Birth‐weight differences at term are explained by placental dysfunction and not by maternal ethnicity

Objective To investigate the influence of ethnicity, fetal gender and placental dysfunction on birth weight (BW) in term fetuses of South Asian and Caucasian origin. Methods This was a retrospective study of 627 term pregnancies assessed at two public tertiary hospitals in Spain and Sri Lanka. All fetuses underwent biometry and Doppler examinations within 2 weeks of delivery. The influences of fetal gender and ethnicity, gestational age (GA) at delivery, cerebroplacental ratio (CPR) and maternal age, height, weight and parity on BW were evaluated by multivariable regression analysis. Results Fetuses born in Sri Lanka were smaller than those born in Spain (mean BW = 3026 ± 449 g vs 3295 ± 444 g; P < 0.001). Multivariable regression analysis demonstrated that GA at delivery, maternal weight, CPR, maternal height and fetal gender (estimates = 0.168, P < 0.001; 0.006, P < 0.001; 0.092, P = 0.003; 0.009, P = 0.002; 0.081, P = 0.01, respectively) were associated significantly with BW. Conversely, no significant association was noted for maternal ethnicity, age or parity (estimates = −0.010, P = 0.831; 0.005, P = 0.127; 0.035, P = 0.086, respectively). The findings were unchanged when the analysis was repeated using INTERGROWTH‐21st fetal weight centiles instead of BW (log odds, −0.175, P = 0.170 and 0.321, P < 0.001, respectively for ethnicity and CPR). Conclusion Fetal BW variation at term is less dependent on ethnic origin and better explained by placental dysfunction. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd

Weight management during teenage pregnancy: Issues to consider when developing appropriate support

Teenage pregnancy is more prevalent in areas of high obesity, compared to areas where obesity levels are low. Risks associated with maternal obesity in pregnant teenagers include pre-eclampsia and caesarean delivery. To reduce these risks, pregnant teenagers need to be supported to gain a healthy weight in pregnancy. This includes encouraging these women to eat healthily through providing appropriate information including online or smartphone apps in conjunction with face-to-face support. These young women also need encouragement to be physically active. This support must be tailored to the teenage population considering their specific barriers and facilitators to behaviour change. Midwives with the aid of a multidisciplinary team play a key role in encouraging these healthy behaviours

the impact of uterine immaturity on obstetrical syndromes during adolescence

Pregnant nulliparous adolescents are at increased risk, inversely proportional to their age, of major obstetric syndromes, including preeclampsia, fetal growth restriction, and preterm birth. Emerging evidence indicates that biological immaturity of the uterus accounts for the increased incidence of obstetrical disorders in very young mothers, possibly compounded by sociodemographic factors associated with teenage pregnancy. The endometrium in most newborns is intrinsically resistant to progesterone signaling, and the rate of transition to a fully responsive tissue likely determines pregnancy outcome during adolescence. In addition to ontogenetic progesterone resistance, other factors appear important for the transition of the immature uterus to a functional organ, including estrogen-dependent growth and tissue-specific conditioning of uterine natural killer cells, which plays a critical role in vascular adaptation during pregnancy. The perivascular space around the spiral arteries is rich in endometrial mesenchymal stem-like cells, and dynamic changes in this niche are essential to accommodate endovascular trophoblast invasion and deep placentation. Here we evaluate the intrinsic (uterine-specific) mechanisms that predispose adolescent mothers to the great obstetrical syndromes and discuss the convergence of extrinsic risk factors that may be amenable to intervention

Levonorgestrel-releasing intrauterine device versus oral progesterone for treatment of simple endometrial hyperplasia without atypia

The aim of this study was to compare the efficacy and effect on the menstrual pattern of the levonorgestrel releasing intrauterine device versus oral progesterone for treatment in patient having simple endometrial hyperplasia (EH) without atypia. Patients who underwent endometrial sampling with abnormal uterine bleeding history and received simple EH without atypia were included in this study between 1 December 2015 and 31 March 2016, retrospectively. Twenty-two patients were treated with the levonorgestrel-releasing intrauterine device (LNG-IUD) and 47 with oral progesterone. Primary outcome measures were regression of hyperplasia after 3 months of therapy. Secondary outcome measures were effect on menstruel pattern during treatment, or rates of hysterectomy and recurrence within a 12 month period. After 3 months of treatment, regression of EH occurred in all of women in LNG-IUD group versus 93% of women in the oral progesterone group (p=0.226). Hb values were increased at the 3th month measurement in both of groups. Endometrial thickness was significantly decreased at the end of the 3th month (p&lt; 0.001). Amenorrhea was more common in the LNG-IUD group (p [Med-Science 2018; 7(1.000): 21-24

Comparing neonatal respiratory morbidity in neonates delivered after 34 weeks of gestation with and without antenatal corticosteroid

