A mystery mass on the placenta

Abstract Chorioangioma or chorangioma is a benign placental tumour which occurs in 1% of the pregnancies. Large lesions of more than 4–5 cm in size, also known as giant chorangiomas, are rare with the incidence of 1:3500 and 1:9000 birth. Unlike small tumours, the giant chorangiomas are highly associated with pregnancy complications. We report a case of multiple large chorangiomas resulting in an extremely preterm delivery. A 24-year-old primigravida presented at 25 weeks of gestation for threatened preterm labour. Transabdominal ultrasound revealed an echogenic mass on the placenta measuring 8.7 × 4.4 cm. Following a successful tocolysis and administration of a course of antenatal corticosteroids, she was discharged home. At 27 weeks of gestation, she developed a second episode of preterm contractions. Besides, the foetus was found to be small for gestational age. In the second episode of preterm contractions, intravenous magnesium sulfate infusion was commenced for foetal neuroprotection. Tocolysis was commenced for severe prematurity. She went into spontaneous preterm labour. Placenta examination revealed multiple solid masses with fleshy and congested dark red surface. A histopathological examination of the placenta confirmed the diagnosis of chorangiomas. The baby was discharged in good condition at 5 months of age. Placental chorangiomas, notably when they are multiple and large in size, are associated with adverse pregnancy outcomes. Therefore, close antenatal surveillance is necessary to allow timely recognition and intervention of pregnancy complications. Our case portrays an unexpected favourable neonatal outcome associated with a giant chorangiomas.

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1382-P: Does Tight Gestational Diabetes Mellitus Control Have an Impact on the Maternal and Neonatal Outcome Compared with General Populations? Which Factors Predict the Adverse Pregnancy Outcomes?

Diabetes ◽

10.2337/db20-1382-p ◽

2020 ◽

Vol 69 (Supplement 1) ◽

pp. 1382-P

Author(s):

PETROS THOMAKOS ◽

OLGA KEPAPTSOGLOU ◽

CAROL BARRETO ◽

ANASTASIA TROUVA ◽

DIMITRIS TROUVAS ◽

...

Keyword(s):

Diabetes Mellitus ◽

Gestational Diabetes ◽

Gestational Diabetes Mellitus ◽

Pregnancy Outcomes ◽

Neonatal Outcome ◽

Adverse Pregnancy Outcomes ◽

Adverse Pregnancy ◽

General Populations

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Prevalence of food insecurity in pregnant women and its association with gestational weight gain pattern, neonatal birth weight, and pregnancy complications in Hamadan County, Iran, in 2018

Agriculture & Food Security ◽

10.1186/s40066-020-00267-5 ◽

2020 ◽

Vol 9 (1) ◽

Author(s):

Farideh Kazemi ◽

Seyedeh Zahra Masoumi ◽

Arezoo Shayan ◽

Seyedeh Zahra Shahidi Yasaghi

Keyword(s):

Weight Gain ◽

Birth Weight ◽

Food Insecurity ◽

Pregnant Women ◽

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Maternal Weight ◽

Cross Sectional ◽

Significance Level ◽

Adverse Pregnancy

Abstract Background The results of some studies have indicated the association between food insecurity and certain adverse pregnancy outcomes. The present study aimed to investigate the prevalence of food insecurity in pregnant women and its association with pregnancy outcomes and complications. Methods The present cross-sectional study was conducted on 772 mothers who visited comprehensive health service centers during the first 10 days after delivery in 2018. The tools included the demographic and midwifery information questionnaire and an 18-item questionnaire devised by the U.S. Department of Agriculture. The significance level was considered to be 0.05. Results 67.5% of pregnant women had food insecurity. The multivariate analysis showed that birth weight decreased with the increase in the severity of food insecurity, but the reduction was not statistically significant. Based on the results, food insecurity had no statistically significant impact on the mothers’ weight gain pattern (p = 0.13). The risk of hypertension/preeclampsia and anemia was not related to food insecurity. Compared with the food-secure group, the probability of gestational diabetes was 56% lower in the food-insecure group without hunger and 61% lower in the food-insecure group with moderate hunger; however, in the food-insecure group with severe hunger, this probability was 1.5 times more than the food-secure group, which is not statistically significant. Conclusions The prevalence of food insecurity was high in pregnant women. Maternal weight gains during pregnancy and birth weight (despite being statistically insignificant) were affected by this condition; therefore, it is necessary to identify women with food insecurity on their first pregnancy visit; it is also crucial to take steps towards improving their health through allocating a family food basket and nutritional support for these women at least during pregnancy. Due to the limited sample size and inability to control the potential confounders, the association between food insecurity during pregnancy and the incidence of pregnancy complications could not be reached, hence the need for more studies.

