miR-27b-3p is highly expressed in serum of patients with preeclampsia and has clinical significance

Background: Preeclampsia (PE) is defined as a salient complication of late pregnancy. microRNAs (miRNAs) have emerged as critical biological regulators in PE. This study determined miR-27b-3p expression in serum of PE patients and investigated its clinical significance in PE. Methods: Totally 130 pregnant women including 90 PE patients (51 mild PE and 39 severe PE) and 40 healthy controls were enrolled in this study. miR-27b-3p expression in the serum of PE patients and healthy controls was detected using RT-qPCR. The correlation among miR-27b-3p expression and 24-h urine protein, systolic blood pressure (SBP), diastolic blood pressure (DBP), serum creatinine, and fetal birth weight was analyzed using Pearson's correlation coefficient. The targeting relationship between miR-27b-3p and PPARG was verified. PPARG protein level in PE patients was detected using ELISA kits. The predictive efficiency of miR-27b-3p and PPARG in PE was analyzed using the receiver operating characteristic (ROC) curve. Results: Compared to normal pregnant women, PE pregnant women, especially severe PE patients had higher miR-27b-3p expression. miR-27b-3p was positively correlated with 24-h urine protein, SBP, DBP, and serum creatinine, but negatively correlated with fetal birth weight. PPARG was poorly expressed in PE patients and negatively correlated with miR-27b-3p. ROC curve showed that both miR-27b-3p and PPARG had good predictive efficacy on PE. Conclusion: miR-27b-3p expression in serum of pregnant women with PE was positively correlated with the severity of PE symptoms, suggesting the involvement of miR-27b-3p in PE occurrence.

Maternal Anemia and Fetal Birth Weight; a comparative, cross-sectional, multi-centric study.

Objective: The objective of this study is to evaluate the relationship between maternal anemia and fetal birth weight and how other variables impact fetal birth weight. Study Design: Comparative, Cross-sectional, Multi-centric study. Setting: Labor Room Jinnah Hospital Lahore, Labor Room Allied Hospital Faisalabad, Labor Room Holy Family Hospital Rawalpindi. Period: 01-08-2020 to 31-10-2020. Material & Methods: The data for this comparative, cross-sectional, multi-centric study was collected using a structured questionnaire from 360 subjects with equal representation among 3 major tertiary care centers of Punjab, Pakistan. Sample size was calculated using Open-Epi software at 95 percent confidence interval, taking frequency of anticipated factor (frequency of LBW babies among anemic females) as 64 percent. The calculated sample was 353 and we recruited 360 subjects for the study. 120 subjects from each study setting were recruited and divided into anemic and non-anemic groups of 60 subjects each. The sample size was equally divided among anemic and non-anemic groups to achieve comparative analysis of both groups for a variety of variables. Data analysis was performed on R v 4.0.2. Results: This study demonstrated a significant association between maternal anemia and low fetal Birth weight. In Anemic group, 28.88% of the babies were born with Low Birth weight, as compared to 17.77% Low Birth weight babies in the Non-Anemic group, the difference being statistically significant (p<0.012). Conclusion: Maternal anemia and fetal birth weight have a significant negative correlation. Mothers with Anemia are more likely to give birth to babies with Low weight at Birth.

The effects of body mass index, smoking and anemia on fetal birth weight

Objective: Fetal growth is an important indicator of fetal health. Low birth weight (LBW) is also associated with increased perinatal morbidity and mortality. Numerous factors that affect fetal weight have been identified. In this study, we aimed to investigate the effect of body mass index, smoking, and anemia on fetal birth weight on term pregnant women who had vaginal delivery in our clinic. Methods: This study is a retrospective cross-sectional study. This study included patients who had a spontaneous vaginal delivery at our hospital between January 1st, 2018, and June 15th, 2020. Measurements of hemoglobin (Hb) and hematocrit (Hct) levels during birth supported the diagnosis of anemia. Hb levels were compared in three categories in this study: (1) Hb<10 g/dL; (2) ≥10<11 g/dL; and (3) Hb ≥11 g/dL. Anemia was defined as having a Hb level <11 mg/dL. Birth weight was categorized as LBW <2500 g; normal birth weight (NBW) as ≥2500–3999 g, and macrosomia as ≥4000 g. Results: Analysis was performed on 1428 pregnant women. There was a statistically significant difference for the Hct and Hb subgroups between the groups (p<0.05). Fetal birth weight was found higher in the non-smoking group than in the smoking group (3302.1± 381.5 g vs. 2839.7±491.5 g; p<0.001). Body mass index (BMI) and Hb levels positively predicted fetal birth weight (β=0.134; p<0.001 and β=0.051; p=0.046), smoking was negatively predicted fetal birth weight (β=-0.245; p<0.001). Conclusion: BMI, Hb levels, and smoking status during mothers’ delivery are effective on fetal weight. Smoking was the strongest predictor of fetal birth weight compared with the other variables.

The enrichment of neutrophil extracellular traps impair the placentas of systemic lupus erythematosus through accumulating decidual NK cells

Despite the advances made in the management of pregnancies in women with systemic lupus erythematosus (SLE), the rate of adverse pregnancy outcomes is still higher than that in the general population. In the last few years, neutrophil extracellular traps (NETs) were proven to be detrimental in both autoimmune diseases and placental injury. We investigated whether NETs could be detected in the placentas of pregnant individuals with SLE and explored the relationship between NETs and decidual natural killer cells (dNKs), which comprise the majority of immune cells at the maternal–fetal interface, using clinical samples and animal models. In this study, we found that the infiltration of NETs and dNKs, especially CD56+CD16+ NK cells, was significantly increased in pregnant individuals with SLE with placental insufficiency. In the murine models of SLE, the number of dNKs was significantly decreased due to the decreased formation of NETs affected by Ly6G. Moreover, the histopathological placental injury was reduced, with a remarkable increase in fetal birth weight. This study shows that NETs may contribute to immunological disorder in the placenta and the pathological changes in pregnancies with SLE, which provides a research basis for further explorations of the mechanism of SLE in placental impairment.

