Nutritional awareness among pregnant women in Latvia

Background: Women's eating habits affect not only the course of pregnancy but also the later life's metabolic health of their off springs. In 2016 Latvian guidelines on healthy nutrition during preconception period, pregnancy and lactation were published. The aim of this study was to analyze the level of nutritional awareness among pregnant women in Latvia.Methods: A descriptive cross-sectional study was carried out in Riga Maternity Hospital. 110 pregnant women receiving antenatal care participated in the survey.Results: 64.5% of respondents received recommendations on proper nutrition from health care professionals during pregnancy, whereas only 20.9% were informed in the preconception period. 68.7% of participants, who received information about the principles of healthy nutrition, considered them to be sufficient. The majority of women got the recommendations from gynecologists-obstetricians- 4.9%. 39.1% of women used non-evidence-based sources when searching for the information about healthy nutrition. 34.5% of all pregnant women had at least one health or social risk factor, which required individualized diet planning, however, 26.3% of them did not receive any recommendations at all. 28.7% of respondents started pregnancy with abnormal Body Mass Index (BMI).Conclusions: Women should be advised to make diet corrections before pregnancy, therefore more consultations in preconception period are needed. Additional educational sources providing information about healthy nutrition should be considered

Intrauterine growth restriction: distribution, risk factors, management of labour and outcome

Background: The development of Intrauterine growth restriction (IUGR) determines maternal, fetal and placental factors. Many of these factors are preventable. There is still no enough developed effective pregnancy and labour management tactics that could protect both mother and child from the unintended consequences.Methods: The research was made in Riga Maternity Hospital. In the research there were included pregnant women who gave birth neonates with weight under 10th percentile (IUGR group) as well there was compiled the control group. The weight of neonates was evaluated using the percentile scales - Intrauterine Growth Curves based on US data.Results: According to the criteria, in the IUGR group were included 209 pregnant women and in the control group was the same number of patients. In the IUGR group mothers discharged from the hospital one day later than it was in the control group both after vaginal delivery (4.0 ± 1.5 vs. 3.3 ± 1.0, p˂0.0001) and after caesarean (5.6 ± 1.5 vs. 4.5 ± 1.0, p=0.0001). Comparing the evaluations after Apgar scale after spontaneous birth, induced labour and caesarean it was discovered that there is no statistically significant difference.Conclusions: IUGR negatively affect not just the fetus but also the mother and this is the reason why she should stay in the hospital for a longer period due to the child or experience the caesarean.

Uterine rupture - clinical analysis of a case series in Riga Maternity Hospital

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Whole Genome Amplification in Preimplantation Genetic Testing in the Era of Massively Parallel Sequencing

Publisher Copyright: © 2022 by the authors. Licensee MDPI, Basel, Switzerland.Successful whole genome amplification (WGA) is a cornerstone of contemporary preimplantation genetic testing (PGT). Choosing the most suitable WGA technique for PGT can be particularly challenging because each WGA technique performs differently in combination with different downstream processing and detection methods. The aim of this review is to provide insight into the performance and drawbacks of DOP-PCR, MDA and MALBAC, as well as the hybrid WGA techniques most widely used in PGT. As the field of PGT is moving towards a wide adaptation of comprehensive massively parallel sequencing (MPS)-based approaches, we especially focus our review on MPS parameters and detection opportunities of WGA-amplified material, i.e., mappability of reads, uniformity of coverage and its influence on copy number variation analysis, and genomic coverage and its influence on single nucleotide variation calling. The ability of MDA-based WGA solutions to better cover the targeted genome and the ability of PCR-based solutions to provide better uniformity of coverage are highlighted. While numerous comprehensive PGT solutions exploiting different WGA types and adjusted bioinformatic pipelines to detect copy number and single nucleotide changes are available, the ones exploiting MDA appear more advantageous. The opportunity to fully analyse the targeted genome is influenced by the MPS parameters themselves rather than the solely chosen WGA.publishersversionPeer reviewe

