Prediction of placental pathology during the second trimester of pregnancy using a new risk assessment scale and fetal cardiotocography

2020 ◽  
Vol 19 (5) ◽  
pp. 36-43
Author(s):  
R.S. Zamaleeva ◽  
◽  
N.A. Cherepanova ◽  
A.V. Frizina ◽  
E.Yu. Yupatov ◽  
...  
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Gestational Hypertension ◽  
Neonatal Morbidity ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Assessment Scale ◽  
Second Trimester ◽  
Placental Pathology ◽  
Perinatal Complications

Objective. Рreclinical prognosis of placental pathology (PP) during the second trimester of pregnancy using a new risk assessment scale and fetal cardiotocography (CTG). Patients and methods. This retrospective study included 264 patients who had undergone risk assessment during the first trimester of pregnancy using the conventional scale followed by reassessment on weeks 12–15 using the new scale. There were 102 women with PP and 162 women with normal pregnancy and delivery. We also performed prospective analysis of CTG results obtained during the second trimester. Results. The calculation of the risk for perinatal complications during the first trimester using the conventional scale demonstrated that 31% of women had PP. After recalculating the risks in the beginning of the second trimester, we found that 90% of women had PP; there was a threefold increase in the accuracy of prognosis. Women with pathological variants of CTG and risk of PP were 1.34 times more likely to have delayed fetal growth, 1.8 times more likely to develop preeclampsia, 2.6 times more likely to have preterm birth, 1.2 times more likely to have gestational hypertension, and 1.75 times more likely to have neonatal morbidity compared to women at risk of PP, but with normal CTG variants during the second trimester. Conclusion. Combination of the new risk assessment scale and CTG during the second trimester helps to identify women at risk of gestational pathology and to find and optimal tactics of their management. Key words: CTG, placental pathology, placental insufficiency, risk scale

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

scholarly journals The Predictive Accuracy of the Violent Offender Treatment Program Risk Assessment Scale

1999 ◽  
Vol 26 (1) ◽  
pp. 125-140 ◽  
Author(s):  
ANN WARD ◽  
JOHN DOCKERILL
Keyword(s):  
Risk Assessment ◽  
At Risk ◽  
Treatment Program ◽  
Predictive Accuracy ◽  
Violent Behavior ◽  
Violent Offenders ◽  
Assessment Scale ◽  
Violent Offender ◽  
Offender Treatment ◽  
Cutoff Score

Current methods for screening violent offenders for program eligibility are expensive and time consuming. Developers of the Violent Offender Treatment Program (VOTP) have designed a brief and economical instrument to screen offenders for program eligibility. The present study was undertaken to assess the reliability and predictive accuracy of the VOTP Risk Assessment Scale (RAS). An interrater reliability of 20 court histories attained a mean kappa of .81. The RAS was applied to court histories of 202 violent offenders released between 1985 and 1987. A 10-year follow-up of convictions for violent behavior yielded a 47% base rate. Receiver Operating Characteristic curves showed that for varying time-at-risk periods, the predictive accuracy remained between .72 and .76. The recommended cutoff score for all time-at-risk periods was 11. The relatively high accuracy rate of the VOTP RAS indicated that it was accurate enough to aid program eligibility decisions.

Modified Multiple Marker Aneuploidy Screening as a Primary Screening Test for Preeclampsia

2021 ◽  
Author(s):  
Tianhua Huang ◽  
H. Melanie Bedford ◽  
Shamim Rashid ◽  
Evasha Rasasakaram ◽  
Megan Priston ◽  
...  
Keyword(s):  
Preterm Birth ◽  
Early Onset ◽  
Biochemical Markers ◽  
Gestational Hypertension ◽  
First Trimester ◽  
Second Trimester ◽  
Aneuploidy Screening ◽  
Maternal Characteristics ◽  
Screening Performance ◽  
Β Hcg

