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

Ultrasound detection of placenta accreta in the first trimester of pregnancy

Placenta accreta is considered a life-threatening condition and the main cause of maternal mortality. Prenatal diagnosis of placenta accreta usually is made by clinical presentation, imaging studies like ultrasound and MRI in the second and third trimester. To determine accuracy of ultrasound findings for placenta accreta in the first trimester of pregnancy. In a longitudinal study 323 high risk patients for placenta accreta were assessed. The eligible women were examined by vaginal and abdominal ultrasound for gestational sac and placental localization and they were followed up until the end of pregnancy. The ultrasound findings were compared with histopathological examinations as a gold standard. The sensitivity, specificity, positive and negative predictive value of ultrasound were estimated for the first trimester and compared with other 2 trimesters in the case of repeated ultrasound examination. Ultrasound examinations in the first trimester revealed that 28 cases had the findings in favor of placenta accreta which ultimately was confirmed in 7 cases. The ultrasound sensitivity and specificity for detecting placenta accreta in the first trimester was 41% [95% CI: 16.2-62.7] and 88% [95% CI: 88.2-94.6] respectively. Ultrasound screening for placenta accreta in the first trimester of pregnancy could not achieve the high sensitivity as second and third trimester of pregnancy

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

Evaluation of the effect of metformin and aspirin on utero placental circulation of pregnant women with PCOS

Women with polycystic ovary syndrome [PCOS] often are infertile and even if they become pregnant, there are complications with some adverse outcomes. It has been reported that aspirin and metformin improve uteroplacental circulation and reduce pregnancy complications. To determine and compare uteroplacental circulation and obstetrics complications in pregnant women with PCOS treated with metformin, aspirin and control group. 105 pregnant women with PCOS were enrolled in this study after assessing uterine artery pulsatility index [PI] with Doppler ultrasonography at 12 weeks of gestation. The patients were divided into three groups and received metformin 2000 mg or aspirin 80 mg daily, or no intervention until the end of pregnancy. PI was assessed for the patients at 20 week of gestation and groups were followed up till delivery. PI and obstetrics complications such as gestational diabetes, preterm labor, preeclampsia and IUGR were compared among groups. All groups had significant reduction in the mean uterine artery PI at 20 weeks measurement [p<0.05], but this reduction was more in metformin and aspirin groups than control group [p=0.002]. There was a significant difference in mean uterine artery PI 20 week of gestation in three groups [p=0.005]. Adverse outcomes have seen 4 out of 35 in metformin group, 7 out of 35 in aspirin group and 11 out of 35 in control group. There weren't significant differences among groups [p=0.12]. Metformin and low dose aspirin reduced uterine artery impedance but there was not associated with reduced obstetrics complication in women with PCOS

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

[Transient diabetes insipidus as a part clinical presentations of preeclampsia: a case report]

Diabetes insipidus is a rare disease which can be considered as a part of broad spectrum of preeclampsia manifestations. A 39-year old primigravid woman, with an unremarkable past medical history, was admitted in the 33rd week of gestation for elevated blood pressure. On admission, her blood pressure was 140/90 mmHg and the only abnormal laboratory findings were trace proteinuria and elevated liver enzymes. During the following days her blood pressure rose to 150/100 mmHg with deterioration of clinical and paraclinical status of the patient characterized by excessive thirst, polydipsia and excretion of large amounts of diluted urine. Having considered the patient's aggravating status, termination of pregnancy was planned. Fortunately, all the clinical and paraclinical presentations, including those related to the probable diabetes insipidus disappeared on the second day of postpartum period. Sign and symptoms of diabetes insipidus should be considered in all cases admitted for preeclampsia