scholarly journals OP0175 INTERNATIONAL MULTICENTRIC PROSPECTIVE STUDY ON PREGNANCY IN SYSTEMIC SCLEROSIS (IMPRESS-2)

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 105.1-105
Author(s):  
E. Tombetti ◽  
V. Ramoni ◽  
M. Betelli ◽  
Y. Allanore ◽  
M. Matucci Cerinic ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Twin Pregnancy ◽  
Gestational Hypertension ◽  
Immunosuppressive Agents ◽  
Growth Restriction ◽  
Controlled Study ◽  
Obstetric Outcomes

Background:Data about the obstetric outcomes of pregnant women with Systemic Sclerosis (SSc) mainly derive from retrospective studies. Moreover, little evidence is available to define if pregnancy impacts on SSc course and if children of SSc mothers have a normal post-natal development.Objectives:To assessed the obstetric, pediatric and rheumatologic outcomes of SSc pregnancies in a prospective controlled studyMethods:Prospective recruitment of three cohorts.1) 110 pregnant women with SSc.2) 218 control pregnancies without systemic autoimmune diseases3) 78 non-pregnant control SSc with a matching subject in cohort-1.SSc was characterized for disease activity, severity, cutaneous/organ involvement and therapy. Women and their offspring were followed until 21 months after enrollment (ie, 12 months after expected delivery).Results:Gestational and neonatal outcomesMiscarriages and fetal death occurred in 7% and 5% of SSc pregnancies. Compared to control pregnancies, SSc pregnancies had higher rates of gestational hypertension (12% Vs 4%, p=0.004), pre-eclampsia (9% Vs 1%, p=0.002), fetal growth-restriction (13% Vs 4%, p=0.004), prematurity (26% Vs 7%, p<0.001) and cesarean section (52% Vs 4%, p=0.002). Newborns from SSc mothers weighted less (2773 Vs 3243g, p<0.001), were more frequently small for gestational age (SGA, 18% Vs 12%, p=0.05) and required neonatal-intensive care unit (ICU) more frequently (12% Vs 1%, p<0.001). Rates of newborn malformation/death, and one year-pediatric outcomes were similar.Univariate and multivariate analyses were performed for relevant outcomes. For example, pre-eclampsia positively associated with baseline skin score and its evolution during pregnancy (p=0.015 and 0.013), immunosuppressive agents, bosentan and iloprost at baseline (p=0.001, 0.041 and 0.007), and twin pregnancy(p=0.006). Multivariate logistic regression for pre-eclampsia in SSc identified baseline arterial hypertension, immunosuppressive agents or of iloprost, twin pregnancy and assisted conception as risk factors (p=0.000, 0.002, 0.0025, 0.000 and 0.027), and baseline calcium channel blockers as protective factors (p=0.001).SSc course during pregnancyAs compared to matched non-pregnant SSc, SSc pregnant women had lower Medsger disease severity index (0.6 +/-0.9 Vs 1.0 +/-1.1, p=0.022), health assessment questionnaire (HAQ, 0.21 +/-0.38 Vs 0.40 +/-0.55, p=0.026), and lower rate of iv iloprost (21% Vs 42%, p=0.006). Pregnant and non-pregnant SSc women had a similar disease course during the 21 months of follow-up, despite a lower use of immunosuppressive agents (17% Vs 36%, p=0.014). Two scleroderma-renal-crises (SRC) occurred during pregnancy (one was a relapse of a previous SRC; the other occurred at week 33, and resolved after premature delivery of a SGA newborn and ACE-inhibitors, preventing differentiation from pre-eclampsia).Conclusion:SSc pregnancies have generally a favorable obstetric/pediatric outcome, albeit at a higher risk of gestational hypertension, pre-eclampsia, fetal growth restriction, prematurity, delivery of SGA newborn and requirement of neonatal-ICU. Pregnancy does not impact on SSc course, although SRC during late pregnancy and pre-eclampsia might be hardly discriminated.References:[1]Taraborelli M et al., Arthritis Rheum, 2012.Disclosure of Interests:None declared