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Effectiveness of Prenatal Vitamin D Deficiency Screening and Treatment Program: A Stratified Randomized Field Trial

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2018-00109 ◽

2018 ◽

Vol 103 (8) ◽

pp. 2936-2948 ◽

Cited By ~ 35

Author(s):

Maryam Rostami ◽

Fahimeh Ramezani Tehrani ◽

Masoumeh Simbar ◽

Razieh Bidhendi Yarandi ◽

Sonia Minooee ◽

...

Keyword(s):

Vitamin D ◽

Pregnant Women ◽

Treatment Program ◽

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Screening Program ◽

Adverse Pregnancy Outcomes ◽

Adverse Outcomes ◽

Adverse Pregnancy ◽

Screening Site

Abstract Context Despite evidence on the association between hypovitaminosis D and adverse pregnancy outcomes and the positive impact of vitamin D supplementation, no evidence exists supporting a universal screening program in pregnancy as part of routine prenatal care. Objective We sought to determine the effectiveness of a prenatal screening program on optimizing 25-hydroxyvitamin D [25(OH)D] levels and preventing pregnancy complications. Also, to identify a safe regimen, we compared several regimens in a subgroup of vitamin D–deficient pregnant women. Design Two cities of Masjed-Soleyman and Shushtar from Khuzestan province, Iran, were selected as the screening and nonscreening arms, respectively. Within the screening arm, a randomized controlled trial was conducted on 800 pregnant women. Setting Health centers of Masjed-Soleyman and Shushtar cities. Patients or Participants Pregnant women aged 18 to 40 years. Intervention Women with moderate [25(OH)D, 10 to 20 ng/mL] and severe [25(OH)D, <10 ng/mL] deficiency were randomly divided into four subgroups and received vitamin D3 (D3) until delivery. Main Outcome Measure Maternal concentration of 25(OH)D at delivery and rate of pregnancy complications Results After supplementation, only 2% of the women in the nonscreening site met the sufficiency level (>20 ng/mL) vs 53% of the women in the screening site. Adverse pregnancy outcomes, including preeclampsia, gestational diabetes mellitus, and preterm delivery, were decreased by 60%, 50%, and 40%, respectively, in the screening site. A D3 injection in addition to monthly 50,000 IU maintenance therapy contributed the most to achievement of sufficient levels at delivery. Conclusions A prenatal vitamin D screening and treatment program is an effective approach in detecting deficient women, improving 25(OH)D levels, and decreasing pregnancy adverse outcomes.

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Selected Micronutrients: An Option to Boost Immunity against COVID-19 and Prevent Adverse Pregnancy Outcomes in Pregnant Women: A Narrative Review

Iranian Journal of Public Health ◽

10.18502/ijph.v49i11.4717 ◽

2020 ◽

Author(s):

NAWSHERWAN NAWSHERWAN ◽

Suliman KHAN ◽

Falak ZEB ◽

Muhammad SHOAIB ◽

Ghulam NABI ◽

...

Keyword(s):

Immune System ◽

Vitamin A ◽

Pregnant Women ◽

Immune Function ◽

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Adverse Pregnancy Outcomes ◽

Adequate Intake ◽

Adverse Pregnancy

The coronavirus disease-19 (COVID-19) negatively affects immune system. It is linked with adverse pregnancy outcomes. These complications may be linked with the infections mediated deficiency of micronutrients in pregnant women. COVID-19 cause’s malabsorption of micronutrients thereby increases the risk of their deficiency. Both micronutrients deficiencies and poor micronutrients intake can compromise immune function and may increase the risk of pregnancy complications associated with COVID-19 infection. Vitamin A, C, D, E, and selected minerals iron (Fe), selenium (Se), and zinc (Zn) are the micronutrients essential for immuno-competency and play a significant role in the prevention of adverse pregnancy outcomes. Immune function and pregnancy outcomes can be improved by adequate intake of micronutrients in diet or in supplements form. Based on regulatory links between viral infection, micronutrients, immunity, and pregnancy outcomes, this review highlights the role of micronutrients in boosting immunity to reduce or prevent pregnancy complications in COVID-19 infected women.

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HYdroxychloroquine to Improve Pregnancy Outcome in Women with AnTIphospholipid Antibodies (HYPATIA) Protocol: A Multinational Randomized Controlled Trial of Hydroxychloroquine versus Placebo in Addition to Standard Treatment in Pregnant Women with Antiphospholipid Syndrome or Antibodies

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0037-1603359 ◽

2017 ◽

Vol 43 (06) ◽

pp. 562-571 ◽

Cited By ~ 39

Author(s):

Karen Schreiber ◽

Karen Breen ◽

Hannah Cohen ◽

Soren Jacobsen ◽

Saskia Middeldorp ◽

...

