Uterine artery Doppler analysis at 11-14 weeks as a predictor of intra-uterine growth restriction

Background: Successful pregnancy results from reciprocity between placental and maternal cardiovascular system. Intra-uterine growth restriction (IUGR) is a condition which arises from insufficiency of placenta and can be seen as variations in waveforms in uterine artery (UtA). In our study, we studied, whether predictive accuracy of various UtA Doppler indices for IUGR in first trimester early enough to provide an intervention for prevention of IUGR, as it was a leading cause of neonatal morbidity and mortality.Methods: The study design was a prospective observational study. UtA Doppler was done at 11-14 weeks in 120 pregnancies attending the outpatient and inpatient department of obstetrics and gynaecology, PCMS, Bhopal. The left and right UtA velocity waveforms were studied. Mean pulsatility index (PI), mean resistive index (RI) and diastolic notch were noted. Results obtained were analyzed and tabulated.Results: Amongst these, 25.86% developed IUGR. First trimester UtA mean RI and PI were remarkably elevated in patients who developed IUGR on follow up. No relationship was noted between diastolic notch and IUGR. Mean RI and PI were found to be good predictors of IUGR. Using receiver operating characteristics (ROC) curve, the best cut-off of mean RI and mean PI to detect IUGR was 0.68 and 1.56 respectively.Conclusions: UtA Doppler at 11-14 weeks of gestation recognizes a huge proportion of women who will develop IUGR.

Disruption of Glucocorticoid Action on CD11c+ Dendritic Cells Favors the Generation of CD4+ Regulatory T Cells and Improves Fetal Development in Mice

A wealth of innate and adaptive immune cells and hormones are involved in mounting tolerance towards the fetus, a key aspect of successful reproduction. We could recently show that the specific cross talk between the pregnancy hormone progesterone and dendritic cells (DCs) is significantly engaged in the generation of CD4+ FoxP3+ regulatory T (Treg) cells while a disruption led to placental alterations and intra-uterine growth restriction. Apart from progesterone, also glucocorticoids affect immune cell functions. However, their functional relevance in the context of pregnancy still needs clarification. We developed a mouse line with a selective knockout of the glucocorticoid receptor (GR) on DCs, utilizing the cre/flox system. Reproductive outcome and maternal immune and endocrine adaptation of Balb/c-mated C57Bl/6 GRflox/floxCD11ccre/wt (mutant) females was assessed on gestation days (gd) 13.5 and 18.5. Balb/c-mated C57Bl/6 GRwt/wtCD11ccre/wt (wt) females served as controls. The number of implantation and fetal loss rate did not differ between groups. However, we identified a significant increase in fetal weight in fetuses from mutant dams. While the frequencies of CD11c+ cells remained largely similar, a decreased expression of co-stimulatory molecules was observed on DCs of mutant females on gd 13.5, along with higher frequencies of CD4+ and CD8+ Treg cells. Histomorphological and gene expression analysis revealed an increased placental volume and an improved functional placental capacity in mice lacking the GR on CD11c+ DCs. In summary, we here demonstrate that the disrupted communication between GCs and DCs favors a tolerant immune microenvironment and improves placental function and fetal development.

Impact of Fetal Growth Restriction on the Neonatal Microglial Proteome in the Rat

Microglial activation is a key modulator of brain vulnerability in response to intra-uterine growth restriction (IUGR). However, the consequences of IUGR on microglial development and the microglial proteome are still unknown. We used a model of IUGR induced by a gestational low-protein diet (LPD) in rats. Microglia, isolated from control and growth-restricted animals at P1 and P4, showed significant changes in the proteome between the two groups. The expression of protein sets associated with fetal growth, inflammation, and the immune response were significantly enriched in LPD microglia at P1 and P4. Interestingly, upregulation of protein sets associated with the oxidative stress response and reactive oxygen species production was observed at P4 but not P1. During development, inflammation-associated proteins were upregulated between P1 and P4 in both control and LPD microglia. By contrast, proteins associated with DNA repair and senescence pathways were upregulated in only LPD microglia. Similarly, protein sets involved in protein retrograde transport were significantly downregulated in only LPD microglia. Overall, these data demonstrate significant and multiple effects of LPD-induced IUGR on the developmental program of microglial cells, leading to an abnormal proteome within the first postnatal days.

Management of Hypertension in Elderly Pregnant Women with IVF Conception: A Case Report

Introduction: Hypertensive complications associated with pregnancy are the primary cause of maternal and fetal morbidity. Early development of cardiovascular disease is also anticipated relatively early after pregnancy is terminated. Over the past 20 years, infertility treatments have steadily increased and proven effective in achieving significant successful conception rates and live birth rates, even among women younger than 35 years of age. Symptoms and important clinical findings: A 45 year sold female was admitted in AVBRH on date 22/01/2021 with chief complaint of breathing difficulty (elderly G5P1D1A3 with 28 weeks of gestational age)having history of previous LSCS with IVF conception with gestational hypertension. Obstetric history: Patient had bad obstetric history of three abortionsand one still-birth. In 2017 she had got the menopause. After menopause she took the treatment in AVBRH Sawangi (M) Wardha and got the regular menses.After regular menses, shereceived IVF cycle and she was conceived in 2nd IVF cycle. The main diagnoses, therapeutic interventions, and outcomes: After physical examination and investigations, this case was diagnosed having 28 weeks of gestation with hypertension. Patient had previous history of LSCS.Patient was treated with antihypertensive drugs to reduce the symptoms of eclampsia. Alsoshe was provided calcium supplement and iron supplement. Present case was stable but ultrasonography revealedsign of stage I- intra uterine growth restriction. Nursing perspectives: Fluid replacement i.e. DNS and RL, monitoring offetal heart rate and vital signs per hourly. Conclusion: Conception with in vitro fertilization have increased risk of gestational hypertension as well as fetal complications like intra uterine growth restriction. But timely treatment and management improves the outcome of pregnancy.