Abstract Background: Maternal biochemical markers used in multiple marker aneuploidy screening have been associated with adverse pregnancy outcomes. This study aims to assess if a combination of maternal characteristics and biochemical markers in the first and second trimesters can be used to screen for preeclampsia (PE), gestational hypertension and preterm birth. Methods: This case-control study used information on maternal characteristics and residual blood samples from pregnant women who have undergone multiple marker aneuploidy screening. The median multiple of the median (MoM) of first and second trimester biochemical markers in cases (women with PE, gestational hypertension and preterm birth) and controls were compared. Biochemical markers included pregnancy-associated plasma protein A (PAPP-A), placental growth factor (PlGF), human chorionic gonadotropin (hCG), alpha feto-protein (AFP), unconjugated estriol (uE3) and Inhibin A. Logistic regression analysis was used to estimate screening performance using different marker combinations. Screening performance was defined as detection rate (DR) and false positive rate (FPR). Preterm and early-onset preeclampsia PE were defined as women with PE delivered < 37 and < 34 weeks of gestation.Results: There were 147 pregnancies with PE (81 term, 49 preterm and 17 early-onset), 295 with gestational hypertension, and 166 preterm birth. Compared to controls, PE cases had significantly lower median MoM of PAPP-A (0.77 vs 1.10, p<0.0001), PlGF (0.76 vs 1.01, p<0.0001) and free-β hCG (0.81 vs. 0.98, p<0.001) in the first trimester along with PAPP-A (0.82 vs 0.99, p<0.01) and PlGF (0.75 vs 1.02, p<0.0001) in the second trimester. The lowest first trimester PAPP-A, PlGF and free β-hCG were seen in those with preterm and early-onset PE. At a 20% FPR, 67% of preterm and 76% of early-onset PE cases can be predicted using a combination of maternal characteristics with PAPP-A and PlGF in the first trimester.Conclusions: Maternal characteristics with first trimester PAPP-A and PlGF measured for aneuploidy screening provided reasonable accuracy in identifying women at risk of developing early onset PE, allowing triage of high-risk women for further investigation and risk-reducing therapy.

scholarly journals OP16.04: Integrated second trimester risk assessment in twin gestations previously screened in the first trimester

2008 ◽  
Vol 32 (3) ◽  
pp. 365-365
Author(s):  
D. A. Kahn ◽  
A. Platt ◽  
N. S. Silverman ◽  
L. D. Platt
Keyword(s):  
Risk Assessment ◽  
First Trimester ◽  
Second Trimester

Is normal pregnancy atherogenic?

1999 ◽  
Vol 96 (4) ◽  
pp. 421-425 ◽  
Author(s):  
U. MARTIN ◽  
C. DAVIES ◽  
S. HAYAVI ◽  
A. HARTLAND ◽  
F. DUNNE
Keyword(s):  
Serum Cholesterol ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Cholesterol Concentration ◽  
Second Trimester ◽  
Third Trimester ◽  
The Third ◽  
Serum Cholesterol Concentration ◽  
Ldl Subfractions ◽  
Normal Gestation

Serum cholesterol, triacylglycerols and low-density lipoprotein (LDL) subfractions were determined in 120 primagravid women during normal gestation (40 in each trimester) and in 20 non-pregnant age-matched controls. LDL subfractions were determined by PAGE, and an LDL score was calculated. The higher the score, the smaller the subfractions. The objective of the study was to determine the effects of the hyperlipidaemia, high oestrogen concentrations and insulin resistance known to exist in normal pregnancy on LDL subfraction formation. Pregnant women had an increased mean serum cholesterol concentration [5.78 (S.D. 1.09) mmol/l] in the first trimester compared with the non-pregnant controls [5.11 (0.77) mmol/l; P< 0.01]. The serum cholesterol concentration increased progressively throughout gestation to a mean of 8.14 (1.39) mmol/l in the third trimester (P< 0.001 compared with the second trimester). Triacylglycerol concentrations in the first trimester were similar to those of controls, and there was a non-significant increase by the second trimester to 1.32 (0.44) mmol/l. However, by the third trimester the mean triacylglycerol concentration had doubled [2.58 (0.98) mmol/l; P< 0.001 compared with the first and second trimester]. During gestation the LDL score increased dramatically, from 1.17 (0.39) during the first trimester to 2.01 (0.37) in the second trimester (P< 0.001) to 2.73 (0.48) in the third trimester (P< 0.001 compared with the second trimester). Thus an atherogenic lipid profile develops during normal gestation. The significance of these changes remains unclear, but thay may have important implications for mother and foetus.

