SUCCESSFUL HYSTEROSCOPY GUIDED SUCTION & EVACUATION OF PRODUCT OF CONCEPTION ALONG WITH REMOVAL OF UTERINE SEPTUM IN SAME SITTING

Objective To report a case of early pregnancy loss with septate uterus, successfully managed by hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum in same sitting. Case report. Tertiary care hospital. One woman with early pregnancy loss with septate Design Setting Patient uterus. Hysteroscopy guided suction & evacuation of product of conception along with removal of uterine septum Intervention in same sitting. Hysteroscopy guided suction & evacuation of product of conception followed by septum removal with Result hysteroscopic scissor was performed, with minimal blood loss, in same sitting. Products of conception were sent for pathologic examination. There were no intra-operative or postoperative complications. Even though the role of septum as a Conclusion contributing factor to miscarriage in not certain, early pregnancy loss may be seen in patients with septate uterus. Blind removal of POCs with dilatation & curettage, may be complicated with retained products of conception (RPOC) or intrauterine adhesion formation, which can lead to adverse fertility outcomes in the future. Also removal of septum, which may or may not be the cause, is often performed before further pregnancy. This requires another admission & exposure to anaesthesia, along with added cost. Hysteroscopy guided resection of POC with septum removal in same sitting has been associated with complete tissue removal under vision, less damage to surrounding endometrium, cost effective combination of two surgical procedures & earlier time to conception compared with 2 sitting procedure (dilation and curettage than septum removal). Thus, hysteroscopy guided suction & evacuation of POC & septum removal in same sitting can be considered as an alternative surgical technique for management of early pregnancy loss in patients diagnosed with septate uterus. This case report demonstrates the successful application of hysteroscopic procedure in a case of early pregnancy loss with septate uterus.

Significado clínico del diagnóstico prenatal de la protuberancia corial en el tamizaje del primer trimestre de la gestación / Clinical significance of prenatal diagnosis of chorionic bump in the first trimester screening

Resumen OBJETIVO: Determinar el significado clínico y el desenlace obstétrico y perinatal luego de la detección de una protuberancia corial en el estudio de tamizaje del primer trimestre de la gestación. MATERIALES Y MÉTODOS: Estudio de cohorte prospectiva efectuado, de abril del 2019 a diciembre 2021, en pacientes referidas para tamizaje del primer trimestre a una unidad de Medicina y Cirugía Fetal de tercer nivel de referencia (Prenatalia Medicina Fetal San Javier, Guadalajara, Jalisco, México). Criterio de inclusión: pacientes con medición de la longitud cráneo caudal comprendida entre 45 y 84 mm durante el tamizaje prenatal del primer trimestre. Se reportaron los hallazgos ecográficos, se obtuvieron información y datos clínicos relevantes de los expedientes electrónicos y cuando se consideró necesario se contactó al ginecoobstetra tratante y a las pacientes. Se utilizó estadística descriptiva con medidas de tendencia central y dispersión. Para el análisis comparativo se utilizó χ2 y U de Mann Whitney para contrastar diferencias entre grupos. RESULTADOS: Se evaluaron 1359 embarazos y la protuberancia corial se documentó en 19 de ellos. En 9 de 19 casos se asoció con sangrado del primer trimestre, previo a la exploración ecográfica. En 16 de 19 casos se encontraron dimensiones de la protuberancia corial mayores a 10 mm. Además, la protuberancia se asoció con episodios de amenaza de parto pretérmino en 13 de los 19 casos. CONCLUSIONES: La protuberancia corial es un hallazgo poco frecuente durante el tamizaje del primer trimestre que se asocia con sangrado y episodios de amenaza de parto pretérmino.

Abstract OBJECTIVE: To determine the clinical significance and obstetric and perinatal outcome after detection of a chorionic protrusion in the first trimester screening study. MATERIALS AND METHODS: Prospective cohort study performed in patients referred for first trimester screening to a third level referral Fetal Medicine and Surgery unit (Prenatalia Medicina Fetal San Javier, Guadalajara, Jalisco, Mexico) from April 2019 to December 2021. Patients with craniocaudal length measurements between 45 and 84 mm during first-trimester prenatal screening were included. Ultrasound findings were reported, relevant clinical information and data were obtained from electronic records, and the treating obstetrician-gynecologist and patients were contacted when necessary. Descriptive statistics with measures of central tendency and dispersion were used. For comparative analysis, 2 and Mann Whitney U were used to contrast differences between groups. RESULTS: 1359 pregnancies were evaluated and chorionic protrusion was documented in 19 of them. In 9 of 19 cases it was associated with first trimester bleeding prior to ultrasound examination. Chorionic protrusion was found to be larger than 10 mm in 16 out of 19 cases. In addition, the protrusion was associated with episodes of threatened preterm labour in 13 of 19 cases. CONCLUSIONS: Chorionic protrusion is a rare finding during first trimester screening that is associated with bleeding and episodes of threatened preterm labour.

