Percentage change in body mass index or gestational weight gain: Which is a better predictor of foetal macrosomia?

The aim of the study was to evaluate gestational weight gain (GWG) and percentage change in body mass index (BMI) for prediction of foetal macrosomia. A total of 409 term pregnant women, of whom 86 delivered macrosomic infants (> 4000 g) and 323 delivered non-macrosomic infants were recruited for the study. GWG and body mass index at delivery were significantly higher in the macrosomic than non-macrosomic group (15.8 ± 5.6 vs 13.9 ± 5.6, and 31.4 ± 4.3 vs 29.5 ± 4.3, respectively) (p < 0.05). The receiver operating characteristic curve analysis for testing the significance of weight gain in prediction of macrosomia showed an area under curve of 0.58 (p = 0.012, 95% confidence interval [CI] = 0.52-0.65), and significance of percentage change in BMI in prediction of macrosomia revealed an area under curve of 0.52 (p = 0.51, 95% CI = 0.46-0.59). BMI percentage changes both in obese (BMI ≥ 25) and non-obese (BMI < 25) groups were not statistically significant (p > 0.05). BMI percentage change does not seem to be a strong predictor of foetal macrosomia, and GWG was not found to be an independent risk factor after multivariate regression analysis was performed.

The comparison of microdose flare-up and multiple dose antagonist protocols based on hCG day estradiol (E2), progesterone (P) and P/E2 ratio among poor responder patients in ICSI-ET cycles.

OBJECTIVE: Elevated progesterone levels surpassing exact treshold values impede endometrial receptivity and decrease clinical pregnancy rates in different responder patients during assisted reproductive techniques. A progesterone (P): estradiol (E2) ratio of > 1 on the day of hCG administration has also been suggested to be a manifestation of low ovarian reserve. The clinical significance of P/E2 ratio on the day of hCG administration was investigated among poor responder patients. PATIENTS AND METHODS: Based on the ESHRE Bologna consensus criteria related to poor ovarian response diagnosis, 48 poor responder patients were treated with the microdose flare-up regimen and 34 patients were treated with the multiple-dose GnRH antagonist protocol. All patients were destined to perform a ICSI-ET procedure at the end of the stimulation protocols. Progesterone levels and P/E2 ratios have been detected during controlled ovarian hyperstimulation. RESULTS: In the microdose flare-up group; the duration of stimulation, total gonadotropin dose used and hCG day E2 levels were significantly higher than the multiple dose antagonist group. However, the mean hCG day P/E2 rate in the microdose flare-up group was less than that in the multiple-dose antagonist group. The clinical pregnancy rates were non significantly higher in the multiple dose antagonist protocol group than in microdose flare-up group. CONCLUSIONS: Impaired endometrial receptivity caused by elevated P levels results with lower pregnancy rates. Regardless of the selected stimulation protocol, poor responder patients are not prone to exhibit high P and E2 secretion. Increased P/E2 ratio of > 1 on hCG day has limited value to predict cycle outcomes in poor responder patients because of ovarian follicle depletion.

The outcomes of surgical treatment modalities to decrease "near miss" maternal morbidity caused by peripartum hemorrhage.

BACKGROUND: The treatment of patients with peripartum hemorrhage is unfortunately characterized by inadequate treatment that does not adhere to standard therapeutic measures. AIM: Assessment of different management strategies among patients with severe hemorrhage, particularly the ones with "near-miss" maternal morbidity and mortality to establish clinically useful guidelines for the prevention and management of peripartum hemorrhage. PATIENTS AND METHODS: In this study, the medical records of 458 patients who have experienced peripartum hemorrhage between March 2009 and March 2012 in a tertiary perinatal center were retrospectively reviewed. Specific surgical treatment modalities utilized to 61 patients with severe peripartum hemorrhage with respect to the procedure timing and effectivity were compared according to the outcomes and efficiency. RESULTS: Sixty-one patients who have been diagnosed as severe peripartum hemorrhage have been included to the study. Six (75%) of the 8 patients who were treated with B-Lynch brace suture for uterine atony and 9 (60%) of the 15 patients who were treated with the Bakri balloon tamponade system for uterine atony or placenta accreta required hysterectomy following the initial therapeutic measures. The patients who have been treated with bilateral hypogastric artery ligation and B-Lynch brace suture or Bakri balloon uterine tamponade system were less likely to need a complementary hysterectomy for definitive treatment of peripartum hemorrhage when compared with patients treated with either B-Lynch brace suture or Bakri uterine tamponade balloon system alone. CONCLUSIONS: The efficiency of B-Lynch compression brace sutures and the Bakri balloon uterine tamponade system is unpredictable in terms of the need for hysterectomy for peripartum hemorrhage patients diagnosed as either uterine atony or placenta previa. Regardless of the initial diagnosis, these modalities seem to be more effective in alleviating peripartum hemorrhage when accompanied by hypogastric artery ligation.

Umbilical CORD S100B levels in active and passive smoker women.

OBJECTIVES: In utero fetal exposure to tobacco smoke has been found to be associated with adverse pregnancy outcome and increased maternal and fetal risks. The aim of this study was to compare umbilical cord blood S100B levels of infants of active smoker, passive smoker and non-smoker mothers. SUBJECTS AND METHODS: A total of 82 women, 26 habitual smokers, 27 passive smokers and 29 controls, who were admitted for repeat elective cesarean delivery with uncomplicated term gestations were included in the study. The age, gravidity, parity and gestational week at delivery were recorded on admission for the delivery. Ultrasonographic evaluation was routinely done on admission and birth weights of the newborns were measured immediately upon delivery. Umbilical cord blood was collected following delivery of the infants and serum S100B levels were analyzed at the end of the study period. The groups were compared according to S100B levels. RESULTS: No significant difference was found between the three groups regarding age, gravidity, gestational week at delivery or birth weight of the infants (p > 0.05). Biparietal diameter of the fetuses of active smoker mothers were significantly smaller than passive smokers and controls (90.3 ± 1.8 vs 94.2 ± 2.8 and 93.8 ± 2.5, respectively). Mean S100B level in the umbilical cord blood of active smokers was lower than passive smokers and controls (768.9 ± 446.9 vs 1050.1 ± 383.2 and 1035.3 ± 405.2) (p = 0.024). CONCLUSIONS: Fetuses of active smoker mothers had lower cord blood S100B levels, suggesting a possible injury of glial cells.