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 Perinatal Outcomes of Monochorionic-Diamniotic Twin Pregnancies Uncomplicated at 28 Weeks of Gestation

2016 ◽  
Vol 7 ◽  
pp. JCM.S38895 ◽  
Author(s):  
Shunji Suzuki
Keyword(s):  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Perinatal Outcomes ◽  
Second Trimester ◽  
Perinatal Complications ◽  
Third Trimester ◽  
The Third ◽  
Perinatal Center ◽  
Twin Pregnancies

We examined the prevalence of specific perinatal complications of monochorionic-diamniotic twin pregnancies in cases without any abnormal findings until the second trimester of pregnancy. This was a retrospective cohort study performed at a tertiary perinatal center in Tokyo, Japan. There were 88 cases of uncomplicated monochorionic-diamniotic twin pregnancies at 28 weeks of gestation. In five of them (5.7%), there were serious complications associated with placental circulatory imbalance between the twins during the third trimester of pregnancy. Two cases were complicated by twin–twin transfusion syndrome, two cases were complicated by twin anemia–polycythemia sequence, and one case was complicated by acute twin–twin transfusion syndrome. In the five cases, no abnormal ultrasonographic findings or symptoms were recognized one or two weeks prior to the diagnosis. Fifty-eight cases (65.9%) were delivered at term uneventfully. Serious complications due to placental circulatory imbalance between twins occurred in about 6% of cases during the third trimester of pregnancy.

scholarly journals First trimester serum angiogenic/anti-angiogenic status in twin pregnancies: relationship with assisted reproduction technology

2011 ◽  
Vol 27 (2) ◽  
pp. 358-365 ◽  
Author(s):  
O. Sanchez ◽  
E. Llurba ◽  
G. Marsal ◽  
C. Dominguez ◽  
C. Aulesa ◽  
...  
Keyword(s):  
Assisted Reproduction ◽  
First Trimester ◽  
Assisted Reproduction Technology ◽  
Twin Pregnancies

scholarly journals Therapeutic levetiracetam monitoring during pregnancy: “mind the gap”

2019 ◽  
Vol 10 ◽  
pp. 204062231985165 ◽  
Author(s):  
Maya Berlin ◽  
Dana Barchel ◽  
Revital Gandelman-Marton ◽  
Nurit Brandriss ◽  
Ilan Blatt ◽  
...  
Keyword(s):  
Reference Range ◽  
Serum Levels ◽  
First Trimester ◽  
Second Trimester ◽  
Serum Concentrations ◽  
Third Trimester ◽  
The Third ◽  
Antiepileptic Medication ◽  
Apparent Clearance ◽  
Neurological Conditions

Background: Epilepsy is one of the most common chronic neurological conditions and its treatment during pregnancy is challenging. Levetiracetam (LEV) is an antiepileptic medication frequently used during pregnancy. Only a few small studies have been published on LEV monitoring during pregnancy, demonstrating decreased serum LEV levels during the first and second trimester; however, the most significant decrease was observed during the third trimester of pregnancy. In this study we aimed to evaluate LEV pharmacokinetics during different stages of pregnancy. Methods: We followed up and monitored serum levels of pregnant women treated with LEV for epilepsy. Results: Fifty-nine women with 66 pregnancies during the study period were included. The lowest raw LEV serum concentrations were observed during the first trimester. Compared with the pre-pregnancy period, raw serum concentration was lower by 5.76 mg/L [95% confidence interval (CI) (2.78, 8.75), p = 0.039] during the first trimester. Comparing the decrease in the first trimester with either the second or the third, no significant changes were observed ( p = 0.945, p = 0.866). Compared with pre-pregnancy measurements, apparent clearance was increased by 71.08 L/day [95%CI (16.34, 125.83), p = 0.011] during the first trimester. About 30% of LEV serum levels during pregnancy were below the laboratory quoted reference range. Conclusions: Raw LEV serum levels tend to decrease during pregnancy, mainly during the first trimester contrary to previous reports. Monitoring of LEV serum levels is essential upon planning pregnancy and thereafter if pre-pregnancy LEV levels are to be maintained. However, more studies are needed to assess the correlation with clinical outcome.

