scholarly journals PREVENTION OF PREECLAMPSIA IN WOMEN WITH MULTIPLE PREGNANCY AFTER ASSISTED REPRODUCTION

2020 ◽  
Vol 73 (3) ◽  
pp. 494-497
Author(s):  
Tamara G. Romanenko ◽  
Olha M. Sulimenko
Keyword(s):  
Pregnant Women ◽  
Biochemical Markers ◽  
Preventive Measures ◽  
Risk Group ◽  
Plasma Concentrations ◽  
Multiple Pregnancy ◽  
Perinatal Outcomes ◽  
High Risk Group ◽  
Prospective Analysis ◽  
Second Trimester

The aim: To reduce the frequency and severity of preeclampsia, to improve obstetrical and perinatal outcomes in women with multiple pregnancy after assisted reproduction by the development and implementation of the preventive algorithm with biochemical markers of endothelial dysfunction prospective analysis. Materials and methods: Clinical and laboratory prospective analysis of 54 cases of twins in women, treated from infertility with assisted reproductive technologies (ART), using the method of intracytoplasmic sperm injection (ICSI) and frozen embryos transfer, have been made. It was proven, that women with multiple pregnancy are always in a high risk group of placental dysfunction (PD) and preeclampsia (PE). Depending on the treatment algorithm and preventive measures, 2 groups of patients were formed. Group I included 29 pregnant women with twins, managed in accordance with developed recommendations. We didn’t find evidence-based European guidelines, that would recommend routine prescription of progesterone to improve chorion invasion and further placentation in such group of patients, but in order to prevent endothelial dysfunction and to decrease the incidence and severity of preeclampsia, placental abnormalities and intrauterine growth restriction (IUGR), we proposed the following algorithm: – micronized progesterone 200 mg vaginally (PV), as soon as pregnancy was diagnosed by positive hCG-test, till 16 weeks of pregnancy, angioprotector diosmin 600 mg once daily orally (PO), 2 courses: from 8 till 12 and from 16 till 20 weeks of gestation, antiaggregant – acetylsalicylic acid 150 mg from 12 till 36 weeks of gestation. Group II included 25 pregnant women with twins after the same ART procedures, who have not received above mentioned treatment. Plasma concentrations of PlGF, sFlt-1 and the ratio of sFlt-1/PlGF in the second trimester were investigated in both groups of women in order to assess the effectiveness of proposed preventive measures. Results: Usage of preventive algorithm has shown the reduction of PE incidences in 26%, PD in 28.1%, IUGR in 35%, prematurity by 23% and fetal distress in 18%, that led to improvement of obstetrical and perinatal outcomes in I group of women with multiple pregnancies after ART-treated infertility, compared with group II (p<0.05). The evaluation of PlGF, sFlt-1 plasma concentrations and the ratio of sFlt-1/PlGF in the second trimester of pregnancy reflected the effectiveness of our method in women with twins after ART. The level of PlGF in the study group was higher (186.5 ± 12 vs 154.2 ± 10.7; p<0.05), and the level of sFlt-1 was lower (1523.1 ± 40.3 vs 1835.3 ± 33.6; p <0.05). Results of sFlt-1/PlGF ratio analysis in the I group also showed effectiveness of the method proposed (20.3 ± 3.1 vs 28.1 ± 2.2; p<0.05). Conclusions: The observed results suggest, that pregnant women with twins after ART-treated infertility are in a high-risk group of PE, PD and IUGR of one or both fetuses. Implementation of the proposed preventive algorithm allows to reduce the incidence of PE, obstetrical and perinatal complications in this group of patients, and can be widely used in clinical practice. Evaluation and prospective assessment of biochemical markers, such as PlGF, sFlt-1 and sFlt-1/PIGF ratio, in the second trimester of pregnancy in the target groups may likely predict the development of PE and its severity.

The Value of Ultrasonography Screening Trisomy 21 during the Second and Third Trimesters of Gestation

2014 ◽  
Vol 668-669 ◽  
pp. 1581-1584
Author(s):  
Yu Ping Pan
Keyword(s):  
Prenatal Diagnosis ◽  
Pregnant Women ◽  
Trisomy 21 ◽  
Detection Rate ◽  
Risk Group ◽  
Late Pregnancy ◽  
High Risk Group ◽  
Age Group ◽  
Second Trimester ◽  
The Relationship

