scholarly journals Hormonal function of the corpus luteum, trophoblast and placenta in pregnant twins who were previously treated for infertility

2021 ◽  
pp. 22-29
Author(s):  
L.E. Tumanova ◽  
◽  
E.V. Kolomiets ◽  
Keyword(s):  
Growth Rate ◽  
Surgical Treatment ◽  
Pregnant Women ◽  
First Trimester ◽  
Multiple Pregnancies ◽  
Hormonal Function ◽  
History Of ◽  
Self Fertilization ◽  
Β Hcg ◽  
Conservative And Surgical Treatment

Purpose — to study the hormonal function of the corpus luteum, trophoblast. Materials and methods. We have studied hormonal parameters from 7 to 14 weeks of pregnancy in 87 women with twins. The study of hormonal parameters was carried out in three groups (six subgroups): Group I — pregnant women who had a history of endocrine infertility: Ia — 21 patients after IVF, Ib — 10 patients who became pregnant on their own after conservative and surgical treatment of infertility, but without IVF; Group II — pregnant women with a history of infertility of inflammatory genesis: IIa — 35 patients after IVF, IIb — 6 patients who became pregnant on their own after conservative and surgical treatment of infertility, but without IVF; Group III — pregnant women who had a history of combined infertility, inflammatory genesis with endocrine, IIIa — 10 patients after IVF, IIIb — 5 patients who became pregnant on their own after conservative and surgical treatment of infertility, but without IVF. The content of placental hormones in the dynamics of pregnancy at 7–10 and 11–14 weeks was studied: estradiol (E2), progesterone, human chorionic gonadotropin (β-hCG) and pregnancy-associated plasmoprotein (PAPP-A). Determination of E2, progesterone was carried out by enzyme immunoassay using standard kits of the «Delfia» system on an analyzer «1420 Victor 2» from Perken Elmer (USA). β-hCG and PAPP-A were determined by the immunochemiluminescent method using test systems manufactured by Siemens. Results. During dynamic monitoring of hormonal parameters in the blood of women of all three groups during the first trimester, we revealed a progressive increase in the content of estradiol and progesterone. At the same time, the rate of increase in the content of estradiol in the blood in the dynamics of pregnancy was greater than that of progesterone. With twins (after IVF), the increase in progesterone reached more than 50%, and the increase in estradiol up to 30–40%, practically did not depend on the cause of infertility. With multiple independent pregnancies, the increase in progesterone reached ≈40–60% (the lowest increase was with combined infertility), and the increase in estradiol ≈75% and practically did not differ across groups. At 7–10 weeks of gestation, the progesterone concentration was significantly higher in women after IVF compared to those in patients after spontaneous fertilization. In this period, the level of progesterone did not depend on the form of infertility. Similar changes were observed with the level of estradiol in the surveyed women. The progesterone/estradiol ratio was virtually the same across the groups. The level of estradiol in the blood of women (11–14 weeks of pregnancy) also practically did not differ, both depending on the form of infertility and the method of fertilization. At 11–14 weeks, comparing progesterone levels, it is necessary to note reliably high rates in women with multiple pregnancies after IVF, which indicates an intense hormone-producing function due to the placentas of two fetuses. It should be noted that with endocrine and combined infertility in women after IVF with twins, there were significantly higher rates compared to those of women in similar groups after self-fertilization. The content of sex hormones at both 7–10 and 11–14 weeks in all groups during pregnancies after IVF was higher than during pregnancies with natural fertilization. The content of sex hormones at both 7–10 and 11–14 weeks in all groups during pregnancies after IVF was higher than during pregnancies with natural fertilization. The progesterone level in pregnant women at 11–14 weeks with a two-fetal natural pregnancy was 256.45±27.6 nmol/L, while the same indicator in pregnant women with two fetuses after IVF was 337.5±26.7 nmol/L. A longer (up to 13 weeks) decrease in the progesterone/estradiol ratio represents a more pronounced relative progesterone deficiency and hyperestrogenism in women after IVF. High levels of progesterone in the first trimester of pregnancy, especially in women after IVF (Ia, IIa, IIIa groups) were the result of intensive maintenance therapy with progestogens, which is necessary to ensure the gestational process in the I trimester in the IVF program. We also studied the indicators of β-hCG and PAPP-A in pregnant women 11–14 weeks. by groups, as classic markers of screening for congenital malformations of the fetus and the risk of complications of pregnancy. Thus, PAPP-A in pregnancies after IVF did not significantly differ from pregnancies with natural fertilization, but had a tendency to increase in multiple pregnancies. Conclusions. At 7 10 weeks of pregnancy, women with twins after IVF had higher levels of estradiol and progesterone than in women with twins after natural fertilization. At 11 14 weeks of pregnancy in women with twins, estradiol did not differ between groups and did not depend on the method of fertilization, and the level of progesterone was higher in pregnant women after IVF. With twins (after IVF), the growth rate of progesterone is higher than that of estradiol. With self-fertilization, the growth rate of estradiol significantly outpaced the growth of progesterone levels in pregnant women with a history of endocrine and concomitant infertility. The concentration of pregnancy-associated plasmoprotein (PAPP-A) in pregnancies after IVF did not significantly differ from pregnancies with natural fertilization and did not depend on the cause of infertility. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. The authors declare that they have no conflicts of interest. Key words: estradiol, progesterone, β-hCG, PAPP-A, twin pregnancy after infertility.

