Cervical length measurement between 11 and 13 + 6 weeks of pregnancy: Comparison of maternal and ultrasonographic characteristics between term and preterm deliveries.

OBJECTIVE: The aim of this study was to evaluate the maternal and ultrasonographic characteristics of pregnant women who underwent cervical length (CL) measurement by transvaginal ultrasound between 11 and 13 + 6 weeks of gestation and who delivered at term or preterm. METHODS: A retrospective cohort study was carried out between March 2013 and December 2018 by analyzing ultrasound data of singleton pregnant women who underwent CL measurement by transvaginal ultrasound during the first trimester scan. CL was compared between the two groups (full-term and preterm birth [PB]) using Student's t-test. RESULTS: A total of 5097 pregnant women were enrolled, of whom 5061 (99.3%) had term and 36 (0.7%) had PB < 34 weeks. CL measurements did not differ between the term and preterm groups (36.62 vs. 37.83 mm, p = 0.08). Maternal age showed a significant and linear association with CL (r = 0.034, p = 0.012) and CRL (r = 0.086, p < 0.001). Smoking status was associated with shorter CL (36.64 vs. 35.09 mm, p = 0.003). When we analyzed the CL of the pregnant women in the term and preterm groups, according to the gestational age cut-offs for prematurity (28, 30, 32, and 34 weeks), we found that there was no significant difference between the measurements in all groups (p > 0.05). CONCLUSION: We observed no significant differences between CL measurements between 11 and 13 + 6 weeks in pregnant women who had preterm and term deliveries. Gestational age and CRL showed a significant and linear association with CL measurement.

The mediating effect of pregnancy adaptation between family support and maternal-fetal bonding: a cross-sectional study.

BACKGROUND: Establishing a nurturing bond with the unborn child is essential for expectant mothers throughout pregnancy. While the influence of family support and pregnancy adaptation on maternal-fetal bonding is evident, these factors remain unexplored in the early stages of pregnancy. This study aims to elucidate the dynamic interaction between family support, pregnancy adaptation, and maternal-fetal bonding during the first trimester, explicitly investigating the mediating role of pregnancy adaptation. METHOD: A cross-sectional design was conducted to recruit expectant mothers between 8 and 12 weeks of gestation without significant complications. RESULTS: Family support and pregnancy adaptation emerged as significant predictors of maternal-fetal bonding, and pregnancy adaptation mediated the relationship between family support and maternal-fetal bonding in the first trimester. CONCLUSIONS: The study confirms the critical role of family support and pregnancy adaptation in facilitating maternal-fetal bonding during early pregnancy, with pregnancy adaptation fully mediating this relationship. Healthcare providers are encouraged to involve family members in early interventions, focusing on assessing family support and engaging them in education and activities to strengthen the emotional bond between the mother and her unborn child.

Placenta acrreta spectrum-first trimester, 2D and 3D ultrasound, and magnetic resonance imaging findings.

BACKGROUND: The term placenta accreta spectrum (PAS) is commonly used to describe abnormal trophoblastic invasion of the myometrium, serosa, or organs adjacent to the uterus. It is of great obstetric importance because of its high morbidity, risk of hemorrhage, admission to the intensive care unit, risk of hysterectomy, and high risk of iatrogenic pelvic lesions and even death. These risks are minimized when prenatal diagnosis is performed. Prenatal diagnosis of PAS is based on imaging findings suggestive of abnormal and pathologically adherent placentation, including placental lacunae (intraplacental sonolucent spaces), disruption of the bladder-uterine serosa interface, turbulent flow on color Doppler, and bridging vessels. OBJECTIVE: In this article, we review the major prenatal imaging features of PAS using diagnostic modalities (first trimester, two-dimensional ultrasound, three-dimensional ultrasound, and magnetic resonance imaging) for the diagnosis of PAS.

Vascular and autonomic function as early predictive biomarkers of the progression to gestational hypertension.