Objective To investigate the value of ultrasonography screening trisomy 21during the second and third trimesters. Methods Amniocentesis and cordocentesis were performed on 3110 and 187pregnant women respectively with indications for prenatal diagnosis to detect karyotype of the fetus during second trimester and late pregnancy, The detection rate of trisomy 21 was compared in pregnant women of different indications. To analyze the relationship between the ultrasonography abnormalities and trisomy 21. Results In chromosomal karyotypes analysis of 3110 pregnant women by amniocentesis, 41 trisomy 21 were detected, The detection rate of trisomy 21 was 1.32%. There were 98 in 3110 pregnant women with ultrasonography abnormalities, 6 trisomy 21 were found within them and the detection rate was 6.12%, the detection rate of trisomy 21 detected by ultrasound (6.12% ) was higher than the Down,s syndrome high risk group (0.98%), advanced age group (0.58%) Within 187 pregnant women of chromosomal karyotypes analysis by cordocentesis, 9 trisomy 21 were detected and the detection rate of trisomy 21 was 4.81% . There were 128 in 187 pregnant women with ultrasonography abnormalities, 5 trisomy 21 were found within them and the detection rate of trisomy 21 was 3.91% . (P<0. 05). Conclusions During the second and third trimesters, ultrasonography has great value .

Does Active Smoking Influence the Second Trimester Biochemical Markers Concentrations?

2017 ◽  
Vol 68 (10) ◽  
pp. 2234-2236
Author(s):  
Dan Navolan ◽  
Florin Birsasteanu ◽  
Adrian Carabineanu ◽  
Octavian Cretu ◽  
Diana Liana Badiu ◽  
...  
Keyword(s):  
Pregnant Woman ◽  
Pregnant Women ◽  
Cigarette Smoke ◽  
Chorionic Gonadotropin ◽  
Reference Values ◽  
Biochemical Markers ◽  
Smoking Status ◽  
Active Smoking ◽  
Second Trimester ◽  
Harmful Effects

Cigarette smoke contains over 7000 different substances some of them exerting harmful effects on embryo and pregnant woman. Nowadays 15 % of adult people and around 10-15% of pregnant women smoke. Previous studies showed that cigarette smoke compounds could exert pharmacodinamic effects and influence some of the second trimester biochemical markers concentration. Therefore there is a need to adjust the reference values of second trimester markers depending of the smoker status. The aim of our study was to analyse which of the markers are influenced by smoking and whether the software used to calculate the risk for aneuploidies is able to counterbalance this influence. Alpha-fetoprotein (AFP), chorionic gonadotropin hormone (hCG) and free estriol (uE3) values were measured in second trimester sera of 1242 pregnant women: 1089 non-smokers and 153 smokers. Only hCG second trimester values were influenced by smoking whereas AFP and uE3 values were not. The correction of medians according to the smoking status was able to counterbalance this effect.

Is there a Need for Own Median Calculation in the Second Trimester Biochemical Markers Screening?

2017 ◽  
Vol 68 (5) ◽  
pp. 1070-1072
Author(s):  
Dan Navolan ◽  
Mirela Nicolov ◽  
Simona Vladareanu ◽  
Ioana Ciohat ◽  
Marius Craina ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Gestational Age ◽  
Biochemical Markers ◽  
Biochemical Marker ◽  
Second Trimester ◽  
Established Method ◽  
Crown Rump Length ◽  
The Difference ◽  
Fetal Aneuploidies ◽  
Singleton Pregnancies

Screening of fetal aneuploidies in early pregnancy is a well-established method in the materno-fetal medicine. The aim of our study was to analyze if the medians recommended by the manufacturers are adequate to perform an accurate screening or if there is a need for own laboratory medians calculation in second trimester biochemical marker screening.Sera were collected between 14 wp and 22 wp from 3374 singleton pregnancies. We analyzed three second trimester biochemical markers (AFP, hCG and free Estriol) concentration in all pregnant women and in a subgroup of pregnant women in which gestational age was determined based on crown-rump length. Our results showed that for all biochemical markers the difference between the manufacturer and the own calculated median was lower than 10% excepting the hCG value in the group of pregnant women in which the gestational age was determined on basis of crown-rump-length. Our results show it is recommended to replace the values of the median for hCG measurement with the own laboratory calculated medians. This does not seem to be necessary in the case of AFP and free Estriol measurement.

scholarly journals Sertraline concentrations in pregnant women are steady and the drug transfer to their infants is low