Objective: To investigate the effect of antenatal corticosteroid prophylaxis on neonatal respiratory morbidity between 34 and 37 weeks of gestation

To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women

Objective: To evaluate the effect of pre-pregnancy body mass index on maternal and perinatal outcomes among adolescent pregnant women

Fasting and post-prandial plasma glucose screening for gestational diabetes mellitus

Background: Gestational diabetes mellitus (GDM) is defined as impaired glucose tolerance with onset during the second or third trimester of pregnancy

Maternal serum advanced glycation end products level as an early marker for predicting preterm labor/PPROM: a prospective preliminary study

Objective: To evaluate the value of maternal serum advanced glycation end products (AGEs) level at 11-13 weeks' gestation for the prediction of preterm labor and or preterm premature rupture of membranes (PPROM). Materials and methods: This prospective cross-sectional study is performed in a university-affiliated hospital between February and April 2016. The participants of this study are low-risk pregnant women. Blood samples for maternal AGEs level were collected in the first trimester of pregnancy and all women completed their antenatal follow-up and delivered in our center. During the follow-up 21 women developed preterm labor/PPROM. The first trimester maternal AGEs levels of preterm labor/PPROM cases were compared with uncomplicated cases (n = 25) matched for age-parity and BMI. The predictive value of AGEs levels for preterm labor/PPROM was also assessed. Results: First-trimester AGEs levels were significantly higher in cases complicated with preterm labor/PPROM (1832 (415-6682) versus 1276 (466-6445) ng/L, p = .001 and 1722 (804-6682) versus 1343 (466-6445) ng/L, p = .025). According to receiver-operating characteristic curve analysis, the calculated cut off value of AGEs was 1538 ng/L with the sensitivity 91.7%, specificity 73.8%; and the negative and positive predictive values were 91.6% and 29.5%, respectively. Conclusions: For the prediction of preterm labor/PPROM, the relatively high AGEs levels in the first trimester might be a useful marker

Malignancy Risk of Endometrial Polyps Among Geriatric Women

Summary: Background: The population of elderly women is increasing worldwide. Here we investigated the prevalence of malignant endometrial polyps in a population of geriatric women. Methods: This retrospective study was conducted at the gynaecology clinic of Zekai Tahir Burak Education and Research Hospital. Women who were aged >65 years and who were pathologically diagnosed with endometrial polyps between 2007 and 2016 were included. All patients with endometrial polyps underwent hysteroscopic resection. Patient characteristics, complaints and imaging and surgical findings were obtained from their medical records. Statistical data analysis was performed using SPSS software. Results: In total, 133 geriatric female patients were included. They had a mean age of 68.96 ± 4.20 (65–83) years. Among them, 114 (85.7%) patients had benign endometrial polyps, 7 (5.2%) had endometrial hyperplasia and 12 (9%) had endometrial cancer. Forty-eight women had been admitted because of postmenopausal bleeding. Eighty-five women presented with either non-specific symptoms, such as abdominal pain, dysuria and urinary incontinence, or had no symptoms and received incidental diagnosis via ultrasound scanning. The mean endometrial thickness was 9.3 ± 6.39 mm in benign cases and 16.44 ± 8.64 mm in premalignant/malignant cases. In multivariate Cox regression analysis, uterine bleeding and endometrial thickness were significantly and independently associated with premalignant or malignant polyps.All malignant polyps were found to be endometrioid adenocarcinoma. Conclusion: In our study, we detected an prevalence of endometrial cancer among 9% of geriatric women with endometrial polyps. Hence, it is important to conduct a pathological evaluation of endometrial polyps in such patients. Keywords: geriatrics, postmenopausal period, polyps, neoplasm

Second-trimester urinary neutrophil gelatinase-associated lipocalin levels in gestational diabetes: preliminary results

Objective: The objective of this study is to investigate the urinary neutrophil gelatinase-associated lipocalin (uNGAL) levels in the second trimester of pregnant patients at the time of gestational diabetes mellitus (GDM) screening.Materials and methods: Urinary samples from 88 pregnant women who underwent gestational diabetes screening test were collected in late second trimester (24-28 weeks) prospectively. After an overnight fasting, 75g GTT was performed. The blood samples were drawn for measurement of glucose, insulin, and HbA1c. The urinary and blood parameters were compared for pregnant women with or without gestational diabetes.Results: uNGAL levels were significantly elevated in pregnant women with gesting compared with the control groups (p<.014). There was a positive correlation between uNGAL and HbA1c levels (p=.001).Conclusions: In the second trimester, at the time of GDM screening, high levels of uNGAL indicate tubular injury in GDM cases which seems to be a result of hyperglycemia. uNGAL may correlate with an inflammatory renal involvement in GDM