Prevention of placental pathology in the second trimester in pregnant women at risk

2021 ◽  
Vol 20 (3) ◽  
pp. 76-84
Author(s):  
N.A. Cherepanova ◽  
◽  
R.S. Zamaleeva ◽  
A.V. Frizina ◽  
E.Yu. Yupatov ◽  
...  
Keyword(s):  
At Risk ◽  
Vitamin D ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Gestational Hypertension ◽  
Growth Restriction ◽  
Second Trimester ◽  
Placental Pathology ◽  
Omega 3

Objective. To justify drug-based preventive treatment in the second trimester of pregnancy in women at risk of developing placental pathology in order to reduce the incidence of adverse perinatal outcomes. Patients and methods. A comprehensive analysis of the course and outcomes of pregnancies in 598 women was carried out. Each pregnant woman at 11-13 weeks was assigned to a low-, moderate- or high-risk group of developing placental pathology with the use of designed scale. In the main group, 299 pregnant women did not receive medications in the second trimester, and 299 patients in the comparison group, who were selected by matching method (copy-pasted pairs), if there was a risk in the second trimester, received treatment including micronized progesterone, vitamin D, omega-3 polyunsaturated fatty acids, magnesium citrate and in case of medical indications – antiplatelet agents and anticoagulants. In risk groups, dynamic cardiotocography (CTG) was performed at 16 and 20 weeks on the General Meditech device. Results and conclusion. Administration of the recommended set of medicines in the second trimester made it possible to achieve a decrease in the incidence of pre-eclampsia by 2.9 times, gestational hypertension – by 2.4 times, disorders of the placental circulation – by 3.6 times, fetal growth restriction – by 2.4 times, neonatal morbidity – by 2.9 times. Carrying out a full complex of drug-based preventive measures in the second trimester of pregnancy had an effect on the CTG parameters, statistically significantly reducing the frequency of unfavorable prognostic factors at 20 weeks compared with the results at 16 weeks. Key words: vitamin D, fetal growth restriction, cardiotocography, placental pathology, pre-eclampsia, progesterone

FETAL GROWTH RESTRICTION WITH EARLY AND LATE MANIFESTATION, PROGNOSTIC MARKERS

2020 ◽  
pp. 27-30
Author(s):  
Yakubova D.I.
Keyword(s):  
Risk Factors ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Prenatal Screening ◽  
Prognostic Markers ◽  
Growth Restriction ◽  
Late Manifestation ◽  
Late Form ◽  
Early Manifestation

Objective of the study: Comprehensive assessment of risk factors, the implementation of which leads to FGR with early and late manifestation. To evaluate the results of the first prenatal screening: PAPP-A, B-hCG, made at 11-13 weeks. Materials and Methods: A retrospective study included 110 pregnant women. There were 48 pregnant women with early manifestation of fetal growth restriction, 62 pregnant women with late manifestation among them. Results of the study: The risk factors for the formation of the FGR are established. Statistically significant differences in the indicators between groups were not established in the analyses of structures of extragenital pathology. According to I prenatal screening, there were no statistical differences in levels (PAPP-A, b-hCG) in the early and late form of FGR.

scholarly journals Maternal plasma fetuin-A levels in fetal growth restriction: A case-control study

2019 ◽  
Author(s):  
Mujde Can Ibano ◽  
Cem Yasar Sanhal ◽  
Seval Ozgu-Erdinc ◽  
Aykan Yucel
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Plasma Levels ◽  
Case Control Study ◽  
Maternal Plasma ◽  
Case Control ◽  
Growth Restriction ◽  
Fetuin A ◽  
Control Study