Value of fetal ultrasonography index in twin fetal heart malformation screening at 11-13 + 6 weeks of gestation / 中华超声影像学杂志

Objective:To investigate the clinical value of fetal ultrasonography in the screening of congenital heart malformations in twins at 11-13 + 6 weeks of gestation. Methods:A retrospective cohort study method was used.Cases were collected from Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing Maternal and Child Health Care Hospital (January 2012 to December 2016) and the Fourth Hospital of Shijiazhuang City (January 2014 to December 2018). The twins with singleton or twins with cardiac malformation were screened out as the cardiac malformation group, and the twins with normal delivery during the same period were selected as the control group. Ultrasound data such as the nuchal translucency (NT), crown-rump-length (CRL), chorionicity, conception method, NT discordance, CRL discordance, NT discordance ≥20% incidence rate between twins, and the CRL discordance ≥10% incidence rate between twins in the two groups at 11-13 + 6 weeks were compared and analyzed. Results:①There were 30 cases in the cardiac malformation group (including 27 twins with singleton cardiac malformation and 3 twins with twin cardiac malformation) and 1 906 cases in the control group. ②The incidence rates of NT value ≥95th percentile and NT value ≥99th percentile in one or two pregnancies were significantly higher in the cardiac malformation group than in the control group (20.00% vs 2.20%, P<0.001; 10.00% vs 0.63%, P=0.002), the area under the ROC curve (AUC) for cardiac malformation screening was 0.589 and 0.549, respectively; CRL discordance in cardiac malformation group was higher than that in control group ( P=0.018), the incidence of CRL discordance ≥10% in the cardiac malformation group was higher than that in the control group (26.67% vs 12.70%, P=0.024), the AUC of cardiac malformation screening was 0.570; there were no significant differences in the incidence of NT discordance, the incidence of NT discordance ≥20%, pregnancy pattern and chorionicity between the two groups (all P>0.05). ③Multivariate Logistic regression analysis was performed using the incidence rates of NT value ≥95% and NT value ≥99%, CRL discordance ≥10%, and NT discordance ≥20%. The incidences of fetal NT value ≥95% and NT value ≥99% were risk factors for cardiac malformation in twins ( OR=11.095, 105.778; 95% CI=4.311-28.558, 16.984-658.796). Conclusions:Ultrasound at 11-13 + 6 weeks of gestation showing thickened value of one or two fetuses, and the CRL discordance≥10%, indicates an increased risk of cardiac malformation in the twins; NT value ≥95% and NT value ≥99% is a risk factor for heart defects in twins.

Investigation and analysis of serum thyroglobulin level in early pregnant women in Dali City, Yunnan Province / 中华地方病学杂志

Objective:To investigate the serum thyroglobulin (Tg) levels of women in early pregnancy in Dali City, Yunnan Province, and provide a scientific basis for evaluation of individual iodine nutrition of early pregnant women in this area.Methods:Dali City, Yunnan Province was divided into 5 sampling areas according to east, west, south, north and middle. One township (town) was selected from each area, and at least 20 women in early pregnancy were selected from each township (town) as survey subjects. General condition and medical history of all subjects were collected, and random urine samples and fasting venous blood samples were collected for determination of urinary iodine and thyroid function indexes, and a portable ultrasound machine was used for thyroid ultrasonography. After excluding the patients with a history of thyroid disease and abnormal thyroid function, the level of Tg in the included early pregnant women was analyzed.Results:A total of 120 women in early pregnancy were investigated, aged from 19 to 40 years. Among them, 61 cases came from urban areas and 59 were from rural areas. The median urinary iodine was 156.54 μg/L, which was at the appropriate level of iodine nutrition. A total of 102 women with normal thyroid function in early pregnancy were included, and the Tg level was 11.56 (6.67, 15.27) ng/ml. Among them, 58 cases were in urban areas and 44 cases were in rural areas. There was no significant difference in serum Tg levels between rural and urban women in early pregnancy ( U = 1 362.50, P = 0.559). Conclusion:The serum Tg level of women in early pregnancy in Dali City can provide a reference for evaluation of individual iodine nutrition of relevant populations in this area.