Background: The changes in endothelial function, arterial stiffness, and heart rate variability (HRV) produced in the first trimester of pregnancy in women who develop gestational hypertension (GH) are still being investigated. Objective: to evaluate the HVR, endothelial function, and arterial stiffness changes during the first trimester of pregnancy and their relationship with the development of GH. Methods: A group of women normotensive during the first trimester (n = 43), who later did (GH; n = 11) or did not (no-GH; n = 32) develop GH in that pregnancy, were enrolled. In the first trimester, endothelial function and arterial stiffness were evaluated through photoplethysmography. HRV, parasympathetic (PNS), and sympathetic (SNS) indexes were measured in a 5-minute continuous electrocardiogram record at rest sitting. The Griess reaction measured urinary nitrite excretion (NOx). Results: Systolic blood pressure (SBP) values were higher in GH (no-GH: 105.8 ± 2.0 vs. GH: 112.7 ± 3.0 mmHg; p < 0.05). Endothelial function was decreased, and arterial stiffness was increased in GH. Only in GH the arterial stiffness was correlated with SBP (Pearson's r: 0.5594; 95%CI: 0.06106-0.8681; p < 0.05). In HRV, GH decreased low-frequency power and the ratio SD2/SD1. The inhibition of PNS was lower in GH. The NOx was reduced in GH (no-GH: 3.4 ± 0.4 vs. GH: 0.3 ± 0.1 µM/L; p < 0.001). NOx was correlated negatively with the SNS index only in GH. Conclusions: Developed GH is preceded early in pregnancy by endothelial dysfunction and increased arterial stiffness. In this context, there are SNS-PNS interrelation modifications with less inhibition of PNS.

The Use of Systemic Inflammatory Markers From Routine Blood Tests in Predicting Preeclampsia and the Impact of Age on Marker Levels.

Our study aimed to investigate the relationship between preeclampsia (PE) and blood levels of neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammatory index (SII) in the first trimester of pregnancy. In addition to examining the potential correlation between these inflammatory markers and PE, we aimed to compare the levels based on age to determine whether there are potential age-related differences in marker levels. Over a six-month period, we reviewed the complete blood count (CBC) analysis results of 126 subjects, where 63 patients had a documented history of PE and 63 were healthy pregnant females. We found that age had no statistically significant effect on NLR, MLR, or SII levels, but there was a statistically significant difference in PLR levels between the 18-25 and 26-35 age groups. The study also revealed that the MLR and PLR in the 18-25 age group of preeclampsia patients were statistically significantly lower than those of healthy patients, whereas the PLR and SII in the 26-35 age group of preeclampsia patients were statistically significantly higher than those of healthy patients. The results suggest that systemic inflammatory response (SIR) markers may be able to predict the development of preeclampsia. The study also emphasized the importance of taking age into account, specifically the 18-25 and 26-35 age groups, when assessing the risk of preeclampsia. Further research is needed however to corroborate existing findings and determine the importance of the examined inflammatory markers in the diagnosis of PE.

Factors Associated with Number of Prenatal Visits in Northeastern Brazil: A Cross-Sectional Study.

The aim of this study is to assess factors associated with the number of prenatal visits of women who delivered in a public maternity hospital in northeastern Brazil. This cross-sectional study focused on 380 puerperal women who gave birth at a public maternity hospital in northeastern Brazil. Prenatal and perinatal data were collected in the immediate postpartum period by interviewing mothers and using medical records. Chi-square/Fisher exact test compared the data, and a logistic regression model estimated the association between birth weight and number of prenatal visits. As a result, the sample was composed of 175 women with <37 weeks of gestational age and 205 women with ≥37 weeks of gestational age. Women with less than four prenatal visits were more likely to give birth to low birth weight (<2500 g) and preterm infants (<37 weeks of gestational age) than those with more than four prenatal visits (p = 0.001). The subjects with less than four prenatal visits had a 2.76-fold higher odds of giving birth to infants weighing less than 2500 g (p = 0.03; 95%CI = 1.05-7.30), without relation to maternal and gestational ages. In conclusion, women with less than four prenatal visits had higher odds of giving birth to low birth infants, independently of maternal and gestational ages, and were more likely to give birth to premature babies.

Dynamic changes and early predictive value of branched-chain amino acids in gestational diabetes mellitus during pregnancy.