Intrapartum ultrasound to predict vaginal labor: a prospective cohort study

Background: Non-invasive transperineal ultrasound has been used to detect the descent of the fetal head using head-perineum distance (HPD) and angle of progression (AOP). The aim was to evaluate HPD and AOP as predictors of vaginal delivery in the first stage of labor.Methods: This was a prospective cohort study in Riga Maternity Hospital in Latvia from May till August 2016. The study included only nulliparous women with singleton pregnancies and cephalic presentation. Ultrasound was used to measure HPD and AOP. Data was collected on demographics, labor parameters and outcome.Results: Of 36 women enrolled, 26 (72.2%) had a vaginal delivery. The area under the receiver–operating characteristics curve for the prediction of vaginal delivery was 0.865 (95% confidence interval (CI) 0.75-0.98) using HPD as the test variable and the area under the curve was 0.877 (95% CI 0.77-0.99) for AOP. The median HPD was lower in the women delivering vaginally than in the women delivering by cesarean section (P40 mm in the other 18 women, of whom 8 (22.2%) delivered vaginally (P<0.001). AOP was ≥105° in 22 (61.1%) women and, of these, 21 delivered vaginally. AOP was <105° in the other 14 (38.9%) women, of whom 5 delivered vaginally (P<0.001).Conclusions: HPD ≤40 mm and AOP ≥105° are both predictive of vaginal delivery in the first stage of labor

Expectant management of intrauterine growth restriction pregnancy: perinatal outcome

Background: Intrauterine growth restriction (IUGR) is the reason for increased morbidity and mortality in all periods of human life. The development of this pathology defines a variety of factors many of which are preventable. There is still no developed effective tactics for pregnancy and delivery, which would protect both mother and child from undesirable consequences.Methods: The research was made in Riga Maternity hospital in Latvia. In the research were included 96 neonates with the weight below 10th percentile (IUGR group) as well there was compiled the control group. We evaluated the condition of neonate by 13 criteria and studied its frequency depending on the gestational period. The weight of neonates was estimated using the percentile scales - intrauterine growth curves based on U.S. data.   Results: In the subgroup of 37-39th week in the IUGR group in comparison with 40-42nd week subgroup, statistically more often was noticed hypoglycaemia, polycythaemia, acidosis, poor feeding, neurological abnormalities, transportation to an intensive care unit, transportation to another hospital for the further treatment and there was a higher number of days spent in the hospital. In the subgroup of 37-39th week in the control group were just 2 criteria that were statistically more frequent.Conclusions: Recognizing the IUGR to the fetus, there is justified the temporizing tactics with regard to resolution of pregnancy if only the health status of mother allows that and preeclampsia is excluded

Impact of Intraoperative Factors on the Development of Postpartum Septic Complications

Publisher Copyright: © 2023 by the authors.Background and Objectives: Triclosan-coated sutures (antibacterial sutures) can reduce the risk of postoperative surgical site infection. This study aimed to investigate the effect of intraoperative factors, including antibacterial sutures, on the risk of postpartum septic complications. Materials and Methods: The prospective study included patients who underwent caesarean section. The exclusion criterion was chorioamnionitis. The investigation group patient’s (n = 67) uterus and fascial sheath of the abdominal wall were sutured with triclosan-coated polyglactin 910 sutures during surgery. The control group consisted of 98 patients using uncoated polyglactin 910 sutures only. The patients were contacted by phone after the 30th postoperative day. Results: No significant difference was found between the investigation group and the control group in the development of postpartum endometritis (11.7% in the investigation group vs. 8.4% in the control group, p = 0.401), wound infection (6.3% vs. 3.6%, p = 0.444) or patients experienced any septic complication (15.9% vs. 12%, p = 0.506). Postpartum endometritis was more common in patients who underwent instrumental uterine examination during the surgery (23.8% vs. 18%, p = 0.043). A moderately strong correlation was found for haemoglobin level on the third–fourth postoperative day with the development of postpartum septic complications, p < 0.001, Pearson coefficient −0.319. Post-caesarean delivery septic complications were not statistically more common in patients with blood loss greater than 1 L. The incidence of post-caesarean endometritis was 13.4%, and wound infection was 4.8% in this study’s hospital, having five to six thousand deliveries per year. Conclusions: Using antibacterial sutures during caesarean section does not affect the incidence of postpartum septic complications. Instrumental uterine examination during caesarean section increases the risk of post-caesarean endometritis and is, therefore, not recommended. Haemoglobin level on the 3rd–4th postoperative day, rather than the estimated blood loss during surgery, affects the development of postpartum septic complications.Peer reviewe