Effects of family function in early pregnancy on pregnant women's health promotion behavior--an analysis of multiple mediating effects based on self-efficacy and sense of coherence / 中国实用护理杂志

Objective:To analyze the current situation of pregnant women′s health promotion behavior in early pregnancy, and to explore the multiple mediating effects of self-efficacy and sense of coherence in family function and health promotion behavior.Methods:The convenience sampling method selected 208 early pregnant women who visited the obstetric clinic of the Affiliated Hospital of Qingdao University from August to December 2020 as the research object was used. The electronic questionnaires including self-made general information questionnaire, Family APGAR Questionnaire, General Self-Efficacy Scale (GSES), Sense of Coherence Scale (SOC-13), and the Health-Promoting Lifestyle ProfileⅡ (HPLP-Ⅱ) were provided to women.Results:The total score of health promotion behaviors for early pregnancy was (139.58 ± 17.27) points with a good level. The influencing factors such as exercise habits and medical payment methods had statistical significance in the effects of health-promoting behaviors in the first trimester of pregnancy ( t=4.68, -3.55, both P<0.05). Structural equation model revealed that the total effect value of family function on health-promoting behaviors was 2.654, the direct effect value was 1.729 and the indirect effect value was 0.925. Meanwhile, the mediating effects of self-efficacy, the sense of coherence and self-efficacy upon the sense of coherence accounted for 15.9%, 15.2% and 3.8% of the indirect effect respectively. Conclusions:Family function of pregnant women in early pregnancy can not only affect health promotion behavior through self-efficacy and sense of coherence, but also indirectly affect sense of coherence through self-efficacy, so as to affect health promotion behavior. Maternal related health workers can construct targeted intervention measures from the perspective of self-efficacy and sense of coherence to maintain and improve the health promotion behavior of pregnant women in the early stage of pregnancy.

Mediating role of sleep in association between maternal heat exposure during early pregnancy and risk of preterm birth / 环境与职业医学

Background Preterm birth-related complications are the leading cause of death in newborns and children under the age of 5 years. Maternal heat exposure has been associated with both sleep status during pregnancy and the increased risk of preterm birth. However, whether sleep status could mediate the association between heat exposure and preterm birth remains unclear. Objective To evaluate the association between maternal heat exposure in early pregnancy and preterm birth, and to further explore potential mediation effect of sleep status on the association between heat exposure and preterm birth. Methods A birth cohort was established in Guangzhou Panyu Maternal Child Health Hospital (Guangzhou Panyu District He Xian Memorial Hospital) from 2017 until now. Pregnant women (with gestational age between 8 and 13 weeks) were included in this study when they presented to the hospital for their first prenatal care visit and signed an informed consent. Then they were followed up until delivery. A total of 3 268 pregnant women were included for the final analysis. Questionnaires were distributed to collect the demographic characteristics, lifestyles, and sleep status of pregnant women. Daily meteorological data during the study period were collected from meteorological monitoring stations in Guangzhou and the average ambient mean temperature of four weeks before the survey was calculated and assigned for each pregnancy. The 75th, 80th, 85th, 90th, and 95th percentiles (P75, P80, P85, P90, and P95) of the average ambient temperature of all pregnant women were used as the thresholds to define heat exposure. Logistic regression was used to evaluate the effects of heat exposure in different definitions on preterm birth and sleep status (sleep duration, night sleep timing, and wake up timing). The mediation effects of sleep status on the relationship between heat exposure and preterm birth were also analyzed. Results Among all the included participants, 165 newborns were preterm births with an incidence rate of 5.0%. Heat exposures with thresholds of P90 and P95 increased the risk of preterm birth, with ORs (95%CIs) of 1.66 (1.04-2.57) and 1.90 (1.03-3.33), respectively (P<0.05). Heat exposures with thresholds of P75, P80, P85, P90, and P95 decreased the sleep duration (<9 h vs. ≥9 h, control group: ≥9 h), and the ORs (95%CIs) were 1.51 (1.25-1.83), 1.44 (1.17-1.77), 1.35 (1.08-1.70), 1.43 (1.09-1.87), and 1.45 (1.00-2.13), respectively. Heat exposures with P75 and P80 thresholds resulted in earlier wake up timing (<8: 00 vs. ≥8: 00, control group: <8: 00), with ORs (95%CIs) of 0.77 (0.63-0.93) and 0.76(0.61-0.93), respectively. No significant association was observed between heat exposure and night sleep timing. The mediation analyses showed that under heat exposure with P90 threshold, a statistically significant mediation effect was observed for sleep duration, and the proportion mediated was 6.07% (95%CI: 0.17%-25.00%) (P<0.05). No significant mediation effect was observed for night sleep timing and wake up timing. Conclusion An elevated risk of preterm birth after heat exposure in early pregnancy may be partly mediated through reducing sleep duration.