Background: Higher Fetuin-A (FA) concentrations were found to be associated with obesity and there is an interest to the relation between maternal FA and pregnancy outcomes. Objective: In this study, our aim was to evaluate the association of maternal plasma levels of FA with fetal growth restriction (FGR). Materials and Methods: 41 pregnant women with FGR and 40 controls were recruited in this case-control study between July and November 2015. At the diagnosis of FGR, venous blood samples (10 cc) were obtained for FA analysis. Results: Maternal plasma FA levels were significantly higher in fetal growth-restricted pregnant women compared with controls (19.3 ± 3.0 ng/ml vs 25.9 ± 6.8 ng/ml, p = 0.001). Area under receiver operating characteristic curve analysis of FA in FGR was 0.815 (95% confidence interval (CI): 0.718-0.912, p < 0.001). The maternal FA levels with values more than 22.5 ng/ml had a sensitivity of about 73.17% (95% CI: 56.79- 85.25) and a specificity of about 82.5% (95% CI: 66.64-92.11) with positive and negative predictive values of about 81.08% (95% CI: 64.29-91.45) and 75% (95% CI: 59.35-86.30), respectively. Therefore, the diagnostic accuracy was obtained about 77.78%. Conclusion: The results of this study show higher maternal plasma levels of FA in FGR. Further studies are needed in order to demonstrate the long-term effects of FA in pregnancies complicated with FGR and early prediction of FGR.

scholarly journals Maternal Sildenafil vs Placebo in Pregnant Women With Severe Early-Onset Fetal Growth Restriction

2020 ◽  
Vol 3 (6) ◽  
pp. e205323 ◽  
Author(s):  
Anouk Pels ◽  
Jan Derks ◽  
Ayten Elvan-Taspinar ◽  
Joris van Drongelen ◽  
Marjon de Boer ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Growth Restriction

scholarly journals Predictive Value of Maternal Anemia in Cases of Fetal Growth Restriction

2021 ◽  
Vol 5 (06) ◽  
pp. 01-06
Author(s):  
Waleed M. Tawfik ◽  
Shaimaa R. Abdelmaksoud ◽  
Ghada M. Mahmoud
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Gestational Age ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Deficiency Anemia ◽  
Haematocrit Level ◽  
Maternal Anemia ◽  
Anemic Patient ◽  
Significant Difference

Anemia can be defined as a state of inadequate O2 delivery to tissues due to reduction of the O2 carrying capacity of blood practically, anemia is diagnosed when there is reduction in the hemoglobin concentration or haematocrit level below normal values. Iron deficiency anemia is a major public health problem among women of reproductive age in most of developing countries approximately 50% of pregnant women and 35% of non pregnant women are anemic. These nutritional disorders, has profound negative effects on pregnancy outcome, health of mothers and babies. The objective of this study: Is to evaluate the maternal anemia during pregnancy as a risk factor for fetal growth restriction. The study was done this study conducted on 120 pregnant women. Pregnant women with inclusion criteria: Singleton pregnancy, Gestational age more than 28 week and Hb level less than 10mg/dl. We exclude multiple pregnancy, Gestational age less than 28 week, Hb level more than 10 mg/dl and other medical disorder with pregnancy. The results of this study reveal the following: There was significant difference between group 1, 2, 3, 4 as regard to Hb level, (PCV), (MCV), (MCH), (MCHC), (Ht) and (CBC). The restriction of fatal growth was significant lower in sever anemic patient rather than mild or moderate anemic patient In conclusions: The result of this study shows that there was restriction of fatal growth was significantly high in sever anemic group than mild or moderate group also, incidence of low birth weight and risk of fatal morbidity or mortality was significantly high in sever anemic group than mild or moderate group.

scholarly journals FGR: Risk Factors and Outcomes

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
G M A Elbishry ◽  
R R Ali ◽  
R T Ramadan
Keyword(s):  
Risk Factors ◽  
Caesarean Section ◽  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Abdominal Circumference ◽  
Maternal Risk ◽  
The Mean ◽  
Estimated Fetal Weight