Keyword(s):

Pregnant Women ◽

Pregnancy Outcome ◽

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Antiphospholipid Antibodies ◽

Pregnancy Loss ◽

Standard Treatment ◽

Randomized Controlled ◽

Improve Pregnancy Outcome ◽

Adverse Pregnancy

AbstractWomen with antiphospholipid antibodies (aPL) are at risk of adverse pregnancy outcomes, including recurrent first-trimester pregnancy loss and late pregnancy complications such as preeclampsia, HELLP (hemolysis, elevated liver enzyme levels, and low platelet levels) syndrome, premature delivery, intrauterine growth restriction, placental abruption, and intrauterine death. Current standard care in obstetric antiphospholipid syndrome includes aspirin and heparin and has resulted in live-birth rates of approximately 70%. However, 30% continue to have pregnancy complications. Hydroxychloroquine (HCQ) is suggested as a new treatment approach, but no randomized controlled trials (RCTs) have assessed its efficacy. This study aims to assess pregnancy outcome in women with aPL treated with HCQ versus placebo in addition to standard treatment. The HYdroxychloroquine to improve Pregnancy outcome in women with AnTIphospholipid Antibodies (HYPATIA) study is a phase IV multicenter RCT, in which pregnant women with persistent aPL will receive either HCQ or placebo in addition to their usual medication. The primary endpoint is a composite of aPL-related adverse pregnancy outcomes: one or more pregnancy loss(es) (either < 10 or > 10 weeks of gestation) and premature birth before 34 weeks due to any of the following preeclampsia, eclampsia, or recognized features of placental insufficiency. The HYPATIA study is expected to provide evidence on the effect of HCQ in pregnant women with persistent aPL.

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Plasma total homocysteine, pregnancy complications, and adverse pregnancy outcomes: the Hordaland Homocysteine Study

American Journal of Clinical Nutrition ◽

10.1093/ajcn/71.4.962 ◽

2000 ◽

Vol 71 (4) ◽

pp. 962-968 ◽

Cited By ~ 348

Author(s):

Stein Emil Vollset ◽

Helga Refsum ◽

Lorentz M Irgens ◽

Barbro Mork Emblem ◽

Aage Tverdal ◽

...

Keyword(s):

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Adverse Pregnancy Outcomes ◽

Total Homocysteine ◽

Adverse Pregnancy ◽

Plasma Total Homocysteine

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Adverse Pregnancy Outcomes of Patients with History of First-Trimester Recurrent Spontaneous Abortion

BioMed Research International ◽

10.1155/2017/4359424 ◽

2017 ◽

Vol 2017 ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Jing Yang ◽

Yan Wang ◽

Xiao-ye Wang ◽

Yan-yu Zhao ◽

Jing Wang ◽

...

Keyword(s):

Risk Factor ◽

Cesarean Section ◽

Spontaneous Abortion ◽

Pregnancy Outcomes ◽

Pregnancy Complications ◽

First Trimester ◽

Recurrent Spontaneous Abortion ◽

Study Group ◽

History Of ◽

Adverse Pregnancy

Although a history of first-trimester recurrent spontaneous abortion (FRSA) is regarded as a risk factor in antenatal care, the characteristic of subsequent pregnancy outcome is not clearly elucidated. Here, a retrospective analysis was performed on the clinical data of 492 singleton pregnant women. 164 of them with the history of FRSA were enrolled in study group, compared to 328 deliveries without the history of FRSA. For maternal outcomes, patients in the study group delivered earlier with mean gestational age and the incidences of cesarean section and postpartum hemorrhage were higher compared to the control group. For placental outcomes, the incidence of placenta-mediated pregnancy complications (PMPC) in the study group increased in terms of late-onset preeclampsia, oligohydramnios, early-onset fetal growth restriction, and second-trimester abortion. Patients in the study group were more likely to suffer from placenta accreta, placenta increta, and placenta percreta. For perinatal outcomes, the proportion of birth defects of newborns in the study group was greater. At last, logistic regression analyses showed that the history of FRSA was an independent risk factor for cesarean section and pregnancy complications. In conclusion, women with the history of FRSA are often exposed to an elevated incidence of maternal-placental-perinatal adverse pregnancy outcomes.

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Maternal Lipid Profile During Early Pregnancy and Pregnancy Complications and Outcomes: The ABCD Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2012-1295 ◽

2012 ◽

Vol 97 (11) ◽

pp. 3917-3925 ◽

Cited By ~ 119

Author(s):

Tanja G. M. Vrijkotte ◽

Náthalie Krukziener ◽

Barbara A. Hutten ◽

Karlijn C. Vollebregt ◽

Manon van Eijsden ◽

...