Study of association between bile acid metabolites in early pregnancy and overweight / 中华内分泌代谢杂志

Objective:This study examined the associations between the levels of bile acids in early pregnancy and the occurrence of overweight.Methods:From 2010 to 2012, 22 302 pregnant women were recruited by Tianjin Women and Children′s Health Center to investigate gestational diabetes. Two hundred and forty-three women with gestational diabetes mellitus provided overnight fasting blood samples in the first trimester, and 243 counterparts without gestational diabetes mellitus matched on age were selected randomly to establish a nested case-control study. The association between bile acids and overweight were evaluated by binary logistic regression with data from 166 overweight pregnant women (body mass index≥24.0 kg/m 2) and 320 normal weight subjects (body mass index <24.0 kg/m 2). Results:Compared to non-overweight group, the level of primary unconjugated bile acids in overweight group was significantly higher. After adjustment of confounding factors, the OR of cholic acid (CA)>0.086 nmol/mL for overweight was 2.09 (95% CI 1.14-3.80, adjusted P=0.040), and OR of chenodeoxycholic acid (CDCA)>0.043 nmol/mL was 2.15 (95% CI 1.22-3.78, adjusted P=0.040) compared with the lower groups. However, the significant associations between the other bile acids and overweight were not detected. Stepwise selection was used to identify significant bile acid species in logistic regression. We found that only CA was independently associated with overweight, and the OR of CA>0.086 nmol/mL vs≤0.086 nmol/mL was 2.03 (95% CI 1.11-3.74, P=0.022). Conclusion:CA and CDCA in early pregnancy maybe associated with overweight, and CA might be independently associated with overweight.

Correlation between preeclampsia and abnormal thyroid function in pregnancy / 中华内分泌外科杂志

Objective:To investigate the correlation between preeclampsia and thyroid dysfunction in pregnancy.Methods:107 early pregnant women with preeclampsia admitted to our hospital from Jan. 2017 to Jan. 2020 were all enrolled (observation group) . The observation group were in 6-34 gestational weeks, with an average parity of (1.67±0.35) times. In addition, 100 cases of normal pregnant women in the same period were selected as the control group. The control group were in 6-34 gestational weeks, with an average parity of (1.61±0.31) times. The two groups were compared at early, mid and late pregnancy in terms of thyroid function, and the correlation of preeclampsia and abnormal thyroid function was analyzed.Results:1. TSH levels in the observation group were (1.92±1.24) , (2.07±0.82) , and (2.30±1.23) mU/L in the first trimester, second trimester and third trimester, respectively, showing an upward trend. The difference between the two groups was statistically significant ( P=0.024) . FT4 levels of the observation group in the first trimester, second trimester and third trimester were (0.80±0.26) , (0.60±0.34) and (0.59±0.32) pmol/L, respectively, showing a decreased trend and the difference was statistically significant compared with those of the control group ( P=0.012) . 2. The incidence of hypothyroidism, TPOAb positive and reduced free tetraiodothyronine in the observation group was significantly higher than that in the control group ( P=0.001, 0.023, 0.005) . There was no significant difference in the incidence of hyperthyroidism or subclinical hypothyroidism between the two groups ( P=0.169, 0.846) . 3. Correlation analysis showed that preeclampsia was related to hypothyroidism, normal thyroid function with TPOAb positive and reduced free tetraiodothyronine ( P=0.000, 0.000, 0.000) . Conclusions:There are changes in thyroid function in pregnant women with preeclampsia. Hypothyroidism, positive TPOAb and reduced free tetraiodothyronine are closely related to the onset of preeclampsia.

Investigation on iodine nutritional status and thyroid function of women in early pregnancy after the implementation of a new standard of iodized salt in Chengde / 公共卫生与预防医学

Objective To investigate the iodine nutritional status and thyroid function of women in early pregnancy after the implementation of a new standard of iodized salt in Chengde. Methods A total of 136 early pregnancy women who had lived in Chengde were randomly selected in this study from January 2018 to March 2020. A questionnaire survey was conducted. The iodized salt, urine and blood samples of the pregnant women were collected to analyze the salt iodine concentration, serum iodine, urinary iodine, serum thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4). Results In 2018 and 2019, the iodized salt coverage rates were 96.97% and 98.57%, the non-iodized salt rates were 3.03% and 1.43%, the iodized salt qualification rates were 95.45% and 97.14%, and the qualified iodized salt consumption rates were 93.94% and 92.86%, respectively. In addition, the median of iodized salt consumption was 22.20 mg/kg and 25.51 mg/kg, in 2018 and 2019, respectively. There was a statistically significant difference in the median urine iodine from 2018 to 2019 among women in early pregnancy (P0.05). Conclusion After the implementation of a new standard of iodized salt in Chengde, the iodine nutritional status of early pregnant women in 2019 was significantly improved, but there was still a small amount of insufficient iodine intake. The incidence of thyroid diseases in early pregnant women with abnormal iodine intake was higher than that in early pregnant women with appropriate iodine intake.