2021 ◽  
Author(s):  
E. Heinonen ◽  
M. Blennow ◽  
M. Blomdahl-Wetterholm ◽  
M. Hovstadius ◽  
J. Nasiell ◽  
...  
Keyword(s):  
Cord Blood ◽  
Pregnant Women ◽  
Plasma Concentrations ◽  
Relative Difference ◽  
Interindividual Variation ◽  
Therapeutic Drug ◽  
Cytochrome P450 Enzyme ◽  
Second Trimester ◽  
P450 Enzyme ◽  
Placental Passage

Abstract Purpose Sertraline, a selective serotonin reuptake inhibitor (SSRI), is one of the most commonly used antidepressant during pregnancy. Plasma sertraline concentrations vary markedly between individuals, partly explained by variability in hepatic drug metabolizing cytochrome P450-enzyme activity. Our purpose was to study the variability in the plasma concentrations in pregnant women and the passage to their infants. Method Pregnant women with moderate untreated depression were recruited in 2016–2019 in Stockholm Region and randomized to treatment with sertraline or placebo. All received Internet-based cognitive behavior therapy as non-medical treatment. Sertraline plasma concentrations were measured around pregnancy weeks 21 and 30, at delivery, 1-month postpartum, in cord blood and at 48 h of age in the infant. The clinical course of the infants was followed. Results Nine mothers and 7 infants were included in the analysis. Median dose-adjusted sertraline concentration in second trimester was 0.15(ng/mL) /(mg/day), in third trimester and at delivery 0.19 and 1-month postpartum 0.25, with a 67% relative difference between second trimester and postpartum. The interindividual variation was 10-fold. Median concentrations in the infants were 33% and 25% of their mothers’, measured in cord blood, and infant plasma, respectively. Only mild and transient adverse effects were seen on the infants. Conclusion Placental passage of sertraline to the infant is low. However, the interindividual variation in maternal concentrations during pregnancy is huge, why therapeutic drug monitoring might assist in finding the poor metabolizers at risk for adversity and increase the safety of the treatment. Trial registration The trial was registered at clinicaltrials.gov July 9, 2014 with TRN: NCT02185547.

scholarly journals Screening for Coxiella burnetii infection during pregnancy: pros and cons according to the Wilson and Jungner criteria

2012 ◽  
Vol 17 (3) ◽  
Author(s):  
J M Munster ◽  
L M Steggerda ◽  
A C Leenders ◽  
J G Aarnoudse ◽  
E Hak
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Coxiella Burnetii ◽  
Q Fever ◽  
Risk Group ◽  
High Risk Group ◽  
Routine Screening ◽  
Maternal Complications ◽  
Clinical Consequences ◽  
Pros And Cons

In Europe the incidence of human Q fever has dramatically increased over the previous years. Untreated infections with Coxiella burnetii, the causal agent of Q fever, have been associated with both obstetric and maternal complications. The majority of pregnant women with a C. burnetii infection remain asymptomatic, hence screening could be of value to prevent unwanted outcomes in this high-risk group. We applied the updated Wilson and Jungner criteria to review the evidence for routine screening for C. burnetii infection during pregnancy. Since much uncertainty remains about the incidence, clinical consequences, diagnostics and treatment of C. burnetii infection during pregnancy, routine screening for C. burnetii infection during pregnancy should not be recommended. Rigorous studies to assess the effectiveness of C. burnetii screening are warranted.

scholarly journals The Effect of Down Syndrome Biochemical Markers on Predicting Severity of Preeclampsia

2020 ◽  
Author(s):  
AYSE OZBAN
Keyword(s):  
Down Syndrome ◽  
Pregnant Women ◽  
Biochemical Markers ◽  
First Trimester ◽  
Maternal Serum ◽  
Screening Tests ◽  
Second Trimester ◽  
Study Results ◽  
Second Trimester Screening ◽  
Trimester Screening

Abstract Objective: This study aims to determine whether it is possible to predict preeclampsia by comparing postpartum results and test results of the pregnant women diagnosed with preeclampsia, whose first and/or second trimester screening tests were accessible, and to demonstrate the predictability of severity and week of onset.Background: 204 patients underwent renal transplantation in our center and 84 of them were female. Five of our patients (one of them had two births) gave birth to a total of 6 pregnancies.Method: 135 patients were diagnosed with preeclampsia and their first and/or second trimester screening tests were accessible, and 366 control participants gave birth to a healthy baby between 37-41 weeks after standard follow-up period for pregnancy and their screening tests were also accessible.Results: The study results show that the first trimester maternal serum PAPP-A level is significantly low in preeclamptic pregnant women, and that the second trimester maternal serum AFP and hCG levels are significantly high and uE3 levels are significantly low The results also suggest that the first and second trimester Down syndrome biochemical markers can be used in preeclampsia screening.Conclusion: Among these markers, uE3 is the parameter which affects the possibility of preeclampsia the most. However, the first and second trimester Down syndrome biochemical markers are not effective in predicting the severity and onset week of preeclampsia.