Objective: Branched-chain amino acids (BCAAs) are closely associated with type 2 diabetes mellitus, but their roles in gestational diabetes mellitus (GDM) are still controversial. This study aims to explore the dynamic changes of BCAAs during pregnancy and identify potential early biomarkers for GDM. Methods: This study is a nested case-control study involved 49 women with GDM and 50 age- and body mass index (BMI)-matched healthy pregnant women. The dynamic changes of valine (Val), isoleucine (Ile), and leucine (Leu) were detected in the first (8-12 weeks) and second trimesters (24-28 weeks) by liquid chromatography-mass spectrometry. Results: Serum Val, Ile, and Leu were higher in GDM patients than in controls in the first trimester. Compared with the first trimester, the serum Val, Ile, and Leu in GDM patients were decreased in the second trimester. In addition, Val, Ile, and Leu in the first trimester were the risk factors for GDM, and Ile presented a high predictive value for GDM. Ile + age (≥ 35) + BMI (≥ 24) exhibited the highest predictive value for GDM (AUC = 0.902, sensitivity = 93.9%, specificity = 80%). Conclusion: Maternal serum Ile in the first trimester was a valuable biomarker for GDM. Ile combined with advanced maternal age and overweight may be used for the early prediction of GDM.

Maternal Anemia during the First Trimester and Its Association with Psychological Health.

Anemia during pregnancy is known to be associated with an increased risk of antenatal and/or postnatal depression, as well as adverse pregnancy outcomes. However, there are few studies evaluating psychological health throughout the antepartum and postpartum periods in women with anemia in early pregnancy. This study analyzed data collected by the Korean Pregnancy Outcome Study, a multicenter prospective cohort study conducted in South Korea, to determine the impact of anemia during the first trimester on birth outcomes and maternal mental health during pregnancy and postpartum. Hemoglobin levels were measured during the first trimester, and psychological health was evaluated at 12, 24, and 36 gestational weeks and 4−6 weeks postpartum. Anxiety and depression were defined using the Hospital Anxiety and Depression Scale and the Edinburgh Postnatal Depression Scale, respectively. Among 4067 Korean participants, 119 (2.9%) were diagnosed with anemia during the first trimester. Incidences of anxiety and depression did not differ over the pregnancy period between those with and without anemia during the first trimester. However, postpartum anxiety and depression were significantly more common in participants with anemia than in those without (p < 0.05, both). Hence, obstetricians should pay attention to postpartum mental health in women with anemia during the first trimester.

Hemostasis System and Plasminogen Activity in Retrochorial Hematoma in the First Trimester of Pregnancy.

(1) Background: The components of the fibrinolytic system and its main component, plasminogen, play a key role in the first months of pregnancy. The effect of autoantibodies interacting with plasminogen in the formation of retrochorial hematoma is unknown. The aim of our study was to determine the role of plasminogen and IgA, IgM, and IgG, which bind to plasminogen, in retrochorial hematoma. (2) Methods: Prothrombin time (PT), thrombin time (TT), partial activated thromboplastin time (aPTT), soluble fibrin-monomer complex (SFMC), D-dimer, plasminogen activity (%Plg), plasminogen concentration (Plg), and the levels of IgG (IgG-Plg), IgM (IgM-Plg), IgA (IgA-Plg) interacting with plasminogen were determined in plasma samples of 57 women with normal pregnancy and 16 with retrochorial hematoma. (3) Results: %Plg in plasma samples from women with retrochorial hematoma was significantly lower than in plasma samples from women with normal pregnancy. The diagnostic significance of %Plg in the ROC analysis was AUC = 0.85. A direct correlation was found between aPTT and the level of autologous IgM interacting with plasminogen. (4) Conclusions: A decrease in the activity of plasminogen in the blood serum of women in the first trimester of pregnancy may indicate disturbances in the hemostasis system and the formation of retrochorial hematoma. According to the results of the study, it is possible to recommend the determination of plasminogen activity in the management of pregnant women in gynecological practice.

First-Trimester Serum Cytokine Profile in Pregnancies Conceived After Assisted Reproductive Technology (ART) With Subsequent Pregnancy-Induced Hypertension.