Expectant management of incomplete miscarriage, anembryonic pregnancy and early fetal demise: a comparative study

Background: Expectant management as first line management of early pregnancy miscarriages is less accepted due to failure and increased complications reported in few studies. Proper selection of cases improves outcome of expectant management. Aim of this study was to compare success rate and complications in expectant management in three groups of early pregnancy miscarriages- Incomplete miscarriage, anembryonic pregnancy and early fetal demise.Methods: Prospective observational study conducted in tertiary care centre for 3 years, including 107 patients with USG confirmed pregnancy miscarriage <13 weeks. Patients preferring expectant management were managed as outpatient without intervention for 2 weeks after which repeat USG was done to ascertain complete miscarriage. Failed expectant management patients underwent planned surgical uterine evacuation. Emergency admission and evacuation was done, if symptomatic during waiting period. Success rate and complications like emergency evacuation, vaginal bleeding, abdominal pain, limitation of physical activity and patient satisfaction were assessed and compared in subgroups of anembryonic pregnancy, early fetal demise and incomplete miscarriage. Statistical analysis was done by chi-square test.Results: Incomplete miscarriage group had highest success rate of 88.46%. followed by anembryonic pregnancy (72.5%) and EFD (47.83%) p value = 0.007. Complication rate was highest in EFD, followed by anembryonic and the least in incomplete miscarriage all of which was statistically significant except vaginal bleeding.Conclusions: Expectant management should be offered as first line choice for all types of early pregnancy miscarriages. Proper selection of case as to type of miscarriage especially incomplete miscarriage and selected cases of anembryonic pregnancy and EFD ensures higher success rate with lesser complications. Reserving medical and surgical management for unsuitable/failed cases.

Perfil clínico e epidemiológico da gravidez na adolescência: um estudo ecológico / Clinical and epidemiological profile of pregnancy in adolescence: an ecological study

OBJETIVO: Descrever o perfil clínico e epidemiológico da gestação na adolescência buscando possíveis diferenças em relação à gestação em mulheres adultas. MÉTODOS: Estudo ecológico a partir de dados secundários (DATA-SUS). Foram estudadas três grupos de variáveis: as relacionadas à mãe, as relacionadas ao parto e as relacionadas ao RN. A análise dos dados foi realizada pelo Teste Qui-quadrado de independência, considerando-se significante P ≤ 0,05. Foram utilizadas planilhas do Microsoft Excel, versão 2013, software Epi Info v.7, para a obtenção do Odds Ratio (OR), com intervalo de confiança (IC) de 95%. RESULTADOS: Foram avaliadas 48.277 gestações, sendo 4.453 (9,22%) em adolescentes com idade média de 16,92 anos (+1,16), e 43.824 (90,78%) em mulheres adultas com idade média de 27,89 anos (+ 5,77). As mães adolescentes eram solteiras (54,61%) e brancas (98,02%) em sua maioria e apresentaram gestação única (98,92%). A prematuridade ocorreu em 10,21%, 61,5% dos partos foram vaginais, com 99,73% ocorridos em ambiente hospitalar. Com relação ao recém-nascido, 51,99% eram do sexo masculino e o baixo peso ao nascer foi de 9,57%. Apgar < 7 no 1º minuto foi de 16,63%, e no 5º minuto, 2,14%. A presença de anomalias congênitas em filhos de mães adolescentes foi de 1,15%. CONCLUSÃO: A gravidez na adolescência se associou com menor número de consultas de pré-natal, maiores taxas de prematuridade e baixo peso, com maior ocorrência de parto vaginal e de anomalias congênitas no RN.

OBJECTIVE: To describe the clinical and epidemiological profile of pregnancy in adolescence, searching possible differences in relation to pregnancy in adult women. METHODS: Ecological study based on secondary data (DATA-SUS). Three groups of variables were studied: those related to the mother, those related to childbirth and those related to the newborn. The data analysis was performed by the Qui-square test of independence, being considered significant P ≤ 0.05. Microsoft Excel spreadsheets, version 2013, Epi Info v.7 software were used to obtain the Odds Ratio (OR), with a 95% confidence interval (CI). RESULTS: A total of 48,277 pregnancies were evaluated, of which 4,453 (9.22%) were adolescents aged 16.92 +1.16 years, and 43,824 (90.78%) in adult women aged of 27.89 years +5.77. Adolescent mothers were single (54.61%) and white (98.02%) in the majority, and presented single gestation (98.92%). Prematurity occurred in 10.21%, and 61.5% of deliveries were vaginal. With regard to the newborn, 51.99% were male and the low birth weight occurred in 9.57%. Apgar <7 in the 1st and 5th minute was present in 16.63% and 2.14% respectively. The presence of congenital anomalies in children of adolescent mothers was 1.15%. CONCLUSION: Adolescent pregnancy was associated with: a lower number of prenatal appointments, higher rates of prematurity and low birth weight, higher incidence of vaginal delivery and congenital anomalies