Changes of Serum Sex Hormone-Binding Globulin, Homocysteine, and Hypersensitive CRP Levels during Pregnancy and Their Relationship with Gestational Diabetes Mellitus

2021 ◽  
pp. 1-7
Author(s):  
Wenhua Liu ◽  
Zheren Huang ◽  
Shanshan Tang ◽  
Zhifen Zhang ◽  
Qing Yu ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Pregnant Women ◽  
Serum Levels ◽  
First Trimester ◽  
Sex Hormone Binding Globulin ◽  
Control Group ◽  
Second Trimester ◽  
Hormone Binding ◽  
Hs Crp

<b><i>Background:</i></b> Inflammatory response state is related to the pathogenesis of gestational diabetes mellitus (GDM). <b><i>Objective:</i></b> To investigate the changes of serum sex hormone-binding globulin (SHBG), homocysteine (Hcy), and hypersensitive CRP (hs-CRP) levels during pregnancy and their relationship with GDM. <b><i>Methods:</i></b> The nested case-control study method was used. Sixty nonobese single pregnant women diagnosed with GDM were divided into the GDM group (GDM, <i>n</i> = 60), together with another 60 pregnant women with normal glucose tolerance who were matched in the same period and divided into the control group (control, <i>n</i> = 60). The serum Hcy, hs-CRP, and SHBG levels were measured. <b><i>Results:</i></b> The serum levels of Hcy and hs-CRP were significantly higher in the GDM group compared with the control group, and serum levels of SHBG was significantly lower in the GDM group compared with the control group at different stages of pregnancy. The serum levels of Hcy and hs-CRP in pregnant women increased with the increase of gestational age, and serum levels of SHBG decreased with the increase of gestational age. Increased Hcy and hs-CRP levels in the second trimester and decreased SHBG levels in the first trimester were related to GDM. The odds ratio (OR) and 95% confidence interval (CI) were as follows: OR: 4.5, 95% CI: 1.5–13.0; OR: 4.2, 95% CI: 1.5–10.1; and OR: 0.4, 95% CI: 0.3–0.7, respectively. <b><i>Conclusion:</i></b> Increased Hcy and hs-CRP in the second trimester and decreased SHBG in the first trimester were independent predictors of GDM, which provides a new idea for early prevention and treatment of GDM.

A Comparative Study on Serum Levels of Iron, Magnesium, Calcium and Phosphorus during First & Second Trimesters of Pregnancy at a Tertiary Referral Hospital in South India

2021 ◽  
Vol 8 (29) ◽  
pp. 2609-2614
Author(s):  
Pradeep Kumar M ◽  
Mayadevi Brahmanandan ◽  
Dini S.B
Keyword(s):  
Body Mass Index ◽  
Birth Weight ◽  
Preterm Birth ◽  
Low Birth Weight ◽  
Serum Levels ◽  
First Trimester ◽  
Second Trimester ◽  
Mean Values ◽  
Calcium And Phosphorus ◽  
In Pregnancy