scholarly journals Twin pregnancies concieved by assisted reproduction - early prediction of preterm birth

2020 ◽  
Vol 77 (2) ◽  
pp. 174-181
Author(s):  
Igor Pilic ◽  
Darko Plecas ◽  
Jelena Dotlic ◽  
Snezana Plesinac
Keyword(s):  
Assisted Reproduction ◽  
Diagnostic Tests ◽  
Serum Levels ◽  
First Trimester ◽  
Abdominal Circumference ◽  
Delivery Time ◽  
Second Trimester ◽  
Perinatal Complications ◽  
Twin Pregnancies ◽  
Fetal Screening

Background/Aim. Twins conceived by assisted reproduction techniques (ART) are the most susceptible for perinatal complications. The aim of this study was to examine the role of prenatal noninvasive fetal screening of the first and second trimester in prediction of delivery time of ART conceived twins. Methods. Prospective cohort study of all ART conceived twin pregnancies was conducted at the Clinic for Obstetrics and Gynecology, Clinical Center of Serbia, during the period from January 1, 2016 to December 31, 2017. In the 12th gestational week (GW) twins crown-rump lenght (CRL) and thickness nuchal translucency (NT) were measured ultrasonographically. Moreover, serum levels of beta subunit of human chorionic gonadotropin (? hCG) and pregnancy-associated plasma protein A (PAPPA) were assessed. In the 17th GW twins biparietal diameter (BPD), abdominal circumference (AC) and femur length (FL) were determined ultrasonografically. Additionally, ? hCG, alphafetoprotein (AFP), estriol (E3) and inhibin (INH) were measured in mothers serum. The GW of delivery was noted for each pregnancy. Results. Study included 100 pregnant women with mean age 35.44 ? 5.82. In the examined sample of ART conceived twins significantly more (51%) were delivered in term (? 35 GW) (p = 0.001). Delivery time correlated negatively with NT and first trimester ? hCG serum levels, while it correlated positively with FL of the smaller twin, second trimester ? hCG, AFP and E3 concentrations. According to obtained model for prediction of delivery time in ART conceived twin pregnancies based on first trimester diagnostic tests the significant predictors were PAPPA and ? hCG in the 12th GW as well as NT of the first larger twin. Nevertheless, reliability (sensitivity 50%?75%, specificity 30%?40%) of these diagnostic tests was moderate. Conclusion. Prenatal noninvasive fetal screening of the first and second trimester (ultrasonography and laboratory testing) can be used for prediction of delivery time of ART conceived twins.

scholarly journals Lipid Profile of Healthy Women During Normal Pregnancy

2009 ◽  
Vol 28 (3) ◽  
pp. 152-160 ◽  
Author(s):  
Margarita Diareme ◽  
Petros Karkalousos ◽  
Georgos Theodoropoulos ◽  
Stefanos Strouzas ◽  
Nikos Lazanas
Keyword(s):  
Pregnant Women ◽  
Lipid Profile ◽  
Gestational Age ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Second Trimester ◽  
Third Trimester ◽  
Predisposing Factor ◽  
Healthy Women ◽  
C 30

Lipid Profile of Healthy Women During Normal PregnancyThe four basic lipid indexes (Chol, Trig, HDL-C and LDL-C) increase during pregnancy, following different rates of increase. Among the four analytes triglycerides show the largest increase and HDL-C the smallest. All analyte values are raised during the 40 weeks of pregnancy, except HDL-C which is stabilized during the second trimester. After delivery the values decrease, except LDL-C which remains steady (for some weeks) before starting to fall following the others. In this study the relations between the four lipid indexes and some predisposing factors (age, gestational age, nationality, body mass index, profession, smoking and diabetes during pregnancy) were investigated. The sample consisted of 413 pregnant women, mainly Greeks and Albanians. After regression analysis it was proved that the only common predisposing factor was the gestational age. Triglycerides and total cholesterol are also influenced by the women's age. The lipid indexes showed no important difference between the pregnant women in the first trimester and the non-pregnant women. On the contrary, there was a statistical difference between the pregnant women in the second and third trimester and between them and the women in the first trimester. The percentages of increase between first and second trimester were: Chol: 38%, Trig: 115%, HDL-C: 30%, LDL-C: 33%. The percentages of increase between first and third trimester were: Chol: 65%, Trig: 208%, HDL-C: 26%, LDLC: 64%.

