incidence of GDM using the National Health Insurance Service-National Sample Cohort (NHIS-NSC), a representative sample of South Koreans. We analyzed the National Health Insurance Service-National Sample Cohort (2002-2013), a population-wide health insurance claim data. Study population was a total of 18 165 pregnant women. GDM was defined as ICD-10 code O244, and noise exposure levels were categorized as daytime (07:00-19:00) and nighttime (23:00-7:00). Other known risk factors for GDM were age, income, residential area, physical activity, smoking, drinking, blood sugar levels, and body mass index before getting pregnant. The study population included 18 165 pregnant women, of which 8.8% developed gestational diabetes. After adjustment, the adjusted OR (95% CI) for GDM associated with 1 dB increase in nighttime noise was 1.07 (95% CI: 1.05-1.10). Compared with the reference group (Quartile 1), the adjusted ORs for GDM in those exposed to the highest quartile of noise exposure (Quartile 4) was 1.61 (95% CI: 1.38-1.87) at nighttime noise. However, no significant association was observed between daytime noise exposure (07:00-19:00) and the incidence of GDM. We observed that the odds of gestational diabetes during the first trimester was 1.6 times higher for pregnant women exposed to elevated nighttime noise compared to similar women exposed to normal baseline noise levels in South Korea. Although this finding

  6. First-trimester plasma tocopherols are associated with risk of miscarriage in rural Bangladesh.

    PubMed

    Shamim, Abu Ahmed; Schulze, Kerry; Merrill, Rebecca D; Kabir, Alamgir; Christian, Parul; Shaikh, Saijuddin; Wu, Lee; Ali, Hasmot; Labrique, Alain B; Mehra, Sucheta; Klemm, Rolf D W; Rashid, Mahbubur; Sungpuag, Pongtorn; Udomkesmalee, Emorn; West, Keith P

    2015-02-01

    Tocopherols were discovered for their role in animal reproduction, but little is known about the contribution of deficiencies of vitamin E to human pregnancy loss. We sought to determine whether higher first-trimester concentrations of α-tocopherol and γ-tocopherol were associated with reduced odds of miscarriage (pregnancy losses <24 wk of gestation) in women in rural Bangladesh. A case-cohort study in 1605 pregnant Bangladeshi women [median (IQR) gestational age: 10 wk (8-13 wk)] who participated in a placebo-controlled vitamin A- or β-carotene-supplementation trial was done to assess ORs of miscarriage in women with low α-tocopherol (<12.0 μmol/L) and γ-tocopherol (<0.81 μmol/L; upper tertile cutoff of the γ-tocopherol distribution in women who did not miscarry). In all women, plasma α- and γ-tocopherol concentrations were low [median (IQR): 10.04 μmol/L (8.07-12.35 μmol/L) and 0.66 μmol/L (0.50-0.95 μmol/L), respectively]. In a logistic regression analysis that was adjusted for cholesterol and the other tocopherol, low α-tocopherol was associated with an OR of 1.83 (95% CI: 1.04, 3.20), whereas a low γ-tocopherol concentration was associated with an OR of 0.62 (95% CI: 0.41, 0.93) for miscarriage. Subgroup analyses revealed that opposing ORs were evident only in women with BMI (in kg/m(2)) ≥18.5 and serum ferritin concentration ≤150 μg/L, although low BMI and elevated ferritin conferred stronger risk of miscarriage. In pregnant women in rural Bangladesh, low plasma α-tocopherol was associated with increased risk of miscarriage, and low γ-tocopherol was associated with decreased risk of miscarriage. Maternal vitamin E status in the first trimester may influence risk of early pregnancy loss. The JiVitA-1 study, from which data for this report were derived, was registered at clinicaltrials.gov as NCT00198822. © 2015 American Society for Nutrition.

  7. [Cross-validation of the first trimester screening algorithm of the FMF London on 38,700 pregnancies in Germany].

    PubMed

    Lüthgens, K; Abele, H; Alkier, R; Hoopmann, M; Kagan, K O

    2011-08-01

    Validation of the performance of the new algorithm of the FMF London for screening for trisomy 21 using a combination of maternal age, fetal nuchal translucency (NT) and maternal serum free β-hCG and PAPP-A. Between 2002 and 2007, NT was measured prospectively in 39,004 pregnancies in the context of routinely performed first trimester screening in Germany. Individual trisomy 21 risks were calculated by a combination of NT, maternal age, free β-hCG, and PAPP-A using the FMF algorithm in force at the time of investigation. In this study we recalculated the trisomy 21 risks applying the new algorithm of the FMF UK that includes the new mixture model for the NT measurement. 38,751 singleton pregnancies could be included in the study of which 109 (0.3 %) had a trisomy 21. Only 35 % of the NT measurements of euploids were above the median and 25 % of the NT measurements were below the 5th percentile of the FMF UK. For sonographers that were qualified according to level II or III of the German DEGUM system, the median NT of fetuses with trisomy 21 was 0.9 mm above the median of the FMF UK and only 0.5 mm above the median for all other sonographers. Despite the limited performance of the NT measurement, the overall detection rate for a trisomy 21 was 90.8 % when combining the NT with maternal age, PAPP-A and free β-hCG. The overall false-positive rate for a trisomy 21 was 6.5 % at a cut-off value of 1:300. In this study we were able to show that the use of the new risk algorithm of the FMF UK leads to a trisomy 21 detection rate of about 90 % at a 5 % false-positive rate in a German collective despite a significant underestimation of the NT. © Georg Thieme Verlag KG Stuttgart · New York.

  8. Screening for trisomy 21 in twin pregnancies in the first trimester: does chorionicity impact on maternal serum free beta-hCG or PAPP-A levels?

    PubMed

    Spencer, K

    2001-09-01

    In a study of 180 twin pregnancies I have examined the distribution of maternal serum free beta-human chorionic gonadotrophin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A), in addition to fetal nuchal translucency thickness (NT), in twins classified as monochorionic or dichorionic, based on ultrasound appearance at 10-14 weeks of gestation. In 45 monochorionic and 135 dichorionic twin pregnancies the median MoM free beta-hCG was not significantly different (1.00 vs 1.01), whilst that for PAPP-A was lower (0.89 vs 1.01) but again with no statistical significance. Previous reports of an increased fetal NT in monochorionic twins pregnancies could not be confirmed (1.03 vs 1.00). It is concluded that the existing pseudo risk twin correction algorithm is appropriate for both monochorionic and dichorionic twins in providing accurate first trimester risks for trisomy 21. Copyright 2001 John Wiley & Sons, Ltd.

  9. First-trimester contingent screening for trisomies 21, 18 and 13 by biomarkers and maternal blood cell-free DNA testing.

    PubMed

    Nicolaides, K H; Syngelaki, A; Poon, L C; Gil, M M; Wright, D

    2014-01-01

    To examine potential performance of screening for trisomies by cell-free (cf) DNA testing in maternal blood contingent on results of first-line testing by combinations of fetal translucency thickness (NT), fetal heart rate (FHR), ductus venosus pulsatility index (DV PIV), and serum-free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein-A (PAPP-A), placental growth factor (PLGF) and α-fetoprotein (AFP). Performance was estimated for firstly, screening by cfDNA in all pregnancies and secondly, cfDNA testing contingent on results of first-line testing by combinations of ultrasound and biochemical markers. In first-line screening by cfDNA testing, the detection rate for trisomy 21 and trisomies 18 or 13 would be 99 and 96%, respectively, after invasive testing in 1% of the population. In contingent screening, a detection rate of 98% for trisomy 21 and 96% for trisomy 18 or 13, at an invasive testing rate of 0.7%, can be achieved by carrying out cfDNA testing in about 35, 20 and 11% of cases identified by first-line screening with the combined test alone (age, NT, FHR, β-hCG, PAPP-A), the combined test plus PLGF and AFP and the combined test plus PLGF, AFP and DV PIV, respectively. Effective first-trimester screening for trisomies can be achieved by contingent screening incorporating biomarkers and cfDNA testing. © 2013 S. Karger AG, Basel.

  10. First Trimester Maternal Serum Screening Using Biochemical Markers PAPP-A and Free β-hCG for Down Syndrome, Patau Syndrome and Edward Syndrome.

    PubMed

    Shiefa, S; Amargandhi, M; Bhupendra, J; Moulali, S; Kristine, T

    2013-01-01

    The first trimester screening programme offers a noninvasive option for the early detection of aneuploidy pregnancies. This screening is done by a combination of two biochemical markers i.e. serum free β-human chorionic gonadotrophin (free β-hCG) and pregnancy associated plasma protein A (PAPP-A), maternal age and fetal nuchal translucency (NT) thickness at 11 + 0-13 + 6 weeks of gestation. A beneficial consequence of screening is the early diagnosis or trisomies 21, 18 and 13. At 11 + 0-13 + 6 weeks, the relative prevalence of trisomies 18 and 13 to trisomy 21 are found to be one to three and one to seven, respectively. All three trisomies are associated with increased maternal age, increased fetal NT and decreased PAPP-A, but in trisomy 21 serum free β-hCG is increased whereas in trisomies 18 and 13 free β-hCG is decreased.

  11. Prevalence of depressive disorders and related factors in women in the first trimester of their pregnancies in Erzurum, Turkey.

    PubMed

    Akçalı Aslan, Puren; Aydın, Nazan; Yazıcı, Esra; Aksoy, Ayse Nur; Kirkan, Tulay Sati; Daloglu, Gokhan Ali

    2014-12-01

    Depression is the most frequently seen mental disease in the pregnancy period. The first trimester of pregnancy is important in terms of its effects on both the fetus and on the mother. This study has researched the prevalence of depression in women in the first trimester of their pregnancies in Erzurum, which is a large province in the Eastern region of Turkey. The study participants were 463 pregnant women who were in the first trimester of their pregnancy. Screening was primarily carried out using the Edinburgh Postnatal Depression Scale (EPDS), and Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition (DSM-IV)-Clinical Version (SCID-I) was applied to those participants with a score of 12 points and higher. To assess the risk factors, a sociodemographic data form was completed by the authors. The total depressive disorder rate was 16.8% in women in the first trimester of their pregnancies (12.3% major depressive disorder, 1.5% double depression, 2.6% minor depressive disorder and 0.4% dysthymia). A history of mental disease, mental disease suffered during a previous pregnancy, exposure to violence in the present pregnancy, an unplanned pregnancy and spouse's unemployment were predictors for depressive disorders. It is important to identify the risk groups for the early recognition of depression in pregnancy. Developing depression screening programs can be useful for early diagnosis and therapy. © The Author(s) 2014.

  12. First trimester prediction of gestational diabetes mellitus: A clinical model based on maternal demographic parameters.

    PubMed

    Sweeting, Arianne N; Appelblom, Heidi; Ross, Glynis P; Wong, Jencia; Kouru, Heikki; Williams, Paul F; Sairanen, Mikko; Hyett, Jon A

    2017-05-01

    Develop a first trimester risk prediction model for GDM based on maternal clinical characteristics in a large metropolitan multi-ethnic population and compare its performance to that of other recently published GDM prediction models and clinical risk scoring systems. A retrospective case control study of 248 women who developed GDM and 732 controls who did not. Maternal clinical parameters were prospectively obtained at 11-13(+6) weeks' gestation. A predictive multivariate regression model for GDM was developed, evaluated using areas under the receiver-operating characteristic (AUC) curve. The performance of this model was then compared with other published GDM prediction models applied to our cohort and our existing clinical risk scoring system. Previous GDM, family history of diabetes, age, south/east Asian ethnicity, parity and body mass index (BMI) were significant predictors for GDM. The AUC of our multivariate regression model was 0.88 (95% Confidence Interval 0.85-0.92). This performed better than other predictive models applied to our cohort (AUCs 0.77-0.82). A multivariate model based on weighted maternal clinical risk factors accurately predicts GDM in early pregnancy and performs better than other proposed multivariate and clinical risk scoring models in a multiethnic cohort. Copyright © 2017 Elsevier B.V. All rights reserved.

  13. Determinants of first trimester combined test participation within the central region of the Netherlands.

    PubMed

    Crombag, Neeltje M T H; Schielen, Peter C J I; Hukkelhoven, Chantal W; Iedema, Rita; Bensing, Jozien M; Visser, Gerard H A; Stoutenbeek, Philip; Koster, Maria P H

    2015-05-01

    Our objective is to study the association between potentially influential determinants and first-trimester combined test (FCT) uptake rates in the central region of the Netherlands. Data were extracted from the national prenatal screening database Peridos and the Netherlands Perinatal Registry and compared at the level of the health care provider. Univariable and multivariable linear regression analysis was used to determine the effect of determinants (maternal age, parity, socio-economic status (SES), mode of conception, ethnicity and urbanisation) on uptake. Prenatal screening data were available for 24 657 women and overall uptake rate was 25.7%. The strongest association with FCT uptake was found for advanced maternal age (β 2.2; 95% CI [1.7, 2.8]). Grand multiparity had a significantly negative association with FCT uptake (β -4.3; 95% CI [-5.9, -2.7]). Positive associations were found for very high urbanisation (β 0.3; 95% CI [0.1, 0.4]) and high SES (β 0.2; 95% CI [0.0, 0.3]). Advanced maternal age is strongly associated with participation in prenatal testing. The role of age related risk perception should be incorporated in future policy making to support women in informed and autonomous decision making. The negative association of grand multiparity and FCT might be religion based but requires further research. © 2015 John Wiley & Sons, Ltd. © 2015 John Wiley & Sons, Ltd.

  14. A Case of Idiopathic Acute Pancreatitis in the First Trimester of Pregnancy

    PubMed Central

    Hara, Tomomi; Kanasaki, Haruhiko; Oride, Aki; Ishihara, Tomoko; Kyo, Satoru

    2015-01-01

    Acute pancreatitis is rare in pregnancy, with an estimated incidence of approximately 1 in 1000 to 1 in 10,000 pregnancies. Acute pancreatitis in pregnancy usually occurs in the third trimester. Here, we report a case of acute pancreatitis in the first trimester. A 36-year-old primigravida at 11 weeks of gestation complained of severe lower abdominal pain. The pain gradually worsened and migrated toward the epigastric region. She had no history of chronic alcoholism. Blood investigations showed elevated level of C-reactive protein (9.58 mg/dL), pancreatic amylase (170 IU/L), and lipase (332 IU/L). There was no gallstone and no abnormality in the pancreatic and biliary ducts on ultrasonography. Antinuclear antibody and IgG4 were negative and no evidence of hyperlipidemia or diabetes was found. There was also no evidence of viral infection. On the third day of hospitalization, she was diagnosed with severe acute pancreatitis on magnetic resonance imaging. Medical interventions were initiated with nafamostat mesilate and ulinastatin, and parenteral nutrition was administered through a central venous catheter. On the eighth day of hospitalization, her condition gradually improved with a decreased level of pancreatic amylase and the pain subsided. After conservative management, she did not have any recurrence during her pregnancy. PMID:26843995

  15. Complications of first-trimester abortion: a report of 170,000 cases.

    PubMed

    Hakim-Elahi, E; Tovell, H M; Burnhill, M S

    1990-07-01

    One hundred seventy thousand first-trimester abortions were performed in three free-standing clinics of Planned Parenthood of New York City from 1971-1987. Seventy percent of the procedures were done under local anesthesia; the remainder under intravenous methohexital. No preoperative medications or routine postoperative antibiotics were given. High-risk patients were referred to a hospital. The clinics operated under uniform written guidelines. Experienced physicians performed the procedures. There were no deaths in this series of patients. One hundred twenty-one patients were hospitalized (0.71 per 1000) for suspected perforation, ectopic pregnancy, hemorrhage, sepsis, or recognized incomplete abortion. There was no major extirpative surgery performed. There were an additional 1438 minor complications (8.46 per 1000). Overall, there were 9.05 complications per 1000 abortions. The complication rates for procedures done under general anesthesia and local anesthesia were similar. We conclude that outpatient abortion on selected patients to the 14th week from the last menstrual period is a safe procedure.

  16. First trimester dietary intake, biochemical measures, and subsequent gestational hypertension among nulliparous women.

    PubMed

    Tande, Desiree L; Ralph, Jody L; Johnson, LuAnn K; Scheett, Angela J; Hoverson, Bonita S; Anderson, Cindy M

    2013-01-01

    The purpose of this study was to evaluate the relationships between first-trimester dietary factors and biochemical measures and subsequent risk of gestational hypertension. This pilot study used a prospective design utilizing a convenience sample of nulliparous women enrolled at their first prenatal visit. A total of 57 women completed the study. Participants were divided into 2 groups for data analysis: normotensive pregnancy and gestational hypertension. Nearly one-quarter of study participants (22.8%) developed gestational hypertension, of whom 84.6% had significant proteinuria meeting the criteria for preeclampsia. There were no significant differences in micronutrient or macronutrient dietary intakes between groups. Serum iron and zinc levels were lower for the gestational hypertension group compared with the normotensive pregnancy group (P ≤ .01). Low serum zinc levels were related to a risk of developing gestational hypertension (adjusted odds ratio, 0.930; 95% confidence interval, 0.872-0.992). Ensuring adequate intake of zinc and monitoring serum zinc levels in nulliparous pregnant women may help to prevent or contribute to early detection of gestational hypertension. © 2013 by the American College of Nurse-Midwives.

  17. RXRα is Upregulated in First Trimester Endometrial Glands of Spontaneous Abortions Unlike LXR and PPARγ

    PubMed Central

    Knabl, J.; Vattai, A.; Hüttenbrenner, R.; Hutter, S.; Karsten, M.

    2016-01-01

    Nuclear receptors are necessary for uterine invasion of the trophoblast and therefore important for maintaining a viable pregnancy. The aim of this study was to investigate the expression pattern and frequency of LXR, PPARγ and RXRα under physiological circumstances and in spontaneous abortions in endometrial glands and decidual tissue cells. A total of 28 (14 physiologic pregnancies/14 spontaneous abortion) human pregnancies in first trimester were analyzed for expression of the nuclear receptors LXR, RXRα and PPARγ. Expression changes were evaluated by immunohistochemistry in decidual tissue and endometrial glands of the decidua. RXRα expression was up-regulated in the endometrial glands of spontaneous abortion (P<0.015). Similar up regulation of RXRα was found in decidual tissue (P<0.05). LXR and PPARγ expression was unchanged in spontaneous abortion. By Correlation analysis we found a trend to positive correlation of LXR and PPARγ (Spearman correlation coefficient r=0.56, P=0.07) in endometrial glands. In decidual tissue, we found significant negative correlation in the control group, for the combination of RXRα and PPARγ (Spearman correlation coefficient r=0.913, P=0.03). Our data show that RXRα expression is increased in miscarriage in endometrial glands and correlation analysis showed that negative correlation between RXRα and PPARγ disappears in miscarriage. This shift is supposable responsible for the loss of regular function in trophoblast and embryonic tissue. PMID:28076928

  18. Vitamin D status in the first-trimester: effects of Vitamin D deficiency on pregnancy outcomes.

    PubMed

    Ates, Seda; Sevket, Osman; Ozcan, Pinar; Ozkal, Fulya; Kaya, Mehmet Onur; Dane, Banu

    2016-03-01

    To assess serum levels of 25-hydroxyvitamin D [25(OH)D] in the first trimester and to determine the factors affecting deficiency levels and its association with pregnancy outcomes. Serum 25(OH)D concentrations were measured at 11-14 weeks' gestation in 229 singleton pregnancies using liquid chromatography-tandem mass spectrometry. The median serum 25(OH)D concentration was 10.8 ng/mL and 45.9% of women had severe vitamin D deficiency with concentrations of <10 ng/mL. Logistic regression analysis revealed that covered dressing style, lack of multivitamin intake, season of blood sampling (November-April) were factors associated with 25(OH)D deficiency. There was a negative correlation between 25(OH)D levels and gestational age at sampling. Low 25(OH)D levels were not associated with adverse pregnancy outcomes. Higher rate of cesarean section (CS) was noted in women with 25(OH)D ≥10 ng/mL compared to those with 25(OH)D < 10mg/ml (p= 0.01). A high prevalence of vitamin D deficiency was observed in early pregnancy which was related to dress code, use of multi-vitamins and season at sampling. Low 25(OH)D levels were not related with adverse pregnancy outcomes. Women with severe vitamin D deficiency were more likely to deliver vaginally.

  19. Circulating placental protein 14: in the first trimester of spontaneous and IVF pregnancies.

    PubMed

    Johnson, M R; Abbas, A; Norman-Taylor, J Q; Riddle, A F; Grudzinskas, J G; Chard, T; Nicolaides, K H

    1993-02-01

    Circulating placental protein 14 (PP14) levels were measured during the first trimester in three groups of pregnant women: (i) natural conception (n = 15); (ii) pituitary desensitization with buserelin and ovarian stimulation with human menopausal gonadotrophin (HMG) followed by in-vitro fertilization and embryo transfer (IVF-ET) (n = 15); and (iii) ovarian stimulation with clomiphene citrate and HMG, followed by IVF-ET (n = 16). A 7- to 8-fold increase in serum PP14 levels was observed in normal pregnancies between weeks 4 and 10. This increase was earlier and less marked in group (ii) and absent in group (iii). These findings support the concept that endometrial function is altered in pregnancies achieved following ovarian stimulation. Alternatively, if the ovary is an important source of PP14, then these data suggest that in contrast to ovarian synthesis of steroids and the peptide relaxin, ovarian stimulation results in an impairment of PP14 synthesis, and that this is most marked when clomiphene citrate has been used.

  20. [Hyperemesis gravidarum: a rare but potentially severe complication of the first trimester of pregnancy].

    PubMed

    Macle, Lucie; Varlet, Marie-Noëlle; Cathébras, Pascal

    2010-06-20

    Although nausea and vomiting are common symptoms in early pregnancy, hyperemesis gravidarum (HG) is a rare complication of the first trimester of pregnancy. This condition is defined as intractable vomiting occurring before 20 weeks of gestation, with fluid and electrolyte disturbance, significant weight loss, and ketonuria, leading to hospitalization in the absence of other cause than pregnancy. Some biological disturbances found in HG, such as hyperthyroidism and hepatic cytolysis, which are correlated with the importance of vomiting, are without severe clinical consequences, but may represent diagnostic pitfalls. The aetiology is unknown, but human chorionic gonadotropin hormones likely play the first role. Psychological disturbance is currently seen as the result of the burden and stress of HG rather than a causal factor. Maternal outcome may be severe in the absence of treatment, but pregnancy outcome seems good, as far as the condition has been adequately controlled. The management of HG includes IV rehydration, thiamine supplementation, antiemetic drugs (doxylamine, metoclopramide and chlorpromazine being the first-line choices), and in severe cases, nasogastric or parenteral nutrition. A psychological support is often necessary.

  1. Clinical application of SNP array analysis in first-trimester pregnancy loss: a prospective study.

    PubMed

    Wang, Y; Cheng, Q; Meng, L; Luo, C; Hu, H; Zhang, J; Cheng, J; Xu, T; Jiang, T; Liang, D; Hu, P; Xu, Z

    2017-06-01

    Chromosomal microarray analysis (CMA) has been used routinely in pediatric and prenatal genetic diagnosis in clinical practice, but it has rarely been applied to miscarriage analysis. In this study, we conducted a prospective study to evaluate the feasibility of CMA for genetic diagnosis of first-trimester miscarriage specimens. We successfully analyzed 551 fresh miscarriage specimens using single-nucleotide polymorphism (SNP) array. Among the specimens, 2.9% (16/551) had significant maternal cell contamination and were excluded from the study. Clinically significant chromosomal abnormalities were identified in 295 (55.1%) cases, including 214 (40%) with aneuploidy, 40 (7.5%) with polyploidy, 19 (3.6%) with partial aneuploidy, 12 (2.2%) with pathogenic microdeletion/microduplication, and 10 (1.9%) with uniparental isodisomy (isoUPD). Variants of uncertain significance were obtained in 15 cases (2.8%). Notably, isoUPD involving a single chromosome (chromosome 22) and two recurrent copy number variations, 22q11.2 microdeletion and 7q11.23 microdeletion, were identified as probably to be associated with miscarriage. The frequency and distribution of genetic aberrations in the spontaneous abortion group was not significantly different from those in the recurrent miscarriage group. Our study suggests SNP array is a reliable, robust, and high-resolution technology for genetic diagnosis of miscarriage in clinical practice. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  2. What Is Trophoblast? A Combination of Criteria Define Human First-Trimester Trophoblast

    PubMed Central

    Lee, Cheryl Q.E.; Gardner, Lucy; Turco, Margherita; Zhao, Nancy; Murray, Matthew J.; Coleman, Nicholas; Rossant, Janet; Hemberger, Myriam; Moffett, Ashley

    2016-01-01

    Summary Controversy surrounds reports describing the derivation of human trophoblast cells from placentas and embryonic stem cells (ESC), partly due to the difficulty in identifying markers that define cells as belonging to the trophoblast lineage. We have selected criteria that are characteristic of primary first-trimester trophoblast: a set of protein markers, HLA class I profile, methylation of ELF5, and expression of microRNAs (miRNAs) from the chromosome 19 miRNA cluster (C19MC). We tested these criteria on cells previously reported to show some phenotypic characteristics of trophoblast: bone morphogenetic protein (BMP)-treated human ESC and 2102Ep, an embryonal carcinoma cell line. Both cell types only show some, but not all, of the four trophoblast criteria. Thus, BMP-treated human ESC have not fully differentiated to trophoblast. Our study identifies a robust panel, including both protein and non-protein-coding markers that, in combination, can be used to reliably define cells as characteristic of early trophoblast. PMID:26862703

  3. What Is Trophoblast? A Combination of Criteria Define Human First-Trimester Trophoblast.

    PubMed

    Lee, Cheryl Q E; Gardner, Lucy; Turco, Margherita; Zhao, Nancy; Murray, Matthew J; Coleman, Nicholas; Rossant, Janet; Hemberger, Myriam; Moffett, Ashley

    2016-02-09

    Controversy surrounds reports describing the derivation of human trophoblast cells from placentas and embryonic stem cells (ESC), partly due to the difficulty in identifying markers that define cells as belonging to the trophoblast lineage. We have selected criteria that are characteristic of primary first-trimester trophoblast: a set of protein markers, HLA class I profile, methylation of ELF5, and expression of microRNAs (miRNAs) from the chromosome 19 miRNA cluster (C19MC). We tested these criteria on cells previously reported to show some phenotypic characteristics of trophoblast: bone morphogenetic protein (BMP)-treated human ESC and 2102Ep, an embryonal carcinoma cell line. Both cell types only show some, but not all, of the four trophoblast criteria. Thus, BMP-treated human ESC have not fully differentiated to trophoblast. Our study identifies a robust panel, including both protein and non-protein-coding markers that, in combination, can be used to reliably define cells as characteristic of early trophoblast. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

  4. First trimester thyroid stimulating hormone as an independent risk factor for adverse pregnancy outcome.

    PubMed

    Arbib, Nissim; Hadar, Eran; Sneh-Arbib, Orly; Chen, Rony; Wiznitzer, Arnon; Gabbay-Benziv, Rinat

    2017-09-01

    Maternal thyroid gland dysfunction may adversely affect pregnancy outcome. We aimed to examine the association between subclinical thyroid dysfunction, both hypothyroidism and hyperthyroidism, to adverse pregnancy outcome. Retrospective cohort study of all women with an available first trimester thyroid function testing and known pregnancy outcome, categorized to subclinical hypothyroidism, or hyperthyroidism and evaluated for complication during gestation and delivery. Four thousand five hundred and four women were included in the final analysis - 3231 were euthyroid, 73 (1.6%) were categorized as subclinical hyperthyroidism and 1200 (26.6%) had subclinical hypothyroidism. Low thyroid-stimulating hormone (TSH) levels, i.e. subclinical hyperthyroidism, correlates with higher rates of placental abruption and extremely low birth weight, below 1500 g. Also, the risk for preterm delivery prior to 34 gestational weeks is higher among women with subclinical hypothyroidism, with greater risk among those with a higher TSH level. (OR 1.81, 95% CI 1.0-3.28 for TSH 2.5-4.0 mIU/L and OR 2.33, 95% CI 1.11-4.42 for those with TSH > 4 4.0 mIU/L). Subclinical hypothyroidism is associated with an increased risk for preterm delivery prior to 34 gestational weeks. Additionally, subclinical hyperthyroidism may also have a role in adverse pregnancy outcome - low birth weight and placental abruption - although this needs to be further explored.

