Adverse perinatal outcomes in borderline amniotic fluid index

Background: Normal amniotic fluid predicts normal placental function, fetal growth and fetal well-being

Objective: To determine adverse pregnancy outcomes in borderline amniotic fluid index [API]

Materials and Methods: Pregnant women [37-40 wks] with diagnosis of borderline API between December 2012 and August 2014 were identified. Antepartum, intrapartum and neonatal data were collected and compared with those of pregnant women with normal API. An API less than 8 and more than 5 cm was defined for borderline API. Pregnancy outcomes included Cesarean section for non-reassuring fetal heart rate, rneconium stained amniotic fluid, 5-min Apgar score <7, low birth weight, umbilical cord blood pH at term and NICU admission

Results: Gestational age at delivery in pregnancies with borderline API was significantly lower than normal API. Cesarean section rate for non-reassuring fetal heart rate in women of borderline API was significantly higher and there was an increased incidence of birth weight less than 10th percentile for gestation age in borderline API group. Incidence of low Apgar score and low umbilical artery pH in pregnancies with borderline API was significantly higher than women with normal API. There were no significant difference in the rate of NICU admission and meconium staining in both groups

Conclusion: There are significant differences for adverse pregnancy outcomes, such as C. lion due to non-reassuring fetal heart rate, birth weight less; than 10[th] pertcentile for gestation age, low 5 min Apgar score and low umbilical artery pH between pregnancies with borderline and normal API

Effect of different maternal metabolic characteristics on fetal growth in women with gestational diabetes mellitus

Fetal growth in diabetic pregnancies is a complex process and probably abnormalities in other metabolic pathways such as protein and lipid, as well as carbohydrate are responsible for delivering of macrosomic newborn. The purpose of this study was to investigate the association between fetal growth and different maternal metabolic parameters in women with gestational diabetes mellitus [GDM] in comparison to control group. This was a prospective cohort study conducted between March 2011 and May 2012, on 112 pregnant women with GDM and 159 healthy pregnant women. In order to determine of lipids or lipoproteins changes during pregnancy and to investigate any possible effects on fetal growth, lipid components, glucose and insulin levels were obtained in maternal serum three times in third trimester. Maternal serum glucose, total cholesterol [TC], low and high density lipoprotein [LDL-c, HDL-c] levels did not show any significant difference between two groups. While insulin, homeostasis model assessment-insulin resistance [HOMA-IR] and triglyceride [TG] values were detected to be significantly higher in the GDM cases especially after 32 weeks of gestation [p<0.001]. After adjustment for confounding variables, maternal hypertriglyceridemia remained as a significant risk factor for delivering large for gestational age [LGA] newborns [p=0.04]; and according to spearman test the increase of TG level was correlated with increase of insulin resistance and HOMA-IR [p<0.001, CI: 0.312]. Due to positive correlation of hypertriglyceridemia and hyperinsulinemia with newborn weight, it is possible to assume that elevated TGs levels in GDM cases is a reflection of variation in maternal insulin levels

Doppler findings in intrapartum fetal distress

The umbilical vein [UV] has a non pulsating and even pattern in normal fetuses. Pulsation of UV has been described in severely growth restricted fetuses with chronic hypoxia. We wanted to see whether UV pulsations could also be seen in fetuses with heart deceleration during labor, as an adjunctive measure to assess the intra partum hypoxia. In a prospective study Doppler examination was performed on 34 fetuses with normal cardiotocography [CGT] and 26 fetuses with abnormal CTGs [GA>37w and cervical dilatation>3cm]. Perinatal outcome was assessed according to presence or absence of UV pulsations. The 2 groups were similar regarding gestational age, cervical dilatation, Umbilical artery blood pH, S/D ratio,Pulsatility Index[PI] and Resistance Index [RI]. Intraabdominal UV pulsation were present in 6 [23.1%] of abnormal CTG group but no case were seen in normal CTG group [P=0.005]. Five of 6 [83.3%] fetuses with UV pulsation underwent cesarean delivery. The rate of cesarean delivery was 90% in abnormal CTG group without pulsation and 14.7% in normal CTG group. The frequency of Apgar score<7 was more in fetuses with UV pulsations [16.7% vs 5%] although not statistically significant. NICU admission was considerably more in UV pulsation group [33% vs 5%, P=0.123]. After exclusion of LBW fetuses the UV pulsation was present in 4 [19%] of abnormal CTG group, who 3 of them underwent cesarean section. Neither umbilical artery pH<7 nor Apger score<7 or NICU admission were seen in these 4 neonates. Pulsation in UV was seen in 23% of fetuses with abnormal CTG during intra partum period. Cesarean delivery and NICU admission was increased in fetuses with UV pulsations, although not statistically significant. When LBW fetuses were excluded no case of UA pH<7, Apgar sore<7or NICU admission were seen

Random urine protein creatinine ratio as a preadmission test in hypertensive pregnancies with urinary protein creatinine ratio

To evaluate the value of random urinary protein creatinine ratio in prediction of 24h proteinuria in hypertensive pregnancies. Random urine samples and routine 24h urine collections were collected from hypertensive pregnant women [n=100]. Reliability of random urinary protein-creatinine ratio was assessed by receiver operator characteristic [ROC] curve to detect significant proteinuria [>/=300mg/day] using 24h. Urine protein as a gold standard. Forty six patients [46%] had significant proteinuria. The random protein creatinine ratio was correlated to 24h urine protein excretion [r[2]=0.777, P<0.001] Area under ROC curve to predict proteinuria was 0.926 [95% CI: 0.854-0.995, P<0.001]. A cut off value of 0.22mg/mg for protein creatinine ratio best predicted significant proteinuria with sensitivity, specificity, positive and negative predictive values of 87%, 92.6%, 90.6% and 89.3% respectively. Random urinary protein creatinine ratio is a simple inexpensive and excellent alternative to 24h urine collection. It's helpful in diagnosis of preeclampsia and can be used as a pre admission test in PIH cases