Correlation between placental pathology and neonatal morbidity: a case-control study

Background: Preterm births occur in approximately 12% of pregnancies worldwide and in 5.6% of pregnancies in Latvia, and the incidence has increased. Prematurity poses the major challenge in perinatology and pediatrics, accounting for 75% of perinatal mortalities and 50% of long-term complication. The placenta is a unique organ in explaining the incomprehensible pathogenesis of prematurity.Methods: The retrospective case-control study was conducted to determine placental histological and microbiological findings associated with gestational age and neonatal morbidity.Results: Histological chorioamnionitis was the most prevalent lesion in extremely preterm and very preterm birth groups compared with moderate to late preterm and term birth groups (P=0.027). A higher rate of funisitis was detected among extremely preterm and very preterm birth cases (P=0.001). Microbiological examination of placentas in preterm birth cases most commonly revealed Streptococcus agalactiae, Staphylococcus epidermidis, Staphylococcus haemolyticus. Umbilical cord vessels thrombosis and placental thrombotic vasculopathy were found mostly in moderate to late preterm birth category (P=0.032; P=0.008, respectively). Intrauterine growth restriction was linked to chorionic villous edema (P=0.007) and chorionic villous fibrinoid necrosis (P=0.014). Chorion-decidual hemorrhage and deciduitis were significantly associated with respiratory distress syndrome (P=0.036; P=0.022, respectively). Chorion-decidual hemorrhage was the main predisposing factor for hypoxic-ischemic encephalopathy (P=0.058).Conclusions: Comprehension of the pathogenic mechanisms of prematurity of the placenta and preterm births, and the impact of placental prematurity on neonatal morbidity may lead to improved prenatal diagnostic and enhanced preventive care for both the mother and the child

Composition of vaginal microflora in relation to vaginal pH and wet mount diagnostic tests in the first trimester of pregnancy

Funding Information: Supported by a grant from the Latvian Ministry of Education and Science (IZM RSU-ZP 07-5) and the European Social Fund. Publisher Copyright: Copyright © 2011-2014 by Walter de Gruyter GmbH.The aim of the study was to determine the relations between vaginal culture results, elevated vaginal pH and abnormal vaginal microflora observed in microscopy, during the first trimester of pregnancy. A cross-sectional, observational study of 100 women receiving antenatal care in five outpatient clinics was carried out in Riga from March 2010 until April 2011. Pregnant women at the first antenatal visit were submitted to a vaginal specimen collection for pH measurement, wet mount and cultures. Fifty pregnant women with vaginal pH 4.5 and 50 subsequent pregnant women with vaginal pH less than 4.5 were included. 96% of women with increased pH and 86% of women with normal vaginal pH showed positive cultures. Increased vaginal pH was significantly associated with M. hominis (P < 0.001), U. urealyticum (P = 0.017) and E. coli (P = 0.018). Abnormal vaginal microflora patterns showed similar associations with culture findings. Multivariate logistic regression analysis showed the highest risk of abnormal vaginal microflora associated with M. hominis (OR 14.4, 95% CI 1.6-124.4, P = 0.015) and E. coli (OR 8.5, 95% CI 1.6-45.9, P = 0.013). Increased vaginal pH and abnormal vaginal microflora pattern in wet mounts was associated with M. hominis and E. coli in vaginal cultures.publishersversionPeer reviewe

The outcomes after transfers of embryos with chromosomal mosaicism : a single reproductive medicine center experience at iVF Riga clinic

Publisher Copyright: © 2020 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group on behalf of the UR MED GRUPP (LLC). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Aim: The aim of this study is to summarize the outcomes of transfers of mosaic embryos, which were classified according to guidelines and in strong collaboration of reproductologists, clinical geneticists and patients approved as suitable for transfer. Material and Methods: Retrospective data were collected from 70 patients from a private IVF center to whom embryos with mosaic changes in chromosomal material were transferred from 2015 to 2019. Results and Conclusion: Implantation outcomes and continuing pregnancies showed slight differences, when compared to fully normal embryos. Artifacts have to be differentiated from undeniable aberrations, and correct interpretation of results must be done with following patient counselling and prenatal testing if necessary.publishersversionPeer reviewe

Case of Inherited Partial AZFa Deletion without Impact on Male Fertility

Male factor infertility accounts for 40–50% of all infertility cases. Deletions of one or more AZF region parts in chromosome Y are one of the most common genetic causes of male infertility. Usually full or partial AZF deletions, including genes involved in spermatogenesis, are associated with spermatogenic failure. Here we report a case of a Caucasian man with partial AZFa region deletion from a couple with secondary infertility. Partial AZFa deletion, involving part of USP9Y gene appears to be benign, as we proved transmission from father to son. According to our results, it is recommended to revise guidelines on markers selected for testing of AZFa region deletion, to be more selective against DDX3Y gene and exclude probably benign microdeletions involving only USP9Y gene.publishersversionPeer reviewe

The application of PGT-A for carriers of balanced structural chromosomal rearrangements