scholarly journals Hormonal monitoring of the function of the corpus luteum, trophoblast and placenta in pregnant women with a history of different types of infertility

2020 ◽  
pp. 6-12
Author(s):  
L.E. Tumanova ◽  
◽  
E.V. Kolomiets ◽  
Keyword(s):  
Surgical Treatment ◽  
Pregnant Women ◽  
Corpus Luteum ◽  
Enzyme Linked Immunosorbent Assay ◽  
Group I ◽  
Rate Of Increase ◽  
History Of ◽  
Natural Conception ◽  
Β Hcg ◽  
Conservative And Surgical Treatment

Purpose — to investigate hormonal monitoring of the function of the corpus luteum, trophoblast and placenta in pregnant women with a history of various types of infertility. Materials and methods. We have studied hormonal parameters from 8 to 14 weeks of pregnancy in 420 women. The study of hormonal parameters was carried out in three groups (six subgroups): Group I — pregnant women with a history of endocrine infertility: Ia — 50 patients after IVF, Ib — 50 patients who became pregnant on their own after conservative and surgical treatment of infertility, but without IVF; Group II — pregnant women with a history of inflammatory infertility: IIa — 100 patients after IVF, IIb — 100 patients who became pregnant independently after conservative and surgical treatment of inflammatory infertility, but without IVF; Group III — pregnant women with a history of combined infertility, inflammatory genesis with endocrine, IIIa — 30 patients after IVF, IIIb — 30 patients who became pregnant on their own after conservative and surgical treatment of combined infertility, but without IVF. A study of the content of placental hormones in the dynamics of pregnancy at 7–10 and 11–14 weeks was carried out: estradiol (E2), progesterone, human chorionic gonadotropin (β-hCG) and pregnancy-associated plasmoprotein (PAPP-A). Determination of E2, progesterone was carried out by the enzyme-linked immunosorbent assay using standard kits of the Delfia system on a 1420 Victor 2 analyzer from Perken Elmer (USA). β-hCG and PAPP-A were determined by the immunochemiluminescent method using test systems manufactured by Siemens. Results. We carried out hormonal monitoring of the corpus luteum and trophoblast function and analyzed the results of fetal biochemical markers in 276 pregnant women. The data obtained indicate that in the period of 7–10 weeks of pregnancy, the concentration of progesterone was significantly higher in women after IVF relative to the indicators of patients with natural conception. At this stage of pregnancy, the level of progesterone did not depend on the form of infertility. Similar changes were observed with respect to estradiol levels. So the level of estradiol in pregnant women of 7–10 weeks during natural pregnancy was ≈5.0 nmol/L, while the same level of estradiol in pregnant women with one fetus after IVF was 8.4±1.1 nmol/L. The progesterone/estradiol ratio was virtually the same across the groups. The level of estradiol and progesterone in the blood of women at 11–14 weeks of gestation also practically did not differ, and did not depend on the form of infertility and the method of conception. It should be especially noted that at 11–14 weeks there was a decrease in the progesterone/estradiol ratio, which represents a progressive pronounced relative progesterone deficiency and hyperestrogenism in women with infertility. The indicators were especially low