Pregnancy-induced hypertension (PIH) is one of the most common pregnancy complications that seriously affects the mother and fetus. The incidence of PIH is higher in pregnancies conceived after assisted reproductive technology (ART) than in spontaneous pregnancies; thus, exploring potential serum biomarkers before PIH onset is of great significance for effective early prediction and prevention of PIH in the ART population. Cytokines are involved in the inflammatory response and immune regulation, which play an essential role in the pathogenesis of PIH. A description of the cytokine profile in the first trimester of pregnancy could help identify new diagnostic tools and develop targeted therapies for PIH in the ART population. The concentrations of classical predictive markers for PIH and another 48 cytokines were measured in the first-trimester pregnancy serum samples from 33 PIH patients and 33 matched normotensive controls (NC), both of whom conceived after ART treatment. The measured values were compared and analyzed between NC and PIH, followed by comprehensive bioinformatic analysis and logistic regression analysis. There was no significant difference in classical predictive markers, including Activin A, PlGF, sFLT1 (VEGFR), and sFLT1/PlGF, between the PIH and NC groups (P > 0.05), while 29 cytokines were significantly lower in the PIH group than in the NC group (P < 0.05). Logistic regression analysis revealed that 17 cytokines (IL-2Rα, M-CSF, IL-6, IL-2, ß-NGF, IL-7, IL-12 (p70), SCF, IL-10, IL-9, MIG, GM-CSF, LIF, IL-1α, MCP-3, IL-4, and HGF) in the first-trimester pregnancy serum were significantly negatively correlated with the subsequent onset of PIH. With the top 3 cytokines (IL-7, MIG, and SCF) of receiver operating characteristic (ROC) analysis, we constructed an efficient multifactor combined detection and prediction model for PIH in ART pregnancy. Classical early predictors for hypertensive disorder complicating pregnancy cannot distinguish PIH from their normal peers in ART pregnancy. In comparison, the description of the cytokine profile in the first trimester of pregnancy enables us to distinguish high-risk ART pregnancy for PIH, permitting enough time for PIH prevention therapy. The cytokine profile we described also provides immunological insight into the further mechanistic exploration of PIH.

Outcomes With Levothyroxine Treatment in Early Pregnancy With Subclinical Hypothyroidism.

Introduction Adverse pregnancy outcomes in women with subclinical hypothyroidism (SCH) are well documented, whereas data regarding the risk and benefit of levothyroxine treatment in such cases are insufficient and inconsistent. Our study aimed to evaluate the effects of levothyroxine treatment on pregnancy outcomes in these women. Materials and methods Healthy women with a singleton pregnancy were screened before 12 weeks of gestation for subclinical hypothyroidism using 2017 American Thyroid Association guidelines. They were treated with an initial dose of 50 mcg of levothyroxine and the dose was adjusted at six-week intervals to achieve a normal thyrotropin level. All the participants were followed up with thyroid function tests and ultrasonography till delivery. Pregnancy outcomes were compared with those of healthy pregnant women with normal thyroid function. Results  A total of 1058 women were screened and 5.1% (n=54) were found to have subclinical hypothyroidism, out of which 57.4% (n=31) were thyroid peroxidase antibody positive. The median gestational age at the initiation of levothyroxine treatment was nine weeks. The risks for miscarriage (odds ratio (OR): 1.284, p=0.811), gestational hypertension (OR: 1.993, p=0.365), intra-uterine growth restriction (OR: 1.688, p=0.488), low birth weight (OR: 1.591, p=0.392), and preterm birth (OR: 1.606, p=0.529) were not significantly higher in women with subclinical hypothyroidism as compared to euthyroid women. However, the risk of gestational diabetes mellitus was significantly higher in women with SCH (OR: 3.432, 95% confidence interval (95% CI): 1.115-10.562). Conclusion Levothyroxine therapy initiated in the first trimester of pregnancy has possible beneficial effects in subclinical hypothyroidism but with a higher risk for gestational diabetes.

Evaluation of ultrasound measurements of abdominal fat for the prediction of gestational diabetes in the first and second trimesters of pregnancy.