BACKGROUND Multiple micronutrient deficiencies commonly coexist in pregnancy and may play a role in the pathogenesis of many high-risk events in pregnancy. Mineral estimation during the first and second trimester may help in the identification of high-risk pregnancies predisposed to pre-eclampsia, preterm birth or low birth weight. Body mass index (BMI) is an independent risk factor influencing the serum levels of micronutrients like iron, calcium, phosphorous and magnesium. The purpose of this study was to compare the serum levels of iron, magnesium, calcium and phosphorus during first & second trimesters of pregnancy and their correlation with body mass index and adverse pregnancy outcomes. METHODS This was a longitudinal descriptive study, done over a period of twelve months, from April 2017 to March 2018. 94 low risk pregnant women were selected in the first trimester, and they were followed up for the entire duration of pregnancy. 2 ml of blood is collected at first and second trimester and analysed for the serum levels of iron (µg/dl), magnesium (mg/dl), calcium (mg/dl) and inorganic phosphorus (mg/dl). Mean values of these elements were noted and BMI was measured. Patients were followed up to observe the pregnancy outcome, especially development of hypertension, preterm birth and low birth weight. The data were subjected to suitable statistical analyses. P value less than 0.05 is considered as statistically significant. RESULTS Mean values of Ca, Mg, inorganic P and Fe were 9.3 mg/dl ± 0.52, 1.79 mg/dl ± 0.28, 3.59 mg/dl ± 0.54 and 83.7 µg/dl ± 25.36 respectively in first trimester and 8.9 mg/dl ± 0.47, 1.62 mg/dl ± 0.16, 3.17 mg/dl ± 0.44 and 76.17 µg/dl ± 21. 69 respectively in the second trimester. Hypocalcaemia was noted in 12.7 % and 38.3 % in the first and second trimester respectively. Hypomagnesaemia was seen in 51.1 % and 80.9 % in the first and second trimester respectively. Hypophosphatemia was seen in 3.2 % and 14.8 % in the first and second trimester respectively. These findings were statistically significant. There was no significant change in the iron levels in the present study. 19.1 % were underweight. 56.4 % had normal BMI. 19.2 % were overweight. 5.3 % were obese. CONCLUSIONS There is no correlation between serum values of trace elements and the BMI of study subjects. Even though significant hypocalcaemia, hypophosphatemia and hypomagnesaemia was noted in second trimester compared to first, there was no predisposition to the development of adverse outcomes like pre-eclampsia, preterm birth or low birth weight. This may be the effect of dietary and pharmacological supplementation during pregnancy. KEYWORDS Micronutrients, Pregnancy Complications, Calcium, Phosphorus, Magnesium, Iron

First-trimester maternal serum levels of placental hormones are independent predictors of second-trimester fetal growth parameters

2006 ◽  
Vol 27 (2) ◽  
pp. 156-161 ◽  
Author(s):  
T. Y. Leung ◽  
L. W. Chan ◽  
T. N. Leung ◽  
T. Y. Fung ◽  
D. S. Sahota ◽  
...  
Keyword(s):  
Fetal Growth ◽  
Growth Parameters ◽  
Serum Levels ◽  
First Trimester ◽  
Maternal Serum ◽  
Second Trimester

scholarly journals Study on the expression of interleukins in patients with twin-twin transfusion syndrome

2020 ◽  
Vol 18 (3) ◽  
pp. 417-423
Author(s):  
Nguyen Duy Anh ◽  
Nguyen Thi Sim ◽  
Phan Huyen Thuong ◽  
Tran Thi Phuong Thao ◽  
Hoang Van Tong ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Birth Defects ◽  
Fetal Death ◽  
Plasma Concentrations ◽  
First Trimester ◽  
Second Trimester ◽  
Potential Marker ◽  
Significant Difference ◽  
Before And After ◽  
Twin Pregnancies

Twin-twin transfusion syndrome (TTTS) is an unusual and serious condition that occurs in twin pregnancies when identical twins share a placenta but develop discordant amniotic fluid volumes. The TTTS has a high risk of fetal death and birth defects if left untreated. IL-1β, IL-6 and IL-8 have been shown to play an important role in preterm birth in twin pregnancies, which is one of the consequences of TTTS. This study quantified plasma levels of IL-1β, IL-6 and IL-8 in twin pregnant women with (n = 52) and without TTTS (n = 73) by ELISA and analyzed the association of interleukin expression levels with TTTS. The results showed that plasma concentrations of IL-1β and IL-8 were low and not significantly different between the first trimester and the second trimester of pregnancy, between the patients with and without TTTS or between patients with TTTS before and after treatment. IL-6 levels showed no significant difference between first trimester and second trimester of pregnancy or between patients with and without TTTS. Importantly, IL-6 levels were significantly elevated in TTTS patients after surgical treatment compared to those before surgical treatment. In conclusion, IL-6 may be considered as a potential marker for the prognosis of surgical treatment of TTTS.