in pregnant women of groups I and III, who had endocrine and combined infertility in the anamnesis. We also investigated the indicators of β-hCG and PAPP-A in pregnant women 11–14 weeks. by groups, as classic markers of screening for congenital malformations of the fetus and the risk of complications of pregnancy. So the level of PAPP-A in pregnant women did not significantly differ in groups, both from the method of conception and the type of infertility in the anamnesis. The level of β-hCG in pregnant women 11–14 weeks of singleton pregnancy after IVF is significantly higher than in women with natural conception. The highest rates were in the group after combined infertility. Conclusions. The level of hormones: estradiol and progesterone in pregnant women after IVF at 7–10 weeks was higher than in women with a history of infertility during natural conception. Already at 11–14 weeks, the same indicators in the same groups did not differ. After natural conception, the rate of increase in estradiol significantly outpaced the increase in progesterone levels in pregnant women with a history of infertility. The concentration of PAPP-A in the first trimester in pregnant women after IVF did not significantly differ from those in women with natural conception. The content of β-hCG at 11–14 weeks in groups of pregnant women after IVF was 1.5–2 times higher. The highest rates were in pregnant women with a history of concomitant infertility. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: estradiol, progesterone, β-hCG, PAPP-A, pregnancy after infertility.

scholarly journals Biochemical Markers for Prediction of Pregnancy Outcome in Cases of Recurrent Pregnancy Loss

2021 ◽  
Vol 5 (1) ◽  
Keyword(s):  
Pregnant Women ◽  
Pregnancy Outcome ◽  
Pregnancy Loss ◽  
Recurrent Pregnancy Loss ◽  
First Trimester ◽  
Serum Progesterone ◽  
Study Results ◽  
Routine Basis ◽  
History Of ◽  
Β Hcg

Objective: To predict pregnancy outcome by studying the relation between serum βHCG, progesterone and CA125 and the occurrence of miscarriage in the first trimester, in cases with history of recurrent pregnancy loss. Methods: Serum βHCG, progesterone and CA125 levels in fifty pregnant women with history of recurrent pregnancy loss were compared to 50 pregnant women with no history of abortion, and to another group of women (No=50) who failed to complete the 1st trimester of pregnancy during the study. Results: Serum B-hCG showed a sensitivity of 100%, a specificity of 50%, a PPV of 50% and a NPV of 100%. Serum progesterone showed a sensitivity of 24%, a specificity of 73%, a PPV of 55.07% and a NPV of 85.18%, while serum CA125 showed a sensitivity of 15.6%, a specificity of 58.59%, a PPV of 16.32% and a NPV of 57.42%. Conclusion: The value of CA125 in recurrent abortions is still unclear and cannot recommended on routine basis. On the other hand, β-HCG is highly sensitive as a single serum measurement for the prediction of pregnancy outcome.

scholarly journals Ectopic pregnancy in a tertiary care centre of Jharkhand, India

2019 ◽  
Vol 8 (8) ◽  
pp. 2969
Author(s):  
Meetali Parashar ◽  
Meena Mehta
Keyword(s):  
Ectopic Pregnancy ◽  
Clinical Presentation ◽  
Previous History ◽  
First Trimester ◽  
Near Miss ◽  
Obstetrics And Gynaecology ◽  
Maternal Morbidity And Mortality ◽  
History Of ◽  
Β Hcg ◽  
A Prospective Study

Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions:Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.Background: Ectopic pregnancy is one in which the fertilized ovum is implanted and develops outside the endometrial cavity. It is an important cause of maternal morbidity and mortality in first trimester. The present study was conducted to study the risk factors, clinical presentation and management of ectopic pregnancy in RIMS, Ranchi, Jharkhand, India.Methods: This was a prospective study conducted in the department of obstetrics and gynaecology, RIMS, Ranchi, Jharkhand during May 2017 to September 2018. A total of 90 cases were included in the study.Results: 80% of the patients presented with amenorrhoea, 98% had abdominal pain and 69% had vaginal bleeding. Ultrasonography revealed hemoperitoneum in about 93% patients. 16 (18%) patients had history of infertility whereas 10 patients (11%) had taken treatment of infertility.6 (7%) patients had history of STD or PID.14 (16%) had undergone bilateral tubectomy.2 (2%) had history of IUCD insertion and 12 (13%) patients had undergone previously lscs. 54 patients (60%) had undergone D and C and 6 patients (7%) had a previous history of ectopic pregnancy. 68 (76%) underwent only salpingectomy.12 (13%) had salpingo-oophorectomy and 10 (11%) had salpingectomy with contralateral tubectomy.Conclusions: Diagnosis of ectopic pregnancy requires clinical suspicion and supportive investigations like UPT, ultrasonography, β HCG and laparoscopy. It is an important cause of admission to RIMS as maternal near miss cases.

scholarly journals Serum adipocytokines and adiposity as predictive indices of preeclampsia

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Ahmed Tijani Bawah ◽  
Francis Agyemang Yeboah ◽  
Salifu Nanga ◽  
Huseini Alidu ◽  
Robert A. Ngala
Keyword(s):  
Family History ◽  
Pregnant Women ◽  
Heart Association ◽  
Hdl Cholesterol ◽  
First Trimester ◽  
Anthropometric Parameters ◽  
Family History Of Diabetes ◽  
Receiver Operating Characteristic Curves ◽  
Significant Difference ◽  
History Of

Abstract Background This study was aimed at determining the levels of serum adiponectin, leptin, resistin, visfatin and lipids during the first trimester in pregnant women and to evaluate the relationship between these biochemical markers and preeclampsia (PE). Available evidence point to changes in the levels of these adipokines in PE hence this study examined the potential of using these biomarkers in the prediction of the disease. Methods This was a case-control study which compared first trimester serum biochemical and anthropometric parameters in pregnant women who subsequently developed PE and those who did not. Blood pressure and urine protein were determined after 20 weeks of gestation and diagnosis of PE performed according to the guidelines of the American Heart Association. Results There was no significant difference (p > 0.05) in the lipid profile with the exception of HDL cholesterol which was significantly lower (p = 0.043) in the PE group compared to the normotensive group. There were, however, significant differences (p <  0.05) in the adipokines between the PE group and those without PE. Analyses of area under the receiver operating characteristic curves (AUCs) for the adipokines, showed their ability to correctly predict PE even after controlling for body mass index (BMI) and family history of hypertension. Conclusion Adiponectin, leptin, resistin and visfatin were found to be significant predictors of PE, with resistin being the best predictor after controlling for BMI. However, adiponectin was the best predictor after controlling for BMI, age, parity and family history of diabetes and preeclmapsia.

scholarly journals Prevalence of pre-gestational diabetes among the antenatal women attending a tertiary care center

2017 ◽  
Vol 6 (3) ◽  
pp. 797 ◽  
Author(s):  
Renji S. R. ◽  
Sujatha Thankappan Lekshmi ◽  
Nirmala Chellamma
Keyword(s):  
Gestational Diabetes ◽  
Pregnant Women ◽  
Statistical Tests ◽  
Care Center ◽  
Tertiary Care ◽  
First Trimester ◽  
Adverse Outcomes ◽  
Tertiary Care Center ◽  
Family History Of Diabetes ◽  
History Of