  5. [Microbiological screening and postoperative course in patients undergoing first trimester abortion].

    PubMed

    La Rosa, R; Ricci, M G; Oliveti, C; Giovani, M; Lapucci, T; Morgante, G; Danero, S; Alegente, G

    1985-01-01

    Pelvic infections are a serious and widespread gynecological disease, often leading to sterility. Procedures like evacuation of the products of conception by vacuum suction are known to facilitate their appearance. 300 patients were examined the same day of the abortion (first trimester); before the hysterosuction a vaginal tampon was taken from the cervix and from the posterior fornix. The patients were invited to come back for an exam in two weeks and to refer to the clinic for any problem before then. A wet mount, aerobic and anaerobic cultures in several media and Gram stains were used to identify the pathogens. 40.3% of the tampons were positive for pathogens, mostly staphilococci (52%), but also Candida, alfa and beta hemolytic Streptococci, Proteus, E. Coli, Trichomonas. 5 patients had serious complications that required hospital admission. Only 128 patients showed up for the postoperative control; of these, 14 presented with symptoms of pelvic infection. Since pelvic infections are the most frequent complication after induced abortion, and considering the larege number of women who carry vaginal pathogens, the Authors strongly recommend a guided antibiotic profilaxis before the hysterosuction operation.

  6. Diagnosis of emergencies/urgencies in gynecology and during the first trimester of pregnancy.

    PubMed

    Zucchini, Stefano; Marra, Elena

    2014-03-01

    Several surgical and/or medical emergencies/urgencies may occur in gynecologic patients and in pregnant women during the first trimester. Particularly, ectopic pregnancies, ruptured or hemorrhagic ovarian cysts, ovarian or adnexal torsions, threatened or inevitable miscarriages, phlogistic gynecological disorders, complications involving the uterine fibroids, endometriosis, and spontaneous uterine rupture are possible acute complications. The diagnosis is suspected on the basis of symptoms (acute pelvic and/or abdominal pain, with or without vaginal bleeding or discharge, until acute abdomen with peritonitis), by means physical evaluation (abdominal, pelvic, and bimanual gynecological examinations), by means of transabdominal (TAS) and/or transvaginal (TVS) sonography, and laboratory tests. However, the diagnosis is often not that simple, especially when the symptoms and clinical signs are minimal, and ultrasound (US) examination is not diriment. The differential diagnosis of abdominal/pelvic pain is broad and includes primarily gastrointestinal and urogenital disorders. Generally, TAS should usually be used in conjunction with TVS for evaluation of the female pelvis. If the US examination is not conclusive, CT or MRI, especially in pregnant patients, should be considered.

  7. Lower vitamin D levels at first trimester are associated with higher risk of developing gestational diabetes mellitus.

    PubMed

    Lacroix, Marilyn; Battista, Marie-Claude; Doyon, Myriam; Houde, Ghislaine; Ménard, Julie; Ardilouze, Jean-Luc; Hivert, Marie-France; Perron, Patrice

    2014-08-01

    The progressive increase of insulin resistance observed in pregnancy contributes to the pathophysiology of gestational diabetes mellitus (GDM). There is controversy whether vitamin D deficiency contributes to abnormal glycemic regulation in pregnancy. We tested the associations between first trimester 25-hydroxyvitamin D (25OHD) levels and: 1) the risk of developing GDM; 2) insulin resistance/sensitivity, beta cell function and compensation indices in a large population-based prospective cohort of pregnant women. Participants (n = 655) were seen at first (6-13 weeks) and second (24-28 weeks) trimesters for blood samples. At first trimester, 25OHD levels were measured. At second trimester, glucose and insulin were measured 3 times during the oral glucose tolerance test to estimate insulin resistance (HOMA-IR), beta cell function (HOMA-B), insulin sensitivity (Matsuda index), insulin secretion (AUCins/gluc) and beta cell compensation (ISSI-2). Based on IADPSG criteria, 54 participants (8.2 %) developed GDM. Lower first trimester 25OHD levels were associated with higher risk of developing GDM even after adjustment for vitamin D confounding factors and GDM risk factors (OR = 1.48 per decrease of one SD in 25OHD levels; P = 0.04). Lower first trimester 25OHD levels were associated with higher HOMA-IR (r = - 0.08; P = 0.03), lower Matsuda index (r = 0.13; P = 0.001) and lower ISSI-2 (r = 0.08; P = 0.04). After adjustment for confounders, we found no significant association with HOMA-B and AUCins/gluc. Our results suggest that low levels of 25OHD at first trimester are (1) an independent risk factor for developing GDM and (2) associated with insulin resistance at second trimester.

  8. Intramuscular ketorolac versus oral ibuprofen for pain relief in first-trimester surgical abortion: a randomized clinical trial.

    PubMed

    Braaten, Kari P; Hurwitz, Shelley; Fortin, Jennifer; Goldberg, Alisa B

    2014-02-01

    Oral nonsteroidal antiinflammatory medications (NSAIDs) have been shown to reduce pain with first-trimester surgical abortion compared to placebo, but it is unclear if one NSAID is better than another. Some providers administer intramuscular ketorolac, though data regarding its efficacy in abortion are limited. This study was designed to compare oral ibuprofen to intramuscular ketorolac for pain management during first-trimester surgical abortion. This was a randomized, double-blind, controlled trial. Women undergoing first-trimester surgical abortion with local anesthesia were randomized to preprocedural oral ibuprofen, 800 mg given 60-90 min preprocedure, or intramuscular ketorolac, 60 mg given 30-60 min preprocedure. The primary outcome was pain with uterine aspiration on a 21-point, 0-100, numerical rating scale. Secondary outcomes included pain with cervical dilation, postoperative pain and patient satisfaction. Ninety-four women were enrolled; 47 were randomized to ibuprofen and 47 to ketorolac. The groups did not differ with regards to demographics, reproductive history or Depression Anxiety Stress Scale scores. Mean pain scores for suction curettage did not differ between groups (52.3 vs. 56.2, p=.53). There was also no difference in pain with cervical dilation (41.6 vs. 45.4, p=0.48) or postoperative pain (22.3 vs. 15.0 p=.076), though patients in the ketorolac group experienced significantly greater arm pain than those who received a placebo injection (30.4 vs. 15.6, p<.001). Satisfaction with pain control did not differ significantly by group. Intramuscular ketorolac does not offer superior pain control compared to oral ibuprofen for first-trimester surgical abortion. Intramuscular ketorolac does not offer superior pain control over oral ibuprofen during first-trimester surgical abortion, is more expensive and causes patients significant arm discomfort. Its use should therefore be reserved for patients who cannot tolerate oral NSAIDs. © 2014.

  9. First trimester combined screening for preeclampsia and small for gestational age - a single centre experience and validation of the FMF screening algorithm.

    PubMed

    Mosimann, Beatrice; Pfiffner, Chantal; Amylidi-Mohr, Sofia; Risch, Lorenz; Surbek, Daniel; Raio, Luigi

    2017-09-05

    Preeclampsia (PE) is associated with severe maternal and fetal morbidity in the acute presentation and there is increasing evidence that it is also an important risk factor for cardiovascular disease later in life. Therefore, preventive strategies are of utmost importance. The Fetal Medicine Foundation (FMF) London recently developed a first trimester screening algorithm for placenta-related pregnancy complications, in particular early onset preeclampsia (eoPE) requiring delivery before 34 weeks, and preterm small for gestational age (pSGA), with a birth weight <5th percentile and delivery before 37 weeks of gestation, based on maternal history and characteristics, and biochemical and biophysical parameters. The aim of this study was to test the performance of this algorithm in our setting and to perform an external validation of the screening algorithm. Between September 2013 and April 2016, all consecutive women with singleton pregnancies who agreed to this screening were included in the study. The proposed cut-offs of ≥1:200 for eoPE, and ≥1:150 for pSGA were applied. Risk calculations were performed with Viewpoint® program (GE, Mountainview, CA, USA) and statistical analysis with GraphPad version 5.0 for Windows. 1372 women agreed to PE screening; the 1129 with complete data and a live birth were included in this study. Nineteen (1.68%) developed PE: 14 (1.24%) at term (tPE) and 5 (0.44%) preterm (pPE, <37 weeks), including 2 (0.18%) with eoPE. Overall, 97/1129 (8.6%) screened positive for eoPE, including both pregnancies that resulted in eoPE and 4/5 (80%) that resulted in pPE. Forty-nine of 1110 (4.41%) pregnancies without PE resulted in SGA, 3 (0.27%) of them in pSGA. A total of 210/1110 (18.9%) non-PE pregnancies screened positive for pSGA, including 2/3 (66.7%) of the pSGA deliveries and 18/46 (39.1%) of term SGA infants. Our results show that first trimester PE screening in our population performs well and according to expectations, whereas screening

  10. Selective serotonin reuptake inhibitor antidepressant use in first trimester pregnancy and risk of specific congenital anomalies: a European register-based study.

    PubMed

    Wemakor, Anthony; Casson, Karen; Garne, Ester; Bakker, Marian; Addor, Marie-Claude; Arriola, Larraitz; Gatt, Miriam; Khoshnood, Babak; Klungsoyr, Kari; Nelen, Vera; O'Mahoney, Mary; Pierini, Anna; Rissmann, Anke; Tucker, David; Boyle, Breidge; de Jong-van den Berg, Lolkje; Dolk, Helen

    2015-11-01

    Evidence of an association between early pregnancy exposure to selective serotonin reuptake inhibitors (SSRI) and congenital heart defects (CHD) has contributed to recommendations to weigh benefits and risks carefully. The objective of this study was to determine the specificity of association between first trimester exposure to SSRIs and specific CHD and other congenital anomalies (CA) associated with SSRI exposure in the literature (signals). A population-based case-malformed control study was conducted in 12 EUROCAT CA registries covering 2.1 million births 1995-2009 including livebirths, fetal deaths from 20 weeks gestation and terminations of pregnancy for fetal anomaly. Babies/fetuses with specific CHD (n = 12,876) and non-CHD signal CA (n = 13,024), were compared with malformed controls whose diagnosed CA have not been associated with SSRI in the literature (n = 17,083). SSRI exposure in first trimester pregnancy was associated with CHD overall (OR adjusted for registry 1.41, 95% CI 1.07-1.86, fluoxetine adjOR 1.43 95% CI 0.85-2.40, paroxetine adjOR 1.53, 95% CI 0.91-2.58) and with severe CHD (adjOR 1.56, 95% CI 1.02-2.39), particularly Tetralogy of Fallot (adjOR 3.16, 95% CI 1.52-6.58) and Ebstein's anomaly (adjOR 8.23, 95% CI 2.92-23.16). Significant associations with SSRI exposure were also found for ano-rectal atresia/stenosis (adjOR 2.46, 95% CI 1.06-5.68), gastroschisis (adjOR 2.42, 95% CI 1.10-5.29), renal dysplasia (adjOR 3.01, 95% CI 1.61-5.61), and clubfoot (adjOR 2.41, 95% CI 1.59-3.65). These data support a teratogenic effect of SSRIs specific to certain anomalies, but cannot exclude confounding by indication or associated factors.

  11. Cell-Free Fetal DNA and Cell-Free Total DNA Levels in Spontaneous Abortion with Fetal Chromosomal Aneuploidy

    PubMed Central

    Lim, Ji Hyae; Kim, Min Hyoung; Han, You Jung; Lee, Da Eun; Park, So Yeon; Han, Jung Yeol; Kim, Moon Young; Ryu, Hyun Mee

    2013-01-01

    Background Cell-free fetal DNA and cell-free total DNA in maternal circulation have been proposed as potential markers for noninvasive monitoring of the placental condition during the pregnancy. However, the correlation of and change in cell-free fetal DNA and cell-free total DNA in spontaneous abortion (SA) with fetal chromosomal aneuploidy have not yet been reported. Therefore, we investigated cell-free fetal DNA and cell-free total DNA levels in SA women with fetal chromosomal aneuploidy. Methodology/Principal Findings A nested case-control study was conducted with maternal plasma collected from 268 women in their first trimester of pregnancy. Subjects included 41 SA with normal fetal karyotype, 26 SA with fetal chromosomal aneuploidy, and 201 normal controls. The unmethylated PDE9A gene was used to measure the maternal plasma levels of cell-free fetal DNA. The GAPDH gene was used to measure the maternal plasma levels of cell-free total DNA. The diagnostic accuracy was measured using receiver-operating characteristic (ROC) curves. Levels of cell-free fetal DNA and cell-free total DNA were significantly higher in both SA women with normal fetal karyotype and SA women with fetal chromosomal aneuploidy in comparison with the normal controls (P<0.001 in both). The correlation between cell-free fetal DNA and cell-free total DNA levels was stronger in the normal controls (r = 0.843, P<0.001) than in SA women with normal karyotype (r = 0.465, P = 0.002) and SA women with fetal chromosomal aneuploidy (r = 0.412, P = 0.037). The area under the ROC curve for cell-free fetal DNA and cell-free total DNA was 0.898 (95% CI, 0.852–0.945) and 0.939 (95% CI, 0.903–0.975), respectively. Conclusions Significantly high levels of cell-free fetal DNA and cell-free total DNA were found in SA women with fetal chromosomal aneuploidy. Our findings suggest that cell-free fetal DNA and cell-free total DNA may be useful biomarkers for the prediction of SA with fetal

  12. Cell-free fetal DNA and cell-free total DNA levels in spontaneous abortion with fetal chromosomal aneuploidy.

    PubMed

    Lim, Ji Hyae; Kim, Min Hyoung; Han, You Jung; Lee, Da Eun; Park, So Yeon; Han, Jung Yeol; Kim, Moon Young; Ryu, Hyun Mee

    2013-01-01

    Cell-free fetal DNA and cell-free total DNA in maternal circulation have been proposed as potential markers for noninvasive monitoring of the placental condition during the pregnancy. However, the correlation of and change in cell-free fetal DNA and cell-free total DNA in spontaneous abortion (SA) with fetal chromosomal aneuploidy have not yet been reported. Therefore, we investigated cell-free fetal DNA and cell-free total DNA levels in SA women with fetal chromosomal aneuploidy. A nested case-control study was conducted with maternal plasma collected from 268 women in their first trimester of pregnancy. Subjects included 41 SA with normal fetal karyotype, 26 SA with fetal chromosomal aneuploidy, and 201 normal controls. The unmethylated PDE9A gene was used to measure the maternal plasma levels of cell-free fetal DNA. The GAPDH gene was used to measure the maternal plasma levels of cell-free total DNA. The diagnostic accuracy was measured using receiver-operating characteristic (ROC) curves. Levels of cell-free fetal DNA and cell-free total DNA were significantly higher in both SA women with normal fetal karyotype and SA women with fetal chromosomal aneuploidy in comparison with the normal controls (P<0.001 in both). The correlation between cell-free fetal DNA and cell-free total DNA levels was stronger in the normal controls (r = 0.843, P<0.001) than in SA women with normal karyotype (r = 0.465, P = 0.002) and SA women with fetal chromosomal aneuploidy (r = 0.412, P = 0.037). The area under the ROC curve for cell-free fetal DNA and cell-free total DNA was 0.898 (95% CI, 0.852-0.945) and 0.939 (95% CI, 0.903-0.975), respectively. Significantly high levels of cell-free fetal DNA and cell-free total DNA were found in SA women with fetal chromosomal aneuploidy. Our findings suggest that cell-free fetal DNA and cell-free total DNA may be useful biomarkers for the prediction of SA with fetal chromosomal aneuploidy, regardless of fetal gender.

  13. Increased first trimester nuchal translucency as a prenatal manifestation of Smith-Lemli-Opitz syndrome

    SciTech Connect

    Hyett, J.A.; Clayton, P.T.; Moscosco, G.; Nicolaides, K.H.

    1995-09-25

    Routine ultrasound examination at 11 weeks of gestation in a woman with no family history of genetic disease demonstrated increased accumulation of fluid in the fetal nuchal region. In view of the association of this defect with chromosomal abnormalities, fetal karyotyping was performed by chorion villus sampling and this demonstrated a normal 46,XY karyotype. Subsequent scans showed resolution of the nuchal fluid, and at the 20-week scan the fetal genitalia appeared to be female. Fetal blood sampling confirmed a normal male karyotype and fetoscopy confirmed the presence of female external genitalia. The parents elected to terminate the pregnancy, and postmortem findings were indicative of Smith-Lemli-Opitz syndrome. This was confirmed by the finding of increased levels of 7-dehydrocholesterol in cultured skin fibroblasts. 11 refs., 2 figs., 1 tab.

  14. First trimester intact hCG as an early marker of trisomy 21: a promise unrecognised?

    PubMed

    Spencer, Kevin; Cowans, Nicholas J; Uldbjerg, Niels; Vereecken, Annie; Tørring, Niels

    2008-12-01

    An initial study of trisomy 21 cases showed that prior to 10 weeks, maternal serum levels of intact hCG in the early first trimester are lower than normal. Here we further study the levels prior to and after 10 weeks of gestation to further establish whether or not the intact hCG is effective as a very early screening marker. Fifty-nine samples from pregnancies with trisomy 21 were identified, 31 were collected between the sixth and ninth weeks of gestation and 28 after the tenth week. A series of 629 gestational age-matched samples collected during the same period formed the control group. Intact hCG was measured by a DELFIA assay. The multiples of the median (MoM) in cases (n = 31) collected prior to 10 weeks were 0.79 (CI 0.62-0.98) at a median gestation of 9.1 weeks. Prior to 9 weeks (n = 14) the median was 0.774 (CI 0.54-1.09) at a median gestation of 8.5 weeks. Modelling the detection rate for a 3 or 5% false-positive rate when screening using intact hCG, free beta-hCG and PAPP-A at 8-10 weeks of gestation indicated that 71 or 77% of cases would be detected. More data are needed to establish a secure MoM for intact hCG in pregnancies prior to 10 weeks, before it could be considered a suitable screening marker. Copyright (c) 2008 John Wiley & Sons, Ltd.

  15. First trimester initiation of prenatal care in the US-Mexico border region.

    PubMed

    McDonald, Jill A; Argotsinger, Brittany; Mojarro, Octavio; Rochat, Roger; Amatya, Anup

    2015-08-01

    To systematically examine prevalence of first trimester prenatal care (FTPNC) in the 44 US counties and 80 Mexican municipios of the binational border region; and to describe disparities between border and nonborder areas within states, border states, and countries. We combined 2009 records of singleton live births from the 10 US-Mexico border states (N=1,370,206) into a single file. We included FTPNC; county/municipio, state, and country of maternal residence; and demographic variables common to all records. We computed prevalence of FTPNC for border and nonborder residents by state and country. Using multivariable regression, we computed adjusted prevalence ratios (aPR) for FTPNC in border relative to nonborder residents, states relative to one another, and the US relative to Mexico. In 2009, 68.8% of US-Mexico border mothers and 72.9% of nonborder mothers received FTPNC. After adjustment, nonborder residents had higher prevalence of FTPNC than border residents in Sonora, New Mexico, Arizona, Coahuila, and Chihuahua (aPR=1.09-124). In US states, prevalence was 13%-36% higher in New Mexico, Arizona, and California than Texas. In Mexico, when compared with Coahuila, adjusted prevalence was 12%-20% higher in neighboring states. Between countries, FTPNC prevalence in border counties/municipios was higher in Mexico among women with low parity/low education and in the United States among women with high parity/high education. In the US and Mexico, women in border counties/municipios receive less timely prenatal care than their nonborder counterparts, but the magnitude of the disparity varies by state. Lack of a consistent, binational approach to birth data collection requires cautious interpretation of findings.

  16. Nitrosatable drug exposure during the first trimester of pregnancy and selected congenital malformations

    PubMed Central

    Brender, Jean D.; Werler, Martha M; Shinde, Mayura U; Vuong, Ann M; Kelley, Katherine E.; Huber, John C.; Sharkey, Joseph R.; Griesenbeck, John S.; Romitti, Paul A.; Malik, Sadia; Suarez, Lucina; Langlois, Peter H.; Canfield, Mark A.

    2012-01-01

    BACKGROUND Nitrosatable drugs can react with nitrite in the stomach to form N-nitroso compounds, and results from animal studies suggest that N-nitroso compounds are teratogens. With data from the National Birth Defects Prevention Study, the relation between prenatal exposure to nitrosatable drugs and limb deficiencies, oral cleft, and heart malformations in offspring was examined. METHODS Maternal reports of drugs taken during the first trimester of pregnancy were classified with respect to nitrosatability for mothers of 741 babies with limb deficiencies, 2,774 with oral cleft malformations, 8,091 with congenital heart malformations, and 6,807 without major congenital malformations. Nitrite intake was estimated from maternal responses to a food frequency questionnaire. RESULTS Isolated transverse limb deficiencies and atrioventricular septal defects were associated with secondary amine drug exposures (adjusted odds ratios [aOR] 1.51, 95% confidence limit [CI] 1.11, 2.06 and aOR 1.97, 95% CI 1.19, 3.26, respectively). Tertiary amines were associated with hypoplastic left heart syndrome (aOR 1.50, 95% CI 1.10, 2.04) and single ventricle (aOR 1.61, 95% CI 1.06, 2.45). These two malformations were also significantly associated with amide drugs. For several malformations, the strongest associations with nitrosatable drug use occurred among mothers with the highest estimated dietary nitrite intake, especially for secondary amines and atrioventricular septal defects (highest tertile of nitrite, aOR 3.30, 95% CI 1.44, 7.58). CONCLUSION Prenatal exposure to nitrosatable drugs may be associated with several congenital malformations, especially with higher nitrite intake. The possible interaction between nitrosatable drugs and dietary nitrite on risk of congenital malformations warrants further attention. PMID:22903972

  17. Two-year outcome after recurrent first trimester miscarriages: prognostic value of the past obstetric history.

    PubMed

    Kling, Christiane; Magez, Julia; Hedderich, Jürgen; von Otte, Sören; Kabelitz, Dieter

    2016-05-01

    Recurrent miscarriage (RM) is a stressful condition which gives rise to extensive diagnostic evaluation and is seen as a potentially curable maternal disease. Nevertheless, epidemiological data have shown that outcome is related to fertility. In addition to maternal age and number of preceding miscarriages, further markers derived from the past history may support counselling. Observational trial comprising 228 couples who were referred between 1996 and 2003 for immunological evaluation at maternal ages 20-39 years after three or more spontaneously conceived primary first trimester miscarriages. They were interviewed in 2005, ongoing pregnancies were followed up until birth in 2006. Past obstetric history was correlated with 2 year cumulative pregnancy and delivery rates (CPR, CDR). CPR and CDR were 206/228 (90.4 %) and 174/228 (76.4 %). Duration of infertility was associated with lower CPR (up to 3/>3 years, p < 0.01), whereas age and number of preceding losses inversely correlated with CDR (<35 years/35-39 years, p < 0.002; 3/>3 miscarriages, p < 0.002). Detection of an embryonic heart beat in 2-3 of the first three miscarriages resulted in favourable outcome (CPR: p < 0.02, CDR: p < 0.002). Prognosis was excellent in younger fertile women after three miscarriages where vital signs had been detected; under less favourable conditions not only risks for further miscarriage, but also for secondary infertility were elevated. Secondary infertility is a feature of RM. Embryonic vital signs in preceding pregnancies are prognostic markers and should be regarded as a strong confounding factor in trials on therapeutic interventions. Prevention may be more appropriate than treatment.

  18. First-trimester prenatal diagnosis of Ellis-van Creveld syndrome.

    PubMed

    Chen, Chih-Ping; Chen, Chen-Yu; Chern, Schu-Rern; Su, Jun-Wei; Wang, Wayseen

    2012-12-01

    To present the perinatal findings and first-trimester molecular and transabdominal ultrasound diagnosis of a fetus with Ellis-van Creveld (EvC) syndrome. A 35-year-old woman was referred for genetic counseling at 13 weeks of gestation because of a family history of skeletal dysplasia. She had experienced one spontaneous abortion, and delivered one male fetus and one female fetus with EvC syndrome. During this pregnancy, a prenatal transabdominal ultrasound at 13(+4) weeks of gestation revealed a nuchal translucency (NT) thickness of 2.0 mm, an endocardial cushion defect, postaxial polydactyly of bilateral hands, and mesomelic dysplasia of the long bones. Amniocentesis was performed at 13(+5) weeks of gestation. Results of a cytogenetic analysis revealed a karyotype of 46,XX and that of a molecular analysis revealed compound heterozygous mutations of c.1195C>T and c.871-2_894del26 in the EVC2 gene. Prenatal ultrasound at 16 weeks of gestation showed a fetus with short limbs, an endocardial cushion defect, and postaxial polydactyly of bilateral hands. The parents decided to terminate the pregnancy, and a 116-g female fetus was delivered with a narrow thorax, shortening limbs, and postaxial polydactyly of the hands. Prenatal diagnosis of an endocardial cushion defect with postaxial polydactyly should include a differential diagnosis of EvC syndrome in addition to short rib-polydactyly syndrome, Bardet-Biedl syndrome, orofaciodigital syndrome, Smith-Lemli-Opitz syndrome, and hydrolethalus syndrome. Copyright © 2012. Published by Elsevier B.V.

  19. Characteristics of first-trimester screening of non-responders in a high-uptake population.

    PubMed

    Wolf, Hanne Trap; Wulff, Camilla Bernt; Ekelund, Charlotte; Sundberg, Karin; Tabor, Ann

    2016-04-01

    Our aim was to compare demographic, social and reproductive health-related medical factors between women who did and women who did not undergo combined first-trimester screening (cFTS) and to examine their reasons for declining a screening offer, especially whether non-participation was an informed choice. This was a nationwide survey conducted in Denmark in 2014. A structured questionnaire with 33 questions relating to demographical data and medical history was mailed to 1,495 randomly selected women who gave birth in 2012. Half of the women were selected among the population without cFTS, the other half from those with cFTS. A cohort of 20 women tested the questionnaire for consistency. The results are based on the responders (58%). The response rate was 88% among the women with cFTS and 19% among the women without. Not having a cFTS performed was associated with the following factors: country of origin other than Denmark (p < 0.01), less education (p < 0.01) and unemployment (p < 0.01). These women more often had a religious belief (p < 0.01), and had undergone fewer induced abortions (p = 0.01). They felt less informed about the cFTS (p < 0.01) and thought it was a more difficult decision (p < 0.01) than the women who had undergone cFTS. The main reason for declining cFTS was a wish to keep the child regardless of any cFTS results (82%). Women without cFTS differ from those who undergo cFTS. Not undergoing cFTS seemed most often to be the result of a conscious choice based on ethical considerations, rather than being the result of a lack of information. However, a low response rate decreases the strength of our conclusions. none. not relevant.

  20. Dichlorodiphenyldichloroethylene exposure during the first trimester of pregnancy alters the anal position in male infants.