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

scholarly journals Comparison of uterine fibroids’ growth pattern during pregnancy according to fetal sex: an observational study

2019 ◽  
Vol 10 (1) ◽  
Author(s):  
Giovanni Delli Carpini ◽  
Valeria Verdecchia ◽  
Maria Papiccio ◽  
Camilla Grelloni ◽  
Andrea Ciavattini
Keyword(s):  
Observational Study ◽  
Uterine Fibroids ◽  
Serum Levels ◽  
First Trimester ◽  
Obstetric Outcomes ◽  
Second Trimester ◽  
Third Trimester ◽  
Fetal Sex ◽  
Female Fetus ◽  
The Mean

Abstract Background To investigate the effect of fetal sex on fibroids’ growth during pregnancy according to the hCG serum levels Methods Observational study conducted from January 2007 to December 2016 on women with ultrasound identification of uterine fibroids who had a pregnancy within 1 year from diagnosis. The fibroids diameter was determined during the pre-pregnancy ultrasound, early first trimester (5–7 weeks), late first trimester (11–13 weeks), second trimester (19–21 weeks), and third trimester (31–33 weeks). The diameter growth was calculated in each interval between two ultrasounds. The hCG serum levels were determined both in early and late first trimester. The correlation between hCG levels and fibroid diameter was evaluated. Obstetric outcomes collected were gestational weeks at birth and the rate of cesarean section. Neonatal outcomes were birthweight and Apgar score at 1 min. Results Eighty-seven of the included women had a male fetus, and 70 had a female fetus. A progressive increase of fibroid diameter was observed from pre-pregnancy to second trimester for both fetal sexes. In third trimester, the mean ± SD fibroid diameter of female fetuses showed a slowdown, while the mean ± SD fibroid diameter of male fetuses continued to grow. Women carrying a female fetus presented a higher fibroid diameter in early first trimester (33.5 ± 13.3 mm vs 27.4 ± 11.0 mm, p < 0.01), late first trimester (40.2 ± 13.9 mm vs 34.6 ± 11.7 mm, p < 0.01), and second trimester (40.5 ± 14.9 mm vs 34.7 ± 10.3 mm, p < 0.01). The hCG serum levels resulted higher in women with a female fetus: 61406 (50554-71760) mU/ml vs 46016 (37160-56744) mU/ml (p < 0.01). A positive correlation between hCG levels and fibroid diameter was found both for male and female fetuses (male r = 0.77, 95% CI 0.71–0.82, p < 0.01 and female r = 0.82, 95% CI 0.76–0.86, p < 0.01). Conclusion Women with female fetus seem to have a higher growth of fibroids up to second trimester of pregnancy. This process may be mediated by the higher serum hCG levels found in women expecting a female fetus.

First trimester β-hCG and estradiol levels in singleton and twin pregnancies after assisted reproduction

2018 ◽  
Vol 46 (8) ◽  
pp. 853-856 ◽  
Author(s):  
Ana Póvoa ◽  
Pedro Xavier ◽  
Alexandra Matias ◽  
Isaac Blickstein
Keyword(s):  
Assisted Reproduction ◽  
First Trimester ◽  
Treatment Protocols ◽  
Assisted Reproduction Technologies ◽  
Β Hcg ◽  
Age Range ◽  
Twin Pregnancies ◽  
Single Laboratory ◽  
Estradiol Levels

Abstract Objective To compare levels of β-hCG and estradiol collected during the first trimester in singleton and twin pregnancies following assisted reproduction technologies (ART). Methods We prospectively evaluated 50 singleton and 47 dichorionic twin pregnancies that eventually ended in live births. Patients were recruited from a single ART center with standard treatment protocols followed by fresh embryo transfers. Hormone measurements were performed within a narrow gestational age range and analyzed in a single laboratory thus minimizing inter- and intra-assay variability. We measured serum β-hCG at 13 days after embryo transfer as well as samples of β-hCG and estradiol at 8–9 weeks+6 days. Results No significant differences existed between singletons and twins in respect to demographic and cycle characteristics. β-hCG and estradiol were all significantly higher in twins (P<0.05). Conclusion The data confirms the higher levels of β-hCG and estradiol in twins, pointing to the potential role of these placental hormones in early support of a twin pregnancy.

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