Background: Number of pregnant women with preexisting diabetes is increasing. Hence the detection and management of diabetes from the beginning of pregnancy itself will help to improve the fetal and maternal outcome. Aim of the study was to determine the prevalence of pre-gestational diabetes among the antenatal women attending a tertiary care center and to study the associated factors.Methods: This was a cross sectional study conducted in SAT hospital, Government Medical College, Trivandrum, Kerala, India for one year. HbA1C was the test used to diagnose diabetes. 400 women attending the OP in their first trimester were selected after informed consent. Socio demographic factors assessed by a structured questionnaire.  Blood samples were taken for HbA1C. Diagnosis of diabetes was made at levels of HbA1C ≥6.5%. Statistical tests used were mean, standard deviation, chi-square and odds ratio.Results: Prevalence of pre-gestational diabetes was 3.8%.in our study. Main associations were age more than 25 years, body mass index, family history of diabetes, history of intra uterine death, gestational diabetes in previous pregnancy, candidiasis and thyroid disease.Conclusions: Screening of all pregnant women in first trimester itself for diabetes will help in early detection of pre-gestational diabetes, so that anticipation of adverse outcomes and proper management can be done in such cases.

scholarly journals DETECTION OF HYPOTHYROIDISM IN EARLY PREGNANCY: UNIVERSAL SCREENING

2020 ◽  
pp. 1-4
Author(s):  
Manpreet Kour ◽  
Taranjeet Kour
Keyword(s):  
Pregnant Women ◽  
Previous History ◽  
First Trimester ◽  
Normal Serum ◽  
Systemic Review ◽  
Overt Hypothyroidism ◽  
Endocrine Disorders ◽  
History Of ◽  
Adverse Pregnancy ◽  
Hypothyroid Patients

Background: Thyroid dysfunction is one of the most common endocrine disorders in women of childbearing (1), second only to diabetes mellitus.The aim of this systemic review was to determine whether an increased maternal TSH level and normal serum T4 levels, as seen in SCH, could also be associated with pregnancy complications. Methods: This study was conducted in Nobel hospital,Pune January 2015 to July 2016 in all the pregnant women attending antenatal clinic in their first trimester of pregnancy. Data was collected on a pre-designed, pre-tested study proforma which includes socio-demographic information of patients, detailed clinical history and examinations of pregnant women and babies. Blood samples were taken under all aseptic precautions and were sent to laboratory of the institute for routine investigations and thyroid profile. Patients were followed up till delivery and babies were followed up till discharge from the hospital. Results:This study was conducted in 220 patients in obstetrics and gynaecology department in Noble Hospital, Pune. Out of 220 cases,198 cases were euthyroid, 13 cases were subclinical hypothyroid and 9 cases were overt hypothyroid. Hypothyroidism was found in 22(10%) of pregnant women in their first trimester. Out of which, 13(5.91%) had subclinical hypothyroidism and 9(4.09%) had overt hypothyroidism. Majority of the patients 45.45% were in age group of 26-30years. 90.91% of hypothyroid patients had regular cycles and 9.09% had irregular cycles. Hypothyroidism was equally distributed between primi and multigravida patients. 31.82% of hypothyroid patients had previous history of abortions and 68.18% had no such history.18.18% of hypothyroid patients had history of infertility and 31.82% had no history of infertility. Anti-TPO was present in 9.09% and none of euthyroid patients. Maternal and Fetal complications were found more in hypothyroid patients than euthyroid patients. Conclusion: Most of the patients in our study who have subclinical thyroid disease are asymptomatic, so screening is the most convenient method to identify such patients. Follow-up of abnormal TSH values with FT3 and FT4 may yield valuable results which could enable us for therapeutic intervention and may go a long way in preventing adverse pregnancy outcomes.

scholarly journals The Role of Routine Ultrasonography in the First Trimester of Pregnancy

