scholarly journals Clinical Importance of Low Level of PAPP-A in First Trimester of Pregnancy - An Obstetrical Dilemma in Chromosomally Normal Fetus

2019 ◽  
Vol 7 (9) ◽  
pp. 1475-1479 ◽  
Author(s):  
Vesna Livrinova ◽  
Igor Petrov ◽  
Igor Samardziski ◽  
Viktorija Jovanovska ◽  
Aleksandra Atanasova Boshku ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Premature Birth ◽  
Mode Of Delivery ◽  
First Trimester ◽  
Target Group ◽  
Control Group ◽  
First Trimester Screening ◽  
Trimester Screening ◽  
The Difference ◽  
And Control

BACKGROUND: A variety of recent evidence exists about the clinical implication of low level of Pregnancy-associated plasma protein A (PAPP-A) in pregnancy. This glycoprotein is a protease, which releases the Insulin-like growth factor from IGFBP 4. Its role is a trophoblastic invasion of decidua, stimulation of cell mitosis and differentiation. It has an immunosuppressive effect in the placenta, inhibition of coagulation and complex role for integration of all these processes in the placenta. Level of PAPP-A (under 0.4 MoM-Multiple of Medians) in first-trimester screening in chromosomally and morphologically normal fetuses, could influence fetal weight, preeclampsia, premature birth and stillbirth. As a result of the complications mentioned above, there is implication on timing, mode of delivery and condition of the newborn. AIM: The study aims to evaluate the influence of low PAPP-A, measured in the first trimester on the outcome of pregnancy, with accent disorders which are the result of placental insufficiency. Also, gestational week, mode of delivery and condition of newborn secondary underlying conditions will be evaluated. MATERIAL AND METHODS: After given information and consultation about the expectation from the screening, pregnant women with a singleton pregnancy were tested for First Trimester Screening to estimate the risk for Trisomy 21, 13, 18- the most frequent chromosomopathies. After exclusion of chromosomopathies and congenital malformations, one hundred and fourteen patients enrolled in the study. The target group (n = 64) with PAPP-A below 0.4 MoM and control group (n = 50) with PAPP-A equal and above 0.4 MoM. An assessment of mode and time of delivery and presence of small for gestational age newborns, preeclampsia, premature birth and newborn condition at delivery was made. RESULTS: The percentage of the patients delivered in term was similar between the target group (n = 64) and the control group (n = 50), 82.81% vs 82.0% respectively. The rate of cesarean section was 29.7 % in the target group vs 32% in the control group. A significant difference was found about elective vs urgent cesarean section in favour of the target group. The difference was present about the complication in pregnancy before delivery, 56% vs 22%, p = 0.023, which were the main indication for cesarean section. The difference in newborn outcome was not significant. CONCLUSION: There is a difference in frequency of complications, in the cases with PAPP-A under 0.4 MoM, such as premature birth, preeclampsia compound with SGA fetuses versus the control group. The difference for SGA newborn and premature birth among the groups has statistical significance. The patients delivered with cesarean section were with the main indications SGA or elevated blood pressure, often occurred combined with prematurity. Apgar score and birth weight were similar in target and control group, but the newborns with a birth weight under 2500 g. were more frequent in the target group. Because these results did not show another significance among two groups, probably lower cut-off is needed, combining with another test (Doppler of uterine arteries in the first trimester, biochemical test). Presence of other diseases which could hurt placental function should be emphasised.

scholarly journals The Reactivity Levels of Progesterone, Nitric Oxide and Nuclear Factor Kappa-B on the Serum of Term and Post-Term Pregnancy, Clinical Study in Padang, West Sumatera, Indonesia

2019 ◽  
Vol 7 (11) ◽  
pp. 1729-1732
Author(s):  
Defrin Defrin ◽  
Eti Yerizel ◽  
Donel Suhaimi ◽  
Afriwardi Afriwardi
Keyword(s):  
Cesarean Section ◽  
Premature Birth ◽  
Mode Of Delivery ◽  
First Trimester ◽  
Target Group ◽  
Control Group ◽  
First Trimester Screening ◽  
Trimester Screening ◽  
The Difference ◽  
And Control