scholarly journals Arrangement of risk group with congenital fetus pathology using artificial neural nets

2003 ◽  
Vol 2 (2) ◽  
pp. 103-109
Author(s):  
O. S. Philippov ◽  
A. A. Kazantseva
Keyword(s):  
Pregnant Women ◽  
Risk Group ◽  
Pregnancy Termination ◽  
Maternal Serum ◽  
High Risk Group ◽  
Neural Nets ◽  
Congenital Defects ◽  
Artificial Neural Nets ◽  
Artificial Neural ◽  
Numeric Scale

The aim of the study is the evaluation of the significance of various risk factors for congenital fetus pathology (congenital defect – CD) and the development of risk numeric scale. 424 pregnant women with fetus CD and 520 pregnant women with fetus without congenital defects have been examined. Artificial neural nets have been used for investigation how various factors effect on pregnancy termination. It has been found that the important factors for congenital fetus defect risk are: age younger 18 years of an pregnant women, age older 35 years, noncarring of pregnancy in anamnesis, complicated clinical course of the first pregnancy trimester, CD cases in a family, ultrasonic markers of chromosome pathology in the first pregnancy trimester. Changes in maternal serum AFP, hCG and uE3 levels and blood flow disorders are important to forming high risk group. A numeric scale for CD risk has been developed on the basis of neuronic net analysis.

scholarly journals The frequency of postpartum hemorrhage in women with different somatotypes

2019 ◽  
Vol 10 (1) ◽  
pp. 37-41
Author(s):  
Sergey N. Gaidukov ◽  
Kristina G. Tomaeva ◽  
Elena N. Komissarova
Keyword(s):  
Postpartum Hemorrhage ◽  
Preventive Measures ◽  
Risk Group ◽  
First Trimester ◽  
High Accuracy ◽  
High Risk Group ◽  
Body Type ◽  
Effective Implementation ◽  
Postpartum Bleeding ◽  
First Trimester Of Pregnancy

The aim of the study was to study the frequency of postpartum hemorrhage in women with different somatotypes and to develop a method for predicting the risk of this pathology. Materials and methods. 390 women were examined, 110 were mаcrosomatotype, 173 – mesosomatotype, and 107 – microsomatotype. Somatometry was performed according to R.N. Dorokhov for women in early pregnancy (before 9-10 weeks of gestation). Results. It was found that postpartum hemorrhage was significantly more prevalent among the women of macro-and microsomatic body type compared with women with mesosomatotypes (p < 0.05). In the course of multiple regression analysis, we obtained a regression equation (formula) for predictive models, which predicts the development of postpartum hemorrhage in women of different somatotypes. The calculations according to the presented formula, allows to predict with high accuracy the prognosis of postpartum bleeding, and also allows to form among patients a high-risk group for the development of this disease in the first trimester of pregnancy when the pregnant woman is registered in the women’s consultation, long before delivery, which will contribute to more effective implementation of therapeutic and preventive measures to prevent the development of postpartum bleeding.

scholarly journals Cohort profile: targeted antenatal screening for haemoglobinopathies in Basel

BMJ Open ◽  
2020 ◽  
Vol 10 (7) ◽  
pp. e035735
Author(s):  
Gabriela Amstad Bencaiova ◽  
Franziska Geissler ◽  
Irene Hoesli
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
Risk Group ◽  
Iron Status ◽  
First Trimester ◽  
High Risk Group ◽  
University Hospital ◽  
Pregnancy Cohort ◽  
Haemoglobin Variant ◽  
Adverse Pregnancy

