High-Grade Fetal Vascular Malperfusion Is Associated With Diffuse Chorionic Hemosiderosis

Introduction Diffuse chorionic hemosiderosis (DCH) is an abnormality of the placental membranes characterized by the deposition of iron pigment. It is usually secondary to recurrent venous bleeding in early pregnancy. In many papers, it is associated with pre-term delivery. Fetal vascular malperfusion (FVM) is an abnormality of the feto-placental circulation that may be seen at any stage of gestation, but most often in the third trimester. It may be graded as low grade (LGFVM) or high grade (HGFVM). No link has been identified in the placental literature between DCH and FVM, but we have noted the 2 co-existing in placentas submitted for analysis. This study explored a possible association of these 2 entities. Methods Laboratory records were searched for singleton cases coded as DCH based on diagnosis on H&E stain over a 6-year period. Of 4478 placentas reported, 66 cases were coded as DCH (1.5%). These were classified as showing HGFVM, LGFVM, or no FVM. Controls (n = 132) were gestational age-matched cases without DCH. Cord length, coiling, insertion, or other abnormalities were noted. Membranes were classified as normal or circumvallate. Results were analyzed using Graphpad. Results Gestation ranged between 16 and 41 weeks gestation. 14/66 (21%) cases of DCH showed HGFVM and 2/66 (3%) showed LGFVM. 16/132 (12%) controls showed HGFVM and 21/132 (15.9%) had LGFVM. Where FVM is present, high-grade FVM is significantly associated with DCH versus controls ( P < .0031 Fischer’s Test). Discussion HGFVM occurs significantly more often in placentas with DCH than in controls. Both FVM and DCH are associated with adverse perinatal outcomes, and a possible relationship between the 2 remains to be clarified.

Ultrasound fetal biometry in third trimester in urban Nepalese population

INTRODUCTION: Fetal biometry is an important component of fetal growth surveillance and can detect small for gestation age fetuses. However, we use growth curves from studies done in other high-income countries and do not have a standard of our own. This study aims to study the deviation of biometry and expected fetal weight from these curves in pregnancy with normal birth weight term deliveries. METHODS: The study was a retrospective hospital record-based study including term delivery from 2018 May to 2020 January. All lowrisk patients visiting ultrasound OPD in our hospital in 3rd trimester were retrieved and included in the study. Patient with low AFI, major fetal anomaly, abnormal fetal heart rate, preterm delivery, birth weight less than 2500 gm (low birth weight), intrauterine fetal demise, preeclampsia or other complications were excluded from the study. Fetal biometry and expected fetal weight were evaluated. Data was entered in predesigned performa and analysis was performed with IBM SPSS 20.0. RESULTS: A total of 590 ultrasound examinations done in 372 patients were included in the study. Mean age of the patients was 30.78+/-3.98 years, median age was 30 years (IQ range-5). Approximately 316(53.6%) patients were under 30 years of age, 198(33.6%) patients were between 30-35 and 76(12.9%) patients were above 35 years. Median gestational age at birth was 39 weeks and median birth weight was 3120 grams. Median and percentile for various biometry was calculated. EFW was below 50th percentile in 424(71.9%) according to WHO chart. The median percentile for EFW was 30.6 (IQ-33.6). CONCLUSION: Expected fetal weight in Nepalese population is smaller than that predicted by WHO chart. Development of country specific fetal growth curve is recommended for accurate fetal growth surveillance.

Analysis of prevalence and sociodemographic conditions among women in labor with and without COVID-19 in public hospitals in Chile