OBJECTIVE: To evaluate whether ultrasound abdominal fat measurements in the first and second trimesters can predict adverse gestational outcomes, particularly gestational diabetes mellitus (GDM), and identify early patients at higher risk for complications. METHODS: A prospective cohort study of 126 pregnant women at 11-14 and 20-24 weeks of gestation with normal fasting glucose levels during early pregnancy. From 126 participants with complete data, 13.5% were diagnosed with GDM, based on the cutoffs established for the peripherical blood glucose. Subcutaneous, visceral, and maximum preperitoneal abdominal fat were measured using ultrasound techniques. GDM status was determined by oral glucose tolerance test (OGTT) with 75 g glucose overload, and the following values were considered abnormal: fasting glucose ≥92 mg/dl and/or 1 h after overload ≥180 mg/dl and/or 2 h after overload ≥153 mg/dl. The receiver operator characteristic (ROC) curve was used to determine the optimal threshold to predict GDM. RESULTS: Maximum preperitoneal fat measurement was predictive of GDM, and subcutaneous and visceral abdominal fat measurements did not show significant differences in the prediction of GDM. According to the ROC curve, a threshold of 45.25 mm of preperitoneal fat was identified as the optimal cutoff point, with 87% sensitivity and 41% specificity to predict GDM. The raw and adjusted odds ratios for age and pre-pregnancy body mass index were 0.730 (95% confidence interval [CI], 0.561-0.900) and 0.777 (95% CI, 0.623-0.931), respectively. CONCLUSION: The use of a 45.25 mm threshold for maximum preperitoneal fat, measured by ultrasound to predict the risk of GDM, appears to be a feasible, inexpensive, and practical alternative to incorporate into clinical practice during the first trimester of pregnancy.

Lower systolic blood pressure levels in early pregnancy are associated with a decreased risk of early-onset superimposed preeclampsia in women with chronic hypertension: a multicenter retrospective study.

To clarify the impact of blood pressure (BP) management ranges on pregnancy outcomes, we conducted a multicenter retrospective analysis of 215 women with singleton pregnancies diagnosed with essential hypertension either before or within 14 weeks of gestation. Patients were classified according to systolic BP (sBP; <130, 130-139, 140-159, and ≥160 mmHg) or diastolic BP (dBP; <80, 80-89, 90-109, and ≥110 mmHg) at 8-11, 12-15, and 16-19 weeks of gestation. The risk of early-onset superimposed preeclampsia and small-for-gestational-age neonates was assessed in each BP group. Moreover, a subgroup analysis was performed in 144 eligible patients whose BP was measured at both 12-13 and 14-15 weeks of gestation. At 16-19 weeks of gestation, higher sBP significantly increased the incidence of early-onset superimposed preeclampsia (13.3%, 24.6%, 32.2% and 75.0%, respectively) and small-for-gestational-age neonates (6.0%, 13.1%, 16.9% and 50.0%, respectively). Multivariate logistic regression analyses showed that women with sBP < 130 mmHg at 16-19 weeks of gestation had a significantly lower risk of early-onset superimposed preeclampsia than women with sBP of 140-159 mmHg. Subgroup analyses also showed that even at 14-15 weeks of gestation, sBP < 130 mmHg was associated with a significantly lower risk of early-onset superimposed preeclampsia than an sBP of 140-159 mmHg. In conclusion, sBP < 130 mmHg within 14 weeks of gestation reduced the risk of developing early-onset superimposed preeclampsia in women with chronic hypertension.

Ultrasound Patterns in the First Trimester Diagnosis of Congenital Heart Disease.

Congenital heart disease (CHD) is the most common birth defect, with a reported prevalence of 5-12 per 1000 live births. Very recently, the American Institute of Ultrasound in Medicine published a guideline recommending the use of the four-chamber and the three-vessel and trachea views to screen for CHD in the first trimester of pregnancy. Our aim is to present abnormal image patterns that are seen in the four-chamber, three-vessel, and trachea views of the fetal heart in the first trimester and to describe their association with specific CHD types. We used a total of 29 cases of CHD from the archives of Filantropia Hospital and the Maternal and Child Health Institute (INSMC) fetal medicine units. We selected cases with a clear and well-documented diagnosis of the CHD type. We identified a series of repeating color doppler flow patterns seen in the four-chamber, three-vessel, and trachea views of the studied cases. Our observations could be developed into a diagnosis algorithm to orientate the examiner to the most likely type of CHD in individual cases.

Influence of smoking habits on mental status in Japanese women during the first trimester of pregnancy.