    PubMed

    Torres-Sanchez, Luisa; Zepeda, Monica; Cebrián, Mariano E; Belkind-Gerson, Jaime; Garcia-Hernandez, Rosa M; Belkind-Valdovinos, Uri; López-Carrillo, Lizbeth

    2008-10-01

    Anogenital distance (AGD) at birth is regarded as a useful measurement that reflects the prenatal androgenic status in rodents. However, the impact of xenoantiandrogens on human development is largely unknown. The aim of this study was to evaluate the potential antiandrogenic impact of prenatal DDT metabolites (p,p'-DDE and p,p'-DDT) exposure on infant AGD, using a non-age-dependent anal position index (API). As part of an ongoing perinatal cohort study on the effects of organochlorine pesticides in children's neurodevelopment, we conducted a cross-sectional study in 71 infants (37 males and 34 females). Maternal serum levels of DDT metabolites (p,p'-DDE and p,p'-DDT) before and during each trimester of pregnancy were determined by electron capture gas-liquid chromatography. During postnatal home visits at 3, 6, and 12 or 18 months of age, the children's weight and API were evaluated. Multiple lineal regression models were used to estimate the potential endocrine disruptor activity of prenatal p,p'-DDE exposure. Boys had significantly higher API values than girls (0.6 versus 0.5; P < 0.001). Only among boys, a doubling increase of maternal p,p'-DDE serum levels during the first trimester of pregnancy, were associated with a significant reduction of API (beta=-0.02; P= 0.02). No effect of p,p'-DDT on AGD was observed. Evidence of the effect of prenatal p,p'-DDE on external genital differentiation is scarce and not consistent in the literature. Further studies are needed to confirm a hormonal disruptive effect on the development of external genitalia, due not only to p,p'-DDE but also due to other antiandrogenic persistent compounds.

  1. Anxiety and quality of life after first-trimester termination of pregnancy: a prospective study.

    PubMed

    Toffol, Elena; Pohjoranta, Elina; Suhonen, Satu; Hurskainen, Ritva; Partonen, Timo; Mentula, Maarit; Heikinheimo, Oskari

    2016-10-01

    Possible effects of termination of pregnancy (TOP) on mental health are a matter of debate. We assessed anxiety and quality of life during a one-year follow up after first-trimester TOP using the State-Trait Anxiety Inventory (STAI) Scale and EuroQoL Quality of Life Questionnaire (EQ-5D, EQ-VAS) in 742 women participating in a randomized controlled trial on early provision of intrauterine contraception. The measurements were performed before TOP, at 3 months and 1 year after TOP. Inclusion criteria were age ≥18 years, residence in Helsinki, duration of gestation <12 weeks, non-medical indication for TOP, and approval of intrauterine contraception. The trial was registered with Clinical Trials [NCT01223521]. When compared with baseline, the overall anxiety level was significantly lower and quality of life higher at 3 months and at 1 year. Reduction of anxiety and improvement of quality of life was especially evident (p < 0.001) in the 58% of women reporting clinically relevant anxiety at baseline. High levels of anxiety at baseline, history of psychiatric morbidity and smoking predicted significantly greater risk of poorer quality of life and elevated level of anxiety during the follow up. TOP is associated with a significant overall reduction of anxiety and an improvement of quality of life among women undergoing it for non-medical indications. High baseline anxiety, history of psychiatric morbidity and smoking are risk factors of persistently high levels of anxiety and poor quality of life after an induced abortion. These data are important when designing and providing post-abortion care. © 2016 Nordic Federation of Societies of Obstetrics and Gynecology.

  2. Representing and intervening: 'doing' good care in first trimester prenatal knowledge production and decision-making.

    PubMed

    Schwennesen, Nete; Koch, Lene

    2012-02-01

    This article investigates processes of knowledge production and decision-making in the practice of the first trimester prenatal risk assessment (FTPRA) at an ultrasound clinic in Denmark. On the basis of ethnographic material and interviews with professionals facilitating FTPRAs in Denmark, we draw attention to the active engagement of health professionals in this process. Current professional and policy debate over the use of prenatal testing emphasises the need for informed choice making and for services that provide prospective parents with what is referred to as 'non-directive counselling'. Studies focusing on professional practice of prenatal counselling tend to deal mainly with how professionals fail to live up to such ideals in practice. In this article we extend such studies by drawing attention to practices of care in prenatal testing and counselling. In doing so, we identify three modes of 'doing' good care: attuning expectations and knowledge, allowing resistance and providing situated influence in the relationship between the pregnant woman and the professional. Such practices may not be seen as immediately compatible with the non-directive ethos, but they express ways of reducing emotional suffering and supporting a pregnant woman's ability to make meaningful choices on the basis of uncertain knowledge. As such, these practices can be seen as representing another (caring) solution to the problem of paternalism and authoritarian power. In opposition to an ethics aiming at non-interference (non-directiveness) such modes of doing good care express an ethics of being locally accountable for the ways in which programmes of prenatal testing intervene in pregnant women's lives and of taking responsibility for the entities and phenomena that emerge through such knowledge production.

  3. Coagulation and fibrinolytic indices during the first trimester of pregnancy in women with polycystic ovary syndrome: a preliminary study.

    PubMed

    Shan, Yu; Wang, Aiming; Sun, Ying; Jiang, Wen; Pang, Baosen; An, Zhiyuan; Du, Xin; Wang, Wei; Huang, Zhongwei

    2013-11-01

    To evaluate the levels of coagulation and fibrinolytic markers during the first trimester of pregnancy in women with polycystic ovary syndrome (PCOS) and determine the effects of PCOS and obesity on the levels of these hemostatic markers. A cross-sectional study was conducted in Beijing, China, on women with PCOS (n = 50), healthy women (n = 50), pregnant women with PCOS (n = 50), and healthy pregnant women (n = 50) at 12 weeks of pregnancy. Coagulation and fibrinolytic parameters were measured. The interaction between PCOS and pregnancy appears to exert effects on the activities of coagulation factors VIII and X. The interaction between PCOS and obesity also seems to affect the level of von Willebrand factor. Pregnant women with PCOS, especially women who are obese, are observed to be in a more prohemostatic state during the first trimester.

  4. First-trimester prediction of pre-eclampsia: external validity of algorithms in a prospectively enrolled cohort.

    PubMed

    Oliveira, N; Magder, L S; Blitzer, M G; Baschat, A A

    2014-09-01

    To evaluate the performance of published first-trimester prediction algorithms for pre-eclampsia (PE) in a prospectively enrolled cohort of women. A MEDLINE search identified first-trimester screening-prediction algorithms for early-onset (requiring delivery < 34 weeks) and late-onset (requiring delivery ≥ 34 weeks) PE. Maternal variables, ultrasound parameters and biomarkers were determined prospectively in singleton pregnancies enrolled between 9 and 14 weeks. Prediction algorithms were applied to this population to calculate predicted probabilities for PE. The performance of the prediction algorithms was compared with that in the original publication and evaluated for factors explaining differences in prediction. Six early and two late PE prediction algorithms were applicable to 871-2962 women, depending on the variables required. The prevalence of early PE was 1.0-1.2% and of late PE was 4.1-5.0% in these patient subsets. One early PE prediction algorithm performed better than in the original publication (80% detection rate (DR) of early PE for 10% false-positive rate (FPR)); the remaining five prediction algorithms underperformed (29-53% DR). Prediction algorithms for late PE also underperformed (18-31% DR, 10% FPR). Applying the screening cut-offs based on the highest Youden index probability scores correctly detected 40-80% of women developing early PE and 71-82% who developed late PE. Exclusion of patients on first-trimester aspirin resulted in DRs of 40-83% and 65-82% for early and late PE, respectively. First-trimester prediction algorithms for PE share a high negative predictive value if applied to an external population but underperform in their ability to correctly identify women who develop PE. Further research is required to determine the factors responsible for the suboptimal external validity. Copyright © 2014 ISUOG. Published by John Wiley & Sons Ltd.

  5. Maternal consumption of non-staple food in the first trimester and risk of neural tube defects in offspring.

    PubMed

    Wang, Meng; Wang, Zhi-Ping; Gao, Li-Jie; Yang, Hui; Zhao, Zhong-Tang

    2015-04-24

    To study the associations between maternal consumption of non-staple food in the first trimester and risk of neural tube defects (NTDs) in offspring. Data collected from a hospital-based case-control study conducted between 2006 and 2008 in Shandong/Shanxi provinces including 459 mothers with NTDs-affected births and 459 mothers without NTDs-affected births. Logistic regression models were used to examine the associations between maternal consumption of non-staple food in the first trimester and risk of NTDs in offspring. The effects were evaluated by odds ratio (OR) and 95% confidence intervals (95% CIs) with SAS9.1.3.software. Maternal consumption of milk, fresh fruits and nuts in the first trimester were protective factors for total NTDs. Compared with consumption frequency of ˂1 meal/week, the ORs for milk consumption frequency of 1-2, 3-6, ≥7 meals/week were 0.50 (95% CI: 0.28-0.88), 0.56 (0.32-0.99), and 0.59 (0.38-0.90), respectively; the ORs for fresh fruits consumption frequency of 1-2, 3-6, ≥7 meals/week were 0.29 (95% CI: 0.12-0.72), 0.22 (0.09-0.53), and 0.32 (0.14-0.71), respectively; the ORs for nuts consumption frequency of 1-2, 3-6, ≥7 meals/week were 0.60 (95% CI: 0.38-0.94), 0.49 (0.31-0.79), and 0.63 (0.36-1.08), respectively. Different effects of above factors on NTDs were found for subtypes of anencephaly and spina bifida. Maternal non-staple food consumption of milk, fresh fruits and nuts in the first trimester was associated with reducing NTDs risk in offspring.

  6. Insulin resistance in first-trimester pregnant women with pre-pregnant glucose tolerance and history of recurrent spontaneous abortion.

    PubMed

    Hong, Y; Xie, Q X; Chen, C Y; Yang, C; Li, Y Z; Chen, D M; Xie, M Q

    2013-01-01

    Insulin resistance (IR) has been reported to play an important role in recurrent spontaneous abortion (RSA) among patients with polycystic ovary syndrome (PCOS). However, scanted materials exist regarding the independent effect of IR on RSA. The aim of this study is to investigate the status of IR in first trimester pregnant patients with normal pre-pregnant glucose tolerance and history of RSA. This two-center case-control study enrolled totally 626 first trimester pregnant women including 161 patients with a history of recurrent spontaneous abortion, who were pre-pregnantly glucose-tolerant according to oral glucose tolerance test (OGTT), and 465 women with no history of abnormal pregnancies of any kind. Clinical, biochemical and hormonal parameters were simultaneously measured in all participants. Serum beta-HCG, estradiol, progesterone, fasting plasma glucose and fasting plasma insulin levels, as well, the calculated homeostasis model assessment of insulin resistance index (HOMA-IR), fasting plasma glucose/insulin ratio(G/I) and pregnancy outcome were analyzed and compared. Serum beta-HCG and progesterone were found to be significantly lower in RSA group compared to controls. Subjects in RSA group were found to have higher HOMA-IR and lower G/I ratio than those in control group. Serum beta-HCG and progesterone were negatively correlated with HOMA-IR, and positively with G/I ratio even after adjustment for BMI. The spontaneous abortion rate within first trimester pregnancy of RSA patients was significantly higher than that in controls. In conclusion, woman with recurrent spontaneous abortion and normal pre-pregnant glucose metabolism tends to be more insulin resistant during first trimester pregnancy than healthy controls, no matter whether she has PCOS or not. Insulin resistance might be one of the direct causes that lead to recurrent abortion.

  7. Use of inhaled corticosteroids during the first trimester of pregnancy and the risk of congenital malformations among women with asthma.

    PubMed

    Blais, Lucie; Beauchesne, Marie-France; Rey, Evelyne; Malo, Jean-Luc; Forget, Amélie

    2007-04-01

    To investigate whether the maternal use of different doses of inhaled corticosteroids (ICSs) during the first trimester of pregnancy for the treatment of asthma increases the risk of congenital malformations in the offspring. From the linkage of three administrative Canadian databases, a cohort of 4561 pregnancies from women with asthma who delivered between 1990 and 2000 was reconstructed. A two-stage sampling cohort design was used to acquire additional data from the woman's medical chart. Cases of congenital malformation were identified from the medical services database or the hospital database. Using refill patterns of medications, the average daily dose of ICSs used during the first trimester was calculated and categorised as follows: 0, 1-500, 500-1000 and >1000 microg/day in beclomethasone-chlorofluorocarbon equivalent. A Generalized Estimation Equation model was used to estimate the adjusted odds ratio of congenital malformation as a function of ICS daily dose. All analyses were performed for all malformations and major malformations separately. Within the cohort 418 babies were identified with a congenital malformation (9.2%), 278 of which had a major malformation. About 40% of women used ICSs during the first trimester, but only 5.3% of women used >500 microg/day. The adjusted odds ratio (95% CI) for all malformations associated with the use of ICSs during the first trimester was: 0.77 (0.53 to 1.13) for 1-500, 0.41 (0.19 to 0.92) for 501-1000 and 1.00 (0.42 to 2.36) for >1000 microg/day. The corresponding figures for major malformations were 0.90 (0.64 to 1.24), 0.56 (0.22 to 1.43) and 1.67 (0.56 to 5.03). This study adds evidence to the safety of ICSs for the treatment of asthma during pregnancy, with regard to the likelihood of congenital malformation.

  8. First trimester PAPP-A MoM values predictive for breech presentation at term of pregnancy.

    PubMed

    Londero, Ambrogio P; Salvador, Stefania; Fruscalzo, Arrigo; Bertozzi, Serena; Biasioli, Anna; Ceraudo, Maria; Visentin, Silvia; Driul, Lorenza; Marchesoni, Diego

    2013-05-01

    Our aim was to state the role of first trimester pregnancy-associated plasma protein A (PAPP-A)-multiple of the median (MoM) value as a predictor for breech presentation at term of pregnancy. In this retrospective study, we present data for 1100 singleton full-term deliveries that took place in a third-level hospital setting in northeast Italy between January 2004 and July 2007. For each case, PAPP-A, free beta-human chorionic gonadotropin and nuchal translucency were measured during prenatal trisomies screening (between 11 weeks and 13 weeks and 6 d). A wide range of predictive factors for breech presentation at term of pregnancy and other confounding elements were considered. Of the 1100 singleton deliveries at term considered in our study, 40 babies were in breech presentation. Using bivariate analysis and multivariate logistic regression, a lower PAPP-A MoM than 0.63 (first quartile of our distribution) in the first trimester (OR 2.41, CI.95 1.25-4.67), and placental index at term higher than the median value (OR 2.04, CI.95 1.00-4.17) were proven to be associated with breech presentation at term. A low PAPP-A during the first trimester was a predictive factor for breech presentation at term of pregnancy. Acknowledging and acting on this predictor could enable improved management of breech foetuses in the future.

  9. First-Trimester Pregnancy Exposure to Venlafaxine or Duloxetine and Risk of Major Congenital Malformations: A Systematic Review.

    PubMed

    Lassen, Dorte; Ennis, Zandra Nymand; Damkier, Per

    2016-01-01

    Major depressive disorder is common among women in child-bearing age, and medical treatment is subject to substantial discussions and controversies. For Selective Serotonin reuptake inhibitors, SSRIs, a vast amount of data are available. For the newer antidepressant group of serotonin and noradrenaline reuptake inhibitors, SNRIs, significantly less data are available. Following the PRISMA guideline for systematic reviews, we performed a systematic search on the risk of major congenital malformations after first trimester in utero exposure to venlafaxine or duloxetine. We identified eight cohort studies reporting on the outcome upon in utero exposure to venlafaxine or duloxetine during the first trimester. The cumulated data for venlafaxine were 3186 exposed infants and 107 major malformations, resulting in a relative risk estimate and 95% confidence interval of 1.12 (0.92-1.35). The corresponding data for duloxetine were 668 infants and 16 major malformations, resulting in a relative risk estimate and 95% confidence interval of 0.80 (0.46-1.29). First-trimester in utero exposure to venlafaxine is not associated with an increased risk of major congenital malformations. The amount of data for duloxetine are significantly smaller but does not suggest a clinically important increased risk. © 2015 Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).

  10. Late onset of large benign ductus arteriosus aneurysm presented with increased nuchal translucency and cystic hygroma at first trimester Down syndrome screening.

    PubMed

    Tsai, Horng-Der; Chen, Kuanting; Lee, Meng-Luen; Lee, Cheng-Han; Chen, Tze-Ho; Lin, Wen-Hsiang; Chen, Ming

    2016-06-01

    Fetal ductus arteriosus aneurysm (DAA) is a rare but potentially risky congenital heart disease. It is often not diagnosed until the third trimester because of its asymptomatic nature and late onset. In rare occasions, DAA may result in serious complications; therefore, prenatal diagnosis is helpful. Herein, we report the case of a foetus with cystic hygroma and increased nuchal translucency in the first trimester (but regressed at 20-week anomalous scan). Karyotyping indicated a 46 XY genotype. A large vascular mass was noted at the apex of the left lung by Doppler ultrasound at 38 weeks of gestation, with a diameter of 12.5 mm. After birth, echocardiography showed a patent ductus arteriosus with aneurysmal dilatation (17 mm as the largest diameter); thus, DAA was impressed. Chest computed tomography and three-dimensional angiography confirmed the large aneurysmal dilatation of the ductus arteriosus with a closed end at the pulmonary arterial side. The male infant survived, but presented mild respiratory distress at birth. He was discharged at 24 days of age. At that time, DAA had regressed partially (diameter of 8.5 mm and much less blood flow), and it fully regressed at 40 days of age. Copyright © 2016. Published by Elsevier B.V.

  11. Pivotal periods for pregnancy loss during the first trimester of gestation in lactating dairy cows.

    PubMed

    Wiltbank, Milo C; Baez, Giovanni M; Garcia-Guerra, Alvaro; Toledo, Mateus Z; Monteiro, Pedro L J; Melo, Leonardo F; Ochoa, Julian C; Santos, José E P; Sartori, Roberto

    2016-07-01

    Loss of pregnancy can occur at many different stages of gestation and for a variety of causes but clearly produces a negative impact for reproductive and economic performances of dairy herds. This review describes four pivotal periods for pregnancy loss during the first trimester of gestation and discusses possible causes for pregnancy failure during these periods. The first period occurs during the first week after breeding with lack of fertilization and death of the early embryo producing major losses in pregnancy, particularly under specific environmental and hormonal conditions. In general, 20%-50% of high-producing lactating dairy cows have already experienced pregnancy loss during the first week of gestation with methods to decrease pregnancy loss during this period targeting improved oocyte quality by alleviating heat stress, inflammatory diseases, and body condition loss, and by increasing progesterone concentrations during preovulatory follicle development. The second pivotal period, from Days 8 to 27, encompasses embryo elongation and the classical "maternal recognition of pregnancy" period with losses averaging ∼30% but with surprising variation between farms (25%-41%). Maintenance of the CL of pregnancy is produced by the embryonic signal interferon-tau and alteration in uterine secretory patterns of prostaglandins F2α, E1, and E2. Failures or delays in trophoblast elongation and/or embryonic development result in loss of pregnancy during the second pivotal period possibly due to suboptimal histotroph. The third pivotal period is during the second month of pregnancy, Days 28 to 60, with losses of ∼12% based on a summary of published results from more than 20,000 pregnancies in high-producing dairy cows. Delays or defects in development of the chorioallantoic placentomes or embryo result in CL regression or embryo death during this pivotal period. Finally, a fourth period during the third month of pregnancy has reduced pregnancy losses (∼2

  12. First-trimester transabdominal multifetal pregnancy reduction: a report of two hundred completed cases.

    PubMed

    Berkowitz, R L; Lynch, L; Lapinski, R; Bergh, P

    1993-07-01

    Multifetal pregnancy reduction has been proposed as a way to reduce the risk of preterm delivery in women who conceive three or more fetuses. This communication presents the outcome of 200 consecutive multifetal pregnancies in which reduction to a smaller number of fetuses was accomplished. All of the procedures were performed in the first trimester by the transabdominal injection of potassium chloride into the thoraces of those fetuses that underwent feticide. All of the pregnancies have been completed and outcome data have been obtained in every case. At the time of the procedure 88 women had triplets, 89 had quadruplets, 16 had quintuplets, and 7 had from 6 to 9 fetuses. These pregnancies were reduced to 189 sets of twins, 5 sets of triplets, and 6 singletons. Reductions to triplets were done at the patient's request, and reductions to singletons were only done for medical indications. There were no cases of chorioamnionitis or other maternal complications attributable to the procedure. A total of 181 women were delivered of one or more live infants after 24 weeks' gestation, and 19 (9.5%) lost all of their fetuses before that time. The mean gestational age for all women delivered after 24 weeks was 35.7 weeks. The mean gestational age at delivery varied inversely with the initial number of fetuses, from 36.1 weeks for women who presented with triplets to 33.8 weeks for those who had 6 or more fetuses, and this trend was statistically significant. Sixteen of the 19 complete pregnancy losses occurred > 4 weeks after the reduction procedure had been performed. The loss rates were 7.9% for those who presented with 3 or 4 fetuses, 12.5% for those with 5, and 42.9% for those with > or = 6. This trend was statistically significant. Two neonates died in the first week of life and one died at 10 months of age as a consequence of the sequelae of severe prematurity. Only two surviving infants have shown evidence of chronic morbidity related to early delivery, and all of

  13. Cervical ripening before first trimester surgical evacuation for non-viable pregnancy.

    PubMed

    Webber, Kylie; Grivell, Rosalie M

    2015-11-10

    Medications or mechanical dilators are often used to soften and dilate the cervix prior to surgical evacuation of the uterus for non-viable pregnancy, or miscarriage. The majority of miscarriages occur in the first trimester. The aim of cervical ripening is to reduce the possibility of injury to the uterus and cervix and improve the surgical ease of the procedure. Cervical ripening agents can have adverse effects and it is uncertain as to whether these risks outweigh the benefits of their use. To systematically review the benefits and harms of using cervical ripening agents prior to surgical evacuation of non-viable pregnancy prior to 14 weeks' gestation. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 April 2015) and reference lists of retrieved papers. Randomised controlled trials (published in full-text form, or as abstracts only), which assessed the use of pharmacological or mechanical agents to ripen the cervix in women undergoing dilation and curettage or vacuum aspiration for non-viable pregnancy at less than 14 weeks' gestation were eligible for inclusion. Cluster-randomised controlled trials and trials using a cross-over design were not eligible for inclusion.Unpublished randomised controlled trials and quasi-randomised trials would have been eligible for inclusion but none were identified. Two review authors independently assessed the studies for inclusion, assessed risk of bias and carried out data extraction. Data were checked for accuracy. We included nine trials with 469 women. A diverse set of medications and regimens were studied in these trials, making the comparisons available for meta-analysis limited. The comparisons draw data from six trials with 383 participants. All trials were relatively small and had several aspects of unclear risk of bias with few of this review's outcomes reported. Due to this, no data from three trials were able to be used despite them meeting inclusion criteria.We carried out four

  14. First-trimester screening for trisomy 21 by free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A: impact of maternal and pregnancy characteristics.

    PubMed

    Kagan, K O; Wright, D; Spencer, K; Molina, F S; Nicolaides, K H

    2008-05-01

    To use multiple regression analysis to define the contribution of maternal variables that influence the measured concentration of free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A), and the interaction between these covariates, in first-trimester biochemical screening for trisomy 21. This was a multicenter study of prospective screening for trisomy 21 by a combination of fetal nuchal translucency thickness, and maternal serum free beta-hCG and PAPP-A at 11 + 0 to 13 + 6 weeks of gestation. In the pregnancies subsequently found to have trisomy 21 and in those with no obvious chromosomal abnormality, we used multiple regression analysis to account for pregnancy characteristics that influence the measured concentrations of free beta-hCG and PAPP-A. We fitted Gaussian distributions to the distribution of log multiples of the median (MoM) values in trisomy 21 and in unaffected pregnancies. There were 491 cases of trisomy 21 and 96 803 chromosomally normal pregnancies. Compared with values in Caucasian women, those who were parous, non-smokers and those who conceived spontaneously, PAPP-A was 57% higher in women of Afro-Caribbean origin, 3% higher in South Asians, 9% higher in East Asians, 2% higher in nulliparous women, 17% lower in smokers and 10% lower in those conceiving by in-vitro fertilization (IVF). Free beta-hCG was 12% higher in women of Afro-Caribbean origin, 9% lower in South Asians, 8% higher in East Asians, 2% higher in nulliparous women, 4% lower in smokers and 9% higher in those conceiving by IVF. In screening for trisomy 21 by maternal age and serum free beta-hCG and PAPP-A the estimated detection rate was 65% for a false-positive rate of 5%. In first-trimester biochemical screening for trisomy 21 it is essential to adjust the measured values of free beta-hCG and PAPP-A for maternal and pregnancy characteristics. Copyright (c) 2008 ISUOG

  15. Evolution of fetal ultrasonography.

    PubMed

    Avni, F E; Cos, T; Cassart, M; Massez, A; Donner, C; Ismaili, K; Hall, M

    2007-02-01

    The authors wish to highlight the evolution that has occurred in fetal ultrasound in recent years. A first significant evolution lies in the increasing contribution of first trimester ultrasound for the detection of fetal anomalies. Malformations of several organs and systems have been diagnosed during the first trimester. Furthermore the systematic measurement of the fetal neck translucency has led to increasing rate of detection of aneuploidies and heart malformations. For several years now, three-dimensional (3D) and 4D ultrasound (US) have been used as a complementary tool to 2D US for the evaluation of fetal morphology. This brings an improved morphologic assessment of the fetus. Applications of the techniques are increasing, especially for the fetal face, heart and extremities. The third field where fetal US is continuously providing important information is the knowledge of the natural history of diseases. This has brought significant improvement in the postnatal management of several diseases, especially urinary tract dilatation and broncho-pulmonary malformation.

  16. Parental Decisions about Prenatal Screening and Diagnosis among Infants with Trisomy 21 in a National Cohort with High Uptake of Combined First-Trimester Screening.

    PubMed

    Miltoft, Caroline Borregaard; Wulff, Camilla B; Kjærgaard, Susanne; Ekelund, Charlotte K; Tabor, Ann

    2017-01-01

    The aim was to investigate the parental decisions about prenatal screening and diagnosis among infants with trisomy 21 (T21) in a national cohort with high uptake of combined first-trimester screening (cFTS). This was a nationwide population-based study including infants born in 2009-2012. Information from the cFTS, fetal karyotype results and pregnancy outcome was obtained from the Danish Fetal Medicine Database on all women with a cFTS risk assessment. Cut-off for referral for invasive testing was ≥1:300. Karyotype results from pregnancies with no cFTS were obtained from the Danish Cytogenetic Central Registry. The uptake rate of cFTS was 91.6%, and 82.8% (8,032/9,704) of the screen-positive women opted for invasive testing. Overall, 82.2% (454/552) chose to terminate an affected pregnancy. In the 4-year period, 102 of 232,962 singletons were born alive with T21. The cFTS risk was true-positive, false-negative or not obtained in 21.6, 48.0 and 30.4%, respectively, of these pregnancies. In this large national cohort, 4.4 per 10,000 live-born infants had T21. Of 102 infants with T21 from 2009 to 2012, 52.0% were born after the women had not opted for cFTS or were true-positive but declined invasive testing or termination, and 48.0% were born after a false-negative risk assessment. © 2016 S. Karger AG, Basel.