Anastrozole promotes implantation by altering the expression of paxillin and fak in rat luminal uterine epithelium / El anastrozol promueve la implantación alterando la expresión de paxilina y fak en el epitelio uterino luminal de rata

An alternative hyper-ovulator inducer to replace clomiphene citrate (CC) is needed as it is unsuitable for women with polycystic ovarian syndrome and is associated with low pregnancy rates. Anastrozole is an effective hyper-ovulator inducer, but has not been well researched. In order to determine the effectiveness of anastrozole as a hyper-ovulator inducer and to an extent compare it with CC in similar situations, this study ascertained the effects of these drugs on the expression of the focal adhesion proteins, paxillin and FAK, which are uterine receptivity markers in the surface luminal uterine epithelial cells of day 1 and day 6 pregnant Wistar rats. The results show that paxillin is localized in focal adhesions at the base of the uterine epithelial cells at day 1 of pregnancy whereas at day 6, paxillin disassembles from the basal focal adhesions and localizes and increases its expression apically. FAK is faintly expressed at the basal aspect of the uterine epithelial cells while moderately expressed at the cell-to-cell contact at day 1 in all groups from where it disassembles and relocates apically and becomes more intensely expressed at day 6 of pregnancy in untreated and anastrozole treated rats. Although paxillin is localized apically at day 6, its expression is significantly down-regulated with CC treatment suggesting its interference with the implantation process. These findings seem to suggest that anastrozole could favor implantation.

Para reemplazar el citrato de clomifeno (CC) es necesario un inductor de hiperovulación alternativo, ya que no es adecuado para mujeres con síndrome de ovario poliquístico y está asociado con tasas bajas de embarazo. El anastrozol es un inductor eficaz del hiper-ovulador, pero no se ha investigado adecuadamente. Con el fin de determinar la efectividad del anastrozol como inductor del hiper-ovulador y, en cierta medida, compararlo con CC en situaciones similares, este estudio determinó los efectos de estos fármacos en la expresión de las proteínas de adhesión focal, paxillin y FAK, uterinas marcadores de receptividad en la superficie luminal de células uterinas epiteliales, del día 1 y día 6 en ratas Wistar preñadas. Los resultados muestran que la paxilina se localiza en adherencias focales en la base de las células epiteliales uterinas en el día 1 del embarazo, mientras que en el día 6, la paxilina se desmonta de las adherencias focales basales y localiza y aumenta su expresión apicalmente. FAK se expresa débilmente en el aspecto basal de las células epiteliales uterinas, mientras que se expresa moderadamente en el contacto de célula a célula en el día 1 en todos los grupos, donde se separa y se reubica apicalmente y se expresa con mayor intensidad el día 6 de la preñez, en pacientes no tratados y tratados. ratas tratadas con anastrozol. Aunque la paxillina se localiza apicalmente en el día 6, su expresión está significativamente disminuida con el tratamiento con CC, lo que sugiere su interferencia con el proceso de implantación. Estos hallazgos sugieren que el anastrozol podría favorecer el proceso de implantación.

Effect of first trimester maternal serum pregnancy associated plasma protein: a level on fetomaternal outcome

Background: Serum pregnancy-associated plasma protein-A (PAPP-A) levels fluctuate in continuation with the pregnancy and thus become an important standalone marker in monitoring the adverse outcomes that may occur in pregnancy.Methods: A prospective observational study was conducted in the department of obstetrics and gynaecology. A total of 240 pregnant women in their first trimester were included in the study. Serum PAPP-A levels were measured at 11-13+6week of gestation and were evaluated with respect to the feto-maternal outcome. The data was entered in MS excel spreadsheet and analysis was done using Statistical Package for Social Sciences (SPSS) version 21.0.Results: The mean age of the study population was 27 years. Among the maternal pregnancy parameters, PIH, pre-term labor and Emergency LSCS were significantly associated with low (<0.5 MoM) Serum PAPP-A levels, P<0.05. All the fetal outcome measures: IUGR, IUD, low birth weight, SGA babies, prematurity and NICU admissions, were significantly associated with low (<0.5 MoM) Serum PAPP-A levels, p <0.05.Conclusions: Serum PAPP-A in the early pregnancy showed significant correlation with feto-maternal outcome. Thus, it has the potential to be used as a prognostic factor and in the management of adverse outcomes by increasing surveillance for pregnant women with high-risk factors.