Abstract Background Fetal Growth Restriction (FGR) is the one of largest contributing factor to perinatal morbidity in non-anomalous fetuses and is associated with an increased risk of stillbirth, neonatal death and short and long-term complications. Fetal growth restriction (FGR) is defined as an estimated fetal weight and/or abdominal circumference (AC) is less than the10th percentile. In order to avoid these adverse outcomes, the management of pregnancies with FGR involves close monitoring of fetal well-being and early delivery when necessary. Screening for FGR during pregnancy is thus a central component of prenatal care, as highlighted in recent national guidelines, first-line tools include risk factor assessment at the beginning and during pregnancy. Hence, in this study we evaluated the maternal risk factors and diagnosis-delivery intervals and perinatal outcomes in FGR. Aim To determine the effect of specific antenatal FGR risk factors on fetal growth trajectory and the outcomes using threshold of estimated fetal weight (EFW) and abdominal circumference (AC) &lt;10th percentile. Methods Prospective observational analytical study was conducted in a tertiary care hospital in Cairo, Egypt on 100 pregnant women with documented fetal growth restriction attended Ain Shams University hospital over a period of 1 year and eight months. All fetuses considered as growth restrictions. Fetuses with multiple pregnancy, congenital malformation, chromosomal abnormality, and premature rupture of membrane were. Socio-demographic, maternal risk, Diagnosis- delivery interval in FGR and neonatal morbidities were studied. Results This study included 100 pregnant women with documented FGR fetuses, the mean maternal age at diagnosis was 28.6±2.7 years, the mean pregnant women weight at diagnosis was 72.7±5.1 (kg) with BMI range 25.6–29.8 (kg/m2) and their pregnancy weight gain was 12.0–25.0 (kg), 50 women used to consume caffeine more than 200 mg/day, and the percentage of nicotine exposure was 22% of total studied pregnants, 19 % were passive smokers and 3% of them were active. 73% were multigravida and the rest were primi-gravida, the mean inter-pregnancy interval was 17.3±4.7 months. Obstetric history of Previous placental mediated diseases included (prior FGR, previous intrauterine fetal death (IUFD), Pre-eclampsia and un-explained antepartum hemorrhage) were distributed as follows 16.0%, 6.0%, 12.0% and 2.0% respectively. Also we found 2.0% had an in vitro fertilization (IVF) and 26 women got regular antenatal care (ANC). At the end of our study 45% of fetuses were delivered at completed 37 weeks and 55% showed pre-term delivery (before 37 weeks). 95% of total were delivered by caesarean section. The indications for caesarean section were different. So, among 100 FGR fetuses, 35 fetus had abnormal Doppler pattern which considered the main indication for termination of pregnancy, the most frequent one was absent/reversed ductus venosus Doppler which was the cause of preterm immediate caesarean section in 4 of fetuses. We also found 2 fetuses with also absent/reversed EDV but with abnormal CTG, we found 20 fetuses with PI &gt; 2SD with preserved EDV and completed 37 weeks, 13% had non-reactive non-stress test (NST) necessitating imminent delivery, also 3 fetuses with absent EDV &gt; 34 weeks while only one fetus with reversed EDV &gt;32 weeks. We found 1 fetus with static growth over 3 weeks during our follow up, also we discovered 1 pregnant women who developed accidental hemorrhage with placental separation and other 3 women developed sever pre-eclampsia who underwent emergency caesarean section after controlling their condition. Conclusion FGR is associated with sociodemographic status and various medical conditions. Analysis of various maternal and familial risk factors is an integral part of in-utero fetal surveillance to identify impending fetal hypoxia. Appropriate management should be offered to these FGR fetuses, is optimizing the timing of delivery to improve perinatal health in FGR.

Can Inflammatory Hematological Parameters be a Guide to Late-onset Fetal Growth Restriction?