  17. Maternal hyperglycemia in singleton pregnancies conceived by IVF may be modified by first-trimester BMI.

    PubMed

    Cai, S; Natarajan, P; Chan, J K Y; Wong, P C; Tan, K H; Godfrey, K M; Gluckman, P D; Shek, L P C; Yap, F; Kramer, M S; Chan, S Y; Chong, Y S

    2017-09-01

    Does IVF independently increase the risk of gestational diabetes mellitus (GDM) and is this increase in risk modified by maternal body mass index? IVF appears to be an independent risk factor for GDM and elevated blood glucose levels in overweight women (BMI > 25 kg/m2). IVF has been associated with increased risk of GDM, but most previous studies did not adequately assess confounding or effect modification by other risk factors. Cross-sectional study using data from 1089 women with singleton pregnancies who participated in a Singaporean birth cohort study (GUSTO) and received a 75 g oral glucose tolerance test (OGTT) at 26-28 weeks gestation. A total of 1089 women (n = 1013 conceived spontaneously, n = 76 conceived through IVF) with singleton pregnancies received a 75 g OGTT at 26-28 weeks gestation. Fasting and 2 h postprandial blood glucose levels were assayed. World Health Organization criteria (1999) standard criteria were used to classify GDM: ≥7.0 mmol/L for fasting and/or ≥7.8 mmol/L for 2-h postprandial plasma glucose levels, which was the clinical guideline in use during the study. IVF pregnancies had nearly double the odds of GDM (OR = 1.83, 95% CI: 1.03-3.26) and elevated fasting (mean difference = 0.12 mmol/L, 95% CI: 0.00-0.24) and OGTT 2-h blood glucose levels (mean difference = 0.64 mmol/L, 95% CI: 0.27-1.01), after adjusting for commonly recognized risk factors for GDM. After stratification by first-trimester BMI, these increased risks of GDM (OR = 3.54, 95% CI: 1.44-8.72) and elevated fasting (mean difference = 0.39 mmol/L, 95% CI: 0.13-0.65) and 2-h blood (mean difference = 1.24 mmol/L, 95% CI: 0.56-1.91) glucose levels were significant only in the IVF group who is also overweight or obese (BMI > 25 kg/m2). One limitation of our study is the absence of a 1 h post-OGTT plasma glucose sample, as we were using the 1999 WHO diagnostic criteria (the clinical guideline in Singapore) at the time of our study, instead of the revised 2013 WHO

  18. First-trimester screening for trisomies 21, 18 and 13 by ultrasound and biochemical testing.

    PubMed

    Wright, D; Syngelaki, A; Bradbury, I; Akolekar, R; Nicolaides, K H

    2014-01-01

    To examine the performance of screening for trisomies 21, 18 and 13 at 11-13 weeks' gestation using specific algorithms for these trisomies based on combinations of fetal nuchal translucency thickness (NT), fetal heart rate (FHR), ductus venosus pulsatility index for veins (DV PIV), and serum free β-human chorionic gonadotropin (β-hCG), pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PLGF) and α-fetoprotein (AFP). Model-based estimates of screening performance were produced for the distribution of maternal ages in England and Wales in 2011, and prospectively collected data on fetal NT, FHR, DV PIV, β-hCG, PAPP-A, PLGF and AFP from singleton pregnancies undergoing aneuploidy screening. In screening by NT, FHR, free β-hCG and PAPP-A, using specific algorithms for trisomy 21 and trisomies 18 and 13 at the risk cutoff of 1:100, the estimated detection rate (DR) was 87.0% for trisomy 21 and 91.8% for trisomies 18 and 13, at a false-positive rate (FPR) of 2.2%. Addition of PLGF, AFP and DV PIV increased the DR to 93.3% for trisomy 21 and 95.4% for trisomies 18 and 13 and reduced the FPR to 1.3%. Effective screening for trisomies can be achieved using specific algorithms based on NT, FHR, DV PIV, β-hCG, PAPP-A, PLGF and AFP. © 2013 S. Karger AG, Basel.

  19. Quality Requirements for the early Fetal Ultrasound Assessment at 11-13+6 Weeks of Gestation (DEGUM Levels II and III).

    PubMed

    von Kaisenberg, C; Chaoui, R; Häusler, M; Kagan, K O; Kozlowski, P; Merz, E; Rempen, A; Steiner, H; Tercanli, S; Wisser, J; Heling, K-S

    2016-06-01

    The early fetal ultrasound assessment at 11 - 13(+6) weeks of gestation remains the cornerstone of care despite the progress in diagnosing fetal chromosomal defects using cell-free fetal DNA (cffDNA) from the maternal circulation. The measurement of nuchal translucency (NT) allows the risk calculation for the fetal trisomies 21, 18 and 13 but also gives information on those fetal chromosomal defects which are at present unable to be detected using cffDNA. Nuchal translucency is the only auditable parameter at 11 - 13(+6) weeks and gives thus information on the quality of the first trimester anomaly scan. In addition it gives indirect information on the risks for fetal defects and for cardiac anomalies. Also the chances for a healthy live baby can be estimated. As experience with first trimester anomaly scanning increases, and the resolution of the ultrasound equipment has increased substantially, more and more details of the fetal anatomy become accessible at the first trimester scan. Therefore fetal anatomical defects and complex anomalies have become amenable to examination in the first trimester. This guideline describes compulsory and optional parameters for investigation at the first trimester scan and outlines a structured method of examining a first trimester fetus at 11 - 13(+6) weeks of gestation. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Prospective validation of first-trimester combined screening for trisomy 21.

    PubMed

    Kagan, K O; Etchegaray, A; Zhou, Y; Wright, D; Nicolaides, K H

    2009-07-01

    To examine the performance of the new algorithm in screening for trisomy 21 by a combination of maternal age, fetal nuchal translucency (NT) and maternal serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A). This was a prospective screening study for trisomy 21 in singleton pregnancies at 11 + 0 to 13 + 6 weeks of gestation using an algorithm combining maternal age, fetal NT thickness based on the mixture model for the assessment of NT, and maternal serum free beta-hCG and PAPP-A based on a multiple regression model for the assessment of serum biochemistry. The NT measurements were performed by 60 operators who had obtained The Fetal Medicine Foundation certificate of competence in the 11-13-week scan. The study population consisted of 19 614 pregnancies with a normal karyotype or delivery of a phenotypically normal baby (euploid group) and 122 cases of trisomy 21. In the euploid fetuses the NT was above the previously defined 50(th), 95(th) and 99(th) centiles in 10 033 (51.2%), 618 (3.2%) and 123 (0.6%) cases and the respective values for trisomy 21 were 117 (95.9%), 94 (77.0%) and 57 (46.7%). The median fetal NT was within 0.1 mm of the expected in 47 (78.3%) of the 60 sonographers and within 0.2 mm in all. In the euploid fetuses the median free beta-hCG was 1.0 (range, 0.1-29.4) multiples of the median (MoM) and the median PAPP-A was 1.0 (range, 0.2-3.3) MoM. The median MoM values were 1.0 or close to 1.0 MoM for each subgroup of pregnancy characteristics, including gestations of 11, 12 and 13 weeks, maternal weight of < 60 kg, 60-80 kg and > 80 kg, different ethnic origins, cigarette smokers and non-smokers, natural conception and in vitro fertilization. For a false-positive rate of 3%, the detection rate of trisomy 21 in screening by maternal age and fetal NT was 81% (95% CI, 73-89%), by maternal age and maternal serum biochemistry it was 63% (95% CI, 56-72%) and by combined screening based on maternal age

  1. Fetal Alcohol Syndrome (FAS)--A Review.

    ERIC Educational Resources Information Center

    Holzman, Ian R.

    1982-01-01

    At least 30 percent of newborn children of alcoholic mothers are affected severely by the fetal alcohol syndrome and 40-45 percent show some stigmata. Risks to offspring of mothers who drink occasionally or binge drink are not clear, but the danger is probably greatest in the first trimester of pregnancy. (CMG)

  2. Fetal Alcohol Syndrome (FAS)--A Review.

    ERIC Educational Resources Information Center

    Holzman, Ian R.

    1982-01-01

    At least 30 percent of newborn children of alcoholic mothers are affected severely by the fetal alcohol syndrome and 40-45 percent show some stigmata. Risks to offspring of mothers who drink occasionally or binge drink are not clear, but the danger is probably greatest in the first trimester of pregnancy. (CMG)

  3. First trimester exposure to ambient air pollution, pregnancy complications and adverse birth outcomes in Allegheny County, PA.

    PubMed

    Lee, Pei-Chen; Roberts, James M; Catov, Janet M; Talbott, Evelyn O; Ritz, Beate

    2013-04-01

    Despite numerous studies of air pollution and adverse birth outcomes, few studies have investigated preeclampsia and gestational hypertension, two pregnancy disorders with serious consequences for both mother and infant. Relying on hospital birth records, we conducted a cohort study identifying 34,705 singleton births delivered at Magee-Women's Hospital in Pittsburgh, PA between 1997 and 2002. Particle (<10 μm-PM10; <2.5 μm-PM2.5) and ozone (O3) exposure concentrations in the first trimester of pregnancy were estimated using the space-time ordinary Kriging interpolation method. We employed multiple logistic regression estimate associations between first trimester exposures and preeclampsia, gestational hypertension, preterm delivery, and small for gestational age (SGA) infants. PM2.5 and O3 exposures were associated with preeclampsia (adjusted OR = 1.15, 95% CI = 0.96-1.39 per 4.0 μg/m(3) increase in PM2.5; adjusted OR = 1.12, 95% CI = 0.89-1.42 per 16.8 ppb increase in O3), gestational hypertension (for PM2.5 OR = 1.11, 95 % CI = 1.00-1.23; for O3 OR = 1.12, 95 % CI = 0.97-1.29), and preterm delivery (for PM2.5 ORs = 1.10, 95% CI = 1.01-1.20; for O3 ORs = 1.23, 95% CI = 1.01-1.50). Smaller 5-8 % increases in risk were also observed for PM10 with gestational hypertension and SGA, but not preeclampsia. Our data suggest that first trimester exposure to particles, mostly PM2.5, and ozone, may increase the risk of developing preeclampsia and gestational hypertension, as well as preterm delivery and SGA.

  4. Development and Validation of a Risk Factor Scoring System for First-Trimester Prediction of Pre-Eclampsia

    PubMed Central

    GOETZINGER, Katherine R.; TUULI, Methodius G.; CAHILL, Alison G.; MACONES, George A.; ODIBO, Anthony O.

    2014-01-01

    Objective To develop a multi-parameter risk-based scoring system for first-trimester prediction of pre-eclampsia and to validate this scoring system in our patient population. Study Design Secondary analysis of a prospective cohort of 1200 patients presenting for first-trimester aneuploidy screening. Maternal serum pregnancy-associated plasma protein A (PAPP-A) levels were measured and bilateral uterine artery (UA) Doppler studies performed. Using the first half of the study population, a prediction model for pre-eclampsia was created. Test performance characteristics were used to determine the optimal score for predicting pre-eclampsia. This model was then validated in the second half of the population. Results Significant risk factors and their weighted scores derived from the prediction model were chronic hypertension [4], history of pre-eclampsia [3], pre-gestational diabetes [2], body mass index ≥ 30kg/m2 [2], bilateral UA notching [1], and PAPP-A MoM <10th percentile [1]. The AUC for the risk scoring system was 0.76 (95% CI 0. 69–0.83), and the optimal threshold for predicting pre-eclampsia was a total score of ≥6. This AUC did not differ significantly from the AUC observed in our validation cohort [AUC 0.78 (95% CI 0.69–0.86), p=0.75]. Conclusion Our proposed risk factor scoring system demonstrates modest accuracy but excellent reproducibility for first-trimester prediction of pre-eclampsia. PMID:24705967

  5. Asthma exacerbations during the first trimester of pregnancy and congenital malformations: revisiting the association in a large representative cohort.

    PubMed

    Blais, Lucie; Kettani, Fatima-Zohra; Forget, Amélie; Beauchesne, Marie-France; Lemière, Catherine

    2015-07-01

    We previously reported an increased prevalence of any congenital malformation among women experiencing moderate-to-severe asthma exacerbations during the first trimester of pregnancy, based on a study in which 90.1% of the cohort of women were social welfare recipients. This study re-examined the association between asthma exacerbations and congenital malformations in a new large representative cohort of asthmatic pregnant women. A cohort of 36 587 pregnancies in asthmatic women was reconstructed from Québec Province administrative databases (1998-2009). Occurrences of asthma exacerbations during the first trimester of pregnancy were assessed and categorised into severe, moderate and no such exacerbations. For comparison, we also considered moderate and severe asthma exacerbations combined. Congenital malformations were identified using diagnoses recorded in the hospitalisation database. Generalised estimation equations were used to estimate adjusted ORs of congenital malformations. The prevalence of any congenital malformation was 19.1%, 11.7% and 12.0% among women with severe, moderate and no such exacerbations during the first trimester, respectively. The adjusted OR for all malformations was 1.64 (95% CI 1.02 to 2.64) when women with severe exacerbations were compared with those in the reference group, while no association was seen for moderate exacerbations. Also, no association was observed between cases of moderate and severe asthma exacerbations combined and any congenital malformation. Only severe asthma exacerbations were found to significantly increase the risk of congenital malformations in this representative study. Previous studies possibly overestimated the risk because they were based mainly on women at a lower socioeconomic status. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  6. Self-Administered Lidocaine Gel for Pain Control With First-Trimester Surgical Abortion: A Randomized Controlled Trial.

    PubMed

    Conti, Jennifer A; Lerma, Klaira; Shaw, Kate A; Blumenthal, Paul D

    2016-08-01

    To compare pain control at various time points during first-trimester surgical abortion using a patient-administered lidocaine gel compared with a traditional lidocaine paracervical block. We conducted a randomized controlled trial of women undergoing surgical abortion at less than 12 weeks of gestation in an outpatient setting. The primary outcome was pain at cervical dilation as measured on a 100-mm visual analog scale. A sample size of 142 participants was planned to detect a 15-mm or greater difference on the 100-mm visual analog scale with 90% power and a significance level of .025, adding 10% for participant dropout and protocol violations. Participants received either 12 mL of a 1% lidocaine paracervical block or 20 mL of a self-administered, 2% lidocaine gel 20-30 minutes before procedure initiation. Secondary outcomes included anticipated pain, baseline pain, pain with speculum and tenaculum placement, pain after suction aspiration, and pain 30-45 minutes postoperatively. From April to October 2015, a total of 142 women were enrolled (68 in the paracervical block group, 69 in the gel group, and five not analyzed as a result of participant withdrawal). Sociodemographic characteristics were similar between groups. The mean pain score with cervical dilation was 60 mm (95% confidence interval [CI] 54-66) in the paracervical block group and 64 mm (95% CI 59-69) in the gel group (P=.3). There was no significant difference between mean pain scores at any time points measured. Self-administration of lidocaine gel before first-trimester surgical abortion is noninferior to a traditional paracervical lidocaine block and should be considered as an alternative, noninvasive approach to pain control for first-trimester surgical abortion. ClinicalTrials.gov, https://clinicaltrials.gov, NCT02447029.

  7. First trimester coffee and tea intake and risk of gestational diabetes mellitus: a study within a national birth cohort.

    PubMed

    Hinkle, S N; Laughon, S K; Catov, J M; Olsen, J; Bech, B H

    2015-02-01

    Coffee and tea consumption is associated with a decreased type 2 diabetes risk in non-pregnant adults. We examined the relation between first trimester coffee and tea consumption and gestational diabetes mellitus (GDM) risk. Population-based cohort study. Denmark 1996-2002. Non-diabetic women with singleton pregnancies in the Danish National Birth Cohort (n = 71,239). Estimated adjusted relative risks (RR) and 95% confidence intervals (95%CI) for the association between first trimester coffee and tea or estimated total caffeine and GDM. GDM ascertained from the National Hospital Discharge Register or maternal interview. Coffee or tea intake was reported in 81.2% (n = 57,882) and 1.3% (n = 912) of pregnancies were complicated by GDM. Among non-consumers, 1.5% of pregnancies were complicated by GDM. Among coffee drinkers, GDM was highest among women who drank ≥8 cups/day (1.8%) with no significant difference across intake levels (P = 0.10). Among tea drinkers, there was no difference in GDM across intake levels (1.2%; P = 0.98). After adjustment for age, socio-occupational status, parity, pre-pregnancy body mass index, smoking, and cola, there was suggestion of a protective, but non-significant association with increasing coffee (RR ≥8 versus 0 cups/day = 0.89 [95%CI 0.64-1.25]) and tea (RR ≥8 versus 0 cups/day = 0.77 [95%CI 0.55-1.08]). Results were similar by smoking status, except a non-significant 1.45-fold increased risk with ≥8 coffee cups/day for non-smokers. There was a non-significant reduced GDM risk with increasing total caffeine. Our results suggest that moderate first trimester coffee and tea intake were not associated with GDM increased risk and possibly may have a protective effect. © 2014 Royal College of Obstetricians and Gynaecologists.

  8. First trimester coffee and tea intake and risk of gestational diabetes mellitus: a study within a national birth cohort

    PubMed Central

    Hinkle, Stefanie N.; Laughon, S. Katherine; Catov, Janet M.; Olsen, Jorn; Bech, Bodil Hammer

    2014-01-01

    Objective Coffee and tea consumption is associated with a decreased type 2 diabetes risk in non-pregnant adults. We examined the relation between first trimester coffee and tea consumption and gestational diabetes mellitus (GDM) risk. Design Population-based cohort study. Setting Denmark 1996-2002. Population Non-diabetic women with singleton pregnancies in the Danish National Birth Cohort (n=71,239). Methods Estimated adjusted relative risks (RR) and 95% confidence intervals (95%CI) for the association between first trimester coffee and tea or estimated total caffeine and GDM. Main outcome measures GDM ascertained from the National Hospital Discharge Register or maternal interview. Results Coffee or tea intake was reported in 81.2% (n=57,882) and GDM complicated 1.3% (n=912) of pregnancies. Among non-consumers, GDM complicated 1.5% of pregnancies. Among coffee drinkers, GDM was highest among women who drank ≥8 cups/d (1.8%) with no significant difference across intake levels (P=.10). Among tea drinkers, there was no difference in GDM across intake levels (1.2%) (P=.98). After adjustment for age, socio-occupational status, parity, prepregnancy body mass index, smoking, and cola, there was suggestion of a protective, but non-significant association with increasing coffee [RR ≥8 vs 0 cups/d=0.89 (95%CI 0.64-1.25)] and tea [RR ≥8 vs 0 cups/d=0.77 (95%CI 0.55-1.08)]. Results were similar by smoking status, except a non-significant 1.45-fold increased risk with ≥8 coffee cups/d for non-smokers. There was a non-significant reduced GDM risk with increasing total caffeine. Conclusions Our results suggest that moderate first trimester coffee and tea intake were not associated with GDM increased risk and possibly may have a protective effect. PMID:24947484

  9. First trimester multivitamin/mineral use is associated with reduced risk of pre-eclampsia among overweight and obese women.

    PubMed

    Vanderlelie, Jessica; Scott, Rani; Shibl, Rania; Lewkowicz, Jessica; Perkins, Anthony; Scuffham, Paul A

    2016-04-01

    The use of pregnancy-specific multivitamin supplements is widely recommended to support maternal homeostasis during pregnancy. Our objective was to investigate whether multivitamin use during pregnancy is associated with a reduced risk of pre-eclampsia. The effect of multivitamin use on incidence of pre-eclampsia in lean and overweight/obese women was analysed using data collected between 2006 and 2011 as part of the Environments for Healthy Living Project, Griffith University, Australia. A total of 2261 pregnancies were included in the analysis with pre-eclampsia reported in 1.95% of subjects. Body mass index (BMI) ≥ 25 was associated with a 1.97-fold [95% confidence interval (CI): 0.93, 4.16] increase in pre-eclampsia risk. First trimester multivitamin use was reported by 31.8% of women and after adjustment, was associated with a 67% reduction in pre-eclampsia risk (95%CI: 0.14, 0.75). Stratification by BMI demonstrated a 55% reduction in pre-eclampsia risk (95%CI: 0.30, 0.86) in overweight (BMI: 25-29.9) and 62% risk reduction (95%CI: 0.16, 0.92) in obese (BMI: ≥30) cohorts that supplemented with multivitamins in the first trimester of pregnancy. This finding may be particular to the Australian population and reflect inherent nutritional deficits. First trimester folate supplementation was found to reduce pre-eclampsia incidence [adjusted odds ratios (AOR) 0.42 95%CI: 0.13, 0.98] and demonstrated significance upon stratification by overweight status for women with BMI >25 (AOR 0.55 95%CI: 0.31, 0.96). These results support the hypothesis that multivitamin supplementation may be beneficial in reducing the incidence of pre-eclampsia during pregnancy and be of particular importance for those with a BMI ≥25. © 2014 John Wiley & Sons Ltd.

  10. Relationship of amniotic fluid index (AFI) in third trimester with fetal weight and gender in a southeast Nigerian population

    PubMed Central

    Ugwu, Anthony C; Shem, Samuel L; Abba, Muhammed

    2016-01-01

    Background Amniotic fluid (AF) is one of the major determinants of fetal biophysical profile and can predict pregnancy outcome. Abnormal value of amniotic fluid index (AFI) may indicate fetal and maternal disorders. Purpose To establish reference standards for AFI for this population after 28 weeks of pregnancy and evaluate the relationship between AFI, the estimated fetal weight (EFWT), and fetal gender. Material and Methods A prospective cross-sectional estimation of AFI and FWT was done in 385 apparently healthy pregnant women in the gestational age range of 28–42 weeks. General scanning in longitudinal, transverse, and oblique directions of the abdomen was done to assess the fetal wellbeing and determine the fetal gender for each participant. AF was measured in each of the quadrants of the abdomen. The four values of the AF were summed to get the AFI. Measurement of the head circumference, biparietal diameter, abdominal circumference, and femoral length of the fetus were obtained. The EFWT was calculated using Hadlock’s formula. The data were divided into five groups: 28–30 weeks 6 days; 31–33 weeks 6 days; 34–36 weeks 6 days; 37–39 weeks 6 days; and 40–42 weeks. AFI for the different gestational age group studied and their percentiles were obtained. Results AFI normogram for the local population was established. Positive and significant correlations of AF and EFWT were seen in all the gestational age groups of the women. No significant correlations between AF and EFWT was seen in male fetuses. Regression equations of EFWT and AFI were obtained for female fetuses. Conclusion The normal range for AFI values for the third trimester was established and could be used to evaluate AFI in the studied population. Established fetal weight should be taken into account when interpreting AFI for female fetuses but this need not be applied for male fetuses. PMID:27570636

  11. Adhering maternal platelets can contribute to the cytokine and chemokine cocktail released by human first trimester villous placenta.

    PubMed

    Blaschitz, A; Siwetz, M; Schlenke, P; Gauster, M

    2015-11-01

    Placental villous explant culture has been increasingly recognized as suitable model to study secretion of inflammatory and immune modulating factors by human placenta. Most of these factors likely derive from the syncytiotrophoblast, whereas extraplacental sources such as maternal peripheral blood cells are rarely considered. Due to their small size and absence of a nucleus, platelets adhering to perivillous fibrinoid of normal placenta are frequently ignored in routine immunohistochemistry. Here we demonstrate adhering maternal platelets on first trimester placental villi after explant culture and point out that platelet-derived factors must be considered when analyzing the inflammatory secretion profile of human placenta. Copyright © 2015 Elsevier Ltd. All rights reserved.

  12. Adhering maternal platelets can contribute to the cytokine and chemokine cocktail released by human first trimester villous placenta

    PubMed Central

    Blaschitz, A.; Siwetz, M.; Schlenke, P.; Gauster, M.

    2015-01-01

    Placental villous explant culture has been increasingly recognized as suitable model to study secretion of inflammatory and immune modulating factors by human placenta. Most of these factors likely derive from the syncytiotrophoblast, whereas extraplacental sources such as maternal peripheral blood cells are rarely considered. Due to their small size and absence of a nucleus, platelets adhering to perivillous fibrinoid of normal placenta are frequently ignored in routine immunohistochemistry. Here we demonstrate adhering maternal platelets on first trimester placental villi after explant culture and point out that platelet-derived factors must be considered when analysing the inflammatory secretion profile of human placenta. PMID:26388607

  13. Use of inhaled corticosteroids during the first trimester of pregnancy and the risk of congenital malformations among women with asthma

    PubMed Central

    Blais, Lucie; Beauchesne, Marie‐France; Rey, Évelyne; Malo, Jean‐Luc; Forget, Amélie

    2007-01-01

    Aim To investigate whether the maternal use of different doses of inhaled corticosteroids (ICSs) during the first trimester of pregnancy for the treatment of asthma increases the risk of congenital malformations in the offspring. Methods From the linkage of three administrative Canadian databases, a cohort of 4561 pregnancies from women with asthma who delivered between 1990 and 2000 was reconstructed. A two‐stage sampling cohort design was used to acquire additional data from the woman's medical chart. Cases of congenital malformation were identified from the medical services database or the hospital database. Using refill patterns of medications, the average daily dose of ICSs used during the first trimester was calculated and categorised as follows: 0, 1–500, 500–1000 and >1000 μg/day in beclomethasone–chlorofluorocarbon equivalent. A Generalized Estimation Equation model was used to estimate the adjusted odds ratio of congenital malformation as a function of ICS daily dose. All analyses were performed for all malformations and major malformations separately. Results Within the cohort 418 babies were identified with a congenital malformation (9.2%), 278 of which had a major malformation. About 40% of women used ICSs during the first trimester, but only 5.3% of women used >500 μg/day. The adjusted odds ratio (95% CI) for all malformations associated with the use of ICSs during the first trimester was: 0.77 (0.53 to 1.13) for 1–500, 0.41 (0.19 to 0.92) for 501–1000 and 1.00 (0.42 to 2.36) for >1000 μg/day. The corresponding figures for major malformations were 0.90 (0.64 to 1.24), 0.56 (0.22 to 1.43) and 1.67 (0.56 to 5.03). Conclusion This study adds evidence to the safety of ICSs for the treatment of asthma during pregnancy, with regard to the likelihood of congenital malformation. PMID:17121872

  14. First-trimester itraconazole exposure and pregnancy outcome: a prospective cohort study of women contacting teratology information services in Italy.

    PubMed

    De Santis, Marco; Di Gianantonio, Elena; Cesari, Elena; Ambrosini, Guido; Straface, Gianluca; Clementi, Maurizio

    2009-01-01

    Itraconazole is an effective fungal treatment; however, there are few human data on prenatal exposure. To evaluate the major malformation rate in itraconazole prenatally exposed infants. The secondary objective includes evaluation of the pregnancy outcome. A prospective cohort study was conducted from January 2002 to October 2006 in women who called two Italian Teratology Information Services (TIS). Pregnant women who were exposed to itraconazole during the first trimester and gave informed consent were matched with a contemporary group of pregnant women who contacted the TIS because they had undergone a non-teratogenic drug exposure during the first trimester. Information was obtained via a structured questionnaire at the time of the initial call to the TIS and no earlier than 1 month after delivery. A trained operator conducted the interview. The main outcome measure was information about major congenital anomalies, type of delivery, birth weight, and any pregnancy or neonatal complications. Data were collected on 206 women who called the TIS because of first-trimester exposure to itraconazole, and 207 controls. There were no significant differences in terms of major congenital anomalies in the exposed group versus the control group (3/163 [1.8%] vs 4/190 [2.1%], respectively). There was no statistical difference in the rate of vaginal delivery between the exposed and control groups (101/162 [62.3%] vs 102/190 [53.8%]), premature birth (11/162 [6.8%] vs 15/190 [7.9%]), low birth weight (1/152 [0.7%] vs 4/175 [2.3%]) and high birth weight (10/152 [6.5%] vs 7/175 [4.0%], respectively). The rates of live births (163/206 [79.1%] vs 190/207 [91.8%]), spontaneous abortion (23/206 [11.2%] vs 10/207 [4.8%]) and termination of pregnancy (19/206 [9.2%] vs 7/207 [3.4%] in the exposed and control groups, respectively) were significantly different (p < 0.05). First-trimester itraconazole-exposed infants were not at increased risk of major congenital anomalies, but the rates

  15. Nitrous oxide versus oral sedation for pain management of first-trimester surgical abortion - a randomized study.

    PubMed

    Singh, Rameet H; Montoya, Maria; Espey, Eve; Leeman, Lawrence

    2017-08-01

    The objective of the study was to compare nitrous oxide with oxygen (N2O/O2) to oral hydrocodone/acetaminophen and lorazepam for analgesia during first-trimester surgical abortion. This double-blind randomized trial assigned women undergoing first-trimester surgical abortion at<11 weeks' gestation to inhaled N2O/O2 vs. oral sedation for pain management. The N2O/O2 group received up to 70:30 ratio during the procedure and placebo pills preprocedure; the oral group received inhaled oxygen during the procedure and oral hydrocodone/acetaminophen 5 mg/325 mg and lorazepam 1 mg preprocedure. The primary outcome was maximum procedural pain, assessed on a 100-mm visual analog scale (VAS; anchors 0=no pain and 100=worst pain) at 2 min postprocedure. A difference of 13 mm on the VAS was considered clinically significant. Satisfaction with pain management was measured on a 100-mm VAS (anchors 0=very unsatisfied, 100=very satisfied). We randomized 140 women, 70 per study arm. Mean age of participants was 26±6.6 years; mean gestational age was 7.3±1.5 weeks. Mean maximum procedure pain scores were 52.5±26.7 and 60.8±24.4 for N2O/O2 and oral groups, respectively (p=.09). Satisfaction with pain management was 69.3±28.4 and 61.5±30.4 for N2O/O2 and oral groups. respectively (p=.15). We found no difference in mean procedural pain scores between women assigned to N2O/O2 vs. those assigned to oral sedation for first-trimester surgical abortion. Satisfaction with both options was high. Women undergoing early surgical abortion experienced no differences in pain and satisfaction between those who used inhaled nitrous oxide and oral sedation. Nitrous oxide, with side effects limited to the duration of inhalation and no need for a ride home, is a viable alternative to oral sedation for first-trimester abortion pain management. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Meckel Gruber syndrome: a first trimester diagnosis of a recurrent case.