scholarly journals First trimester serum vitamin D, hs-CRP and second trimester uterine artery diastolic notching in predicting gestational hypertension and preeclampsia

2019 ◽  
Vol 8 (12) ◽  
pp. 4897
Author(s):  
Renu Arora ◽  
Sueba Salmani ◽  
Rekha Bharti ◽  
B. C. Kabi ◽  
Anjali Dabral
Keyword(s):  
Vitamin D ◽  
Uterine Artery ◽  
Gestational Hypertension ◽  
Serum Vitamin ◽  
First Trimester ◽  
Second Trimester ◽  
Serum Vitamin D ◽  
Doppler Study ◽  
Vitamin D Levels ◽  
Hs Crp

Background: Gestational hypertension and preeclampsia is one of the leading causes of maternal and fetal morbidity and mortality. The objective of this study was to study prediction of gestational hypertension/preeclampsia by using first trimester serum vitamin D and hs-CRP and second trimester uterine artery diastolic notching.Methods: It was an observational study conducted in the departments of obstetrics and gynaecology, clinical biochemistry and radiology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India. All pregnant women with 11 to 14 weeks gestational age attending antenatal clinic between October 2012 and June 2013 were enrolled in the study. A detailed history including history of the duration of sun exposure was taken and a general physical examination including obstetrical examination was done at every visit. Serum sample were taken for hs-CRP and vitamin-D levels at 11-14 weeks. Uterine artery colour doppler study was done between 22-24 weeks for uterine artery diastolic notching. The main outcome measures were development of gestational hypertension/ preeclampsia/ eclampsia.Results: The mean vitamin D levels were significantly lower and mean hs-CRP levels were significantly higher in the hypertensive group as compared to the normotensive group, p=0.001 and p=0.004, respectively. Significant number women who developed hypertension had unilateral (46.2%) or bilateral (20.4%) uterine artery diastolic notching, p=0.005 and p=0.000, respectively. Crude’s odds ratio of uterine artery diastolic notching for prediction of hypertension in pregnancy was high, 9.894, 95% CI, 3.273-29.907 as compared to vitamin D (<13.5 ng/ml) and hs-CRP (>9.15 mg/L), 2.859, 95% CI, 1.418-5.763 and 7.16, 95% CI, 3.33-15.397.Conclusions: Uterine artery diastolic notching in the early second trimester is found to be the best predictor of PE followed by first trimester hs-CRP and vitamin D.

Hypertension in pregnancy

2010 ◽  
pp. 2093-2102 ◽  
Author(s):  
C.W.G. Redman
Keyword(s):  
Blood Pressure ◽  
Renal Insufficiency ◽  
Arterial Pressure ◽  
Diastolic Pressure ◽  
Gestational Hypertension ◽  
Systolic Pressure ◽  
First Trimester ◽  
Normal Pregnancy ◽  
Pregnancy Induced Hypertension ◽  
In Pregnancy

In normal pregnancy the arterial pressure falls in the second half of the first trimester: systolic pressure then remains unchanged throughout pregnancy, with diastolic pressure tending to rise gradually towards its prepregnancy level in the later weeks. Definitions, epidemiology and clinical features—(1) Pregnancy-induced hypertension (PIH), transient hypertension of pregnancy, or gestational hypertension describe new hypertension, defined as blood pressure equal to or in excess of 140/90 mmHg, which without proteinuria affects up to 10% of women after mid term (20 weeks) and resolves after delivery. (2) Pre-eclampsia, which affects 3 to 5% of pregnancies, is defined by the presence of PIH and pregnancy-induced proteinuria arising after 20 weeks gestation that both improve after delivery. Other features include (a) renal insufficiency; (b) hepatocellular dysfunction and/or severe epigastric/right upper quadrant pain; (c) neurological problems—convulsions (eclampsia), severe headaches, persistent scotomata; (d) haematological disturbances—thrombocytopenia, disseminated intravascular coagulation, haemolysis; (e) fetal growth restriction....

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