Maternal serum CA-125 repeated measurement during pregnancy and how to use as a prognostic factor of first trimester pregnancy outcome

Background: The aim of this study was to estimate the prognostic efficacy of repeated measurement of maternal serum CA125 in first trimester threatened miscarriage.Methods: Prospective case control study was conducted in the outpatient clinic. 100 pregnant women were divided into 50 women with normal course of pregnancy, and the other 50 were subdivided into 25 pregnant women with lower abdominal pain without vaginal bleeding and 25 presented with minimal vaginal bleeding. Repeated measuring of serum CA125 was done for each case on the 5th, 10th weeks of gestation.Results: Findings of this study suggested the possibility of using serum CA-125 for determining the prognosis of first trimester threatened miscarriage with cut-off value of CA125 38.25 U/ml on the 5th week of gestation and 53 U/ml on the 10th week of gestation in patients presented with pain only but in patients presented with minimal vaginal bleeding the cut-off value of CA125 on the 5th week of gestation become 45.6 U/ml and 68 U/ml on the 10th week of gestation.Conclusions: CA125, on its own, can discriminate between continued and non-continued pregnancy.

A randomized controlled study of acupuncture for pain relief during first trimester surgical termination of pregnancy performed under local analgesia

Background: Acupuncture reduces pain levels in many painful conditions. This study compared pain levels during surgical termination of first trimester pregnancy by suction evacuation (SE) under local analgesia with and without the use of acupuncture. Methods: In all, 60 nulliparous women undergoing SE before 10 weeks of gestation were randomly assigned into one of the following three groups in a 1:1:1 ratio according to a computer-generated randomization list. In the control group, women received oral diazepam 5 mg and intramuscular (i.m.) injection of pethidine 30 and 15 min, respectively, prior to SE. In the acupuncture group, women received acupuncture 10 min before SE until the end of SE while oral diazepam 5 mg and i.m. injection of normal saline were given. In the combined group, women received acupuncture in addition to the drugs in the control group. Data from 52 participants were analysed. Pain scores during and after SE, post-operative side-effects and satisfaction levels were compared. Results: The three groups had similar baseline characteristics. The median pain levels during SE differed significantly between the control, acupuncture, and combined groups (80, 50 and 66 mm, respectively, p = 0.03). Pain levels during SE in the acupuncture and combined groups were significantly lower than that of the control group. However, the anxiety scores did not differ between the three groups after SE (p = 0.86). Conclusion: Acupuncture can provide additional benefit in terms of pain relief in women undergoing first trimester termination of pregnancy by SE under local analgesia.

Maternal Secondhand Smoke Exposure Enhances Macrosomia Risk Among Pregnant Women Exposed to PM2.5: A New Interaction of Two Air Pollutants in a Nationwide Cohort

Background: Fine particulate matter (PM2.5) is one of the most common outdoor air pollutants, and secondhand smoking (SHS) is an important source of inhalable indoor air pollution. Previous studies were controversial and inconsistent about PM2.5 and SHS air pollutants on neonatal birth weight outcomes, and no studies assessed the potential interactive effects between PM2.5 and SHS on birth weight outcomes.Purpose: To investigate the interaction between gestational PM2.5 and SHS air pollution exposure on the risk of macrosomia among pregnant women and examine the modifying effect of SHS exposure on the association of PM2.5 air pollution and birth weight outcomes during pregnancy.Methods: Research data were derived from the National Free Preconception Health Examination Project (NFPHEP), which lasted 3 years from January 1, 2010, to December 31, 2012. At least 240,000 Chinese women from 220 counties were enrolled in this project. PM2.5 exposure concentration was obtained using a hindcast model specific for historical PM2.5 estimation from satellite-retrieved aerosol optic depth. Different interaction models about air pollution exposure on birth weight outcomes were established, according to the adjustment of different confounding factors and different pregnancy stages. The establishment of interaction models was based on multivariable logistic regression, and the main confounding factors were maternal age at delivery and pre-pregnancy body mass index (BMI) of participants. SHS subgroups analysis was conducted to further confirm the results of interaction models.Results: In total, 197,877 participants were included in our study. In the full-adjusted interaction model, maternal exposure to PM2.5 was associated with an increased risk of macrosomia in whole, the first-, second-, and third trimesters of pregnancy (p < 0.001). The interactive effect was statistically significant between maternal exposure to PM2.5 and SHS on the risk of macrosomia in the whole (interaction p < 0.050) and the first-trimester pregnancy (interaction p < 0.050), not in the second (interaction p > 0.050) or third trimester (interaction p > 0.050) of pregnancy. The higher frequency of SHS exposure prompted the stronger interaction between the two air pollutants in the whole pregnancy and the first-trimester pregnancy.Conclusions: In the whole and first-trimester pregnancy, maternal exposure to SHS during pregnancy enhanced the risk of macrosomia among pregnant women exposed to PM2.5 air pollutants, and the interaction became stronger with the higher frequency of SHS exposure.