PURPOSE: We examined the relation between smoking habits and maternal mental status such as depression and anxiety during the first trimester of pregnancy. MATERIAL AND METHODS: Between July 2016 and June 2018, we examined the increased odds of depressive and anxiety symptoms in the women with smoking habits during prepregnancy with and without smoking cessation during the first trimester of pregnancy in comparison with those without smoking habits using self-administered questionnaires. RESULTS: The rate of depressive and anxiety symptom in the women with smoking habits during prepregnancy (46.4 and 47.3%, respectively) was higher than those in the women without smoking habits during the first trimester of pregnancy irrespective of smoking cessation. The rate of depressive or anxiety symptom during the first trimester of pregnancy did not change significantly by smoking cessation in the women with smoking habits during prepregnancy (depressive symptom: 44.6 versus 53.7%, p = .13; anxiety symptom: 45.3 versus 55.2%, p = .17). CONCLUSIONS: Smoking habits during prepregnancy seemed to be associated with the increased perinatal mental disorders irrespective of smoking cessation.

Management for a patient of moyamoya disease presenting with ischemic stroke in the first trimester of pregnancy.

We report an extremely rare case of a 27-year-old woman presenting with ischemic stroke as an initial manifestation of moyamoya disease in the first trimester of pregnancy. We conducted an artificial abortion when her neurological symptoms rapidly became refractory to optimal antithrombotic treatments. The progression of neurologic deficits stopped immediately after abortion, resulting in recovery to independence, with slight motor aphasia and right hemiparesis due to improved cerebral flow. We highlight rapid artificial abortion combined with antithrombotic treatment for patients of moyamoya disease with pregnancy-associated ischemic stroke as an appropriate treatment to correct hemodynamic instability and suppress the progression of neurological symptoms.

Zika Virus and Pregnancy: Association between Acute Infection and Microcephaly in Newborns in the State of Rio de Janeiro, Brazil.

Introduction Aim of the study was to evaluate the association between microcephaly and acute infection with Zika virus (ZIKV) in pregnant women in the state of Rio de Janeiro, Brazil. Infection was confirmed by laboratory testing. Materials and Methods A cross-sectional retrospective study of pregnant women with symptoms occurring between 2015 and 2016 suggestive of acute ZIKV infection was carried out, with confirmation of infection done by blood or urine RT-PCR. The relative proportions of categorical variables were calculated for two distinct groups: pregnant women whose newborns had microcephaly and pregnant women who gave birth to infants without microcephaly. Confidence intervals with a 95% level of agreement were estimated for the relative ratios. Results A total of 1609 pregnant women with a mean age of 26.4 ± 6.5 years were evaluated. As regards the time of acute infection, 19.6% (316) of cases occurred in the first trimester of pregnancy. Nineteen (76%) of the 25 cases with microcephaly (1.5%) were associated with an infection contracted in the first trimester of pregnancy (p < 0.001, OR = 13.7, 95% CI: 5.6 - 37.7). 48% (12/25) of the newborns with microcephaly had a birth weight of < 2500 grams, while only 7% (116/1597) of the group of newborns without microcephaly had a similarly low birth weight (p < 0.001, OR = 11.7, 95% CI: 5.2 - 26.2). Logistic regression showed that a birth weight of < 2500 g (OR = 12.54) and ZIKV infection in the first trimester of pregnancy (OR = 14.05) were associated with microcephaly (area under ROC curve = 0.86). Conclusion Acute ZIKV infection in the first trimester of pregnancy and low birth weight are associated with microcephaly.

A Patient with Subarachnoid Hemorrhage Related to a Ruptured Aneurysm in Week 8 of Pregnancy: Usefulness of Coil Embolization of Intracranial Aneurysms as a Treatment Option before Delivery.

Object: We report a case of endovascular surgery for subarachnoid hemorrhage (SAH) that developed in early pregnancy. Case Presentations: An 8-week pregnant 35-year-old female was admitted to our hospital with severe headache and loss of consciousness. Cephalic computed tomography (CT) revealed SAH (Hunt and Hess grade II). Digital subtraction angiography (DSA) demonstrated a 2.7 mm aneurysm at the right internal carotid artery-posterior communicating artery (IC-PC) bifurcation. We prioritized maternal treatment. Cerebral aneurysm coil embolization was performed on the 1st day under general anesthesia. During the operation, we tried to avoid irradiating the fetus by limiting the irradiation range and time. She was discharged on the 36th day of illness and gave birth to a 2532-g baby at 36 weeks of gestation. Conclusion: If SAH develops in early pregnancy, it is necessary to prioritize maternal treatment. Endovascular surgery should be considered as a treatment option.