BACKGROUND: A variety of recent evidence exists about the clinical implication of low level of Pregnancy-associated plasma protein A (PAPP-A) in pregnancy. This glycoprotein is a protease, which releases the Insulin-like growth factor from IGFBP 4. Its role is a trophoblastic invasion of decidua, stimulation of cell mitosis and differentiation. It has an immunosuppressive effect in the placenta, inhibition of coagulation and complex role for integration of all these processes in the placenta. Level of PAPP-A (under 0.4 MoM-Multiple of Medians) in first-trimester screening in chromosomally and morphologically normal fetuses, could influence fetal weight, preeclampsia, premature birth and stillbirth. As a result of the complications as mentioned earlier, there is implication on timing, mode of delivery and condition of the newborn.AIM: The study aims to evaluate the influence of low PAPP-A, measured in the first trimester on the outcome of pregnancy, with accent disorders, which are the result of placental insufficiency. Also, gestational week, mode of delivery and condition of newborn secondary underlying conditions will be evaluated.MATERIAL AND METHODS: After given information and consultation about the expectation from the screening, pregnant women with a singleton pregnancy were tested for First Trimester Screening to estimate the risk for Trisomy 21, 13, 18- the most frequent chromosomopathies. After exclusion of chromosomopathies and congenital malformations, one hundred and fourteen patients enrolled in the study. The target group (n = 64) with PAPP-A below 0.4 MoM and control group (n = 50) with PAPP-A equal and above 0.4 MoM. An assessment of mode and time of delivery and presence of small for gestational age newborns, preeclampsia, premature birth and newborn condition at delivery was made.RESULTS: The percentage of the patients delivered in term was similar between the target group (n = 64) and the control group (n = 50), 82.81% vs 82.0% respectively. The rate of cesarean section was 29.7 % in the target group vs 32% in the control group. A significant difference was found about elective vs urgent cesarean section in favour of the target group. The difference was present about the complication in pregnancy before delivery, 56% vs 22%, p = 0.023, which were the main indication for cesarean section. The difference in newborn outcome was not significant.CONCLUSION: There is a difference in frequency of complications, in the cases with PAPP-A under 0.4 MoM, such as premature birth, preeclampsia compound with SGA fetuses versus the control group. The difference for SGA newborn and premature birth among the groups has statistical significance. The patients delivered with cesarean section were with the main indications SGA or elevated blood pressure, often occurred combined with prematurity. Apgar score and birth weight were similar in target and control group, but the newborns with a birth weight under 2500 g. were more frequent in the target group. Because these results did not show another significance among two groups, probably lower cut-off is needed, combining with another test (Doppler of uterine arteries in the first trimester, biochemical test). Presence of other diseases which could hurt placental function should be emphasised.

scholarly journals The Effect of Maternal Socio-Demographic Status and First Trimester Screening Test in Predicting Term Stillbirth

2021 ◽  
Author(s):  
Ahkam Göksel Kanmaz ◽  
Emrah Beyan ◽  
Emrah Töz ◽  
Murat Alan ◽  
Abdurrahman Hamdi İnan ◽  
...  
Keyword(s):  
Screening Test ◽  
Demographic Data ◽  
First Trimester ◽  
Developed Countries ◽  
World Health ◽  
Control Group ◽  
Stillbirth Rate ◽  
First Trimester Screening ◽  
Income Status ◽  
Trimester Screening

Objective: Stillbirth is defined by the World Health Organization as the complete birth of a fetal death baby. Stillbirth rate in Turkey is determined approximately 9.3/1000. Although many reasons have been identified in the etiology of stillbirth, idiopathic stillbirths are still detected. Currently, a cost-effective stillbirth screening strategy has not been recommended. Methods: Term stillbirth cases that occurred in our clinic during 4 years period were investigated retrospectively. Pregnancies resulting in stillbirth and control group pregnancies were compared in terms of sociodemographic status and first trimester screening test results. Results: Maternal age was found to be higher in the pregnancies resulting in stillbirth, while birth weight and gestational age were lower (p=0.003 and p<0.001 and p<0.001, respectively). There was no significant effect of maternal refugee status or income status on stillbirth. Pregnancy-related plasma protein A, one of the first trimester test markers, was not found to have an effect on predicting stillbirth, whereas low values of free beta-human chorionic gonadotrapine (BhCG) might have a role in predicting stillbirth (AUC 0.731 and p=0.006). Nuchal translucency (NT) was also found to be significant in predicting stillbirth but not as effective as free BhCG. Conclusion: In our country, the stillbirth rate is almost twice that of developed countries. Free BhCG, NT, and maternal demographic data can be used to predict term stillbirths with often unknown causes.