PurposeThe pregnancy cohort was established to examine the prevalence and variety of haemoglobinopathies in a high-risk group of pregnant women.ParticipantsThe pregnancy cohort is located in the Department of Obstetrics and Antenatal Care, University Hospital of Basel. The pregnant women were recruited in the first trimester between June 2015 and May 2019. Family origin questionnaires were used to screen pregnant women for the risk of a haemoglobin variant. Based on the questionnaire, pregnant women were divided into two groups: women with a high risk and women with a low risk of a haemoglobin variant. In women with a high risk, red blood cell indices, iron status and chromatography were conducted.Findings to date1785 pregnant women were recruited. Out of the 1785 women, 929 were identified as a part of the high-risk group. Due to the missing data of 74 pregnant women with a high risk, the final analysis was conducted in the remaining 855 women. The prevalence of haemoglobinopathies in the high-risk group was 14.5% (124/855).Future plansThis cohort will be used to: (1) implement the screening in prenatal care in Basel; (2) recommend the screening among pregnant women with a high risk of a haemoglobin variant in Switzerland; (3) improve prenatal and neonatal care in patients with a haemoglobin variant; (4) examine adverse pregnancy outcomes in women with a haemoglobin variant and (5) reduce maternal and neonatal morbidity and mortality in the future.Trial registration numberClinicalTrials.gov Registry (NCT04029142).

Safety and Efficacy of Low-Molecular-Weight Heparin in Pregnant Women at Increased Risk of Venous Thromboembolism: A Prospective Stratified Multicentre Trial.

Blood ◽  
2006 ◽  
Vol 108 (11) ◽  
pp. 715-715
Author(s):  
Rupert M. Bauersachs ◽  
Joachim Dudenhausen ◽  
Andree Faridi ◽  
Thorsten Fischer ◽  
Samson Fung ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Pregnant Women ◽  
Risk Group ◽  
High Risk Group ◽  
Group Iii ◽  
Group I ◽  
Increased Risk ◽  
At Deficiency ◽  
Group Ii ◽  
Heparin Prophylaxis

Abstract Women with a history of VTE, thrombophilia or both are at increased risk for VTE during pregnancy, but the optimal management strategy, and the need for thromboprophylaxis is not well defined in clinical guidelines because of limited trial data. The EThIG (Efficacy of Thromboprophylaxis as an Intervention during Gravidity) is a multicenter trial that prospectively enrolled 810 pregnant women at risk of VTE. Women were assigned to one of 3 management strategies: Low risk group I (including women with prior secondary VTE, or asymptomatic thrombophilia) with “watchful waiting” management, and dalteparin prophylaxis postpartum (50–100 IU/kg), or earlier if additional risk factors occurred; high risk group II (e.g. idiopathic VTE or symptomatic thrombophilia) receiving 50–100 IU/kg dalteparin; and very high-risk group III (e.g. acute VTE, prior long-term OAC, symptomatic AT-deficiency or antiphospholipid syndrome), receiving 100–200 IU/kg dalteparin. Primary efficacy outcome measure was symptomatic VTE, main safety outcome measures were haemorrhages, osteoporosis, thromboctopenia and pregnancy outcome. Results (mean ± SD / 95% CI): 810 women (age 30.8±5.4 years, weight 73.6±16.1kg) were enrolled, 28 % in group I, 58 % in II and 14% in III, including 66 women with acute VTE. 60.1% had prior VTE, 75.4% had thrombophilia (42.1 % FV-Leiden, 2.1 % homozygous, 9.5 % FII G20210A, 4.1% PC-, 1 % AT-deficiency; 17.4 % APS). 35.8 % had previous miscarriage, still birth or physical malformation. Comorbid conditions included lupus erythematosus, liver transplantation, ventricular septum defect, paraplegia, hepatitis C, nephrotic syndrome, asthma, chronic haemolytic anaemia, thalassaemia, osteoporosis and thrombocytopaenia. Median treatment initiation was at 17.0 weeks, at 24.0 weeks in group I, 14.5 weeks in group II and 16.0 weeks for group III. Mean daily dose was 66.2 ± 22.5 IU per kg (group I), 76.8 ± 24.1 IU per kg (group II) and 120.0 ± 49.1 IU per kg (group III). Objectively confirmed, symptomatic VTE occurred in 5 of 810 women (0.6%;0.2–1.5%). The rate of serious bleeding was 3.0% (1.9–4.4%), 0.9% (0.3–1.8%) occurred in the antepartum period, 2.1% (1.3–3.4%) peri-partum;1.1% (0.5–2.2%) was possibly heparin-related. There was no evidence of heparin-induced thrombocytopenia, and one case of osteoporosis (fracture of the saccygous bone during delivery). There were 94.4% successful pregnancies, 40 foetuses (4.9%; 3.6–6.7%) were lost due to miscarriage, 7 due to elective termination. Risk-stratified heparin prophylaxis was associated with a low incidence of symptomatic venous thromboembolism and few clinically important adverse events. Antepartum heparin prophylaxis is warranted in pregnant women with prior idiopathic thrombosis or symptomatic thrombophilia.

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