scholarly journals Comparison of pregnancy outcomes and placental characteristics between selective fetal growth restriction with and without thick arterio-arterial anastomosis in monochorionic diamniotic twins

2022 ◽  
Vol 22 (1) ◽  
Author(s):  
Xueju Wang ◽  
Luyao Li ◽  
Pengbo Yuan ◽  
Yangyu Zhao ◽  
Yuan Wei
Keyword(s):  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Venous Anastomosis ◽  
Placental Angiogenesis ◽  
Arterial Anastomosis ◽  
Group 5

Abstract Background Unequal placental territory in monochorionic diamniotic twins is a primary cause of selective fetal growth restriction (sFGR), and vascular anastomoses play important role in determining sFGR prognosis. This study investigated differences in placental characteristics and pregnancy outcomes in cases of sFGR with and without thick arterio-arterial anastomosis (AAA). Methods A total of 253 patients diagnosed with sFGR between April 2013 and April 2020 were retrospectively analyzed. An AAA greater than 2 mm in diameter was defined as a thick AAA. We compared placental characteristics and pregnancy outcomes between cases of sFGR with and without thick AAA. Results Prevalence of AAA, thick arterio-venous anastomosis (AVA), veno-venous anastomosis (VVA), and thick VVA were significantly higher in the thick AAA group relative to the non-thick AAA group (100.0 vs. 78.5%, P < 0.001; 44.3 vs. 15.4%, P < 0.001; 27.1 vs. 10.8%, P = 0.017, and 24.3 vs. 6.2%, P = 0.004, respectively). The total numbers of AVA and total anastomoses were significantly higher in thick AAA group relative to the non-thick AAA group (5 [1, 14] vs. 3 [1, 15, P = 0.016; and 6 [1, 15] vs. 5 [1, 16], P = 0.022, respectively). The total diameter of AAA, AVA, VVA, and all anastomoses in the thick AAA group was larger than in the non-thick AAA group (3.4 [2.0,7.1] vs. 1.4 [0.0, 3.3], P < 0.001; 6.3 [0.3, 12.0] vs. 2.5 [0.3, 17.8], P < 0.001; 4.2±1.8 vs. 1.9±1.2, P =0.004; and 10.7 [3.2,22.4] vs. 4.4 [0.5, 19.3], P < 0.001, respectively). Growth-restricted fetuses in the thick AAA group exhibited significantly increased birthweight relative to those in thenon-thick AAA group (1570 (530, 2460)g vs. 1230 (610, 2480)g, p = 0.002). Conclusions In the placentas associated with sFGR, thick AAA can co-occur with thick AVA and VVA, and placental angiogenesis may differ significantly based upon whether or not thick AAA is present. The birth weights of growth-restricted fetuses in cases of sFGR with thick AAA are larger than in cases without thick AAA.

Evaluating the Effect of Pravastatin in Early-Onset Fetal Growth Restriction: A Nonrandomized and Historically Controlled Pilot Study

2020 ◽  
Author(s):  
Manel Mendoza ◽  
Raquel Ferrer-Oliveras ◽  
Erika Bonacina ◽  
Pablo Garcia-Manau ◽  
Carlota Rodo ◽  
...  
Keyword(s):  
Pilot Study ◽  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Early Onset ◽  
Maternal Serum ◽  
Angiogenic Factors ◽  
Interquartile Range ◽  
Growth Restriction ◽  
Control Group