Objectives The SARS-CoV-2 virus continues wreaking worldwide havoc on health and between March and August 2020, the first outbreak of COVID-19 hit Chile. The pregnant population is especially vulnerable to infection. Studies have been published that associate socioeconomic status, overcrowding, and poverty with a higher prevalence of SARS-CoV-2 infection. There are few studies about the development of this pandemic in Latin American countries so far. This study seeks to show the prevalence and sociodemographic and perinatal characteristics in pregnant women at the time of delivery, comparing both groups with positive and negative COVID-19 PCR results. Methods A prospective, cross-sectional study of pregnant women who delivered at the San Juan de Dios Hospital in Santiago between April 15, 2020 and June 15, 2020. Analysis of epidemiological, sociodemographic, obstetric, perinatal and sociodemographic data of patients with positive and negative COVID-19 PCR results. Results There were 701 patients included in the study. The prevalence of those with a positive COVID-19 PCR was 9.7% and 67.7% being asymptomatic. Pre-term delivery was significantly higher in the group of positive patients (23.5%) vs. negative patients (8.7%), which was not the same rate as with cesarean sections (C-sections). A 13.2% of patients required management of the pathology in the Critical Care Unit (CCU) and there were no cases of maternal or fetal deaths. We found no significant difference between both groups when analyzing socioeconomic variables, though we noted a trend of greater overcrowding among the group of patients with infection. Conclusions The majority of pregnant patients with SARS-CoV-2 infection are asymptomatic. COVID-19 increases the rate of premature births, but this rate is not same with C-sections. Sociodemographic conditions and overcrowding do not show a higher infection rate in a homogeneous population in relation to the economic, social and demographic level.

Hyperuricemia as a Risk Factor for Preterm Delivery in Women with Pre-Eclampsia

Objective: To determine hyperuricemia as a risk factor for preterm delivery in women with pre-eclampsia. Study Type: Case control study. Duration and Place of Study: Department of Gynaecology and Obstetrics, Sadiq Abbasi Hospital Bahawalpur from 1st July to 31st December 2019. Material and Methods: One hundred cases of pre-eclamptic and hyperuricemic women admitted for delivery through out-patient and emergency departments were divided in two groups, 50 cases in each group. Results: 70% women had hyperuricemia and pre-eclampsia deliver preterm and 34% women who had hyperuricemia and preeclampsia deliver at term. Conclusion: High serum uric acid concentration increased the chances of preterm delivery in pre-eclamptic women. Keywords: Hyperuricemia, Pre-eclampsia, Gestational hypertension, Uric acid, Pre-term delivery

A rare cause of postpartum vaginal bleeding

Background Invasive mole is a trophoblastic disease (GTD) caused by trophoblast cells invading the myometrium during pregnancy. The GTD range also includes mole hydatidiform, choriocarcinoma, and placental site trophoblastic tumor (PSTT). Invasive moles are most common following molar pregnancies; however, they can even rarely occur after a full-term birth. Despite the fact that pathology is the only way to make a clear diagnosis, clinic and radiologic evaluation can be helpful. We wanted to highlight a rare incidence of invasive mole following a healthy full-term delivery in this case. Case presentation A 28-year-old female patient presented with intermittent prolonged severe vaginal bleeding for 2 weeks after a term healthy vaginal delivery. In workup, beta human chorionic gonadotropin levels (b-hCG) value was 7540 mIU/ml. After suspicion of gestational trophoblastic neoplasm (GTN), the patient was sent to ultrasonography (US) and magnetic resonance imaging (MRI). GTN was confirmed by radiological and clinical findings, and a conclusive diagnosis of an invasive mole was made histopathologically. Conclusion Invasive mole should be considered in the differential diagnosis in patients with postpartum bleeding and a persistently high b-hCG level after a healthy term delivery.

Increased level of malondialdehyde in preterm labor

Background: The pathophysiological mechanism associated with spontaneous preterm delivery is oxidative stress through the increased formation of reactive oxygen species (ROS) due to lipid peroxidation. Malondialdehyde (MDA) is one of the biomarkers of oxidative stress produced through the lipid peroxidation process. Objective: The aim of this study is to observe the difference in MDA levels among preterm labor compared to full-term labor. Methods: Observational research was conducted with a comparative cross-sectional design. Maternal venous blood samples were taken from private hospitals and midwives in Padang city and Aro Suka Hospital Solok Regency. Samples were selected by consecutive sampling and divided into two groups with a total of 40 samples. MDA level was measured using the spectrophotometry method. Results: MDA levels in preterm delivery were 3,6±0.42 nmol/mL and in full-term delivery were 2.9±0.33 nmol/mL. Conclusion: There was a significant difference in MDA levels between preterm labor and full-term delivery. MDA levels in preterm childbirth were higher than MDA levels in full-term delivery.

Should we have surgery before pregnancy for women with congenital heart disease?