Acute Cholecystitis in pregnancy: a case report

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Management of Pregnancy with Cervical Shortening: Real-Life Clinical Challenges

Funding Information: The study was funded by the Fundamental and Applied Research Projects grant of The Latvian Council of Science (Project No. 2020/1-0042 to DR). The funders had no role in the study design, data collection or analysis, decision to publish, or preparation of the manuscript. Publisher Copyright: © 2023 by the authors.Background and Objectives: Preterm birth is the leading cause of neonatal mortality worldwide and may be responsible for lifelong morbidities in the survivors. Cervical shortening is one of the common pathways to preterm birth associated with its own diagnostic and management challenges. The preventive modalities that have been tested include progesterone supplementation and cervical cerclage and pessaries. The study aimed to assess the management strategies and outcomes in a group of patients with a short cervix during pregnancy or cervical insufficiency. Materials and Methods: Seventy patients from the Riga Maternity Hospital in Riga, Latvia, were included in the prospective longitudinal cohort study between 2017 and 2021. Patients were treated with progesterone, cerclage, and/or pessaries. The signs of intra-amniotic infection/inflammation were assessed, and antibacterial therapy was given when the signs were positive. Results: The rates of PTB were 43.6% (n = 17), 45.5% (n = 5), 61.1% (n = 11), and 50.0% (n = 1) in progesterone only, cerclage, pessary, and cerclage plus pesssary groups, respectively. The progesterone therapy was associated with a reduced preterm birth risk (x2(1) = 6.937, p = 0.008)), whereas positive signs of intra-amniotic infection/inflammation significantly predicted the risk of preterm birth (p = 0.005, OR = 3.82, 95% [CI 1.31–11.11]). Conclusions: A short cervix and bulging membranes, both indicators of intra-amniotic infection/inflammation, are the key risk factors in preterm birth risk predictions. Progesterone supplementation should remain at the forefront of preterm birth prevention. Among patients with a short cervix and especially complex anamnesis, the preterm rates remain high. The successful management of patients with cervical shortening lies between the consensus-based approach for screening, follow-up, and treatment on the one side and personalising medical therapy on the other.publishersversionPeer reviewe

A systematic review and standardized clinical validity assessment of genes involved in female reproductive failure

Genetic testing is becoming increasingly required at almost every stage of failed female reproduction/infertility. Nonetheless, clinical evidence for the majority of identified gene-disease relationships is ill-defined, thus leading to difficult gene variant interpretation and poor translation of existing knowledge into clinics. We aimed to identify the genes that have ever been implicated in monogenic female reproductive failure in humans and to classify the identified gene-disease relationship pairs using a standardized clinical validity assessment. A PubMed search following PRISMA guidelines was conducted on 20 September 2021 aiming to identify studies pertaining to genetic causes of phenotypes of female reproductive failure. The clinical validity of identified gene-disease pairs was assessed using standardized criteria, counting whether sufficient genetic and experimental evidence has been accumulated to consider a single gene 'characterized' for a single Mendelian disease. In total, 1256 articles were selected for the data extraction; 183 unique gene-disease pairs were classified spanning the following phenotypes: hypogonadotropic hypogonadism, ovarian dysgenesis, premature ovarian failure/insufficiency, ovarian hyperstimulation syndrome, empty follicle syndrome, oocyte maturation defect, fertilization failure, early embryonic arrest, recurrent hydatidiform mole, adrenal disfunction and Mullerian aplasia. Twenty-four gene-disease pairs showed definitive evidence, 36 - strong, 19 - moderate, 81 - limited and 23 - showed no evidence. Here, we provide comprehensive, systematic and timely information on the genetic causes of female infertility. Our classification of genetic causes of female reproductive failure will facilitate the composition of up-to-date guidelines on genetic testing in female reproduction, the development of diagnostic gene panels and the advancement of reproductive decision-making.publishersversionPeer reviewe