scholarly journals Operative delivery in pregnant women with asthma

2019 ◽  
Vol 68 (4) ◽  
pp. 19-26
Author(s):  
Olga V. Lavrova ◽  
Elena A. Shapovalova ◽  
Yulia R. Dymarskaya ◽  
Dmitry S. Sudakov ◽  
Anna V. Paliychuk
Keyword(s):  
Cesarean Section ◽  
Pregnant Women ◽  
Allergic Diseases ◽  
First Trimester ◽  
Control Group ◽  
Operative Delivery ◽  
Common Chronic Disease ◽  
Pregnancy And Childbirth ◽  
Asthma Patients ◽  
And Control

Hypothesis/aims of study. Asthma is the most common chronic disease of the respiratory system in women during pregnancy. Numerous studies show an increased frequency of all complications of pregnancy and delivery by cesarean section in women with asthma. Such delivery is reported to be observed more often in patients with severe asthma and asthma exacerbations during gestation. There are conflicting data showing that the use of asthma medication increases the risk of complications of pregnancy and childbirth. This study aimed at analyzing the frequency of cesarean section in patients with asthma, depending on the severity, course, and control of the disease. Study design, materials and methods. This retrospective study involved data of 170 patients with varying severity and control of asthma, who were under the supervision of a pulmonologist from the first trimester of pregnancy. According to the severity of asthma, patients were divided into subgroups with mild intermittent, mild persistent, and moderate and severe course of the disease. The control group was represented by 30 patients who did not suffer from any pulmonary and allergic diseases. Results. The cesarean delivery rate in patients with asthma in the whole group was significantly higher than in patients of the control group. Exacerbation of asthma during pregnancy significantly increases the frequency of abdominal operative delivery, and the use of modern drugs to achieve control of asthma during pregnancy has a positive effect and is associated with a lower birth rate by cesarean section. Conclusion. The active simultaneous management of pulmonary problems in pregnant women allows timely and adequate therapeutic measures aimed to achieve control of asthma during pregnancy, thereby reducing obstetric and perinatal risks, including those associated with the method of delivery.

Correlation of first-trimester thymus size with chromosomal anomalies

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Sarah Kleemann ◽  
Raphael Koch ◽  
Ralf Schmitz ◽  
Helen A. Köster ◽  
Janina Braun ◽  
...  
Keyword(s):  
Trisomy 21 ◽  
First Trimester ◽  
Trisomy 18 ◽  
Trisomy 13 ◽  
Control Group ◽  
Chromosomal Anomalies ◽  
First Trimester Screening ◽  
Fetal Thymus ◽  
Trimester Screening ◽  
Thymus Size

Abstract Objectives The aim of this study was to investigate the correlation between fetal thymus size measured during first-trimester screening and chromosomal anomalies. Methods This study is a retrospective evaluation, in which the anterior-posterior diameter of the thymus in a midsagittal plane was measured in first-trimester ultrasound between 11+0 and 13+6 weeks of gestation in 168 fetuses with chromosomal anomalies (study group) and 593 healthy fetuses (control group). The included cases were subdivided into six groups: (1) trisomy 21, (2) trisomy 18, (3) trisomy 13, (4) Turner syndrome, (5) triploidy and (6) normal controls. Thymus size measurements were adjusted to the week of gestation, which was determined by ultrasound using crown-rump-length (CRL), by calculating a ratio between CRL and thymus size (CRL-thymus-ratio). Each study group was compared with the control group separately. Results Thymus size in fetuses affected by trisomy 18 or trisomy 13 was noticeably smaller compared to the control group (1.4 mm [1.3, 1.5] and 1.3 mm [1.2, 1.4] vs. 1.8 mm [1.6, 2.1]; all p<0.001; respectively). The thymus size of fetuses with trisomy 21 and Turner syndrome did not differ from healthy fetuses. Between the CRL-thymus-ratios of the separate study groups no statistically noticeable differences could be found. Conclusions Fetal thymus size appeared to be smaller in pregnancies affected by trisomy 18 and trisomy 13. The predictive value of fetal thymus size in first-trimester screening should be evaluated prospectively.