The comparison of amniotic fluid nuclearfactor-kappa B levels in pregnant women who underwent cesarean section or normal vaginal labor

Objective Inflammatory changes in the amniotic membranes during prenatal period have a critical important in the rupture of membranes and the onset of labor. The inflammatory changes in the membranes caused by normal vaginal labors and cesarean sections (C/S) are different than each other. Nuclear factor-kappa B (Nf- kB) is the basic cellular marker of the inflammation change in biological fluids and tissues. We planned this study to compare amniotic fluid NF-kB (AF-NF-kB) concentrations in normal vaginal labor cases and those who underwent non-emergency C/S. Methods One-hundred singleton term pregnant women who did not have any serious fetal and maternal problems were included in the study. The pregnant women were separated into two groups, which contained 50 cases each. The week of gestation was calculated according to the last menstrual period and ultrasonography measurements. The groups included 50 patients who did not have the history of clinical chorioamnionitis and preterm premature rupture of membranes and were decided to have normal vaginal labor, and 50 term pregnant women who were decided to have cesarean section due to maternal or perinatal reasons. The amniotic fluid samples were collected during cesarean section or normal vaginal labor. After opening the membranes by scalpel in C/S cases and following spontaneous or artificial membrane rupture in vaginal labor cases, the amniotic fluid samples were collected. AF-NF-kB concentrations were evaluated by ELISA method. Results AF-NF-kB levels of the patients in the group of normal vaginal labor were significantly higher than AF-NF-kB levels of the patients in C/S group. AF-NF-kB levels were about 2 times higher in the group of normal vaginal labor (1.44±0.40 ng/ mL vs. 0.71±2.60 ng/mL, p<0.001). There was a positive but insignificant correlation between the fetal birth weight and AF-NF-kB levels in the patients who underwent normal vaginal labor. There was no significant correlation between AF-NF-kB levels and demographic and clinical characteristics of the patients who underwent labor by C/S. Conclusion Normal vaginal labor is associated with the increased AF-NF-kB concentrations compared to C/S cases. AF-NF-kB levels seem to be a potential predictor for the spontaneous fetal membrane rupture.

Covert postpartum urinary retention, is there a place for routine bladder ultrasound in postpartum care?

Postpartum urinary retention (PUR) is defined as inability to void after six hours from delivery or having abnormal post-void residual volume after delivery (PVRV). Overt PUR is easily detectable condition but covert PUR usually remains undiagnosed. We aim to investigate the incidence of covert PUR and identify the risk factors. A retrospective analysis of the postpartum women was undertaken between January-July 2016. PVRV of the patients either delivered vaginally or cesarean section were assessed with ultrasound after first micturition. All the ultrasound scans were made by experienced gynecologist. PVRV of more than 150 mL was defined as covert PUR. Maternal age, parity, BMI, type of delivery, episiotomy, first urination time, fetal head circumference, labor augmentation and fetal birth weight were investigated as possible risk factors for covert PUR. The characteristics of the patients with or without covert PUR were compared. Of the 450 women included, 67 (17.49%) were diagnosed as covert PUR. Birth weight (p= 0.001), head circumference (p=0.043), vaginal delivery (p=0.001) and need for episiotomy (p=0.003) were statistically different between patients with PVRV under 150 mL and above 150 mL. Fetal head circumference appeared as the only independent risk factor for covert PUR (95% CI for OR=1.11-1.127, p=0.04). Although covert PUR is a common problem after delivery, risk factors and treatment have not been established. Until risk factors are identified clearly with larger studies, postpartum routine PVRV evaluation may be beneficial for preventing long-term voiding dysfunction problems.

Prospective verification of sonographic fetal weight estimators among term parturients in Uganda

Background Accuracy of fetal weight estimation by ultrasound is essential in making decisions on the time and mode of delivery. There are many proposed formulas for fetal weight estimation such as Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard. What best applies to the Ugandan population is not known since no verification of any of the formulas has been done before. The primary aim of this study was to determine the accuracy of sonographic estimation of fetal weight using five most commonly used formulas, and analyze formula variations for different weight ranges. Methods This was a hospital based prospective cohort study at Mulago National Referral Hospital, Kampala, Uganda. A total of 356 pregnant women who consented and were within 3 days of birth were enrolled. Prenatal ultrasound fetal weight determined by measuring the biparietal diameter, head circumference, abdominal circumference, femoral length, and then was compared with actual birth weight. Results The overall accuracy of Hadlock 1, Hadlock 2, Hadlock 3, Hadlock 4 and Shepard formula were 66.9, 73.3, 77.3, 78.4 and 69.7% respectively. All Hadlocks showed significant mean difference between weight estimates and actual birth weight (p < 0.01) whereas Shepard formula did not [p - 0.2], when no stratification of fetal weights was done. However, all Hadlocks showed a none significant (p-values > 0.05) mean difference between weight estimates and actual birth weight when the actual birth weight was ≥4000.0 g. Shepard weight estimates showed a none significant mean difference when actual birth weight was < 4000 g. Bland-Altman graphs also showed a better agreement of weight estimated by Shepard formula and actual birth weights. Conclusion All the five formulas were accurate at estimating actual birth weights within 10% accuracy. However, this accuracy varied with the fetal birth weight. Shepard was more accurate in estimating actual birth weights < 4000 g whereas all Hadlocks were more accurate when the actual birthweight was ≥4000 g.