Objective This study aimed to analyze the effect of pravastatin on angiogenic factors, feto–maternal Doppler findings and pregnancy outcomes in women with early-onset fetal growth restriction (FGR) treated with pravastatin compared with nontreated controls. Study Design This was a pilot study conducted between March 2016 and September 2017. Women with single pregnancies and FGR diagnosed at ≤ 28 weeks of gestation were offered 40 mg of pravastatin daily. Doppler progression, soluble fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) values, and pregnancy outcomes were assessed and compared with consecutive historical controls. Controls were matched to treated women for gestational age, maternal characteristics, maternal and obstetric history, Doppler severity classification, and angiogenic factors at diagnosis. The sFlt-1/PlGF was measured in maternal serum at two different times: before pravastatin was started (ratio M0) and during pravastatin treatment (ratio M1). Doppler severity was classified into four categories: normal, mild, moderate, and severe. Results A total of 38 women were enrolled in this study. No differences were observed in baseline characteristics between groups. However, when compared with the ratio M0, M1 was increased by a median (interquartile range) of 67.0 (−34.8 to 197.3) in the control group but decreased by a median (interquartile range) of −10.1 (−53.1 to −0.07) in the pravastatin treated group (p < 0.001). No significant differences were observed in Doppler progression throughout pregnancy. Median interval from diagnosis to delivery was extended by 16.5 days, the median newborn birthweight was increased from 1,040 to 1,300 g, and the number of women with preeclampsia decreased from 9 (47.4%) to 6 (31.6%) in treated women; however, these trends were not statistically significant. Conclusion In women with early-onset FGR, treatment with pravastatin 40 mg daily was associated with significant improvement in the angiogenic profile. Additionally, median pregnancy duration and median birthweight increased and the incidence of PE was reduced in treated women. Nevertheless, since this pilot study was underpowered, none of these differences were statistically significant. Key Points

scholarly journals Effect of Endogenic and Exogenic Oxidative Stress Triggers on Adverse Pregnancy Outcomes: Preeclampsia, Fetal Growth Restriction, Gestational Diabetes Mellitus and Preterm Birth

2021 ◽  
Vol 22 (18) ◽  
pp. 10122
Author(s):  
Eun Hui Joo ◽  
Young Ran Kim ◽  
Nari Kim ◽  
Jae Eun Jung ◽  
Seon Ha Han ◽  
...  
Keyword(s):  
Oxidative Stress ◽  
Diabetes Mellitus ◽  
Preterm Birth ◽  
Gestational Diabetes ◽  
Gestational Diabetes Mellitus ◽  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Adverse Pregnancy

Oxidative stress is caused by an imbalance between the production of reactive oxygen species (ROS) in cells and tissues and the ability of a biological system to detoxify them. During a normal pregnancy, oxidative stress increases the normal systemic inflammatory response and is usually well-controlled by the balanced body mechanism of the detoxification of anti-oxidative products. However, pregnancy is also a condition in which this adaptation and balance can be easily disrupted. Excessive ROS is detrimental and associated with many pregnancy complications, such as preeclampsia (PE), fetal growth restriction (FGR), gestational diabetes mellitus (GDM), and preterm birth (PTB), by damaging placentation. The placenta is a tissue rich in mitochondria that produces the majority of ROS, so it is important to maintain normal placental function and properly develop its vascular network to ensure a safe and healthy pregnancy. Antioxidants may ameliorate these diseases, and related research is progressing. This review aimed to determine the association between oxidative stress and adverse pregnancy outcomes, especially PE, FGR, GDM, and PTB, and explore how to overcome this oxidative stress in these unfavorable conditions.

Pregnancy outcomes in correlation with placental histopathology in subsequent pregnancies complicated by fetal growth restriction

Placenta ◽  
2019 ◽  
Vol 80 ◽  
pp. 36-41 ◽  
Author(s):  
Michal Levy ◽  
Michal Kovo ◽  
Letizia Schreiber ◽  
Ilia Kleiner ◽  
Ehud Grinstein ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Growth Restriction

Preterm Preeclampsia with Severe Features: Composite Maternal and Neonatal Morbidities Associated with Fetal Growth Restriction

2018 ◽  
Vol 35 (08) ◽  
pp. 785-790 ◽  
Author(s):  
Raminder Khanagura ◽  
Heather Kregel ◽  
Farah Amro ◽  
Baha Sibai ◽  
Suneet Chauhan ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Gestational Age ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Multivariable Analysis ◽  
Growth Restriction ◽  
Tertiary Center ◽  
Appropriate For Gestational Age ◽  
Adverse Pregnancy ◽  
Estimated Fetal Weight