    PubMed

    Tanriverdi, Hamit Alper; Hendrik, Hans Joachim; Ertan, Kubilay; Schmidt, Werner

    2002-06-01

    We report of a case of Meckel Gruber Syndrome (MGS) in a woman, who suffered previously from a pregnancy with the same disorder. MGS, consisting of an occipital encephalocele, bilateral cystic kidneys and postaxial polydactyly, is a rare autosomal recessive disorder, with a recurrence risk of 25%. With the present technology, a targeted ultrasound in the late embryonic or early fetal stages of pregnancy has the potential to diagnose this syndrome. Clinical screening in further pregnancies is of utmost importance and the management of such cases is presented.

  17. Individualized correction for maternal weight in calculating the risk of chromosomal abnormalities with first-trimester screening data.

    PubMed

    Merz, E; Thode, C; Eiben, B; Faber, R; Hackelöer, B J; Huesgen, G; Pruggmaier, M; Wellek, S

    2011-02-01

    In the algorithm developed by the Fetal Medicine Foundation (FMF) Germany designed to evaluate the findings of routine first-trimester screening, the false-positive rate (FPR) was determined for the entire study group without stratification by maternal weight. Based on the data received from the continuous audit we were able to identify an increase in the FPR for the weight-related subgroups of patients, particularly for patients with extremely high body weights. The aim of this study was to demonstrate that the variability of the FPR can be reduced through adjusting the concentrations of free β-HCG and PAPP-A measured in the maternal serum by means of a nonlinear regression function modeling the dependence of these values on maternal weight. The database used to establish a version of the algorithm enabling control of the FPR over the whole range of maternal weight consisted of n = 123 546 pregnancies resulting in the birth of a child without chromosomal anomalies. The group with positive outcomes covered n = 500 cases of trisomy 21 and n = 159 trisomies 13 or 18. The dependency of the serum parameters free β-HCG and PAPP-A on maternal weight was analyzed in the sample of negative outcomes by means of nonlinear regression. The fitted regression curve was of exponential form with negative slope. Using this model, all individual measurements were corrected through multiplication with a factor obtained as the ratio of the concentration level predicted by the model to belong to the average maternal body weight of 68.2 kg, over the ordinate of that point on the regression curve which belongs to the weight actually measured. Subsequently, the totality of all values of free β-HCG and PAPP-A corrected for deviation from average weight were used as input data for carrying out the construction of diagnostic discrimination rules described in our recent paper for a database to which no corrections for over- or under-weight had been applied. This entailed in particular the

  18. [Prenatal diagnosis and management of fetal megacystis].

    PubMed

    El Fekih, Chiraz; Ouerdiane, Nadia; Mourali, Mechaal; Oueslati, Seddik; Oueslati, Boujemaa; Binous, Naoufel; Chaabène, Mounira; Ben Zineb, Nabil

    2009-12-01

    Prenatal diagnosis of fetal megacystis particularly in the first trimester requires assessement of pronostic and aetiologycal criteria. Report a new case. we report a case of severe megacystis in female fetus diagnosed at 23 weeks of gestation. There are no other associated ultrasound findings. Fetal karyotyping was normal (46XX). Termination of pregnancy for medical indications was realised because of progressive enlargement of the fetal bladder. Post-mortem examination shown megacystis-microcolon-intestinal hypoperistalsis syndrome. Fetal megacystis is a severe condition when diagnosed early in pregnancy. Ultrasonography follow-up and fetal karyotyping are important to evaluate prognosis.

  19. Prenatal diagnosis of sickle-cell anemia in the first trimester of pregnancy.

    PubMed

    Goossens, M; Dumez, Y; Kaplan, L; Lupker, M; Chabret, C; Henrion, R; Rosa, J

    1983-10-06

    To investigate the usefulness of chorionic biopsy for prenatal diagnosis of sickle-cell anemia by restriction-endonuclease analysis of fetal DNA, we studied 30 pregnancies before elective abortion. When the reproducibility of the technique for obtaining adequate DNA samples was established, we successfully applied the test to five pregnancies at risk for sickle-cell anemia. In two cases, sickle-cell disease of the fetus led to a decision to terminate the pregnancy. In three other cases, a normal or AS genotype was demonstrated. One normal infant has been born, and one other pregnancy is continuing normally. In one case in which fetal death was observed three weeks after sampling, placental abnormalities found on histologic examination were compatible with a chromosomal aberration. Our study shows that chorionic biopsy is feasible for the prenatal diagnosis of sickle-cell disease before the 10th gestational week. If subsequent experience demonstrates this technique to be safe enough for mother and fetus, the ability to test in early pregnancy may make prenatal diagnosis acceptable to more couples at risk for serious genetic disorders.

  20. Effect of parity on first-trimester uterine artery Doppler indices and their predictive value for pregnancy complications.

    PubMed

    Dane, Banu; Batmaz, Gonca; Ozkal, Fulya; Bakar, Zehra; Dane, Cem

    2014-01-01

    To investigate the relationship between parity and first-trimester uterine artery Doppler indices and determine their predictive value for pregnancy complications. In 679 singleton pregnancies (388 parous and 291 nulliparous) attending for routine care at 11-14 weeks of gestation, we recorded maternal characteristics, medical and obstetric history, the presence of protodiastolic notching and measured uterine artery resistance index (RI). Parous women had a lower prevalence of bilateral notches (64 vs. 77.6%; p = 0.0002), median level of RI did not show any significant difference. In parous cases complicated with pregnancy-induced hypertension (PIH) (0.78 vs. 0.70; p = 0.0003) or miscarriage (0.86 vs. 0.71; p = 0.0003) mean levels of RI were significantly higher than in the nulliparous cases. By using mean RI we could predict the cases with PIH (area under curve (AUC) 0.63; p = 0.012), early PIH (AUC 0.84; p < 0.0001) and miscarriage (AUC 0.87; p < 0.0001) in the group of parous women. Parity has a significant effect on uterine artery Doppler findings in the first trimester of pregnancy. In the group of parous women the mean level of RI had a higher predictive value for miscarriage, early PIH and PIH.

  1. The effect of parity on first trimester uterine artery Doppler waveforms in low-risk singleton pregnancies.

    PubMed

    Ulkumen, Burcu Artunc; Pala, Halil Gursoy; Uyar, Yildiz; Baytur, Yesim Bulbul; Koyuncu, Faik Mumtaz

    2014-12-01

    The aim of the study was to evaluate the effeot of parity on uteroplacental blood flow during the first trimester in low-risk singleton pregnancies. Uterine artery Doppler examinations were performed in 190 singleton pregnancies between 11-14 gestational weeks. Twenty-five pregnancies were excluded from the study due to history ci preeclampsia, diabetes mellitus or inherited thrombophilia. A total of 165 low-risk singleton pregnancies were included in the study Mean uterine artery pulsatility index (P1) was recorded and compared between nulliparous and multiparous women. The relation between maternal age, gestational week, maternal weight, parity biochemica, markers and abnormal uterine artery Doppler flows was evaluated. T-test and logistic regression analyses were used for the statistical analysis. A total of 165 singleton pregnancies without any risk factors for uteroplacental insufficiency were includec in the study Of them, 58 (36.7%) were nulliparous and 107(63.3%) were parous. Correlation analysis revealed that the uterine artery pulsatifity indices during the first trimester were not affected by maternal age and parity: Mean uterine artery pulsatility indices are not different in nulliparous and multiparous low nisA pregnancies at 11-14 weeks of gestation.

  2. Changes in first trimester screening test parameters in pregnancies complicated by placenta previa and association with hyperemesis gravidarum

    PubMed Central

    Tülek, Fırat; Kahraman, Alper; Taşkın, Salih; Özkavukçu, Esra; Söylemez, Feride

    2014-01-01

    Objective To assess the possible changes in first trimester screening test parameters in pregnancies complicated with placenta previa and to determine whether there is an association between hyperemesis gravidarum and placenta previa. Material and Methods A total of 131 singleton spontaneously conceived pregnancies that were complicated by placenta previa and delivered between May 2006 and May 2013 were evaluated from birth charts. Ninety patients without placenta previa were selected amongst patients who delivered within the same period of time as the control group. Cases of low lying placenta (n=52) within the study group were assessed as a separate group. The rest of the cases was considered to be in a different group. Results Beta human chorionic gonadotropin (BhCG) multiples of medians (MoMs) and nuchal translucency (NT) MoMs were significantly higher in the placenta previa group in comparison with the low lying placenta and control groups. Apgar scores at both the 1st and 5th minutes were significantly lower in the placenta previa group. Hyperemesis gravidarum was found to be significantly more frequent in the placenta previa group. Conclusion The prevalence of hyperemesis gravidarum in the first trimester is higher in pregnancies complicated by placenta previa. Paying more attention to the development of placenta previa in the routine pregnancy follow-up of patients with hyperemesis gravidarum could be considered. PMID:25584028

  3. Changes in first trimester screening test parameters in pregnancies complicated by placenta previa and association with hyperemesis gravidarum.

    PubMed

    Tülek, Fırat; Kahraman, Alper; Taşkın, Salih; Özkavukçu, Esra; Söylemez, Feride

    2014-01-01

    To assess the possible changes in first trimester screening test parameters in pregnancies complicated with placenta previa and to determine whether there is an association between hyperemesis gravidarum and placenta previa. A total of 131 singleton spontaneously conceived pregnancies that were complicated by placenta previa and delivered between May 2006 and May 2013 were evaluated from birth charts. Ninety patients without placenta previa were selected amongst patients who delivered within the same period of time as the control group. Cases of low lying placenta (n=52) within the study group were assessed as a separate group. The rest of the cases was considered to be in a different group. Beta human chorionic gonadotropin (BhCG) multiples of medians (MoMs) and nuchal translucency (NT) MoMs were significantly higher in the placenta previa group in comparison with the low lying placenta and control groups. Apgar scores at both the 1st and 5th minutes were significantly lower in the placenta previa group. Hyperemesis gravidarum was found to be significantly more frequent in the placenta previa group. The prevalence of hyperemesis gravidarum in the first trimester is higher in pregnancies complicated by placenta previa. Paying more attention to the development of placenta previa in the routine pregnancy follow-up of patients with hyperemesis gravidarum could be considered.

  4. Asymptomatic pyuria in pregnant women during the first trimester is associated with an increased risk of adverse obstetrical outcomes.

    PubMed

    Lai, Yun-Ju; Hsu, Te-Yao; Lan, Kuo-Chung; Lin, Hao; Ou, Chia-Yu; Fu, Hung-Chun; Tsai, Ching-Chang

    2017-04-01

    Urinalysis is included in the prenatal examination in the first trimester in Taiwan, in contrast to Western countries. We aimed to investigate whether asymptomatic pyuria as detected by urinalysis was associated with adverse perinatal outcomes. A total of 1187 singleton pregnant women who received prenatal care at Kaohsiung Chang Gung Memorial Hospital between January 2012 and December 2013 were included for retrospective analysis. We defined asymptomatic pyuria as the presence of 15 or more white blood cells/μL in midstream urine without symptoms. Adverse perinatal outcomes including preterm delivery, preterm premature rupture of membrane, low birth weight, and Apgar scores were analyzed. Univariate and multivariate logistic regression analyses were used to identify independent predictors. The prevalence of asymptomatic pyuria was 21.3% in our cohort. Univariate analysis showed that pyuria was the only factor associated with preterm delivery before 36 weeks of pregnancy, preterm premature rupture of membrane, and low birth weight. In multivariate analysis, both pyuria (odds ratio: 4.89, 95% confidence interval: 1.80-13.25, p=0.002) and a maternal age of 35 years or older (odds ratio: 3.46, 95% confidence interval: 1.11-10.78, p=0.033) were significant independent predictors for a low 5 minute Apgar score (<7). The identification of asymptomatic pyuria via urinalysis in the first trimester may be a predictor for adverse perinatal outcomes. Copyright © 2017. Published by Elsevier B.V.

  5. Severity of ASD symptoms and their correlation with the presence of copy number variations and exposure to first trimester ultrasound.

    PubMed

    Webb, Sara Jane; Garrison, Michelle M; Bernier, Raphael; McClintic, Abbi M; King, Bryan H; Mourad, Pierre D

    2017-03-01

    Current research suggests that incidence and heterogeneity of autism spectrum disorder (ASD) symptoms may arise through a variety of exogenous and/or endogenous factors. While subject to routine clinical practice and generally considered safe, there exists speculation, though no human data, that diagnostic ultrasound may also contribute to ASD severity, supported by experimental evidence that exposure to ultrasound early in gestation could perturb brain development and alter behavior. Here we explored a modified triple hit hypothesis [Williams & Casanova, ] to assay for a possible relationship between the severity of ASD symptoms and (1) ultrasound exposure (2) during the first trimester of pregnancy in fetuses with a (3) genetic predisposition to ASD. We did so using retrospective analysis of data from the SSC (Simon's Simplex Collection) autism genetic repository funded by the Simons Foundation Autism Research Initiative. We found that male children with ASD, copy number variations (CNVs), and exposure to first trimester ultrasound had significantly decreased non-verbal IQ and increased repetitive behaviors relative to male children with ASD, with CNVs, and no ultrasound. These data suggest that heterogeneity in ASD symptoms may result, at least in part, from exposure to diagnostic ultrasound during early prenatal development of children with specific genetic vulnerabilities. These results also add weight to on-going concerns expressed by the FDA about non-medical use of diagnostic ultrasound during pregnancy. Autism Res 2017, 10: 472-484. © 2016 International Society for Autism Research, Wiley Periodicals, Inc. © 2016 International Society for Autism Research, Wiley Periodicals, Inc.

  6. Amniotic fluid volumetry by three-dimensional ultrasonography during the first trimester of pregnancy.

    PubMed

    Gadelha, Patricia Spara; Da Costa, Antonio Gadelha; Filho, Francisco Mauad; El Beitune, Patricía

    2006-08-01

    In a longitudinal prospective study, we quantitated the amniotic fluid volume (AFV) of 25 normal fetuses by endovaginal 3-D ultrasonography (3D-US) from the 8th to the 11th week of pregnancy. AFV by 3D-US was obtained by subtracting the volumetric measurement of the embryo (EV) from the amniotic sac volume (ASV). EV and ASV were obtained by virtual organ computer-aided analysis (VOCAL), using 6 degrees of rotation. AFV increased from 5.75 to 42.96 cm(3) from the 8th to the 11th week (ANOVA, p < 0.05), with a correlation between gestational age and AFV (p < 0.001, r(2) = 98.1%). We conclude that there was an increase in AFV assessed by 3D-US. The AFV values for normal fetuses can be used for comparison with those detected in pregnancies with risk of fetal loss.

  7. Downregulation of A(1) and A(2B) adenosine receptors in human trisomy 21 mesenchymal cells from first-trimester chorionic villi.

    PubMed

    Gessi, Stefania; Merighi, Stefania; Stefanelli, Angela; Mirandola, Prisco; Bonfatti, Alessandra; Fini, Sergio; Sensi, Alberto; Marci, Roberto; Varani, Katia; Borea, Pier Andrea; Vesce, Fortunato

    2012-11-01

    Human reproduction is complex and prone to failure. Though causes of miscarriage remain unclear, adenosine, a proangiogenic nucleoside, may help determine pregnancy outcome. Although adenosine receptor (AR) expression has been characterized in euploid pregnancies, no information is available for aneuploidies, which, as prone to spontaneous abortion (SA), are a potential model for shedding light on the mechanism regulating this event. AR expression was investigated in 71 first-trimester chorionic villi (CV) samples and cultured mesenchymal cells (MC) from euploid and TR21 pregnancies, one of the most frequent autosomal aneuploidy, with a view to elucidating their potential role in the modulation of vascular endothelial growth factor (VEGF) and nitric oxide (NO). Compared to euploid cells, reduced A(1) and A(2B) expression was revealed in TR21 CV and MCs. The non-selective adenosine agonist 5'-N-ethylcarboxamidoadenosine (NECA) increased NO, by activating, predominantly, A(1)AR and A(2A)AR through a molecular pathway involving hypoxia-inducible-factor-1 (HIF-1α), and increased VEGF, mainly through A(2B). In conclusion the adenosine transduction cascade appears to be disturbed in TR21 through reduced expression of A(2B) and A(1)ARs. These anomalies may be implicated in complications such as fetal growth restriction, malformation and/or SA, well known features of aneuploid pregnancies. Therefore A(1) and A(2B)ARs could be potential biomarkers able to provide an early indication of SA risk and their stimulation may turn out to improve fetoplacental perfusion by increasing NO and VEGF.

  8. Civil conflict, gender-specific fetal loss, and selection: a new test of the Trivers-Willard hypothesis.

    PubMed

    Valente, Christine

    2015-01-01

    A sizeable economics literature explores the effect of prenatal shocks on later health or socioeconomic status. Work in other disciplines, following the seminal contribution of Trivers and Willard (1973), suggests that prenatal shocks may increase fetal loss and reduce the number of boys relative to girls at birth. This has been largely ignored in the economics literature and could affect the interpretation of estimates of the effect of prenatal shocks and that of gender in other applied economics contexts. This paper analyzes the effect of in utero exposure to a shock - civil conflict in Nepal - on (i) fetal loss, and (ii) gender and (iii) health at birth. Maternal fixed effects estimates show that exposed pregnancies are more likely to result in a miscarriage and in a female birth, but exposed newborns are neither smaller nor more subject to neonatal mortality.

  9. Fetal cell-free nucleic acids in the maternal circulation: new clinical applications.

    PubMed

    Wataganara, Tuangsit; Bianchi, Diana W

    2004-06-01

    Six years after the demonstration of the presence of cell-free fetal nucleic acids in maternal plasma, perinatal clinical applications continue to expand. The focus of this article is on advances that have occurred since the CNAPS II conference held in Hong Kong in 2001. Circulating fetal DNA levels (fDNA) are elevated in pregnancies complicated by fetal trisomies 13 and 21 but not 18. Measurement of fDNA levels improves the performance of the current standard maternal serum screen, by increasing the detection of Down syndrome cases by 5% with no increase in the false-positive rate. fDNA levels are elevated in women who have developed clinical symptoms of preeclampsia, but they are also elevated by the early second trimester in women who will eventually develop preeclampsia. fDNA and mRNA gamma globin measurement may have clinical utility as markers for fetomaternal hemorrhage in the late first trimester. Cell-free fetal DNA levels are quite high in the amniotic fluid, permitting fetal genomic isolation and analysis using comparative genomic hybridization techniques. Fetal DNA crosses the blood-brain barrier and is detectable in maternal cerebrospinal fluid in a subset of pregnant women. The biological implications of this are currently unknown. Review of the literature suggests that the placenta is the predominant source of the circulating fetal nucleic acids. However, detection of gamma globin mRNA sequences in the plasma of pregnant women suggests that fetal blood cells also contribute to the pool of nucleic acids. Widespread incorporation of fetal nucleic acid measurement into routine prenatal care depends on the identification of a readily accessible gender-independent fetal marker.

  10. First-trimester screening for trisomy 21 with adjustment for biochemical results of previous pregnancies.

    PubMed

    Wright, David; Syngelaki, Argyro; Birdir, Cahit; Bedei, Ivonne; Nicolaides, Kypros H

    2011-01-01

    To investigate the effect of associations in serum free β-hCG and PAPP-A between successive pregnancies on the performance of screening for trisomy 21 at 11-13 weeks' gestation. In 8,499 women with two consecutive pregnancies, including 49 women with fetal trisomy 21 in the second pregnancy, the correlation in serum free β-hCG multiples of the median (MoM) and PAPP-A MoM between pregnancies was determined, and the effects of correcting for the correlation on the performance of screening was estimated. There were significant associations between pregnancies in free β-hCG MoM (r = 0.4435) and PAPP-A MoM (r = 0.4796). In screening by maternal age and biochemistry at a risk cutoff of 1 in 100, in the second pregnancies the false-positive rate was 35.5% for those with screen-positive results in the first pregnancy, and this was reduced to 17.1% after adjustment for the results of the first pregnancy. Similarly, in women with screen-negative results in the first pregnancy, adjustment for the results improved the detection rate in the second pregnancy from 66.7 to 81.2%. In screening for trisomy 21, adjustment for the biochemical findings in a previous pregnancy has major effects on individual patient-specific risks, increases the detection rate and reduces the false-positive rate. Copyright © 2011 S. Karger AG, Basel.

  11. [Assessment of patients' knowledge of first-trimester combined Down syndrome screening at the time of their first trimester ultrasonographic evaluation: Results of a prospective study about 201 women].

    PubMed

    de Villardi de Montlaur, D; Desseauve, D; Marechaud, M; Pierre, F

    2016-01-01

    Assess pregnant women's knowledge on first-trimester combined Down syndrome screening, at the time of their first trimester ultrasound scan. A questionnaire was submitted to the patients coming for their 12-week pregnancy ultrasonographic evaluation in a University Hospital prenatal clinic between May 2012 and May 2013. Correct and incorrect statements on Down syndrome screening were proposed to the mothers who were asked to rate them. Each patient was questioned on her prior exposition to Down syndrome screening, the category of medical of professional she previously consulted, and the information she received. Patients' knowledge was evaluated according to these criteria. Two hundred and one patients were included in this study. The average correct answer rating was 4.6 (out of 8 questions). The average incorrect answer rating was 2.4 (out of 6 questions). No difference was found between the different social and demographic groups, nor according to the category of professional consulted before the first ultrasound scan. Higher correct answer ratings were observed when the patient had already been submitted to a Down syndrome screening (P=0.039), when they had previously received explanations about the screening (P=0.003); and when they stated that they had been sufficiently informed (P=0.042). These results show that patients' knowledge on Down syndrome screening is inadequate and depends on their experience of previous screening and information. It is deemed necessary to improve information especially to young women who are pregnant for the first time. Copyright © 2015. Published by Elsevier Masson SAS.

  12. [Medication use during the first trimester of pregnancy: drug safety and adoption of folic acid and ferrous sulphate].

    PubMed

    Lunardi-Maia, Tânia; Schuelter-Trevisol, Fabiana; Galato, Dayani

    2014-12-01

    To identify the profile of use of medication during the first trimester of pregnancy with emphasis on safety assessment and on the adoption of folic acid and ferrous sulfate by pregnant women attended at a Basic Health Unit in Brazil. This was a cross-sectional study nested in a cohort of pregnant women. Medications were classified according to the Anatomical Therapeutic Chemical (ATC), and their safety was evaluated according to the Food and Drug Administration (FDA) and the Brazilian Health Surveillance Agency (ANVISA). The adoption of ferrous sulfate and folic acid was investigated according to the protocol set forth by the Brazilian Ministry of Health. The survey included 212 pregnant women, 46.7% of whom were taking medications at the time of pregnancy diagnosis, and 97.6% used medication during the first trimester after diagnosis. The highest percentage of self-medication occurred before the beginning of prenatal care (64.9%). According to the FDA criteria, there was a high level of exposure to D and X risk drugs before the beginning of prenatal care (23.0%), which was also observed for drugs not recommended by ANVISA (36.5%). Of the surveyed sample, 32.5% did not follow the protocol of the Brazilian Ministry of Health. In all, 67.9% of pregnant women had inadequate drug exposure. There was a difference between the proportions of drugs used according to the ATC, and the main anatomical groups identified were the drugs that act on blood and blood-forming organs, and anti-infective medications for systemic use. When pregnancy was diagnosed, the use of a large number of medications that act on the genitourinary system and sex hormones (16.2%) was identified, such as oral contraceptives, a fact probably related to the percentage of unplanned pregnancies (67.0%), on the same occasion 4 pregnant women used folic acid and 3 used ferrous sulphate. The present results show that a large number of medications are used during pregnancy. Even if there was little exposure

  13. Impact of new society of radiologists in ultrasound early first-trimester diagnostic criteria for nonviable pregnancy.

    PubMed

    Hu, Maowen; Poder, Liina; Filly, Roy A

    2014-09-01

    New early first-trimester diagnostic criteria for nonviable pregnancy recommended by the Society of Radiologists in Ultrasound via a multispecialty consensus panel extended the diagnostic size criteria of crown-rump length from 5 to 7 mm for embryos without a heartbeat and mean sac diameter from 16 to 25 mm for "empty" sacs. Our study assessed the potential impact of the new criteria on the number of additional follow-up sonograms these changes would engender. A retrospective study of all first-trimester sonograms in women with first trimester bleeding from 1999 to 2008 was conducted. Everyone included in the study had a visible gestational sac in the uterus. There were no pregnancies of unknown location or ectopic pregnancies included in this study cohort. Pregnancy of unknown location was used to describe cases in which there were no signs of pregnancy inside or outside the uterus on transvaginal sonography despite a positive pregnancy test result. A total of 1013 patients met the inclusion criteria. Seven hundred fifty-two patients (74%) had identifiable embryos, and 261 (26%) did not. Of those with an identifiable embryo, 286 (38%) had no detectable embryonic cardiac activity. The breakdown of crown-rump lengths in this group was as follows: 100 measuring less than 5 mm, 36 measuring 5 to 7 mm, and 150 measuring 7 mm or greater. The breakdown of mean sac diameters in those without a visible embryo was as follows: 120 measuring less than 16 mm, 90 measuring 16 to 25 mm, and 51 measuring 25 mm or greater. When diagnosing a failed pregnancy, there can be no room for error. Only 126 of 1013 early pregnancies threatening to abort (12%) fell into the more conservative zones defined by the new compared to the former size criteria (crown-rump length, 5-7 mm; mean sac diameter, 16-25 mm). Therefore, the potential impact of the new guidelines on follow-up sonograms does not appear inordinate. © 2014 by the American Institute of Ultrasound in Medicine.

  14. First-trimester sonographic prediction of obstetric and neonatal outcomes in monochorionic diamniotic twin pregnancies.