Depression symptoms and influencing factors in early pregnant women in China / 公共卫生与预防医学

Objective To analyze the prevalence of depression in early pregnancy, explore its possible influencing factors, and provide reference for mental health care during pregnancy. Methods A baseline survey of 9 193 early pregnant women recruited by the Chinese Pregnant Women Cohort Study (CPWCS) program was conducted. Edinburgh Postnatal Depression Scale was used to assess the depression symptoms in early pregnancy. The χ2 test and multivariable logistic regression were used to analyze the influencing factors. Results The rate of depression in early pregnant women in CPWCS was 46.50%. Multivariate analysis showed that unplanned pregnancy (OR=1.23, 95%CI: 1.12~1.35, P<0.001), passive smoking (OR=1.28, 95%CI: 1.18~1.39, P<0.001), drinking (OR=1.35, 95%CI: 1.12~1.63, P=0.002) and consumption of carbonated or sugary beverages （OR=0.80, 95%CI: 0.73~0.88, P<0.001） were risk factors for depression during early pregnancy, while enough sleep (OR=0.71, 95%CI: 0.57~0.88, P=0.002), moderate-high level of physical activity (OR=0.87, 95%CI: 0.78~0.98, P=0.023), healthy intake of vegetables and fruits（OR=0.60, 95%CI: 0.51~0.70, P<0.001), animal foods（OR=0.82, 95%CI: 0.74~0.91, P<0.001） and milk and dairy products（OR=0.81, 95%CI: 0.72~0.90, P<0.001）were protective factors. Conclusion The rate of depression was high and it was affected by many factors. It is necessary to pay more attention to depression symptoms during early pregnancy and carry out targeted psychological health care during pregnancy.

Effectiveness Of Metformin In Preventing Early Pregnancy Loss In Women With Polycystic Ovarian Syndrome

OBJECTIVE : To evaluate the effectiveness of metformin therapy in preventing early pregnancy loss in pregnant women with polycystic ovary syndrome (PCOS). MATERIALS AND METHODS : This is a prospective cohort study conducted in the Obstetric Department of Krishna Institute of Medical Sciences, Karad, Maharashtra, India for a period of 2 years. This study involved 100 nondiabetic pregnant women with PCOS. They were divided into two groups, namely, the group that received metformin throughout pregnancy (metformin group) and the group that got pregnant but, did not receive metformin (control group). A comparison was made between the two groups of patients with respect to certain basal characteristics (age, body mass index, previous obstetric outcome, serum glucose with free testosterone). Statistical analysis was performed using Chi-square test to compare the differences between the two groups. RESULTS : There were 50 patients who received metformin during pregnancy (metformin group) compared with 50 patients who did not receive the treatment (control group). The rate of early pregnancy loss in the metformin group was 10% (5/50) compared with 36% (18/50) in the control group (p < 0.001). For patients in the metformin group with a history of previous miscarriage, the rate of pregnancy loss was 45% (35 cases/50 pregnancies). CONCLUSION : Metformin therapy in pregnant women with PCOS was associated with a significant reduction in the rate of early pregnancy loss.

Kisspeptin: new biomarker of pregnancy

Background: The recently identified hormone kisspeptin has been suggested to play an important regulatory role in placentation. The aim and objective of the study is the measurement of serum kisspeptin level in asymptomatic pregnant women and to find out the association of serum kisspeptin with gestational age in women with early pregnancy.Methods: This was a longitudinal study to the evaluation of 178 asymptomatic pregnant women with a gestation of 6 to 16 weeks attending routine antenatal booking visit recruited as study participants from the Antenatal Clinical of Obstetrics and Gynaecology Department, S.M.S. Medical College and Attached Hospitals, Jaipur, Rajasthan, India.Results: After initial clinical examination of every participant, a single blood sample was taken for the measurement of serum kisspeptin. Serum kisspeptin measurement test was performed by ELISA method and results were expressed as ng/ml. Pregnancy outcome was recorded prospectively. Mean serum kisspeptin level of study participants was 2.80±1.87ng/ml and median were 2.41 (Range 0.244-14.06ng/ml). Our result showed the relationship of serum kisspeptin with gestational age (GA) (p<0.000).Conclusions: serum kisspeptin level increases in pregnancy and showed positive relationship with gestational age significantly (p<0.000).

Manual vacuum aspiration: a safe and effective surgical management of early pregnancy loss

Background: Manual vacuum aspiration (MVA) is an alternative to the standard sharp uterine curettage, performed under local anaesthetic or sedation in the daycare setting. The objectives of this study were to assess the efficacy and safety of MVA, the pain perception and the factors related to it.Methods: This was a prospective observational study of 58 consecutive patients who had undergone Manual Vacuum Aspiration (MVA) in Early Pregnancy Assessment Clinic, Hospital Kemaman between January and December 2017. Data on the patients’ characteristics and the procedures were analysed.Results: The efficacy of the procedure was 96.5% (56/58) with no major complication recorded. Majority of the patients (91.3%) reported mild to moderate pain with 2/3 of them agreed to undergo MVA in the future and would recommend it to other patients. There was no significant difference in mean pain score between different groups of women (parity, education levels, occupations, previous uterine evacuation) or procedural techniques (analgesia, sedation, cervical block, cervical dilatation, procedure duration, number of aspiration passes).Conclusions: MVA is safe and well accepted procedure for out-patient surgical evacuation of early miscarriages.