Assessment of ß-human-derived chorionic gonadotrophic hormone (ßhCG) and pregnancy-associated plasma protein A (PAPP-A) levels as predictive factors of preeclampsia in the first trimester among Iranian women: a cohort study.

BACKGROUND: Preeclampsia (PE) is a leading cause of maternal and perinatal mortality. There are controversial findings regarding the prediction of PE through the assessment of the Pregnancy-Associated Plasma Protein A (PAPP-A) and ß-Human-Derived Chorionic Gonadotrophic hormone (ßhCG) levels in the first trimester of pregnancy. Therefore, this cohort study was conducted to evaluate of PAPP-A and ßhCG levels as predictive factors for PE development in the first trimester among Iranian women. METHODS: In this cohort study, a total of 4605 volunteer Primigravida and Multigravida women were selected by the census from 16 randomly selected Health Centers in Isfahan, Iran, from July 2016 to June 2018. Eligible pregnant women participated in the study had already undergone fetal anomalies screening tests between 11 + 0 and 13 + 6 weeks of pregnancy and their PAPP-A and ßhCG biomarkers were adjusted to the Multiples of the Median (MOM). MOM PAPP-A <  0.4 and MOM ßhCG > 3 were considered abnormal. The samples were followed up until delivery. The biomarkers' levels were compared in the two groups of women with and without PE and Relative risk (RR) and odds ratio (OR) of PE calculated. RESULTS: In the PE group, the mean MOM PAPP-A was significantly lower (1 vs. 1.09 with P = 0.006) and MOM ßhCG was significantly higher (1.51 vs. 1.14 with P = 0.001) than the group without PE. RR and OR for PE in subjects with MOM PAPP-A <  0.4 were reported as follows: RR = 2.49, (p = 0.001) and OR = 2.09, (p = 0.001). RR and OR for PE in subjects with MOM ßhCG > 3 were also reported as follows: RR = 4.02, (p = 0.001) and OR = 5.65, (p = 0.001). Adjusted OR for MOM PAPP-A <  0.4 and MOM ßhCG > 3 was obtained as follows: OR = 2.09 (P = 0.001) and OR = 5.65 (P = 0.001), respectively. CONCLUSION: The results of the study showed that the high levels of ßhCG would cause 5.65 times increase and the low levels of PAPP-A would cause 2.09 times increase in the chance of developing PE.

Examining to what extent pregnancy-related physical symptoms worry women in the first trimester of pregnancy: a cross-sectional study in general practice.

BACKGROUND: Women often wish to discuss their pregnancy symptoms with their GP. However, the two parties' understanding of symptoms may not be aligned. AIM: To examine to what degree a specific pregnancy-related symptom worried women in the first trimester and analyse the characteristics of the most worried women. DESIGN & SETTING: A cross-sectional study was performed in general practice in Denmark from 1 March 2015-15 August 2016. METHOD: Women attending the first prenatal care visit completed a questionnaire about pregnancy-related physical symptoms and worries. Women were recruited from 125 GP practices and 294 GPs participated in the study. Further data were obtained from their pregnancy health record. Multivariable logistic regression analysis was used to assess the associations between the women's worries and the severity of the symptoms, which were adjusted for age and parity. RESULTS: A total of 1508 women, aged 16-45 years, were included and 1455 completed the questionnaire. Nausea, vomiting, pelvic cavity pain, and back pain were the most common symptoms, and 88% reported having two or more symptoms simultaneously. Among the 1278 women reporting nausea, only 21% were worried, while 88% of the 252 women reporting vaginal bleeding were worried. Primigravidae (those pregnant for the first time) were significantly more worried about vomiting and nausea than multigravidae (those who have experienced pregnancy previously). Those aged >35 years were more worried about pelvic girdle pain and pelvic cavity pain than younger women. CONCLUSION: Pregnancy-related physical symptoms are frequent in the first trimester. The severity of worries depends on the symptom. Vaginal bleeding and pain give rise to the majority of severe worries, especially among young women.