    PubMed

    Allaf, M Baraa; Vintzileos, Anthony M; Chavez, Martin R; Wax, Joseph A; Ravangard, Samadh F; Figueroa, Reinaldo; Borgida, Adam; Shamshirsaz, Amir; Markenson, Glenn; Davis, Sarah; Habenicht, Rebecca; Haeri, Sina; Ozhand, Ali; Johnson, Jeffery; Sangi-Haghpeykar, Haleh; Spiel, Melissa; Ruano, Rodrigo; Meyer, Marjorie; Belfort, Michael A; Ogburn, Paul; Campbell, Winston A; Shamshirsaz, Alireza A

    2014-01-01

    The purpose of this study was to investigate whether discordant nuchal translucency and crown-rump length measurements in monochorionic diamniotic twins are predictive of adverse obstetric and neonatal outcomes. We conducted a multicenter retrospective cohort study including all monochorionic diamniotic twin pregnancies with two live fetuses at the 11-week to 13-week 6-day sonographic examination who had serial follow-up sonography until delivery. Isolated nuchal translucency, crown-rump length, and combined discordances were correlated with adverse obstetric outcomes, individually and in composite, including the occurrence of 1 or more of the following in either fetus: intrauterine growth restriction (IUGR), twin-twin transfusion syndrome (TTTS), intrauterine fetal death (IUFD), growth discordance (≥ 20%), and preterm birth before 28 weeks' gestation. Correlations with adverse composite neonatal outcomes were also studied. A receiver operating characteristic curve analysis and a logistic regression analysis with a generalized estimating equation were conducted. Fifty-four of the 177 pregnancies included (31%) had an adverse composite obstetric outcome, with TTTS in 19 (11%), IUGR in 21 (12%), discordant growth in 14 (8%), IUFD in 14 (8%), and preterm birth before 28 weeks in 10 (6%). Of the 254 neonates included in the study, 69 (27%) were complicated by adverse composite neonatal outcomes, with respiratory distress syndrome being the most common (n = 59 [23%]). The areas under the curve for the combined discordances to predict composite obstetric and neonatal outcomes were 0.62 (95% confidence interval, 0.52-0.72), and 0.54 (95% confidence interval, 0.46-0.61), respectively. In our population, nuchal translucency, crown-rump length, and combined discordances in monochorionic diamniotic twin pregnancies were not predictive of adverse composite obstetric and neonatal outcomes.

  15. Continuing pregnancy after mifepristone and "reversal" of first-trimester medical abortion: a systematic review.

    PubMed

    Grossman, Daniel; White, Kari; Harris, Lisa; Reeves, Matthew; Blumenthal, Paul D; Winikoff, Beverly; Grimes, David A

    2015-09-01

    We conducted a systematic review of the literature on the effectiveness of medical abortion "reversal" treatment. Since the usual care for women seeking to continue pregnancies after ingesting mifepristone is expectant management with fetal surveillance, we also performed a systematic review of continuing pregnancy after mifepristone alone. We searched PubMed, CINAHL (Cumulative Index to Nursing and Allied Health Literature), Scopus and the Cochrane Library for articles published through March 2015 reporting the proportion of pregnancies continuing after treatment with either mifepristone alone or after an additional treatment following mifepristone aimed at reversing its effect. From 1115 articles retrieved, 1 study met inclusion criteria for abortion reversal, and 13 studies met criteria for continuing pregnancy after mifepristone alone. The one report of abortion reversal was a case series of 7 patients receiving varying doses of progesterone in oil intramuscularly or micronized progesterone orally or vaginally; 1 patient was lost to follow-up. The study was of poor quality and lacked clear information on patient selection. Four of six women continued the pregnancy to term [67%, 95% confidence interval (CI) 30-90%]. Assuming the lost patient aborted resulted in a continuing pregnancy proportion of 57% (95% CI 25-84%). The proportion of pregnancies continuing 1-2 weeks after mifepristone alone varied from 8% (95% CI 3-22%) to 46% (95% CI 37-56%). Continuing pregnancy was more common with lower mifepristone doses and advanced gestational age. In the rare case that a woman changes her mind after starting medical abortion, evidence is insufficient to determine whether treatment with progesterone after mifepristone results in a higher proportion of continuing pregnancies compared to expectant management. Legislation requiring physicians to inform patients about abortion reversal transforms an unproven therapy into law and represents legislative interference in the

  16. First trimester Down's syndrome screening shows high detection rate for trisomy 21, but poor performance in structural abnormalities--regional outcome results.

    PubMed

    Rissanen, Anne; Niemimaa, Marko; Suonpää, Mikko; Ryynänen, Markku; Heinonen, Seppo

    2007-01-01

    To evaluate whether first trimester screening markers are altered in pregnancies affected both by other chromosomal defects than trisomy 21 and structural anomalies and whether it is possible to detect these pregnancies by combined ultrasound and biochemical screening test. Altogether 4,776 singleton pregnancies underwent first trimester screening. Of them, 3,101 women were screened using a combination of maternal serum free hCG, pregnancy-associated plasma protein A and nuchal translucency and 1,361 women with first trimester biochemistry without ultrasound. Nuchal translucency screening was performed between the 11th and 13+6th gestational weeks, and biochemistry 1-2 weeks earlier. Using a fixed cut-off rate of 1:250 for Down's syndrome, the detection rate of trisomies 21, 18 and 13 were 92, 67 and 0%, respectively. All open defects, 85% of cardiac defects and other minor defects were not detected in first trimester screening. Majority of these structural abnormalities occurred in women under 35 years of age. First trimester Down's syndrome screening is effective in trisomy screening, but its performance in structural abnormalities is low, when used as a part of routine clinical practice. We conclude that it is too early to drop second trimester screening ultrasound entirely from antenatal care programs if a high detection rate is to be achieved also in structural defects.

  17. Single extra-amniotic injection of prostaglandin E2 in Tylose gel to induce first trimester abortion in young nullipara.

    PubMed

    Djahanbakhch, O; Bassan, T S; Marshall, D E; Gardner, N H

    1982-01-01

    A single extra-amniotic injection of 2 or 4 mg of prostaglandin E2 in Tylose gel was administered to 30 primigravidae between the ages of 14 and 20 years to induce first-trimester abortion. Twenty-three patients (76.7%) aborted, though incompletely, within 9 hours, with a mean induction-abortion interval of 6.3 hours. In the remaining 7 (23.3%) the cervical os was found to be open and no mechanical dilatation was required at the time of vacuum aspiration. The only side effect was vomiting, which occurred in 2 patients. The method was shown to be safe and effective and may be employed in young primigravidae, thus eliminating the cervical complications attending vacuum aspiration.

  18. [Misoprostol: off-label use in the first trimester of pregnancy (spontaneous abortion, and voluntary medical termination of pregnancy)].

    PubMed

    Beucher, G; Dolley, P; Carles, G; Salaun, F; Asselin, I; Dreyfus, M

    2014-02-01

    State of knowledge about misoprostol's use out of its marketing authorization during the first trimester of pregnancy, in early miscarriage or to induce abortion or medical termination of pregnancy. French and English publications were searched using PubMed, Cochrane Library and international learned societies recommendations. Cervical ripening prior to surgical uterine evacuation during the first trimester of pregnancy facilitates cervical dilatation and reduces operative time and uterine retention risk. Misoprostol, mifepristone and osmotic cervical dilators are equally efficient. Concerning first trimester miscarriage, surgical uterine evacuation remains the most effective and the quickest method of treatment (EL 1). Depending on the clinical situation, medical treatment using misoprostol (missed miscarriage) or expectative attitude (incomplete miscarriage) does not increase the risk of complications, neither haemorrhagic nor infectious (EL 1). However, these alternatives generally require longer outpatient follow-up, which leads to more consultations, prolonged bleeding and not planned surgical procedures (EL 1). Concerning missed miscarriage, a vaginal dose of 800 μg of misoprostol, possibly repeated 24 to 48 hours later, seems to offer the best efficiency/tolerance ratio (EL 2). Concerning early abortion, medical method is a safe and efficient alternative to surgery (EL 2). Success rates are inversely proportional to gestational age (EL 2). According to the modalities of its marketing authorization, 400 μg of misoprostol can only be given by oral route, for less than 7 weeks of amenorrhea (WA) pregnancies and after 36 to 48 hours following 600 mg of mifepristone (EL 1). However, 200mg of mifepristone is as efficient as 600 mg (EL 1). Beyond 7WA, misoprostol buccal dissolution (sublingual or prejugal) or vaginal administration are more efficient and better tolerated than oral ingestion (EL 1). Between 7 and 9WA, the best protocol in terms of efficiency and

  19. Is maternal serum total hCG a marker of trisomy 21 in the first trimester of pregnancy?

    PubMed

    Spencer, K; Berry, E; Crossley, J A; Aitken, D A; Nicolaides, K H

    2000-04-01

    In a study of 130 first trimester cases of trisomy 21 and 959 controls we have shown that the median MoM for alpha-fetoprotein (AFP) is lower (0.82) and that for total human chorionic gonadotrophin (hCG) is higher (1.31) than in the control group. For AFP 15.3% of cases were below the 5th centile and for total hCG 19. 8% were above the 95th centile. The median shift observed for AFP and total hCG is poorer than that for pregnancy associated plasma protein-A (PAPP-A) or free beta-hCG and together with maternal age, AFP and total hCG could only be expected to detect 40% of cases. In combination with PAPP-A, total hCG would identify 52% of cases, somewhat less than the 67% observed with free beta-hCG and PAPP-A. However, we have demonstrated for total hCG a significant temporal change in median MoM with gestational age. Before 70 days the median MoM was less than 0.5, between 70 and 83 days this increased to 1.13, and between 84 and 97 days this increased to 1.52. This median shift has significant implications for interpreting previous studies and even more significant implications for detection rates. When population parameters specific to the gestational age in question are used, detection rates with total hCG and PAPP-A increase from 47% at 70-83 days to 60% at 84-97 days. This observation explains much of the confusion around total hCG in the first trimester and shows the importance of selecting analyte pairs and population parameters appropriate to the time in gestation when screening is performed. Copyright 2000 John Wiley & Sons, Ltd.

  20. Comparison of extravillous trophoblast cells derived from human embryonic stem cells and from first trimester human placentas.

    PubMed

    Telugu, B P; Adachi, K; Schlitt, J M; Ezashi, T; Schust, D J; Roberts, R M; Schulz, L C

    2013-07-01

    Preeclampsia and other placental pathologies are characterized by a lack of spiral artery remodeling associated with insufficient invasion by extravillous trophoblast cells (EVT). Because trophoblast invasion occurs in early pregnancy when access to human placental tissue is limited, there is a need for model systems for the study of trophoblast differentiation and invasion. Human embryonic stem cells (hESC) treated with BMP4- differentiate to trophoblast, and express HLA-G, a marker of EVT. The goals of the present study were to further characterize the HLA-G(+) cells derived from BMP4-treated hESC, and determine their suitability as a model. HESC were treated with BMP4 under 4% or 20% oxygen and tested in Matrigel invasion chambers. Both BMP4-treated hESC and primary human placental cells were separated into HLA-G(+) and HLA-G(-)/TACSTD2(+) populations with immunomagnetic beads and expression profiles analyzed by microarray. There was a 10-fold increase in invasion when hESC were BMP4-treated. There was also an independent, stimulatory effect of oxygen on this process. Invasive cells expressed trophoblast marker KRT7, and the majority were also HLA-G(+). Gene expression profiles revealed that HLA-G(+), BMP4-treated hESC were similar to, but distinct from, HLA-G(+) cells isolated from first trimester placentas. Whereas HLA-G(+) and HLA-G(-) cells from first trimester placentas had highly divergent gene expression profiles, HLA-G(+) and HLA-G(-) cells from BMP4-treated hESC had somewhat similar profiles, and both expressed genes characteristic of early trophoblast development. We conclude that hESC treated with BMP4 provide a model for studying transition to the EVT lineage. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. Comparison of extravillous trophoblast cells derived from human embryonic stem cells and from first trimester human placentas

    PubMed Central

    Telugu, B.P.; Adachi, K.; Schlitt, J.M.; Ezashi, T.; Schust, D.J.; Roberts, R.M.; Schulz, L.C.

    2013-01-01

    Introduction Preeclampsia and other placental pathologies are characterized by a lack of spiral artery remodeling associated with insufficient invasion by extravillous trophoblast cells (EVT). Because trophoblast invasion occurs in early pregnancy when access to human placental tissue is limited, there is a need for model systems for the study of trophoblast differentiation and invasion. Human embryonic stem cells (hESC) treated with BMP4- differentiate to trophoblast, and express HLA-G, a marker of EVT. The goals of the present study were to further characterize the HLA-G+ cells derived from BMP4-treated hESC, and determine their suitability as a model. Methods HESC were treated with BMP4 under 4% or 20% oxygen and tested in Matrigel invasion chambers. Both BMP4-treated hESC and primary human placental cells were separated into HLA-G+ and HLA-G−/TACSTD2+ populations with immunomagnetic beads and expression profiles analyzed by microarray. Results There was a 10-fold increase in invasion when hESC were BMP4-treated. There was also an independent, stimulatory effect of oxygen on this process. Invasive cells expressed trophoblast marker KRT7, and the majority were also HLA-G+. Gene expression profiles revealed that HLA-G+, BMP4-treated hESC were similar to, but distinct from, HLA-G+ cells isolated from first trimester placentas. Whereas HLA-G+ and HLA-G− cells from first trimester placentas had highly divergent gene expression profiles, HLA-G+ and HLA-G− cells from BMP4-treated hESC had somewhat similar profiles, and both expressed genes characteristic of early trophoblast development. Conclusions We conclude that hESC treated with BMP4 provide a model for studying transition to the EVT lineage. PMID:23631809

  2. Tube formation in the first trimester placental trophoblast cells: Differential effects of angiogenic growth factors and fatty acids.

    PubMed

    Pandya, Abhilash D; Das, Mrinal K; Sarkar, Arnab; Vilasagaram, Srinivas; Basak, Sanjay; Duttaroy, Asim K

    2016-06-01

    The study aims to investigate whether cytosolic fatty acid-binding protein-4 (FABP4) is involved in angiogenic growth factors- and fatty acid-induced tube formation in first trimester placental trophoblast cells, HTR8/SVneo. We determined the tube formation both at basal as well as stimulated levels in the absence and presence of inhibitors of FABP4 and VEGF signaling pathways. Basal level of tube formation was maximally reduced in the presence of 50 µM of FABP4 inhibitor compared with those by VEGF signaling pathway inhibitors (rapamycin, L-NAME, and p38 MAP kinase inhibitor). Whereas docosahexaenoic acid, 22:6n-3 (DHA)-, and VEGF-induced tube formation was maximally inhibited by p38 MAP kinase inhibitor (63.7 and 34.5%, respectively), however, leptin-induced tube formation was inhibited maximally by FABP4 inhibitor (50.7%). ANGPTL4 and oleic acid (OA)-induced tube formation was not blocked by any of these inhibitors. The FABP4 inhibitor inhibited cell growth stimulated by DHA, leptin, VEGF, and OA (P < 0.05) but was not affected by ANGPTL4. VEGF, leptin, and OA also increased FABP4 protein level in these cells, though the uptake of fatty acids by these cells was not affected by the presence of FABP4 inhibitor. Our data demonstrate that FABP4 may be involved in part in the basal level, and stimulated tube formation by VEGF, DHA, and leptin, whereas it has little or no effect in ANGPTL4- and OA-induced tube formation in these cells. Thus, FABP4 may play a differential role in fatty acids and angiogenic growth factors-mediated tube formation in the first trimester trophoblast cells in vitro.

  3. Ethanol exposure during the early first trimester equivalent impairs reflexive motor activity and heightens fearfulness in an avian model.

    PubMed

    Smith, Susan M; Flentke, George R; Kragtorp, Katherine A; Tessmer, Laura

    2011-02-01

    Prenatal alcohol exposure is a leading cause of childhood neurodevelopmental disability. The adverse behavioral effects of alcohol exposure during the second and third trimester are well documented; less clear is whether early first trimester-equivalent exposures also alter behavior. We investigated this question using an established chick model of alcohol exposure. In ovo embryos experienced a single, acute ethanol exposure that spanned gastrulation through neuroectoderm induction and early brain patterning (19-22h incubation). At 7 days posthatch, the chicks were evaluated for reflexive motor function (wingflap extension, righting reflex), fearfulness (tonic immobility [TI]), and fear/social reinstatement (open-field behavior). Chicks exposed to a peak ethanol level of 0.23-0.28% were compared against untreated and saline-treated controls. Birds receiving early ethanol exposure had a normal righting reflex and a significantly reduced wingflap extension in response to a sudden descent. The ethanol-treated chicks also displayed heightened fearfulness, reflected in increased frequency of TI, and they required significantly fewer trials for its induction. In an open-field test, ethanol treatment did not affect latency to move, steps taken, vocalizations, defecations, or escape attempts. The current findings demonstrate that early ethanol exposure can increase fearfulness and impair aspects of motor function. Importantly, the observed dysfunctions resulted from an acute ethanol exposure during the period when the major brain components are induced and patterned. The equivalent period in human development is 3-4 weeks postconception. The current findings emphasize that ethanol exposure during the early first trimester equivalent can produce neurodevelopmental disability in the offspring.

  4. IUD in first-trimester abortion: immediate intrauterine contraceptive devices insertion vs delayed insertion following the next menstruation bleeding.

    PubMed

    Tsikouras, Panagiotis; Vrachnis, Nikolaos; Grapsa, Anastasia; Tsagias, Nikolaos; Pinidis, Petros; Liberis, Anastasios; Ammari, Alexandros; Grapsas, Xenofon; Galazios, Georgios; Liberis, Vasileios

    2014-07-01

    Approximately 21 days after an abortion, ovulation occurs in 50 % of women. Installation of an IUD directly after induced or spontaneous abortion offers immediate contraceptive protection. The purpose of the present study was to weigh up contraceptive safety and adverse reactions of IUD inserted directly after first-trimester abortion under general or paracervical anesthesia as against the fitting of IUD in the days of the next menstrual cycle without anesthesia. During the period May 1987 to October 2010, 73 women (Group A) underwent an immediate post-abortion insertion IUD after a first-trimester spontaneous or induced abortion under general or local paracervical anesthesia and 69 participants (Group B) received IUD during the next menstrual cycle without anesthesia. Questionnaires were completed by all the women of the study with respect to the effects of IUD. The women were examined every 3 months for 1 year after the fitting of the IUD in the out-patient department of the University Obstetrics Gynecological Department of Alexandroupolis, Democritus University of Thrace, Greece. The demographic characteristics of the women of the two groups were similar. The age of the women ranged between 19 and 44 years, while 61.98 % were women with one or two children and 38.02 % were women with three or more children. During the first menstrual cycles, with the exception of vaginal hemorrhages (5 %) and adnexitis (1 %), no serious adverse reactions were noted. During the transvaginal ultrasonography checks in both groups, no observation was made of any dislocation of the IUD, except for two cases in the subgroup of those women with paracervical anesthesia and one case in the women of Group B. As concerns the questionnaire with regard to the women's subjective evaluation of IUD, satisfactory answers were given. There were no differences between the two groups either with respect to the security of the supplied contraceptive methods or to the development of side effects.

  5. Risk factors for first trimester miscarriage--results from a UK-population-based case-control study.

    PubMed

    Maconochie, N; Doyle, P; Prior, S; Simmons, R

    2007-02-01

    The aim of this study was to examine the association between biological, behavioural and lifestyle risk factors and risk of miscarriage. Population-based case-control study. Case-control study nested within a population-based, two-stage postal survey of reproductive histories of women randomly sampled from the UK electoral register. Six hundred and three women aged 18-55 years whose most recent pregnancy had ended in first trimester miscarriage (<13 weeks of gestation; cases) and 6116 women aged 18-55 years whose most recent pregnancy had progressed beyond 12 weeks (controls). Women were questioned about socio-demographic, behavioural and other factors in their most recent pregnancy. First trimester miscarriage. After adjustment for confounding, the following were independently associated with increased risk: high maternal age; previous miscarriage, termination and infertility; assisted conception; low pre-pregnancy body mass index; regular or high alcohol consumption; feeling stressed (including trend with number of stressful or traumatic events); high paternal age and changing partner. Previous live birth, nausea, vitamin supplementation and eating fresh fruits and vegetables daily were associated with reduced risk, as were feeling well enough to fly or to have sex. After adjustment for nausea, we did not confirm an association with caffeine consumption, smoking or moderate or occasional alcohol consumption; nor did we find an association with educational level, socio-economic circumstances or working during pregnancy. The results confirm that advice to encourage a healthy diet, reduce stress and promote emotional wellbeing might help women in early pregnancy (or planning a pregnancy) reduce their risk of miscarriage. Findings of increased risk associated with previous termination, stress, change of partner and low pre-pregnancy weight are noteworthy, and we recommend further work to confirm these findings in other study populations.

  6. First trimester trophoblasts forming endothelial-like tubes in vitro emulate a 'blood vessel development' gene expression profile.

    PubMed

    Highet, Amanda R; Buckberry, Sam; Mayne, Benjamin T; Khoda, Sultana M; Bianco-Miotto, Tina; Roberts, Claire T

    2016-07-01

    Extravillous cytotrophoblasts isolated from first trimester placenta, and immortalised cell lines derived from them, have the intrinsic ability to form endothelial-like tubes when cultured on Matrigel™ extracellular matrix. This in vitro tube formation may model placental angiogenesis and/or endovascular differentiation by trophoblasts. To interpret the relevance of this phenomenon to placental development, we used a gene expression microarray approach to identify which genes and pathways are associated with the tube-forming phenotype of HTR8/SVneo first trimester trophoblasts (HTR8-M), compared with HTR8/SVneo not forming tubes on plastic culture surface (HTR8-P). Furthermore, we used weighted gene co-expression network analysis (WGCNA) of microarray data to identify modules of co-expressed genes underlying the biological processes. There were 481 genes differentially expressed between HTR8-M and HTR8-P and these were significantly enriched for blood vessel development and related gene ontologies. WGCNA clustered the genes into 9 co-expression modules. One module was significantly associated with HTR8-M (p = 1.15E-05) and contained genes involved in actin cytoskeleton organization, cell migration and blood vessel development, consistent with tube formation on Matrigel. Another module was significantly associated with HTR8-P (p = 1.94E-05) and was enriched for genes involved in mitosis, consistent with proliferation by cells on plastic which do not differentiate. Up-regulation of angiogenesis and vascular development pathways in endovascular trophoblasts in vivo could underpin spiral artery remodelling processes, which are defective in preeclamptic pregnancies.

  7. First-trimester bleeding characteristics associate with increased risk of preterm birth: data from a prospective pregnancy cohort

    PubMed Central

    Velez Edwards, D.R.; Baird, D.D.; Hasan, R.; Savitz, D.A.; Hartmann, K.E.

    2012-01-01

    BACKGROUND Prior evidence linking first-trimester bleeding with preterm birth (PTB, <37 weeks gestation) risk has been inconsistent and may be biased by subject selection and/or incomplete documentation of bleeding episodes for all participants. Prior studies have not carefully examined the role of bleeding characteristics in PTB risk. In the present study, we estimate the association between first-trimester bleeding and PTB in a non-clinical prospective cohort and test whether bleeding characteristics better predict risk. METHODS Women were enrolled in Right from the Start (2000–2009), a prospective pregnancy cohort. Data about bleeding and bleeding characteristics were examined with logistic regression to assess association with PTB. RESULTS Among 3978 pregnancies 344 were PTB and 3634 term. Bleeding was reported by 986 (26%) participants. After screening candidate confounders, only multiple gestations remained in the model. Bleeding associated with PTB [odds ratio (OR)adjusted = 1.40, 95% confidence interval (CI) 1.09–1.80]. Risk did not vary by race/ethnicity. Compared with non-bleeders, PTB risk was higher for bleeding with red color (ORadjusted = 1.92, 95% CI, 1.32–2.82), for heavy episodes (ORadjusted = 2.40, 95% CI 1.18–4.88) and long duration (ORadjusted = 1.67, 95% CI 1.17–2.38). CONCLUSIONS Bleeding associated with PTB was not confounded by common risk factors for bleeding or PTB. PTB risk was greatest for women with heavy bleeding episodes with long duration and red color and would suggest that combining women with different bleeding characteristics may affect the accuracy of risk assessment. These data suggest a candidate etiologic pathway for PTB and warrant further investigation of the biologic mechanisms. PMID:22052384

  8. First-Trimester Prediction of Gestational Diabetes Mellitus: Examining the Potential of Combining Maternal Characteristics and Laboratory Measures

    PubMed Central

    Savvidou, Makrina; Nelson, Scott M.; Makgoba, Mahlatse; Messow, Claudia-Martina; Sattar, Naveed; Nicolaides, Kypros

    2010-01-01

    OBJECTIVE Predictors of gestational diabetes mellitus (GDM) have been widely studied, but few studies have considered multiple measures. Our objective was to integrate several potential GDM predictors with consideration to both simple and novel measures and to determine the extent to which GDM can be predicted in the first trimester. RESEARCH DESIGN AND METHODS We identified first-trimester maternal samples from 124 women who developed GDM and 248 control subjects who did not. We gathered data on age, BMI, parity, race, smoking, prior GDM, family history of diabetes, and blood pressure. Using retrieved samples, we measured routine (lipids, high-sensitivity C-reactive protein, and γ-glutamyltransferase) and novel (adiponectin, E-selectin, and tissue plasminogen activator [t-PA]) parameters. We determined independent predictors from stepwise regression analyses, calculated areas under the receiver-operating characteristic curves (AUC-ROC), and integrated discrimination improvement (IDI) for relevant models. RESULTS Compared with control subjects, women who subsequently developed GDM were older, had higher BMIs, were more likely to be of Asian origin, had a history of GDM or family history of type 2 diabetes, and had higher systolic blood pressure (P < 0.05 for all). With regard biochemical measures, stepwise analyses identified only elevated t-PA and low HDL cholesterol levels as significant (P ≤ 0.015) independent predictors of GDM beyond simple non–laboratory-based maternal measures. Their inclusion improved the AUC-ROC from 0.824 to 0.861 and IDI by 0.052 (0.017–0.115). CONCLUSIONS GDM can be usefully estimated from a mix of simple questions with potential for further improvement by specific blood measures (lipids and t-PA). PMID:20876721

  9. First-trimester combined screening for trisomy 21 with different combinations of placental growth factor, free β-human chorionic gonadotropin and pregnancy-associated plasma protein-A.

    PubMed

    Kagan, K O; Hoopmann, M; Abele, H; Alkier, R; Lüthgens, K

    2012-11-01

    To examine placental growth factor (PlGF) in euploid and trisomy 21 pregnancies at 11-13 weeks' gestation and to model the impact on first-trimester combined screening. PlGF was measured in 509 (409 euploid and 100 trisomic) fetal serum samples derived from prospective first-trimester combined screening for trisomy 21 at 11-13 weeks' gestation. The serum samples were stored at -80°C, following the measurement of free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) levels, for median time spans of 0.9 and 4.1 years in the euploid and trisomy 21 pregnancies, respectively. The effect of additional PlGF measurement at the time of combined screening was investigated by simulating fetal nuchal translucency (NT) measurements and multiples of the median (MoM) values for PAPP-A, free β-hCG and PlGF for 20,000 euploid and 20,000 trisomy 21 pregnancies. Patient-specific combined risks were calculated based on maternal age and fetal NT in addition to free β-hCG, PAPP-A and PlGF, PAPP-A and PlGF or free β-hCG and PlGF, and detection and false-positive rates were calculated. Median PlGF-MoM was 1.0 (95% confidence interval (CI), 0.96-1.04) in euploid fetuses and significantly lower, at 0.73 (95% CI, 0.70-0.76), in trisomy-21 fetuses (P < 0.0001). There was no significant dependency between PlGF-MoM and either gestational age at the time of blood sampling (r = 0.087, P = 0.392) or sample storage time (r = 0.028, P = 0.785). Modeled detection and false-positive rates for first-trimester combined screening (based on maternal and gestational age, fetal NT and maternal serum biochemistry) without PlGF were 85% and 2.7% for a fixed risk cut-off of 1:100. The addition of PlGF increased the detection rate to 87% and reduced the false-positive rate to 2.6%. Screening by maternal age and fetal NT in combination with PlGF and PAPP-A or in combination with PlGF and free β-hCG provided detection rates of 82% and 79%, with false-positive rates

  10. Expression of serum amyloid A4 in human trophoblast-like choriocarcinoma cell lines and human first trimester/term trophoblast cells

    PubMed Central

    Rossmann, C.; Hammer, A.; Koyani, C.N.; Kovacevic, A.; Siwetz, M.; Desoye, G.; Poehlmann, T.G.; Markert, U.R.; Huppertz, B.; Sattler, W.; Malle, E.