2020 ◽  
Author(s):  
Demet Aydogan kırmızı ◽  
Emre Baser ◽  
Taylan Onat ◽  
Melike Demir Caltekin ◽  
Mustafa Kara ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Late Onset ◽  
Hematological Parameters ◽  
Growth Restriction ◽  
Control Group ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Significant Difference

Abstract Purpose To compare the rates obtained from hematological parameters in cases of late-onset idiopathic fetal growth restriction (FGR) with healthy pregnancies and to evaluate the effect on neonatal outcomes. Methods The study group consisted of 63 pregnant women with late-onset idiopathic FGR and the control group consisted of 91 healthy pregnant women. The determined rates were calculated from the control hemograms of patients at 28 weeks. Both groups were compared for neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and other parameters. Results NLR, leukocyte and neutrophil levels were significantly higher in the FGR group (p<0.05). There was no significant difference in PLR, platelet and lymphocyte levels between the groups (p>0.05). To predict FGR, the best cut-off value of NLR was determined to be 4.11 with 56% sensitivity and 88% specificity values. Conclusion Neutrophil, lymphocyte and platelet interactions have an important role in FGR development. Inflammation can be involved in the etiopathogenesis in late-onset FGR.

scholarly journals The Association Between Hypertension in Pregnancy and Preterm Birth with Fetal Growth Restriction in Singleton and Twin Pregnancy: Use of Twin Versus Singleton Charts

2020 ◽  
Vol 9 (8) ◽  
pp. 2518
Author(s):  
Erkan Kalafat ◽  
Aisha Abiola ◽  
Basky Thilaganathan ◽  
Amar Bhide ◽  
Asma Khalil
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Gestational Hypertension ◽  
Growth Restriction ◽  
Hypertensive Disorders Of Pregnancy ◽  
Hypertension In Pregnancy ◽  
Subgroup Analyses ◽  
Strength Of Association ◽  
Twin Pregnancies ◽  
Singleton Pregnancies

Objective: To compare the rates of fetal growth restriction (FGR) in singleton and twin pregnancies using singleton and twin-specific birthweight standards. Methods: The study included liveborn twin and singleton pregnancies between January 2000 and January 2019. Hypertensive disorders of pregnancy (HDP) included gestational hypertension and pre-eclampsia. The study outcomes were FGR or small-for-gestational-age (SGA) at birth as assessed using singleton and twin reference charts. Results: The analysis included 1473 twin and 62,432 singleton pregnancies. In singleton pregnancies the risk of PTB <34 weeks without HDP (OR 2.82, p < 0.001), delivery ≥34 weeks with HDP (OR 2.38, p < 0.001), and PTB <34 weeks with HDP (OR 13.65, p < 0.001) were significantly higher in the pregnancies complicated by FGR compared to those without. When selective fetal growth restriction (sFGR) was assessed using the singleton standard, the risk of PTB <34 weeks without HDP (OR 1.03, p = 0.872), delivery ≥34 weeks with HDP (OR 1.36, p = 0.160) were similar in the pregnancies complicated by sFGR compared to those without, while the risk of PTB <34 weeks with HDP (OR 2.41, p = 0.025) was significantly higher in the pregnancies complicated by sFGR compared to those without. When sFGR was assessed using the twin-specific chart, the risk of PTB <34 weeks without HDP (OR 3.55, p < 0.001), delivery ≥34 weeks with HDP (OR 3.17, p = 0.004), and PTB <34 weeks with HDP (OR 5.69, p < 0.001) were significantly higher in the pregnancies complicated by sFGR compared to those without. The stronger and more consistent association persisted in the subgroup analyses according to chorionicity. The strength of association in dichorionic twin pregnancies resembles that of the singletons more closely and consistently when the FGR was diagnosed using the twin-specific charts. Conclusion: FGR in twin pregnancies has a stronger and more consistent association with HDP and PTB when using twin-specific rather than singleton charts. This study provides further evidence supporting the use of twin-specific charts when assessing fetal growth in twin pregnancies.

Prenatal Identification of Confined Placental Mosaicism in Pregnant Women with Fetal Growth Restriction

2021 ◽  
Author(s):  
Keiko Miyagami ◽  
Nahoko Shirato ◽  
Mikiko Izumi ◽  
Tatsuko Hirose ◽  
Osamu Yasui ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Placental Mosaicism
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