Association between unhealthy diets and depression in early pregnancy / 中华疾病控制杂志

Objective To explore the association between unhealthy diets and depression in early pregnancy. Methods 7 976 women in early pregnancy were recruited and analyzed in this study from the Chinese Pregnant Women Cohort Study (CPWCS) from July 25th, 2017 to July 24th, 2018. Differences of baseline characteristics between the two groups were conducted by a chi-square test. The qualitative food frequency questionnaire and the edinburgh postnatal depression scale were used to assess depression status and food intake frequency during the first trimester respectively. Log-binomial regression was used to analyze the relationship between unhealthy diets and depression in early pregnancy. Prevalence ratio (PR) and its 95% confidence interval (95% CI) were calculated. Results Eating regularly (PR=0.45, 95% CI:0.38-0.54，P<0.001) and eating breakfast frequently (PR=0.80, 95% CI:0.72-0.90, P<0.001) were related to the low incidence of depression while frequent consumption of fried food (PR=1.25, 95% CI:1.03-1.53, P=0.027), Western-style fast food (PR=1.36, 95% CI:1.06-1.74, P=0.015) and puffed food (PR=1.37, 95% CI:1.11-1.70, P=0.003) as well as drinking sugar-sweetened beverage (PR=1.37, 95% CI:1.17-1.61, P<0.001),wine (PR=1.60, 95% CI:1.26-2.01, P<0.001) and liqueur (PR=1.26, 95% CI:1.00-1.59, P=0.047) were linked with the high incidence of depression. Conclusions There might be an association between unhealthy diets and depression in early pregnancy. Pregnant women should take the initiative to better understand what are healthy diets and reduce the frequency of unhealthy diets consumption to decrease the incidence of depression during pregnancy.

Influence of early pregnancy body mass index(BMI)and gestation weight gain(GWG)on adverse pregnancy outcomes / 中国实用妇科与产科杂志

OBJECTIVE: To explore the impact of early pregnancy body mass index(BMI)and weight gain during pregnancy(GWG)on adverse pregnancy outcome in mothers and children.METHODS: The clinical data of 890 primiparas of childbearing age who underwent regular antenatal examination and delivered in the First Affiliated Hospital of Xinjiang Medical University from March to August 2018 were analyzed retrospectively. The cases were divided into low body bass group(BMI35-40 years old)also increased the risk of cesarean section(OR=6.42),gestational diabetes(OR=4.89),gestational hypertensive diseases(OR=3.98),and premature rupture of fetal membranes(OR=2.48).CONCLUSION: Early pregnancy overweight or obesity,excessive GWG and advanced age will increase cesarean section rate,leading to adverse outcomes in mothers and children. Therefore,it is of great importance to control the weight in the preparation of pregnancy and to increase the weight reasonably during pregnancy.

S100 proteins: An emerging cynosure in pregnancy & adverse reproductive outcome

S100 proteins are calcium (Ca2+)-binding proteins and these have an important function in progression, manifestation and therapeutic aspects of various inflammatory, metabolic and neurodegenerative disorders. Based on their involvement in intracellular or extracellular regulatory effects, S100 proteins are classified into three subgroups: one subgroup is specialized in exerting only intracellular effects, other performs both intracellular and extracellular functions and the third subgroup members only display extracellular regulatory effects. S100 proteins are expressed particularly in vertebrates and have cell-specific expression. Functionally, S100 proteins act through their surface receptors and regulate cell functions in autocrine or paracrine mode. Receptor for advanced glycation end products (RAGEs) and toll-like receptor 4 are the main surface receptors. S100 proteins participate in the regulation of cellular differentiation, proliferation, apoptosis and inflammation along with Ca2+ homeostasis, energy metabolism and cellular migration, and perform the respective functions through their interaction with transcription factors, nucleic acids, enzymes, receptors, cytoskeleton system, etc. Currently, their role in adverse pregnancy outcomes and compromised reproductive health is being explored. These proteins are present in amniotic fluid, endometrium tissue and foetal brain; therefore, it is quite likely that alterations in the expression levels of S100 family members will be affecting the particular function they are involved in and ultimately affecting the pregnancy in adverse manner. The current review discusses about an association of S100 proteins in pregnancy disorders such as endometriosis, intrauterine growth retardation and miscarriage.