    2014-01-01

    Trophoblast invasion into uterine tissues represents a hallmark of first trimester placental development. As expression of serum amyloid A4 (SAA4) occurs in tumorigenic and invasive tissues we here investigated whether SAA4 is present in trophoblast-like human AC1-M59/Jeg-3 cells and trophoblast preparations of human first trimester and term placenta. SAA4 mRNA was expressed in non-stimulated and cytokine-treated AC1-M59/Jeg-3 cells. In purified trophoblast cells SAA4 mRNA expression was upregulated at weeks 10 and 12 of pregnancy. Western-blot and immunohistochemical staining of first trimester placental tissue revealed pronounced SAA4 expression in invasive trophoblast cells indicating a potential role of SAA4 during invasion. PMID:24951172

  11. Maternal First Trimester TSH Concentrations: Do They Affect Perinatal and Endocrine Outcomes?

    PubMed

    Fraenkel, M; Shafat, T; Erez, O; Lichtenstein, Y; Awesat, J; Novack, V; Tsur, A

    2016-07-01

    We aimed to examine the distribution of 1(st) trimester TSH and evaluate its association with perinatal outcomes and future development of maternal thyrotoxicosis. This retrospective cohort study included data of all women without prior thyroid disease who delivered a singleton at our medical center from 1/2001 to 12/2011 and had a 1(st) trimester TSH<4.0 mU/l. Women were divided according to 1(st) trimester TSH concentrations into quartiles and by predefined TSH values (mU/l): 1) TSH<0.1; 2) TSH 0.11-0.2; 3) TSH 0.21-0.4; and 4) TSH 0.4-4. Obstetrical outcomes, hCG concentrations, and future thyroid status were collected from electronic medical records. A total of 13 841 women fulfilled the inclusion criteria. Mean maternal TSH concentration at 5 weeks of gestation was 2.09±0.83 mU/l and decreased to 1.29±0.87 mU/l in weeks 8-9 with an increase towards the end of the 1(st) trimester. Odds ratio for future thyrotoxicosis was 3.64 in the lowest compared to the highest TSH quartile and 10.03 in those with TSH<0.1 compared to TSH 0.41-4 mU/l. Rates of female fetuses were higher in the low TSH quartiles and in the lower TSH groups, however baby gender was not associated with increased risk of future thyrotoxicosis. Low maternal 1(st) trimester TSH quartiles or concentrations were not associated with adverse pregnancy outcome. Only a minor fraction of pregnant women with a low first tirmester TSH subsequently developed future thyrotoxicosis.

  12. Does First-Trimester Screening Modify the Natural History of Congenital Heart Disease? Analysis of Outcome of Regional Cardiac Screening at 2 Different Time Periods.

    PubMed

    Jicinska, Hana; Vlasin, Pavel; Jicinsky, Michal; Grochova, Ilga; Tomek, Viktor; Volaufova, Julia; Skovranek, Jan; Marek, Jan

    2017-03-14

    The study analyzed the impact of first-trimester screening on the spectrum of congenital heart defects (CHDs) later in pregnancy and on the outcome of fetuses and children born alive with a CHD. The spectrum of CHDs, associated comorbidities, and outcome of fetuses, either diagnosed with a CHD in the first trimester (Group I, 127 fetuses) or only in the second-trimester screening (Group II, 344 fetuses), were analyzed retrospectively between 2007 and 2013. Second-trimester fetuses diagnosed with a CHD between 2007 and 2013 were also compared with Group III (532 fetuses diagnosed with a CHD in the second trimester from 1996 to 2001, the period before first-trimester screening was introduced). The spectrum of CHDs diagnosed in the first and second trimesters in the same time period differed significantly, with a greater number of comorbidities (P<0.0001), CHDs with univentricular outcome (P<0.0001), intrauterine deaths (P=0.01), and terminations of pregnancy (P<0.0001) in Group I compared with Group II. In Group III, significantly more cases of CHDs with univentricular outcome (P<0.0001), intrauterine demise (P=0.036), and early termination (P<0.0001) were identified compared with fetuses diagnosed with CHDs in the second trimester between 2007 and 2013. The spectrum of CHDs seen in the second-trimester groups differed after first-trimester screening was implemented. First-trimester screening had a significant impact on the spectrum of CHDs and the outcomes of pregnancies with CHDs diagnosed in the second trimester. Early detection of severe forms of CHDs and significant comorbidities resulted in an increased pregnancy termination rate in the first trimester. © 2017 American Heart Association, Inc.

  13. Mid-trimester maternal ADAM12 levels differ according to fetal gender in pregnancies complicated by preeclampsia.

    PubMed

    Myers, Jenny E; Thomas, Grégoire; Tuytten, Robin; Van Herrewege, Yven; Djiokep, Raoul O; Roberts, Claire T; Kenny, Louise C; Simpson, Nigel A B; North, Robyn A; Baker, Philip N

    2015-02-01

    An overrepresentation of adverse pregnancy outcomes has been observed in pregnancies associated with a male fetus. We investigated the association between fetal gender and candidate biomarkers for preeclampsia. Proteins were quantified in samples taken at 20 weeks from women recruited to the SCreening fOr Pregnancy Endpoints (SCOPE) study (preeclampsia n = 150; no preeclampsia n = 450). In contrast to placental growth factor, soluble endoglin, and insulin-like growth factor acid labile subunit, levels of metallopeptidase domain 12 (ADAM12) at 20 weeks were dependent on fetal gender in pregnancies complicated by preeclampsia, for male (n = 73) fetuses the multiples of the median (MoM; interquartile range [IQR] 1.1-1.5) was 1.3, whereas for female fetuses (n = 75) MoM was 1.1 (1.0-1.3); P < .01. Prediction of preeclampsia using ADAM12 levels was improved for pregnancies associated with a male fetus (area under receiver-operator curve [AUC] 0.73 [95% confidence interval [CI] 0.67-0.80]) than that of a female fetus (AUC 0.62 [0.55-0.70]); P = .03. The data presented here fit a contemporary hypothesis that there is a difference between the genders in response to an adverse maternal environment and suggest that an alteration in ADAM12 may reflect an altered placental response in pregnancies subsequently complicated by preeclampsia.

  14. Complications of first-trimester abortion by vacuum aspiration after cervical preparation with and without misoprostol: a multicentre randomised trial.

    PubMed

    Meirik, Olav; My Huong, Nguyen Thi; Piaggio, Gilda; Bergel, Eduardo; von Hertzen, Helena

    2012-05-12

    Little information is available about the incidence of complications from vacuum aspiration for first-trimester abortion after cervical preparation with prostaglandin analogues. We compared incidence of complications from vacuum aspiration in women who had had cervical preparation with misoprostol and those who had not. We did a randomised parallel-group trial at 14 centres in nine countries between Oct 22, 2002, and Sept 24, 2005. Healthy women seeking first-trimester abortion were randomly assigned via a computer-generated randomisation sequence stratified by centre, to receive vaginal administration of either two 200 μg tablets of misoprostol or two placebo tablets 3 h before abortion by vacuum aspiration. Participants and health-care personnel other than staff administering the treatment were masked to group assignment. Follow-up was up to 2 weeks. The primary outcome was one or more complications of vacuum aspiration (cervical tear, uterine perforation, incomplete abortion, uterine re-evacuation, pelvic inflammatory disease, or any other serious adverse event). We included women undergoing treatment and vacuum aspiration in the analysis of immediate complications; whereas, in the analysis of delayed complications, we included only those followed-up. In the analysis of any immediate or delayed complication, we excluded women lost to follow-up. This trial is registered, number ISRCTN85366519. We randomly assigned 2485 women to the misoprostol group and 2487 to the placebo group. Two women in the misoprostol group did not have vacuum aspiration. 56 women in each group were lost to follow-up. 50 (2%) of 2427 women in the misoprostol group and 74 (3%) of 2431 in the placebo group had one or more complication of vacuum aspiration (relative risk [RR] 0·68, 95% CI 0·47-0·96). No women in the misoprostol group had cervical tears and three had uterine perforations compared with two women in the placebo group who had cervical tears and one who had perforation. 19 (<1

  15. Mass spectrometric discovery and selective reaction monitoring (SRM) of putative protein biomarker candidates in first trimester Trisomy 21 maternal serum.

    PubMed

    Lopez, Mary F; Kuppusamy, Ramesh; Sarracino, David A; Prakash, Amol; Athanas, Michael; Krastins, Bryan; Rezai, Taha; Sutton, Jennifer N; Peterman, Scott; Nicolaides, Kypros

    2011-01-07

    The accurate diagnosis of Trisomy 21 requires invasive procedures that carry a risk of miscarriage. The current state-of-the-art maternal serum screening tests measure levels of PAPP-A, free bhCG, AFP, and uE3 in various combinations with a maximum sensitivity of 60-75% and a false positive rate of 5%. There is currently an unmet need for noninvasive screening tests with high selectivity that can detect pregnancies at risk, preferably within the first trimester. The aim of this study was to apply proteomics and mass spectrometry techniques for the discovery of new putative biomarkers for Trisomy 21 in first trimester maternal serum coupled with the immediate development of quantitative selective reaction monitoring (SRM) assays. The results of the novel workflow were 2-fold: (1) we identified a list of differentially expressed proteins in Trisomy 21 vs Normal samples, including PAPP-A, and (2) we developed a multiplexed, high-throughput SRM assay for verification of 12 new putative markers identified in the discovery experiments. To narrow down the initial large list of differentially expressed candidates resulting from the discovery experiments, we incorporated receiver operating characteristic (ROC) curve algorithms early in the data analysis process. We believe this approach provides a substantial advantage in sifting through the large and complex data typically obtained from discovery experiments. The workflow efficiently mined information derived from high-resolution LC-MS/MS discovery data for the seamless construction of rapid, targeted assays that were performed on unfractionated serum digests. The SRM assay lower limit of detection (LLOD) for the target peptides in a background of digested serum matrix was approximately 250-500 attomoles on column and the limit of accurate quantitation (LOQ) was approximately 1-5 femtomoles on column. The assay error as determined by coefficient of variation at LOQ and above ranged from 0 to 16%. The workflow developed in

  16. Prediction of preeclampsia in primigravida in late first trimester using serum placental growth factor alone and by combination model.

    PubMed

    Agarwal, Rachna; Chaudhary, Shweta; Kar, Rajarshi; Radhakrishnan, Gita; Tandon, Anupama

    2017-10-01

    We investigated a placental growth factor alone and combined clinical (mean arterial pressure, MAP), biophysical (uterine artery pulsability index, PI) and biochemical (placental growth factor, PLGF) model for predicting preeclampsia in late first trimester. The inclusion criteria was primigravida (<40 years) attending their first hospital visit with singleton pregnancy at 11-14 weeks of gestation. Of the enrolled and followed 291 subjects, 35 (12%) later developed PE (5.8%)/GH (6.2%). An equal number of randomised women with normotensive non-proteinuric course were considered as reference group. For preeclampsia, PLGF alone had detection rate of 40% and 51% with 5% and 10% FPR, respectively. On addition of MAP, the AUC improved to 0.937 for PE. Further, addition of mean PI slightly improved AUC to 0.965. This signifies that a model with all three markers had better prediction of preeclampsia rather than PLGF alone. Impact statement In view of high morbidity and mortality due to hypertensive disorders in pregnancy, there has been extensive research for developing markers to detect/screen the condition in early pregnancy. Several such markers have been tested in their individual capacities and in combination during early pregnancy. Most of these studies have originated from high income countries and focussed mainly on the second trimester of pregnancy. We investigated a placental growth factor alone and combined clinical (mean arterial pressure, MAP), biophysical (uterine artery pulsability index, PI) and biochemical (placental growth factor, PLGF) model for predicting preeclampsia in the first trimester in primigravida (<40 years). A nested case control model was used for our study. For preeclampsia, PLGF alone had detection rate of 40% and 51% with 5% and 10% FPR, respectively. On addition of MAP, the AUC improved to 0.937 for PE. Further, addition of mean PI slightly improved AUC to 0.965. The present study has been done in an Indian subcontinent setting

  17. Prenatal Risk Calculation (PRC) 3.0: An Extended DoE-Based First-Trimester Screening Algorithm Allowing For Early Blood Sampling

    PubMed Central

    Merz, E.; Thode, C.; Eiben, B.; Wellek, S.

    2016-01-01

    Aim: Both previous versions of the German PRC algorithm developed by our group for routine first-trimester screening relied on the assumption that maternal blood sampling and fetal ultrasonography are performed at the same visit of a pregnant women. In this paper we present an extension of our method allowing also for constellations where this synchronization is abandoned through preponing blood sampling to dates before 11 weeks of gestation. Methods: In contrast to the directly measured concentrations of the serum parameters PAPP-A and free ß-hCG, the logarithmically transformed values could be shown to admit the construction of reference bands covering the whole range from 16 to 84 mm CRL [corresponding to 63 to 98 days of gestation]. Prior to determining reference limits from which the DoEs for each individual patient had to be calculated, the log concentrations of all PAPP-A and free ß-hCG values were transformed once more using the calibration approach established in 1 for the elimination of the influence of maternal weight. Results: Although that part of the database which was available for estimating the reference bands for blood sampling times prior to 11 weeks of gestation was comparatively sparse (898 out of 186 215 pregnancies with euploid outcome), the key statistical characteristics of the extended risk-calculation procedure turned out to be very satisfactory. Using the same cutoff value of 1:150 for the posterior risks of trisomy 21 and 13/18, the overall FPR (false positive rate) for diagnosing a T21 was found to be 3.42%. The corresponding DTR (detection rate) was obtained to be 86.8% and thus exceeded the DTR attained by PRC 2.0 for trisomy 21. For trisomies 13 and 18, the proportions of patients with calculated posterior risks exceeding the cutoff value of 1:150 were obtained to be 1.60% (=FPR) and 86.4% (=DTR). Conclusion: Transforming the measured concentrations of PAPP-A and free ß-hCG to the logarithmic scale allows one to extend the Do

  18. The expression of Steroidogenic Factor-1 and its role in bovine steroidogenic ovarian cells during the estrus cycle and first trimester of pregnancy.

    PubMed

    Mlynarczuk, J; Wrobel, M H; Rekawiecki, R; Kotwica, J

    2013-04-01

    of ovarian function during both the estrous cycle and the first trimester of pregnancy in cows. Furthermore, the concentrations of the SF-1 inhibitor and stimulator that we used in the primary cell culture could effectively modify the activity of this receptor.

  19. Prenatal Risk Calculation (PRC) 3.0: An Extended DoE-Based First-Trimester Screening Algorithm Allowing For Early Blood Sampling.

    PubMed

    Merz, E; Thode, C; Eiben, B; Wellek, S

    2016-03-01

    Both previous versions of the German PRC algorithm developed by our group for routine first-trimester screening relied on the assumption that maternal blood sampling and fetal ultrasonography are performed at the same visit of a pregnant women. In this paper we present an extension of our method allowing also for constellations where this synchronization is abandoned through preponing blood sampling to dates before 11 weeks of gestation. In contrast to the directly measured concentrations of the serum parameters PAPP-A and free ß-hCG, the logarithmically transformed values could be shown to admit the construction of reference bands covering the whole range from 16 to 84 mm CRL [corresponding to 63 to 98 days of gestation]. Prior to determining reference limits from which the DoEs for each individual patient had to be calculated, the log concentrations of all PAPP-A and free ß-hCG values were transformed once more using the calibration approach established in 1 for the elimination of the influence of maternal weight. Although that part of the database which was available for estimating the reference bands for blood sampling times prior to 11 weeks of gestation was comparatively sparse (898 out of 186 215 pregnancies with euploid outcome), the key statistical characteristics of the extended risk-calculation procedure turned out to be very satisfactory. Using the same cutoff value of 1:150 for the posterior risks of trisomy 21 and 13/18, the overall FPR (false positive rate) for diagnosing a T21 was found to be 3.42%. The corresponding DTR (detection rate) was obtained to be 86.8% and thus exceeded the DTR attained by PRC 2.0 for trisomy 21. For trisomies 13 and 18, the proportions of patients with calculated posterior risks exceeding the cutoff value of 1:150 were obtained to be 1.60% (=FPR) and 86.4% (=DTR). Transforming the measured concentrations of PAPP-A and free ß-hCG to the logarithmic scale allows one to extend the DoE-based algorithm developed by the

  20. Positive predictive values for detection of trisomies 21, 18 and 13 and termination of pregnancy rates after referral for advanced maternal age, first trimester combined test or ultrasound abnormalities in a national screening programme (2007-2009).

    PubMed

    Siljee, Jacqueline E; Knegt, Alida C; Knapen, Maarten F C M; Bekker, Mireille N; Visser, Gerard H A; Schielen, Peter C J I

    2014-03-01

    The objective of this article is to analyse the positive predictive value (PPV) of trisomies 21, 18 and 13 after referral for advanced maternal age (AMA), first trimester combined test or ultrasound findings to suggest improvements for clinical practice. Data (48 457 combined tests, 134 000 fetal anomaly scans and 24 379 invasive prenatal tests) were combined to calculate PPV and termination of pregnancy rates. For referral for AMA, the PPV for T21 was 1.0% and 1.8% for amniocentesis and chorionic villus biopsy, respectively; for the combined test at a maternal age ≥36 years, these percentages were 4.9% and 12.5%, respectively and for maternal age <36 years, 4.4% and 8.1%, respectively. For ultrasound findings, the PPV was 5.3% and 14.8%, respectively. Termination of pregnancy rate upon trisomy 21 diagnosis was >90% unless detected after referral for ultrasound findings (71.5-85.9%). About 50% of pregnant women with a high combined test risk chose not to have invasive testing. Advanced MA is still a large contributor to invasive testing but should be abandoned (low PPV, high fetal loss rate) and be replaced by reimbursable combined test screening for all women. Patient information on second trimester ultrasound screening should indicate that abnormal ultrasound findings are associated with high trisomy rate. © 2013 John Wiley & Sons, Ltd.

  1. Predicting SGA neonates using first-trimester screening: influence of previous pregnancy's birthweight and PAPP-A MoM.

    PubMed

    Krauskopf, Alexandra Lara; Knippel, Alexander Johannes; Verde, Pablo Emilio; Kozlowski, Peter

    2016-09-01

    Investigating the proportions of anamnestic and biochemical variables of the previous and current pregnancies for the prediction of small for gestational age (SGA) neonates in the current pregnancy. In this observational retrospective study, 45 029 pregnancies were examined, including 3862 patients with more than one pregnancy. Odds ratios for SGA using anamnestic parameters and pregnancy-associated plasma protein A (PAPP-A) values from all pregnancies were estimated by using a logistic regression model. There were 2552 (5.7%) SGA neonates. Two threshold PAPP-A values were identified at 0.15 MoM and 0.33 MoM with probabilities for SGA of 23% and 17%, respectively. A previous SGA < 10th centile and a current PAPP-A MoM value < 5th centile result in odds ratios of 4.8 (95% CI: 3.5-6.5) and 3.0 (95% CI: 1.8-5.0), respectively. The parameters' combined odds ratio is 14.1 (95% CI: 3.9-50.3) with a number needed to screen of ten for one SGA neonate at a detection rate of 37%. Information on previous pregnancies affected by SGA and a current pregnancy's low PAPP-A value are reliable predictors for a SGA delivery. First-trimester biochemical analysis should be maintained to detect women at risk for delivering a SGA neonate.

  2. First trimester β-hCG and estradiol levels in singleton and twin pregnancies after assisted reproduction.

    PubMed

    Póvoa, Ana; Xavier, Pedro; Matias, Alexandra; Blicksttein, Isaac

    2017-07-28

    To compare levels of β-hCG and estradiol collected during the first trimester in singleton and twin pregnancies following assisted reproduction technologies (ART). We prospectively evaluated 50 singleton and 47 dichorionic twin pregnancies that eventually ended in live births. Patients were recruited from a single ART center with standard treatment protocols followed by fresh embryo transfers. Hormone measurements were performed within a narrow gestational age range and analyzed in a single laboratory thus minimizing inter- and intra-assay variability. We measured serum β-hCG at 13 days after embryo transfer as well as samples of β-hCG and estradiol at 8-9 weeks+6 days. No significant differences existed between singletons and twins in respect to demographic and cycle characteristics. β-hCG and estradiol were all significantly higher in twins (P<0.05). The data confirms the higher levels of β-hCG and estradiol in twins, pointing to the potential role of these placental hormones in early support of a twin pregnancy.

  3. A synthetic thiourea-based tripodal receptor that impairs the function of human first trimester cytotrophoblast cells.

    PubMed

    Horvat, Darijana; Khansari, Maryam Emami; Pramanik, Avijit; Beeram, Madhava R; Kuehl, Thomas J; Hossain, Md Alamgir; Uddin, Mohammad Nasir

    2014-07-21

    A synthetic tripodal-based thiourea receptor (PNTTU) was used to explore the receptor/ligand binding affinity using CTB cells. The human extravillous CTB cells (Sw.71) used in this study were derived from first trimester chorionic villus tissue. The cell proliferation, migration and angiogenic factors were evaluated in PNTTU-treated CTB cells. The PNTTU inhibited the CTBs proliferation and migration. The soluble fms-like tyrosine kinase-1 (sFlt-1) secretion was increased while vascular endothelial growth factor (VEGF) was decreased in the culture media of CTB cells treated with ≥1 nM PNTTU. The angiotensin II receptor type 2 (AT2) expression was significantly upregulated in ≥1 nM PNTTU-treated CTB cells in compared to basal; however, the angiotensin II receptor, type 1 (AT1) and vascular endothelial growth factor receptor 1 (VEGFR-1) expression was downregulated. The anti-proliferative and anti-angiogenic effect of this compound on CTB cells are similar to the effect of CTSs. The receptor/ligand affinity of PNTTU on CTBs provides us the clue to design a potent inhibitor to prevent the CTS-induced impairment of CTB cells.

  4. In Vitro Differentiation of First Trimester Human Umbilical Cord Perivascular Cells into Contracting Cardiomyocyte-Like Cells

    PubMed Central

    Szaraz, Peter; Librach, Matthew; Maghen, Leila; Iqbal, Farwah; Barretto, Tanya A.; Kenigsberg, Shlomit; Gauthier-Fisher, Andrée; Librach, Clifford L.

    2016-01-01

    Myocardial infarction (MI) causes an extensive loss of heart muscle cells and leads to congestive heart disease (CAD), the leading cause of mortality and morbidity worldwide. Mesenchymal stromal cell- (MSC-) based cell therapy is a promising option to replace invasive interventions. However the optimal cell type providing significant cardiac regeneration after MI is yet to be found. The aim of our study was to investigate the cardiomyogenic differentiation potential of first trimester human umbilical cord perivascular cells (FTM HUCPVCs), a novel, young source of immunoprivileged mesenchymal stromal cells. Based on the expression of cardiomyocyte markers (cTnT, MYH6, SIRPA, and CX43) FTM and term HUCPVCs achieved significantly increased cardiomyogenic differentiation compared to bone marrow MSCs, while their immunogenicity remained significantly lower as indicated by HLA-A and HLA-G expression and susceptibility to T cell mediated cytotoxicity. When applying aggregate-based differentiation, FTM HUCPVCs showed increased aggregate formation potential and generated contracting cells within 1 week of coculture, making them the first MSC type with this ability. Our results indicate that young FTM HUCPVCs have superior cardiomyogenic potential coupled with beneficial immunogenic properties when compared to MSCs of older tissue sources, suggesting that in vitro predifferentiation could be a potential strategy to increase their effectiveness in vivo. PMID:27123009

  5. [The use of a synthetic analog of prostaglandin E1 for medical treatment of first trimester pregnancy failure].

    PubMed

    Houminer, Aryeh; Kopernic, Gideon; Hagay, Zion

    2009-07-01

    First trimester failure is a common event accruing in 15-20% of pregnancies that has traditionally been treated by surgical curettage. An alternate therapy is medical treatment using misoprostol, a synthetic analog of prostaglandin E1. Numerous studies have been carried out comparing treatment by misoprostol with a placebo. They have found a significant advantage to misoprostol mode of treatment. Other studies comparing surgical and medical treatment found the surgical treatment to be superior to the latter. It must be noted that the medical mode of treatment was indeed found to be successful in over 80% of cases. No significant differences were noted in the complication rates of the two groups. Misoprostol therapy has been found to be effective when administered orally or vaginally, although vaginal therapy is slightly superior. No large scale studies have been carried out to date testing the safety of this treatment in patients with a scarred uterus (due to Cesarean section or hysterotomy). However, on the basis of reported facts, it seems plausibLe to suggest misoprostoL treatment for these patients.

  6. Medical abortion in the first trimester: the use of serum hCG and endometrial thickness as markers of completeness.

    PubMed

    Parashar, Pooja; Iversen, Ole Erik; Midbøe, Grete; Myking, Ole; Bjørge, Line

    2007-12-01

    The combination of mifepristone and misoprostol is an established method for induction of early first trimester abortion, but there is no consensus about the best evaluation of treatment outcome. We assessed endometrial thickness, determined by ultrasound and serum-human chorionic gonadotropin (s-hCG) as markers of successful management. Prospective trial involving 255 women, with a gestation of 62 days or less, who were to undergo medical abortion. In addition to our established routines of performing clinical and ultrasound examinations, we also determined the s-hCG level prior to treatment and at follow-up. Of the 255 subjects treated during the study, 20 (7.8%) were lost to follow-up. The overall complete abortion rate was 94.0%. Fourteen subjects required vacuum aspiration, nine of them prior to the scheduled follow-up and five thereafter. None of the pregnancies were ongoing. A decrease of 99% in s-hCG levels was noted in 99% of the women, when levels determined prior to mifepristone intake and those measured 15-71 days post-abortion were compared. This study confirms that s-hCG levels drop sharply after medical abortion. To assess the completeness of medical abortion, we recommend that clinical examination to be combined with determination of s-hCG. Ultrasonography should be carried out only when indicated.

  7. Alleviation of streptozotocin-induced diabetes in nude mice by stem cells derived from human first trimester umbilical cord.

    PubMed

    Cao, M; Zhang, J B; Dong, D D; Mou, Y; Li, K; Fang, J; Wang, Z Y; Chen, C; Zhao, J; Yie, S M

    2015-10-16

    Cells isolated from human first trimester umbilical cord perivascular layer (hFTM-PV) tissues display the pluripotent characteristics of stem cells. In this study, we examined whether hFTM-PV cells can differentiate into islet-like clusters (ILCs) in vitro, and whether transplantation of the hFTM-PV cells with and without differentiation in vitro can alleviate diabetes in nude mice. The hFTM-PV cells were differentiated into ILCs in vitro through a simple stepwise culture protocol. To examine the in vivo effects of the cells, the hFTM-PV cells with and without differentiation in vitro were transplanted into the abdominal cavity of nude mice with streptozotocin (STZ)-induced diabetes. Blood glucose levels, body weight, and the survival probability of the diabetic nude mice were then statistically analyzed. The hFTM-PV cells were successfully induced into ILCs that could release insulin in response to elevated concentrations of glucose in vitro. In transplantation experiments, we observed that mice transplanted with the undifferentiated hFTM-PV cells, embryonic body-like cell aggregations, or ILCs all demonstrated normalized hyperglycemia and showed improved survival rate compared with those without cell transplantation. The hFTM-PV cells have the ability to differentiate into ILCs in vitro and transplantations of undifferentiated and differentiated cells can alleviate STZ-induced diabetes in nude mice. This may offer a potential cell source for stem cell-based therapy for treating diabetes in the future.