Objective The objective of this study was to compare adverse pregnancy outcomes between fetuses with estimated fetal weight (EFW) < 10 to > 10% in women with preterm preeclampsia (PE) with severe features. Materials and Methods All women with preterm PE with severe features and nonanomalous singletons with EFW were identified at a tertiary center. Women with oligohydramnios or absent/reversed umbilical Doppler velocimetry were excluded. Using multivariable analysis, we compared the composite maternal and neonatal morbidities (CMM and CNM) between those with appropriate for gestational age (AGA) fetal growth, defined as EFW at 10 to 90th versus those with fetal growth restriction (FGR), defined as EFW < 10th percentile for gestational age (GA). Results In this study, 165 patients were included; 112 had EFW at 10th to 90th percentile, and 53 had FGR. Of the 53 with FGR, 33 (62%) had EFW at 5 to 9% for GA and 20 (38%) had EFW < fifth percentile for GA. The CMM was significantly higher among women with FGR versus AGA (29 vs. 7%; p < 0.001). The CNM was significantly higher with FGR versus AGA (20 vs. 6%; p = 0.01). Conclusion Women with preterm PE with severe features and FGR, when compared with those with AGA, have significantly higher risk of CMM and CNM.

scholarly journals Placental Angiogenesis and Fetal Growth Restriction

10.5772/37879 ◽  
2012 ◽  
Author(s):  
Victor Gourvas ◽  
Efterpi Dalpa ◽  
Nikos Vrachnis ◽  
Stavros Sifakis
Keyword(s):  
Fetal Growth ◽  
Fetal Growth Restriction ◽  
Growth Restriction ◽  
Placental Angiogenesis

Risk factors associated with adverse pregnancy outcomes in patients with new-onset systemic lupus erythematosus during pregnancy

Lupus ◽  
2021 ◽  
pp. 096120332098053
Author(s):  
Jian Chen ◽  
Zi-Zi Xiao ◽  
Qing Shi ◽  
Hui-Min Wang ◽  
Fang He ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Birth ◽  
Fetal Growth ◽  
Pregnancy Outcomes ◽  
Fetal Growth Restriction ◽  
Pregnancy Loss ◽  
Renal Involvement ◽  
Growth Restriction ◽  
Adverse Pregnancy ◽  
New Onset

Objective To investigate the risk factors for Adverse pregnancy outcome (APOs) in patients with new-onset SLE during pregnancy. Methods Eighty-five patients with new-onset SLE during pregnancy were analyzed retrospectively. Univariate and multivariate logistic regression were used to identify risk factors for different APOs (pregnancy loss, preterm birth, fetal growth restriction, and eclampsia/preeclampsia). A two-sided p-value below 0.05 was considered significant, and two-sided 95% confidence intervals (CIs) are reported. Results Multivariate analysis indicated that renal involvement (aOR: 7.356; 95%CI:1.516,35.692) and greater SLE disease activity index (SLEDAI) grade (aOR:5.947;95%CI: 1.586,22.294) increased the risk for composite APO, and that use of heparin therapy (aOR: 0.081; 95%CI: 0.012, 0.532) was a protective factor. Advanced gestational age at disease onset (aOR: 0.879; 95%CI: 0.819,0.943) and high serum albumin level (aOR: 0.908,95%CI: 0.831,0.992) protected against pregnancy loss. Renal involvement increased the risk for preterm birth (aOR: 2.272; 95%CI: 1.030,7.222) and fetal growth restriction (aOR: 9.070; 95%CI: 1.131,72.743). Hypertension (aOR: 19.185; 95%CI: 3.921,93.868), renal involvement (aOR: 8.380, 95%CI: 1.944,74.376) increased the risk for eclampsia/preeclampsia. Conclusion New onset SLE during pregnancy increased the risk for multiple APOs. Timely management of the risk factors identified here may help to improve pregnancy outcomes in these patients.

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