2021 ◽  
pp. 950-958
Author(s):  
T. Saravanan ◽  
Hephzibah Kirubamani
Keyword(s):  
Pregnant Women ◽  
First Trimester ◽  
Antenatal Clinic ◽  
Specific Method ◽  
Medical College ◽  
Early Pregnancy Failure ◽  
Ultrasound Findings ◽  
History Of ◽  
First Trimester Of Pregnancy

Introduction: In the early stages of pregnancy, ultrasound is an extremely specific method for examination. This article reviews how the normal development of a baby in the first trimester of pregnancy relates to ultrasound findings. Aim: To highlight the importance of routine ultrasonography in the first trimester of pregnancy in detecting and dating gestation, its viability and early detection of anomalies and complications Methods: This descriptive study involved 100 pregnant women within 12 weeks of gestation attending antenatal clinic at Saveetha Medical college, during the study period Inclusion Criteria: Pregnant women with history of amenorrhea <12 weeks of gestation. Exclusion criteria: Individuals with history of pain abdomen and bleeding per vaginum Results: A total of 99 pregnancies were intrauterine of which 1 was anembryonic and 2 had early pregnancy failure, 15 pregnancies were redated. One ectopic and one fibroid complicating pregnancy were aslo found. Conclusion: Ultrasonography is an effective method to detect and date pregnancy, identify nonviable pregnancies, fetal abnormalities and early trimester complications. Hence it is ideal to use it routinely as screening tool during the first trimester of pregnancy.

scholarly journals Serum Magnesium Levels among Pregnant Women with and without Complications: A Cross-sectional Study

2020 ◽  
Author(s):  
Santhini Gopalakrishnan Sethulekshmi ◽  
S Sumathy ◽  
Banani Dutta
Keyword(s):  
Pregnant Women ◽  
Magnesium Deficiency ◽  
Serum Magnesium ◽  
First Trimester ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Significant Difference ◽  
History Of ◽  
Student’S T

Introduction: Pregnancy is a period that is characterised by remarkable physiological changes which are needed to support the growing fetus. Micronutrients play a crucial role in the maintenance of pregnancy. Among the micronutrients, magnesium has got ample amount of clinical relevance to pregnancy. Magnesium deficiency has been associated with reproductive risk during pregnancy such as anaemia, pre-eclampsia, eclampsia, fetal growth retardation, preterm labour, low intrauterine growth rate and leg cramps. Aim: To find out whether there was significant difference in the magnesium levels among pregnant women with and without pregnancy related complications and also to find out whether the magnesium levels differed significantly among the three trimesters. Materials and Methods: This was a cross-sectional study done among 240 pregnant patients from different trimesters attending the Obstetrics and Gynaecology Outpatient Department. Out of them 164 women had complications like pre-eclampsia, Gestational Diabetes Mellitus, leg cramps and history of abortions. Demographic details were obtained from all the women. BMI was calculated for each subject using the formula BMI=weight(kg)/height(m2). Haemoglobin was assessed in all samples using cyanmethaemoglobin method. Magnesium levels were analysed in the all samples using automated analyser in the Biochemistry laboratory. Student’s t-test was used to compare the levels of magnesium among the groups with and without complications. ANOVA test was used to compare the three trimesters. Results: The pregnant women were divided into three groups based on the different trimesters in which the samples were taken. Magnesium levels among the women in the first trimester were (2.96±0.83) second trimester (2.99±1.48) and third trimester (3.05±1.48) respectively. Women with previous abortions were found to have less magnesium levels (2.71) compared to women without a history of abortion (3.11) and value was found to be statistically significant (p<0.007) and magnesium levels among vegetarians (2.45) were lower than non vegetarians (3.08) and it was found to be statistical significant (p<0.013). There was no significant difference in the magnesium levels among pregnant women with complications and those without complications. Conclusion: The study shows the importance of maintaining the magnesium levels among pregnant women. There was no difference in the magnesium levels among the three trimesters. Study also points out the influence of parity, diet and occupation of pregnant women on the levels of magnesium.

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