  8. Recruitment of healthy first-trimester pregnant women: lessons from the Chemicals, Health & Pregnancy study (CHirP).

    PubMed

    Webster, Glenys M; Teschke, Kay; Janssen, Patricia A

    2012-02-01

    To describe and evaluate recruitment techniques used to enroll 152 healthy pregnant women fewer than 15 weeks gestation into a prospective study of environmental chemical exposure during pregnancy. Posters, a website, online and print advertising, recruitment emails, media coverage, recruitment from clinic waiting rooms, networking within the pregnancy community and presenting a study booth at baby "trade shows" were used to advertise the study. Participants had to meet a strict set of eligibility criteria, and were asked to donate two-second-trimester blood samples, complete two questionnaires, have samples of air, dust, lint and tap water collected from their homes, and donate a cord blood sample at delivery. Over 17 months, 171 women enrolled (49% of initial contacts, and 99% of all eligible women) and 152 women completed the study (89% retention). Total recruitment costs were approximately $400 Cdn per final participant. Posters, study booth presentations and online advertising generated the most inquiries about the study. Word of mouth, referral from another study and direct email were the most cost-effective strategies. Not surprisingly, the recruited study population was less ethnically diverse, more affluent and more educated than the background population of pregnant women in Vancouver. A combination of passive and active recruitment techniques were successful for recruiting healthy women in roughly the first trimester of pregnancy (<15 weeks gestation). While a convenience sample of women is suitable for our study questions, additional strategies may be required to recruit a more representative pregnant population in future studies.

  9. Excessive Gestational Weight Gain in the First Trimester among Women with Normal Glucose Tolerance and Resulting Neonatal Adiposity

    PubMed Central

    Josefson, Jami L.; Simons, Hannah; Zeiss, Dinah M.; Metzger, Boyd E.

    2016-01-01

    Objective To assess whether weight gain above or below Institute of Medicine (IOM) recommended amounts in an ethnically diverse obstetric population with normal glucose tolerance is associated with differences in neonatal adiposity. Study Design In this prospective cohort study, healthy women with normal glucose tolerance based on the International Association of Diabetes and Pregnancy Study Groups guidelines were enrolled. Gestational weight at multiple time points were collected. Neonatal adiposity was measured by air displacement plethysmography at 24-72 hours of life. Analyses included Fisher's exact test, ANOVA, and a trajectory analysis using a group-based weight gain trajectory model with a censored normal distribution. Result Overweight and obese women were more likely to exceed IOM weight gain guidelines. Regardless, there was no significant difference in %body fat of neonates born to mothers who either met or exceeded gestational weight gain guidelines. Gestational weight gain timing influenced neonatal anthropometrics: women who gained excessively by the first prenatal visit had neonates with significantly higher birth weight (3.91 kg vs. 3.45 kg, p<0.001), and %body fat (13.7% vs. 10.9%, p=0.0001) compared to women who had steady, moderate gestational weight gain. Conclusion Avoidance of excessive gestational weight gain in the first trimester may prevent high amounts of neonatal adiposity. PMID:27583397

  10. The accuracy of using last menstrual period to determine gestational age for first trimester medication abortion: a systematic review.

    PubMed

    Schonberg, Dana; Wang, Lin-Fan; Bennett, Ariana H; Gold, Marji; Jackson, Emily

    2014-11-01

    We sought to evaluate the accuracy of assessing gestational age (GA) prior to first trimester medication abortion using last menstrual period (LMP) compared to ultrasound (U/S). We searched Medline, Embase and Cochrane databases through October 2013 for peer-reviewed articles comparing LMP to U/S for GA dating in abortion care. Two teams of investigators independently evaluated data using standard abstraction forms. The US Preventive Services Task Force and Quality Assessment of Diagnostic Accuracy Studies guidelines were used to assess quality. Of 318 articles identified, 5 met inclusion criteria. Three studies reported that 2.5-11.8% of women were eligible for medication abortion by LMP and ineligible by U/S. The number of women who underestimated GA using LMP compared to U/S ranged from 1.8 to 14.8%, with lower rates found when the sample was limited to a GA <63 days. Most women (90.5-99.1%) knew their LMP, 70.8-90.5% with certainty. Our results support that LMP can be used to assess GA prior to medication abortion at GA <63 days. Further research looking at patient outcomes and identifying women eligible for medication abortion by LMP but ineligible by U/S is needed to confirm the safety and effectiveness of providing medication abortion using LMP alone to determine GA. Copyright © 2014 Elsevier Inc. All rights reserved.

  11. A Synthetic Thiourea-Based Tripodal Receptor that Impairs the Function of Human First Trimester Cytotrophoblast Cells

    PubMed Central

    Horvat, Darijana; Khansari, Maryam Emami; Pramanik, Avijit; Beeram, Madhava R.; Kuehl, Thomas J.; Hossain, Md. Alamgir; Uddin, Mohammad Nasir

    2014-01-01

    A synthetic tripodal-based thiourea receptor (PNTTU) was used to explore the receptor/ligand binding affinity using CTB cells. The human extravillous CTB cells (Sw.71) used in this study were derived from first trimester chorionic villus tissue. The cell proliferation, migration and angiogenic factors were evaluated in PNTTU-treated CTB cells. The PNTTU inhibited the CTBs proliferation and migration. The soluble fms-like tyrosine kinase-1 (sFlt-1) secretion was increased while vascular endothelial growth factor (VEGF) was decreased in the culture media of CTB cells treated with ≥1 nM PNTTU. The angiotensin II receptor type 2 (AT2) expression was significantly upregulated in ≥1 nM PNTTU-treated CTB cells in compared to basal; however, the angiotensin II receptor, type 1 (AT1) and vascular endothelial growth factor receptor 1 (VEGFR-1) expression was downregulated. The anti-proliferative and anti-angiogenic effect of this compound on CTB cells are similar to the effect of CTSs. The receptor/ligand affinity of PNTTU on CTBs provides us the clue to design a potent inhibitor to prevent the CTS-induced impairment of CTB cells. PMID:25050653

  12. First-time first-trimester induced abortion and risk of readmission to a psychiatric hospital in women with a history of treated mental disorder.

    PubMed

    Munk-Olsen, Trine; Laursen, Thomas Munk; Pedersen, Carsten B; Lidegaard, Ojvind; Mortensen, Preben Bo

    2012-02-01

    Mental health problems are associated with women's reproductive decisions and predict poor mental health outcomes after abortion and childbirth. To study whether having a first-trimester induced abortion influenced the risk of psychiatric readmission and compare findings with readmission risk in women with mental disorders giving birth. Survival analyses were performed in a population-based cohort study merging data from the Danish Civil Registration System, the Danish Psychiatric Central Register, and the Danish National Hospital Register from January 1,1994, to December 31, 2007. Denmark. All women born in Denmark between 1962 and 1992 with a record of 1 or more psychiatric admissions at least 9 months before a first-time first-trimester induced abortion or childbirth. Main Outcome Measure  Readmission at a psychiatric hospital with any type of mental disorder from 9 months before to 12 months after a first-time first-trimester induced abortion or childbirth. Relative risk (RR) for readmission risk 9 to 0 months before a first-trimester induced abortion was 0.95 (95% CI, 0.73-1.23) compared with the first year after the abortion. This contrasts with a reduced risk of readmission before childbirth (RR, 0.56; 95% CI, 0.42-0.75) compared with the first year post partum. Proximity to previous psychiatric admission in particular predicted rehospitalization risks in both the abortion and the childbirth group. Risk of readmission is similar before and after first-time first-trimester abortion, contrasting with a marked increased in risk of readmission post partum. We speculate that recent psychiatric episodes may influence women's decisions to have an induced abortion; however, this decision does not appear to influence the illness course in women with a history of treated mental disorders.

  13. First trimester miscarriage evaluation.

    PubMed

    Lathi, Ruth B; Gray Hazard, Florette K; Heerema-McKenney, Amy; Taylor, Joanne; Chueh, Jane Tsung

    2011-11-01

    Miscarriage is a relatively common occurrence for otherwise healthy women. Despite its frequency, evaluation for cause is rare. The most common cause of miscarriage is sporadic chromosome errors. Chromosomal analysis of the miscarriage offers an explanation in at least 50% of cases. Conventional cytogenetic evaluation can only be done on fresh tissue, so it is critical that the treating physician consider genetic testing at the time of the miscarriage. Ultrasound can estimate the gestational age at the time of miscarriage and identify major abnormalities in some embryos. A careful pathological examination can add to the evaluation by ruling out rare disorders with the highest recurrence risk. A multidisciplinary approach to miscarriage evaluation is essential to understanding the cause and risk of recurrence. A thorough evaluation of a miscarriage, in combination with emotional support, can often provide the necessary reassurance and confidence as the patient prepares for her next pregnancy.

  14. Increased nitric oxide production and gender-dependent changes in PPARα expression and signaling in the fetal lung from diabetic rats.

    PubMed

    Kurtz, Melisa; Martínez, Nora; Capobianco, Evangelina; Higa, Romina; Fornes, Daiana; White, Verónica; Jawerbaum, Alicia

    2012-10-15

    The fetal lung is affected by maternal diabetes. Nuclear receptor PPARα regulates nitric oxide (NO) overproduction in different tissues. We aimed to determine whether fetal lung PPARα expression is altered by maternal diabetes, and if there are gender-dependent changes in PPARα regulation of NO production in the fetal lung. Fetal lungs from control and diabetic rats were explanted on day 21 of gestation and evaluated for PPARα expression and NO production. Fetuses were injected with the PPARα ligand LTB(4) on days 19, 20 and 21, and the fetal lung explanted on day 21 to evaluate PPARα and the inducible isoform of NO synthase (iNOS). Besides, pregnant rats were fed with olive oil- and safflower oil-supplemented diets, enriched in PPAR ligands, for evaluation of fetal lung NO production and PPARα expression. We found reduced PPARα concentrations only in the lung from male fetuses from the diabetic group when compared to controls, although maternal diabetes led to NO overproduction in both male and female fetal lungs. Fetal activation of PPARα led to changes in lung PPARα expression only in female fetuses, although this treatment increased iNOS expression in both male and female fetuses in the diabetic group. Diets supplemented with olive oil and not with safflower oil led to a reduction in NO production in male and female fetal lungs. In conclusion, there are gender-dependent changes in PPARα expression and signaling in the fetal lung from diabetic rats, although PPARα activation prevents maternal diabetes-induced lung NO overproduction in both male and female fetuses.

  15. The Effect of Fetal Gender on the Delivery Outcome in Primigravidae Women with Induced Labours for all Indications

    PubMed Central

    Papoutsis, Dimitrios

    2016-01-01

    Introduction There is increasing evidence of a gender-related phenomenon where the presence of a male fetus may have an adverse effect on the outcome of pregnancy. Aim The aim of this study was to investigate the effect of fetal gender on the delivery outcome in primigravidae women with induced labours. Materials and Methods This was an observational cohort study of primigravidae women who had Induction Of Labour (IOL) for all indications during a two-year period. Women with breech vaginal deliveries, stillbirths, multiple pregnancies and elective Caesarean Section (CS) were excluded. Results Of the 936 eligible patients identified, 493(52.6%) gave birth to male neonates and 443(47.4%) to female neonates. Age, ethnicity, Body Mass Index (BMI) and smoking were similar between women that delivered male and female neonates. More than half of all women were induced for post-date pregnancies. In women who gave birth to male neonates, the CS delivery rate was higher than in those with female neonates (23.7% vs 17.8%; p=0.029). Though emergency admission rates to the neonatal Intensive Care Unit (ICU) and arterial/venous pH from umbilical cord sampling immediately after birth were similar between male and female neonates, nevertheless male neonates had lower Apgar scores of <7 at 1 minute after birth (p=0.02). Conclusions This study has shown that, male gender fetuses have a higher CS delivery rate in primigravidae women undergoing IOL and may be more vulnerable to fetal compromise when in labour. PMID:28208944

  16. Predictive value for preterm birth of abnormal vaginal flora, bacterial vaginosis and aerobic vaginitis during the first trimester of pregnancy.

    PubMed

    Donders, G G; Van Calsteren, K; Bellen, G; Reybrouck, R; Van den Bosch, T; Riphagen, I; Van Lierde, S

    2009-09-01

    Abnormal vaginal flora (AVF) before 14 gestational weeks is a risk factor for preterm birth (PTB). The presence of aerobic microorganisms and an inflammatory response in the vagina may also be important risk factors. The primary aim of the study was to investigate the differential influences of AVF, full and partial bacterial vaginosis, and aerobic vaginitis in the first trimester on PTB rate. The secondary aim was to elucidate why treatment with metronidazole has not been found to be beneficial in previous studies. Unselected women with low-risk pregnancies attending the prenatal unit of the Heilig Hart General Hospital in Tienen, Belgium, were included in the study. At the first prenatal visit, 1026 women were invited to undergo sampling of the vaginal fluid for wet mount microscopy and culture, of whom 759 were fully evaluable. Abnormal vaginal flora (AVF; disappearance of lactobacilli), bacterial vaginosis (BV), aerobic vaginitis (AV), increased inflammation (more than ten leucocytes per epithelial cell) and vaginal colonisation with Candida (CV) were scored according to standardised definitions. Partial BV was defined as patchy streaks of BV flora or sporadic clue cells mixed with other flora, and full BV as a granular anaerobic-type flora or more than 20% clue cells. Vaginal fluid was cultured for aerobic bacteria, Mycoplasma hominis and Ureaplasma urealyticum. Outcome was recorded as miscarriage first trimester had a 75% lower risk of delivery before 35 weeks compared with women with AVF [odds ratio (OR) 0

  17. Comparison of three first trimester screening algorithms for trisomy 21 with and without adjustment for maternal characteristics.

    PubMed

    Lüthgens, K; Merz, E; Hackelöer, B J; Thode, C; Eiben, B; Kagan, K O

    2013-04-01

    Comparison of three algorithms (DoE 2007 and DoE 2011 algorithm of the FMF Germany and MoM algorithm of the FMF UK) in first trimester biochemical screening for trisomy 21 based on maternal and gestational age, free ß-hCG, and PAPP-A and assessment of relevant maternal characteristics. Data from 22 449 euploid singleton pregnancies undergoing combined screening for trisomy 21 at 11 to 13 weeks of gestation were examined. The measured maternal free β-hCG and PAPP-A concentrations were converted into DoE 2007 and DoE 2011 values according to the algorithm of the FMF Germany and into MoM values according to the algorithm of the FMF UK. In each pregnancy, patient-specific risks and false-positive rates (FPR) were computed according to the three algorithms and were stratified according to gestational age, maternal ethnicity, maternal weight, and smoking status. Free ß-hCG and PAPP-A MoM and DoE 2011 were acceptably independent from maternal characteristics and gestational age, while there was a strong relationship between maternal weight and the DoE 2007 values. For a risk cut-off that corresponds to an overall 5 % FPR rate for each algorithm, the FPR in each group were around 5 % at gestational week 11 - 13. The FPR of the DoE 2007 algorithm increased linearly with maternal weight from 3.6 % in women of 50 kg or less to 11.8 % in women of more than 110 kg. Especially maternal weight has a significant impact on the risk calculation. In contrast to the DoE 2007 algorithm, the DoE 2011 and MoM algorithms both adjust for maternal weight. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Adverse influence of coumestrol on secretory function of bovine luteal cells in the first trimester of pregnancy.

    PubMed

    Młynarczuk, J; Wróbel, M H; Kotwica, J

    2013-07-01

    Coumestrol is one of a few biologically active substances present in leguminous plants, which are widely used as fodder for ruminants. Depending on the doses, coumestrol acts on the reproductive processes as an estrogen-like factor or antiestrogen to evoke a decrease in ovulation frequency, elongation of estrous cycle duration. The aim of the current investigations was to study the influence of coumestrol on secretory function of luteal cells obtained from first trimester of pregnant cows. Luteal cells (2.5 × 10(5) /mL) from 3rd to 5th, 6th to 8th, and 9th to 12th week of pregnancy were preincubated for 24 h and incubated with coumestrol (1 × 10(-6) M) for successive 48 h and the medium concentrations of progesterone (P4), oxytocin (OT), prostaglandin (PG) E2 and F2α were determined. Moreover, the expression of mRNA for neurophysin-I/oxytocin (NP-I/OT; precursor of OT) and peptidyl-glycine-α-amidating mono-oxygenase (PGA, an enzyme responsible for post-translational OT synthesis) was determined after 8 h of treatment. Coumestrol did not affect P4 secretion but increased the secretion of OT from the cells collected at all stages of gestation studied. Hence, the ratio of P4 to OT was markedly decreased. Simultaneously, coumestrol increased the expression of NP-I/OT mRNA during 9th to 12th weeks of pregnancy, and mRNA for PGA during 3rd to 5th and 9th to 12th weeks of gestation. Furthermore, coumestrol decreased PGE2 secretion from luteal cells in all studied stages of pregnancy, while it affected PGF2α metabolite (PGFM) concentration only from week 3 to 5 of pregnancy. Obtained results suggest that coumestrol impairs secretory function of the corpus luteum (CL) and this way it can affect the maintenance of pregnancy in the cow.

  19. Sublingual misoprostol plus laminaria for cervical preparation before surgical management of late first trimester missed abortions, a randomized controlled trial.

    PubMed

    Khooshideh, Maryam; Yarmohammadi, Nasim; Shahriari, Ali; Sheikh, Mahdi

    2017-02-01

    Comparing the efficacy of low-dose sublingual misoprostol plus laminaria to medium-dose sublingual misoprostol alone for cervical dilation before surgical management of late first trimester missed abortions. Randomized, controlled trial evaluated 70 women with missed abortion, admitted for surgical termination of pregnancy. The patients were randomly assigned to receive 200 μg sublingual misoprostol with cervical laminaria (intervention group) or 400 μg sublingual misoprostol without laminaria (control group), four hours before surgical process. The study is registered at www.irct.ir (IRCT2014070711020N4). More patients in the intervention group achieved the desired cervical dilation (≥Hegar7) before surgical process than the control group (91.4% versus 17.1%, p < 0.001). Patients in the intervention group experienced less pain during the waiting period (mean Visual Analog Scale scores: 30.8 ± 3.7 versus 43.7 ± 5.9, p < 0.001), and had higher satisfaction level (highly satisfied: 97.1% versus 77.1%, p = 0.02). Four patients in the intervention group and none in the control group had spontaneous expulsion of pregnancy products (p = 0.11). Compared to medium-dose sublingual misoprostol alone, using a combination of cervical laminaria plus low-dose sublingual misoprostol before surgical process is associated with significantly more effective and rapid cervical dilation, lower requirement for mechanical dilation, lower abdominal pain and discomfort during the waiting period and higher patients' satisfaction.

  20. The dose of levothyroxine in pregnant women with hypothyroidism should be increased by 20-30% in the first trimester.

    PubMed

    Hubaveshka, Julia; Michaelsson, Luba Freja; Nygaard, Birte

    2014-12-01

    Severe hypothyroidism in pregnancy is associated with maternal and foetal complications, and in less severe cases impaired neuropsychological foetal development is seen. The aim of the present study was to evaluate the efficiency of the clinical control suggested in the guidelines. This was a retrospective study of 93 consecutive pregnant women with hypothyroidism who were followed at Herlev Hospital in 2012. The thyroid function was evaluated upon confirmation of pregnancy and thereafter every fourth week. The aim of the treatment was a concentration of serum thyroid-stimulating hormone (S-TSH) less than 2.5 mU/l. The frequency of an S-TSH of more than 4.1 mU/l was 39%. In 27% of all patients, a single measurement was made of a slight increase in S-TSH during the pregnancy, and only 12% had several increased S-TSH measurements exceeding 4.1 mU/l. Furthermore, 62% had a minimum of one S-TSH measurement above 2.5 mU/l. The pregnant women with increased S-TSH levels in the beginning of their pregnancy had a tendency to be overtreated later in their pregnancy. Although a careful follow-up was performed, we found a high number of patients with a single occurrence of S-TSH outside of the recommended range during their first trimester. The high S-TSH values were registered during the first weeks of the pregnancy, but hereafter corrected, and the number of pregnancy complications recorded did not seem to differ from the number of complications in patients with a normal thyroid function. We recommend increased attention and monitoring of fertile women with hypothyroidism who are planning pregnancy. not relevant. ClinicalTrials.gov identifier: NCT02094079.

  1. The Impact of First Trimester Phthalate and Phenol Exposure on IGF2/H19 Genomic Imprinting and Birth Outcomes

    PubMed Central

    LaRocca, Jessica; Binder, Alexandra; McElrath, Thomas F.; Michels, Karin B.

    2014-01-01

    Genomic imprinting leads to parent-of-origin specific gene expression and is determined by epigenetic modification of genes. The paternally expressed gene insulin-like growth-factor 2 (IGF2) is located about ∼100 kb from the maternally expressed non-coding gene H19 on human chromosome 11, and both genes play major roles in embryonic and placental growth. Given adverse gestational environments can influence DNA methylation patterns in extra-embryonic tissues, we hypothesized that prenatal exposure to endocrine disrupting chemicals (EDCs) alters H19 and IGF2 methylation in placenta. Our study was restricted to a total of 196 women co-enrolled in the Predictors of Preeclampsia Study and the Harvard Epigenetic Birth Cohort. First trimester urine concentrations of 8 phenols and 11 phthalate metabolites were measured and used to characterize EDC exposure profiles. We assessed methylation of differentially methylated regions (DMRs) by pyrosequencing of H19, IGF2DMR0, and IGF2DMR2 and correlated values with phenol and phthalate metabolites. We also assessed overall expression and allele-specific expression of H19 and IGF2. We found several significant associations between DNA methylation and additive biomarker measurements. A significant decrease in H19 methylation was associated with high level of the sum (Σ) of phthalate metabolites and metabolites of low molecular weight (LMW) phthalates. Σphthalate and LMW phthalate concentrations were inversely associated with IGF2DMR0 methylation values. Variation in methylation was not associated with changes in allele-specific expression. However increased deviation of allele-specific expression of H19 was associated with Σ di(2-ethylhexyl) phthalate metabolites and high molecular weight phthalates. Neither methylation nor expression of these imprinted regions had a significant impact on birth length or birth weight. Overall, our study provides new insight into an epigenetic mechanism that occurs following EDC exposure. PMID

  2. Determinants of first trimester attendance at antenatal care clinics in the Amazon region of Peru: A case-control study

    PubMed Central

    Moore, Nora; Blouin, Brittany; Razuri, Hugo; Casapia, Martin; Gyorkos, Theresa W.

    2017-01-01

    Objective To identify determinants which influence the timing of the first antenatal care (ANC) visit in pregnant women. Design Retrospective matched nested case-control study. Setting Two health centres, Belén and 6 de Octubre, in the Peruvian Amazon. Population All pregnant women who had attended ANC during the years 2010, 2011, and 2012. Methods All cases (819 women initiating ANC in their first trimester) were selected from ANC registries from 2010 to 2012. A random sample of controls (819 women initiating ANC in their second or third trimester) was matched 1:1 to cases on health centre and date of first ANC visit. Data were obtained from ANC registries. Conditional logistic regression analyses were performed. Main outcome measure Case-control status of each woman determined by the gestational age at first ANC visit. Results Cases had higher odds of: 1) being married or cohabiting (aOR = 1.69; 95% CI: 1.19, 2.41); 2) completing secondary school or attending post-secondary school (aOR = 1.45; 95% CI: 1.02, 2.06); 3) living in an urban environment (aOR = 1.79; 95% CI: 1.04, 3.10) and 4) having had a previous miscarriage (aOR = 1.56; 95% CI: 1.13, 2.15), compared to controls. No statistically significant difference in odds was found for parity (aOR = 1.08; 95% CI: 0.85, 1.36). Conclusions This study provides empirical evidence of determinants of first ANC attendance. These findings are crucial to the planning and timing of local interventions, like deworming, aimed at pregnant women so that they can access and benefit fully from all government-provided ANC services. PMID:28207749

  3. Placental growth hormone and growth hormone binding protein are first trimester maternal serum markers of Down syndrome.

    PubMed

    Christiansen, Michael

    2009-12-01

    Placental growth hormone (PGH) is synthesised by the placenta, and its function is modulated by growth hormone binding protein (GHBP). The potential of PGH and GHBP as maternal serum screening markers for Down syndrome (DS) was examined. Maternal serum concentrations of PGH and GHBP were determined by ELISA in 74 DS and 261 control pregnancies in gestational week 8(+0) to 13(+4). Log(10) MoM distributions of the markers were established. The performance of DS screening was estimated by Monte Carlo simulation. PGH log(10) MoM (SD) was decreased (p < 0.001) to -0.201 (0.373) and GHBP log(10) MoM to -0.116 (0.265) (p = 0.04), in DS pregnancies (n = 34) in week 8(+0) to 10(+0). In week 10(+1) to 13(+4), neither PGH (p = 0.16) nor GHBP (p = 0.13) was reduced in DS pregnancies. The detection rate (DR) for PGH in screening for DS in week 8(+0) to 10(+0) was 39% for a false positive rate (FPR) of 5%; increasing to 72% in combination with PAPP-A + hCGbeta. PGH + GHBP in combination with PAPP-A + hCGbeta + nuchal translucency (NT) (CUB test) had a DR of 91% compared with 80% for the CUB test. PGH and GHBP are early first trimester maternal serum markers for DS [Correction made here after initial online publication]. Copyright (c) 2009 John Wiley & Sons, Ltd.

  4. Determinants of first trimester attendance at antenatal care clinics in the Amazon region of Peru: A case-control study.

    PubMed

    Moore, Nora; Blouin, Brittany; Razuri, Hugo; Casapia, Martin; Gyorkos, Theresa W

    2017-01-01

    To identify determinants which influence the timing of the first antenatal care (ANC) visit in pregnant women. Retrospective matched nested case-control study. Two health centres, Belén and 6 de Octubre, in the Peruvian Amazon. All pregnant women who had attended ANC during the years 2010, 2011, and 2012. All cases (819 women initiating ANC in their first trimester) were selected from ANC registries from 2010 to 2012. A random sample of controls (819 women initiating ANC in their second or third trimester) was matched 1:1 to cases on health centre and date of first ANC visit. Data were obtained from ANC registries. Conditional logistic regression analyses were performed. Case-control status of each woman determined by the gestational age at first ANC visit. Cases had higher odds of: 1) being married or cohabiting (aOR = 1.69; 95% CI: 1.19, 2.41); 2) completing secondary school or attending post-secondary school (aOR = 1.45; 95% CI: 1.02, 2.06); 3) living in an urban environment (aOR = 1.79; 95% CI: 1.04, 3.10) and 4) having had a previous miscarriage (aOR = 1.56; 95% CI: 1.13, 2.15), compared to controls. No statistically significant difference in odds was found for parity (aOR = 1.08; 95% CI: 0.85, 1.36). This study provides empirical evidence of determinants of first ANC attendance. These findings are crucial to the planning and timing of local interventions, like deworming, aimed at pregnant women so that they can access and benefit fully from all government-provided ANC services.

  5. Cervical priming with misoprostol before manual vacuum aspiration versus electric vacuum aspiration for first-trimester surgical abortion.

    PubMed

    Mittal, Suneeta; Sehgal, Rohini; Aggarwal, Sagarika; Aruna, Janaki; Bahadur, Anupama; Kumar, Guresh

    2011-01-01

    To compare the efficacy of manual vacuum aspiration (MVA) with electric vacuum aspiration (EVA) and to evaluate whether cervical priming with misoprostol facilitates cervical dilation and reduces complications associated with first-trimester medical abortion performed up to 10 weeks of pregnancy. A total of 600 women who requested termination of pregnancy were randomized into 4 groups (150 women in each group). Group I and II received a vaginal placebo 3 hours before MVA or EVA, respectively. Group III and IV received 400 μg of vaginal misoprostol 3 hours before MVA or EVA, respectively. Complete abortion rates after MVA and EVA were both 97.9%; after cervical priming with misoprostol complete abortion rates were 98.6% versus 97.3% after cervical priming with placebo (P>0.05). Administration of misoprostol into the vagina before MVA resulted in 99.3% complete abortions (P=0.40), and the least operative blood loss, operating time, and need for cervical dilation (P<0.05). Overall complications and adverse effects were similar in all groups (P>0.05). For surgical evacuation, EVA and MVA did not differ in efficacy. Cervical priming 3 hours before MVA for termination of pregnancy significantly reduced the need for cervical dilation and the operative time, and improved the efficacy of the procedure. Pretreatment with vaginal misoprostol before MVA is a safe and effective method for terminating pregnancies of up to 10 weeks of gestat