Objective: To investigate whether it is better to have surgery before pregnancy for pregnant women with congenital heart disease (CHD). Methods: Patients with CHD in Beijing Anzhen Hospital from 2010 to 2019 were collected and divided into surgical and non-surgical group, and the differences of events between the two groups were compared. Results: A total of 999 patients with CHD (mean age, 28.7±4.3years) were collected, including 403 cases (40.0%) in the surgical group and 596 cases (60.0%) in the non-surgical group. The most common CHD was atrial septal defect(33.1%), followed by ventricular septal defect (26.9 %), patent ductus arteriosus (9.9 %), and Tetralogy of Fallot (6.9 %). There were significant statistical differences in region, education degree and gravidity (P＜0.05), and the percentage of almost all events in the surgical group was higher. Pre-term delivery (17.1 vs. 9.9), low birth weight (11.6 vs. 6.5), heart failure (6.7 vs. 2.7), cesarean section (85.9 vs. 75.7), pulmonary arterial hypertension (36.2 vs. 13.6), Eisenmenger syndrome (9.7 vs. 0.2), and death (2.3 vs. 0.5) had statistically significant (P＜0.05). A total of 16 (1.6%) patients died, 14 (87.5%) in the surgical group, more than 2 (12.5%) in the non-surgical group. Conclusions: The outcome of surgical group was better than that of non-surgical group, surgery before pregnancy can reduce maternal and infant risk.

Healthy Habits and Emotional Balance in Women during the Postpartum Period: Differences between Term and Preterm Delivery

Breastfeeding could be considered as a vulnerable period, rising the risk to shift from optimism to pessimism. Preterm delivery is an event that increases postpartum maternal stress and depression, which can have a negative impact on breastfeeding and maternal–filial wellbeing. The adherence to healthy habits may have a positive influence on this vulnerable population. We aimed to analyze the impact of prematurity on maternal psychological aspects during postpartum and to study if adherence to the Healthy Food Pyramid influences psychological variables. Fifty-five breastfeeding women being attended in the Hospital Clínico San Carlos (Madrid, Spain) were recruited during the first day postpartum. The medical data were collected from the obstetrical records. The women answered an auto-administered questionnaire with several sections: sociodemographic characteristics, Perceived Stress Scale (PSS), and Life Orientation Test (LOT), at 14 days and 6 months postpartum, Adherence to the Healthy Food Pyramid Questionnaire (AP-Q) at 28 days postpartum and the Edinburgh Postpartum Depression Scale (EPDS) at 6 months postpartum. The PSS and LOT scores were not statistically different in mothers with preterm compared to term delivery either at 14 days or at 6 months postpartum. Longitudinally, the PSS did not show significant differences, but the LOT score was lower at 6 months compared to 14 days postpartum (p-Value = 0.046). A higher EPDS score was significantly found in mothers with preterm delivery (9.0 ± 4.7) than those with a term delivery (5.4 ± 4.2; p-value = 0.040). A significant and positive correlation was observed between the AP-Q score and LOT both at 14 days and 6 months postpartum. Conclusively, maternal optimism decreases during the postpartum period, women with preterm delivery being at risk of postpartum depression. Furthermore, there is a relationship between optimism and adherence to healthy habits. Healthcare professional counseling is essential during the entire breastfeeding period, particularly in vulnerable mothers with preterm delivery.

Transcriptomic Characterization of Postmolar Gestational Choriocarcinoma

The human placenta shares properties with solid tumors, such as rapid growth, tissue invasion, cell migration, angiogenesis, and immune evasion. However, the mechanisms that drive the evolution from premalignant proliferative placental diseases—called hydatidiform moles—to their malignant counterparts, gestational choriocarcinoma, as well as the factors underlying the increased aggressiveness of choriocarcinoma arising after term delivery compared to those developing from hydatidiform moles, are unknown. Using a 730-gene panel covering 13 cancer-associated canonical pathways, we compared the transcriptomic profiles of complete moles to those of postmolar choriocarcinoma samples and those of postmolar to post-term delivery choriocarcinoma. We identified 33 genes differentially expressed between complete moles and postmolar choriocarcinoma, which revealed TGF-β pathway dysregulation. We found the strong expression of SALL4, an upstream regulator of TGF-β, in postmolar choriocarcinoma, compared to moles, in which its expression was almost null. Finally, there were no differentially expressed genes between postmolar and post-term delivery choriocarcinoma samples. To conclude, the TGF-β pathway appears to be a crucial step in the progression of placental malignancies. Further studies should investigate the value of TGF- β family members as biomarkers and new therapeutic targets.