The aim of this study was to analyze differences in chromosomal aberrations and euploidy in embryos of each translocation type and gender of carrier in the case series of 10 couples with balanced translocations who underwent IVF with embryos trophectoderm (TE) biopsy and PGT-A to detect chromosomal aberrations. This is a Case Series (Retrospective study). In each case, controlled ovarian hyperstimulation, oocyte insemination with intracytoplasmic sperm injection (ICSI) and cultivation gave multiple blastocysts, that underwent trophectoderm (TE) biopsy with PGT-A analysis using aCGH and NGS. Number of total unbalanced translocations compared to the number of sporadic aneuploid embryos was 39.6% to 39.6% (50% to 50% of all 37 aneuploid embryos). The highest euploidy rate was in male carrier group–26.7% and the lowest in the Robertsonian translocation carrier group–18.2%. Sporadic aneuploidy–68.2% was highest in Robertsonian translocation carrier group and lowest in female group–11.1%. Chromosomal aberrations related to translocation were highest in female carrier group–77.8% and lowest in Robertsonian translocation carrier group–13.6%. Our study showed that expectancy of total embryo aneuploidy rates will be higher in carriers, than in people with normal karyotype. The prevalence of chromosomal aberrations related to translocation was 4.5 times higher in Reciprocal carrier group than in Robertsonian translocation carrier group. Among maternal and paternal carrier groups, the embryos from female carriers had the lowest euploidy rate, unbalanced translocation rate 4.7 times higher than in the male carrier group and higher total aneuploidy rates.publishersversionPeer reviewe

Current use of noninvasive prenatal testing in Europe, Australia and the USA : A graphical presentation

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Literature review of Cervical Regeneration after Loop Electrosurgical Excision Procedure, and Study Project (CeVaLEP) proposal

Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Objective: To compile existing knowledge on the level of cervical regeneration (detected by ultrasound) after loop electrosurgical excision procedure (LEEP) and to suggest research protocol for further studies. Methods: We conducted a literature search of Medline, Web of Science, Scopus, and Cochrane databases using the keywords “cervix” and “regeneration” without year restrictions. Our eligibility criteria included studies that analysed cervical volume and length regeneration using ultrasound. A literature review was conducted following PRISMA guidelines and registered in PROSPERO (reg. no. CRD42021264062). Information about the studies was extracted from each analysed study on an Excel datasheet and the average regeneration with standard deviation was calculated. All included studies’ possible biases were assessed by the National Institutes of Health’s (NIH) quality assessment tool. Results: The literature search identified 802 papers and four trials (n = 309) that met our criteria. They investigated cervical length and volume regeneration after LEEP using ultrasound, concluding that there is a profound regeneration deficit. Average cervical length regeneration after 6 months was 83.4% (±10.8%) and volume regeneration was 87.4% (±6.1%). All analysed studies had their biases; therefore, based on the conducted studies’ protocols, we present a CeVaLEP research protocol to guide high-quality studies. Conclusion: After LEEP, there is a cervical regeneration deficit. There is a lack of high-quality studies that assess cervical volume regeneration and its relation to obstetrical outcomes. There is a gap in the field and more research is needed to define the prenatal risks related to cervical regeneration.publishersversionPeer reviewe

Does a Caesarean section scar affect placental volume, vascularity and localization?

Caesarean section is associated with an increased risk of abnormal placental implantation and adverse pregnancy outcomes in subsequent pregnancies. Besides the placenta accrete spectrum, only a few of the previous studies focused on other placental development alterations in the scarred uterus. We assessed placental development deviations in the uterus with a Caesarean section scar by evaluating placental volume (PV) and vascular flow indexes. From 1 January 2021 until 31 March 2022, placental volumes and vascularization indexes (VI, FI, VFI) were prospectively measured by 3D power Doppler and VOCAL techniques in 221 patients attending the first trimester screening program. We also calculated the placental quotient to standardize PV to the gestational age. No statistically significant differences in the values of placental volume, placental quotient and placental vascularization indexes were detected between women with previous Caesarean section delivery or women with vaginal delivery. FI was significantly lower in nulliparous in the first trimester. The results of our study suggest that 3D placental evaluation was not able to detect placental development alteration in the uterus with a Caesarean section scar. Future research needs to verify whether 3D power Doppler and Vocal techniques can provide more information if used in an earlier gestational age.publishersversionPeer reviewe

The correlation between abnormal uterine artery flow in the first trimester and genetic thrombophilic alteration : a prospective case-controlled pilot study

Introduction. Evaluation of the first trimester uterine artery flow can predict the development of obstetrical complications. A genotype, making women prone to microthrombi. constitutes the main known susceptibility factor for anomalous development of placenta. Our aim was to study whether polymorphisms of 10 genes leading to blood clotting abnormalities are related to abnormal uterine artery blood flow in the first trimester, and may predict placenta-related diseases. Material and methods. In primary analyses we included 19 singleton pregnancies with abnormal blood flow in the uterine arteries during the first trimester of gestation, and 24 matched control with normal flow patterns. All patients were genotyped for sequence variations in F5, F2, F11, MTHFR, SERPINE-1, CYP4V2, SELE, GP6, angiotensinogen (AGT) and fibrinogen gamma (FGG) genes and followed up until delivery. Results. There were no differences between groups regarding selected sequence variations in any of these genes. The co-occurrence of several polymorphisms in the same patient was also not related to the blood flow patterns in the uterine arteries. Conclusions. Although we found certain trends of genetic polymorphisms being related to preeclampsia and fetal growth, we failed to find an association between clotting gene polymorphisms, single or in combination, with the abnormal uterine flow in the first trimester