Keyword(s):

Preterm Birth ◽

Lipid Profile ◽

Total Cholesterol ◽

Outcome Measures ◽

Early Pregnancy ◽

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Adverse Pregnancy Outcomes ◽

Child Loss ◽

Adverse Pregnancy

Context: Elevated lipid levels during late pregnancy are associated with complications and adverse outcome for both mother and newborn. However, it is inconclusive whether a disturbed lipid profile during early pregnancy has similar negative associations. Objective: Our objective was to investigate whether nonfasting maternal total cholesterol and triglyceride levels during early pregnancy are associated with six major adverse pregnancy outcomes. Methods: Data were derived from the Amsterdam Born Children and Their Development (ABCD) cohort study. Random blood samples of nonfasting total cholesterol and triglyceride levels were determined during early gestation (median = 13, interquartile range = 12–14 wk). Outcome measures were pregnancy-induced hypertension (PIH), preeclampsia, preterm birth, small/large for gestational age (SGA/LGA), and child loss. Only nondiabetic women with singleton deliveries were included; the baseline sample consisted of 4008 women. Analysis for PIH and preeclampsia were performed in nulliparous women only (n = 2037). Results: Mean (sd) triglyceride and total cholesterol levels were 1.33 (0.55) and 4.98 (0.87) mmol/liter, respectively. The incidence of pregnancy complications and perinatal outcomes were as follows: PIH, 4.9%; preeclampsia, 3.7%; preterm birth, 5.3%; SGA, 9.3%; LGA, 9.3%; and child loss, 1.4%. After adjustments, every unit increase in triglycerides was linearly associated with an increased risk of PIH [odds ratio (OR) = 1.60, P = 0.021], preeclampsia (OR = 1.69, P = 0.018), LGA (OR = 1.48, P < 0.001), and induced preterm delivery (OR = 1.69, P = 0.006). No associations were found for SGA or child loss. Total cholesterol was not associated with any of the outcome measures. Conclusions: Elevated maternal triglyceride levels measured during early pregnancy are associated with pregnancy complications and adverse pregnancy outcomes. These results suggest that future lifestyle programs in women of reproductive age with a focus on lowering triglyceride levels (i.e. diet, weight reduction, and physical activity) may help to prevent hypertensive complications during pregnancy and adverse birth outcomes.

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Risks of reproductive loss and placenta-mediated pregnancy complications in women with antiphospholipid antibodies

Obstetrics Gynecology and Reproduction ◽

10.17749/2313-7347/ob.gyn.rep.2020.181 ◽

2021 ◽

Vol 14 (6) ◽

pp. 592-601

Author(s):

Yu. S. Dolgova ◽

D. R. Eremeeva ◽

M. S. Zainulina

Keyword(s):

Pregnancy Outcomes ◽

Pregnancy Complications ◽

Antiphospholipid Antibodies ◽

Pregnancy Loss ◽

Fetal Death ◽

Treatment Algorithm ◽

Special Treatment ◽

Multisystem Disease ◽

Relative Risks ◽

Adverse Pregnancy

Introduction. Antiphospholipid syndrome (AРS) is a multisystem disease characterized by elevated levels of antiphospholipid antibodies (AРA), arterial and/or venous thrombosis, thrombocytopenia, and habitual miscarriage. Various AРA types have multifactorial and indirect effects on pregnancy course from the earliest stages, leading to termination of pregnancy and putting the prerequisites for further obstetric complications. Aim: determine rate and relative risk of pregnancy complications in AРA carriers. Materials and Methods. The retrospective study, conducted between 2017 and 2019, included 268 pregnant women. All women underwent a comprehensive study consisting of clinical examination and laboratory methods. AРA of IgM and IgG classes were measured by using ELISA, lupus anticoagulant (LA) was estimated by using a coagulometer. Results. APA were detected in 213 (79.48 %) women examined; 55 (20.52 %) patients (n = 55) lacked APA. Failed in vitro fertilization attempts were 2 times more common in women with AРA (10.33 vs. 5.45 %, respectively; p < 0.001). Also, significant differences were found in this group in antenatal fetal death (4.23 vs. 1.82 %, respectively; p < 0.001) and chronic placental insufficiency without fetal malnutrition (23.47 vs. 18.18 %, respectively; p < 0.05). Of 165 women with early pregnancy loss syndrome, AРA were found in 130 (78.79 %), late pregnancy loss – in 29 (76.32 %) and antenatal fetal death – in 9 (90.0 %) women carrying serum AРA. The relative risks of unfavorable pregnancy outcomes have been identified for various AРA subtypes. Conclusion. Identifying clear-cut relative risks of adverse pregnancy outcomes for various subtypes of antiphospholipid antibodies will allow to determine risk groups and develop a special treatment algorithm for preventing pregnancy complications and perinatal losses.

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