FRACTIONAL DETERMINATIONS OF URINARY 17-KETOSTEROIDS IN HYPEREMESIS GRAVIDARUM

1962 ◽  
Vol 41 (1) ◽  
pp. 123-128 ◽  
Author(s):  
Pentti A. Järvinen ◽  
Sykkö Pesonen ◽  
Pirkko Väänänen
Keyword(s):  
Hyperemesis Gravidarum ◽  
First Trimester ◽  
Control Group ◽  
Before And After ◽  
Daily Urine ◽  
First Trimester Of Pregnancy ◽  
The Difference

ABSTRACT The fractional determination of 17-ketosteroids in the daily urine was performed in nine cases of hyperemesis gravidarum and in four control cases, in the first trimester of pregnancy both before and after corticotrophin administration. The excretion of total 17-KS is similar in the two groups. Only in the hyperemesis group does the excretion of total 17-KS increase significantly after corticotrophin administration. The fractional determination reveals no difference between the two groups of patients with regard to the values of the fractions U (unidentified 17-KS), A (androsterone) and Rest (11-oxygenated 17-KS). The excretion of dehydroepiandrosterone is significantly higher in the hyperemesis group than in the control group. The excretion of androstanolone seems to be lower in the hyperemesis group than in the control group, but the difference is not statistically significant. The differences in the correlation between dehydroepiandrosterone and androstanolone in the two groups is significant. The high excretion of dehydroepiandrosterone and low excretion of androstanolone in cases of hyperemesis gravidarum is a sign of adrenal dysfunction.

Trends in early prenatal screening for chromosomal abnormalities and congenital malformations in Russia in 2018

2020 ◽  
pp. 76-78
Author(s):  
Е.А. Калашникова ◽  
Е.Н. Андреева ◽  
П.А. Голошубов ◽  
Н.О. Одегова ◽  
Е.В. Юдина ◽  
...  
Keyword(s):  
Reference Values ◽  
Congenital Malformations ◽  
Prenatal Screening ◽  
Chromosomal Abnormalities ◽  
First Trimester ◽  
First Trimester Screening ◽  
Trimester Screening ◽  
Overall Effectiveness ◽  
Regions Of Russia

В ходе анализа результатов раннего пренатального скрининга (РПС) в России за 2018 г. (Аудит-2019) дана оценка качества мероприятий, общей эффективности и тенденций развития системы РПС в субъектах РФ посредством сравнения рассчитанных основных организационных, методологических и интегральных показателей с международными референтными значениями. In the course of analyzing the results of early prenatal combined first-trimester screening (FTS) in Russia for 2018 (Audit-2019) the assessment of the quality of measures, the overall effectiveness and trends in the development of the FTS system in the regions of Russia. They are presented by comparing the calculated main organizational, methodological and integral indicators with international reference values.

Effect of aromatherapy massage with orange essential oil on postoperative pain after cesarean section: a randomized controlled trial

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Seyedmohammad Mirhosseini ◽  
Ali Abbasi ◽  
Nastaran Norouzi ◽  
Fatemeh Mobaraki ◽  
Mohammad Hasan Basirinezhad ◽  
...  
Keyword(s):  
Side Effects ◽  
Essential Oil ◽  
Cesarean Section ◽  
Statistical Tests ◽  
Intervention Group ◽  
Nursing Intervention ◽  
Anxiety Score ◽  
Control Group ◽  
And Control ◽  
Orange Essential Oil

Abstract Objectives Many women in recent years have been willing to undergo puncture surgery for childbirth, which, like other surgeries, has physical and psychological side effects such as incision, infertility, chronic pain, and anxiety. Therefore, it is important to reduce and improve these side effects. The aim of this study was to determine the effect of foot massage with orange essential oil on pain and anxiety in women undergoing cesarean section. Methods This randomized clinical trial study was conducted in 2019 on 80 women referred to Bahar Shahroud Hospital after cesarean section surgery. The samples were divided into two groups by intervention (foot massage with orange essential oil) and control (foot massage without orange essential oil). The Spielberger scale was used to determine anxiety scores after cesarean section. In the intervention group, the feet were massaged with orange essential oil, and in the control group, the orange essential oil massage was performed without oil. Anxiety before, immediately after, and 60 min after the intervention was measured and evaluated in both groups. Data analysis was performed using descriptive and inferential statistics. Significant levels were considered for all statistical tests (p<0.05). Results The anxiety score before the intervention in the two groups of intervention and control was 57.12 ± 3.12 and 57.07 ± 3.54, respectively, which were not significantly different, but immediately after the intervention, the anxiety scores in both groups decreased significantly so that there was a further decrease in the intervention group (52.10 ± 4.75 and 56.02 ± 3.77), 1 h after the intervention, the anxiety score in the intervention group decreased compared to the previous stage and increased in the control group (50.40 ± 3.74 and 56.85 ± 4.27). Conclusions Foot massage with orange essential oil can probably be effective as a proper nursing intervention in reducing anxiety after cesarean section surgery.

Sign in / Sign up

Export Citation Format

Share Document