First trimester pregnancy outcomes in a large IVF center from the Lombardy County (Italy) during the peak COVID-19 pandemic

At the beginning of 2020, the Italian Lombardy region was hit by an “epidemic tsunami” which was, at that point in time, one of the worst pandemics ever. At that moment the effects of SARS-COV 2 were still unknown. To evaluate whether the pandemic has influenced ART (Assisted Reproduction Techniques) outcomes in an asymptomatic infertile population treated at one of the major COVID-19 epicentres during the weeks immediately preceding lockdown. All ART procedures performed during two time periods were compared: November 1st, 2018 to February 28th, 2019 (non-COVID-19 risk) and November 1st, 2019 to February 29th, 2020 (COVID-19 risk). In total 1749 fresh cycles (883 non-COVID-19 risk and 866 COVID-19 risk) and1166 embryos and 63 oocytes warming cycles (538 and 37 during non-COVID and 628 and 26 during COVID-19 risk, respectively) were analysed. Clinical pregnancies per cycle were not different: 370 (25.38%) in non-COVID versus 415 (27.30%) (p = 0.237) during COVID-19 risk. There were no differences in biochemical pregnancy rates 52 (3.57%) versus 38 (2.50%) (p = 0.089) nor in ectopic pregnancies 4 (1.08%) versus 3 (0.72%) (p = 0.594), spontaneous miscarriages 84 (22.70%) versus 103 (24.82%) p = 0.487, nor in intrauterine ongoing pregnancies 282 (76.22%) versus 309 (74.46%) p = 0.569. A multivariate analysis investigating differences in spontaneous miscarriage rate showed no differences between the two timeframes. Our results support no differences in asymptomatic infertile couples’ ART outcomes between the pre COVID and COVID-19 periods in one of the earliest and most severe pandemic areas.

Evaluation of yolk sac size and embryonic heart rate in first trimester and pregnancy outcome

Background: Accurate differentiation between normal pregnancy and pregnancy loss in early gestation remains a clinical challenge-previous studies have described the association between embryonic well-beings and the characteristics of gestational sac. The aim of the study was to evaluate the yolk sac size and embryonic heart rate as a prognostic factor for the first trimester pregnancy outcome.Methods: This was a prospective cohort observesional study. It included 52 pregnant women in their first trimester from 6 week till 12 weeks gestation. Transvaginal sonographic examination after explanation and agreement of each patient. All pregnancies were followed for their pregnancy outcome after completion of 12 weeks. The adverse outcome was spontaneous miscarriage occurring before or at 12 weeks of gestation. These patients allocated into four study groups: according to gestational age at presentation and pregnancy outcome. Group I included women who were examined during (6-7 weeks+6 days). Group II included women who were examined during (8-9 weeks+6 days). Group III included women who were examined during (10-12 weeks). Group IV included women who had their pregnancies resulted into first trimester spontaneous miscarriage.Results: The validity of YS diameter regarding the prognosis of first trimester pregnancy outcome shows that; YSD had 100% specificity and 97.8% sensitivity in prediction of miscarriage. Regarding embryonic heartbeat, there was a statistically significant difference between group IV and the other groups. There was embryonic bradycardia in the miscarriage group. EHR had a sensitivity of 97.5% and specificity of 100% in prediction of first trimester pregnancy outcome.Conclusions: Abnormal yolk sac diameter, in the form of small, enlarged, absent or irregular yolk sac, and embryonic bradycardia are associated with poor pregnancy outcome.