The role of individual blood flow parameters through ductus venosus in the first and second trimesters of pregnancy in predicting the condition of the fetus and newborn

Objectives: To predict fetal and neonatal outcome during pregnancy based on detailed analysis of ductus venosus blood flow velocities in first and second-trimester fetuses. Material and methods: A retrospective analysis was made in 680 patients with single pregnancies in years 2015 and 2016. The following ductus venosus blood flow velocities in first and second-trimester were analyzed: S-wave velocity, D-wave velocity, a-wave velocity, Tmax velocity, PIV. Results were divided into sub-groups with reduced value, normal value and increased value and compared with fetal and neonatal condition. Results: The relationship between the increased PIV value in the first trimester of pregnancy and an increased risk of chromosomal aberrations was observed, whereas the increased DV PI value in the second trimester of pregnancy with reduced A -wave were associated with a higher incidence of FGR. No correlation between the remaining DV blood flow velocities in the first and second trimester of pregnancy and the more frequent occurrence of fetal and neonatal complications has been confirmed. Conclusions:  The increased DV PIV is a good prognostic tool for the detection of chromosomal aberrations in first trimester of pregnancy.  In the second trimester, the increased DV PIV and the reduced A- wave velocity correlate with the fetal growth restriction. Ductus venosus seems to be an indirect indicator of intrauterine hypoxia with moderate prognostic value for adverse obstetric outcomes

Ductus venosus opens in high-risk pregnancies without signs of increased central venous pressure

Objectives: It has been belived that changes in diastolic blood velocities in the fetal ductus venosus were due to increased central venous pressure secondary to increased fetal heart strain during hypoxia or heart failure. There have been recent reports of changes in ductus venosus blood velocity without signs of increased fetal heart strain. The aim of this evaluation was to compare blood velocity in the right hepatic vein as a marker of increased central venous pressure in relationship to changes in ductus venosus blood velocity. Material and methods: Fifty pregnancies suspected of fetal growth resitriction were evaluated by Doppler ultrasound. Blood velocity was recorded in the right hepatic vein, ducus venosus and in the umbilical vein. Placental blood flow was also recorded in the uterine and umbilical arteries as well as the fetal middle cerebral artery. Results: Increased umbilical artery pulsatility index was recorded in 19 fetuses and 20 has signes of brain sparing according to recordings in the middle cerebral artery. Abnormal blood velocity in the ductus venosus was recorded in 5 fetuses, none of these fetuses had an abnormal pulsatility in the right hepatic vein. Conclusions: Opening of the ductus venosus is not only related to fetal cardiac strain. This might indicate that the ductus venosus does not primarily open due to increased central venous pressure in moderate fetal hypoxia.  Increased fetal cardiac strain might be a late event in the process of chronic fetal hypoxia

Influence of gestational diabetes in twin pregnancy on the condition of newborns and early neonatal complications

Objectives: Diabetes mellitus is the most common metabolic complication in pregnancy and increasing worldwide. In Europe, it occurs in 3–5% of pregnant women. The rate of twin pregnancy has been increased similarly to gestational diabetes mellitus (GDM). Twin pregnancy is associated with a higher complication rate compared to singleton pregnancy. The growing prevalence of GDM and twin pregnancy has given rise to their increasing concurrent presentation. Material and methods: The retrospective analysis included 212 twin-pregnant patients. The analysis excluded cases of miscarriage and early fetal death in the first trimester of pregnancy. The influence of GDM on the condition of newborns and mothers after delivery was analyzed. For statistical analysis R 3.6.2 software was used. Results: No statistically significant relationship between GDM and Non-GDM group and periparturient complications was found. Birth weight was significantly higher in the GDM G2 group. Apgar Score was the lowest in the GDM G1 group. In the group of larger newborns of the GDMG1 group respiratory distress syndrome (RDS) , a higher incidence of second-degree intracranial bleeding and grade II of preterm retinopathy were observed. There was no statistically significant relationship between GDM G1, GDM G2 and other neonatal complications. Conclusions: In summary, our results indicate that GDM in twin pregnancy does not increase the risk of cesarean section but increases some neonatal complications. In conclusion women with twin pregnancies complicated by GDM require specialist care during pregnancy and childbirth should take place in a third-level reference center

The Prognostic Role of CDK9 in Bladder Cancer

Introduction: Most patients with urothelial carcinoma are diagnosed with non-invasive tumors, but the prognosis worsens with the progression of the disease. Overexpression of cyclin-dependent kinase 9 has been recently linked to increased cancer proliferation, faster progression, and worse prognosis. However, some cancers seem to contradict this rule. In this work, we explored the prognostic role of CDK9 expression in urothelial carcinoma. Materials and Methods: We performed immunohistochemical analysis on 72 bladder cancer samples. To assess a larger group of patients, the Cancer Genome Atlas (TCGA) database containing 406 cases and transcriptomics information through the Human Pathology Atlas were analyzed. Results: CDK9 is overexpressed in urothelial cancer tissues when compared to normal urothelial tissues (p < 0.05). High CDK9 expression was observed in low-stage, low-grade, and non-muscle-invasive tumors (p < 0.05). The patients with high CDK9 expression had a significantly higher 5-year overall survival rate than those with low CDK9 expression (77.54% vs. 53.6% in the TMA group and 57.75% vs. 35.44% in the TCGA group, respectively) (p < 0.05). The results were consistent in both cohorts. Multivariate Cox regression analysis indicated that low CDK9 status was an independent predictor for poor prognosis in the TCGA cohort (HR 1.60, CL95% 1.1–2.33, p = 0.014). Conclusions: High CDK9 expression predicts a favorable prognosis in urothelial carcinoma and is associated with clinicopathological features characteristic for early-stage disease. The decrease in CDK9 expression can be associated with the build-up of genetic instability and may indicate a key role for CDK9 in the early stages of urothelial carcinoma

SARS-CoV-2 Infection during Delivery Causes Histopathological Changes in the Placenta

Background: SARS-CoV-2 can damage human placentas, leading to pregnancy complications, such as preeclampsia and premature birth. This study investigates the histopathological changes found in COVID-19-affected placentas. Materials and Methods: This study included 23 placentas from patients with active COVID-19 during delivery and 22 samples from patients without COVID-19 infection in their medical history. The samples underwent histopathological examination for pathology, such as trophoblast necrosis, signs of vessel damage, or fetal vascular malperfusion. Results: Newborns from the research group have lower weights and Apgar scores than healthy newborns. In the COVID-19 group, calcifications and collapsed intervillous space were more frequent, and inflammation was more severe than in the healthy group. At the same time, the placenta of SARS-CoV-2-positive patients showed signs of accelerated vascular maturation. Trophoblast necrosis was found only in the placentas of the research group. The expression of CD68+ was elevated in the COVID-19 cohort, suggesting that macrophages constituted a significant part of the inflammatory infiltrate. The increase in lymphocyte B markers was associated with placental infarctions, while high levels of CD3+, specific for cytotoxic T lymphocytes, correlated with vascular injury. Conclusions: SARS-CoV-2 is associated with pathological changes in the placenta, including trophoblast necrosis, calcification, and accelerated villous maturation. Those changes appear to be driven by T cells and macrophages, whose increased expression reflects ongoing histiocytic intervillositis in the placenta