Fetal abdominal overgrowth is already present at 20–24 gestational weeks prior to diagnosis of gestational diabetes mellitus

Fetal abdominal obesity (FAO) was detected at the time of gestational diabetes mellitus (GDM) diagnosis at 24–28 gestational weeks (GW) in older (≥ 35 years) and/or obese (≥ body mass index 25 kg/m2) women and persisted until delivery. We investigated whether FAO is already present at 20–24 GW. Medical records of 7820 singleton pregnancy including 384 GDM were reviewed. Fetal abdominal overgrowth was assessed by the fetal abdominal overgrowth ratios (FAORs) of the ultrasonographically estimated gestational age (GA) of abdominal circumference per actual GA by the last menstruation period, biparietal diameter or femur length, respectively. FAO was defined as FAOR ≥ 90th percentile. FAORs measured at 20–24 GW in older and/or obese but not in young and non-obese GDM subjects were significantly higher than those in NGT subjects. Relative to NGT subjects without FAO at 20–24 GW, odds ratios for exhibiting FAO at GDM diagnosis and large for gestational age in GDM with FAO at 20–24 GW were 10.15 and 5.57, and their primary cesarean delivery rate was significantly higher than those in GDM without FAO (44% vs. 29%). Earlier diagnosis and active interventions of GDM well before 20–24 GW might be necessary to prevent FAO in the older and/or obese women.

Analytic Study of Indications and Complications Associated with Cesarean Section in Omar AL-Mukhtar Hospital

Cesarean section (C-section) is a surgical procedure designed to ensure the safety of the mother and the child when vaginal delivery is not possible. There is a progressive increase in cesarean deliveries across the world. C-section is associated with increased morbidity and mortality in pregnant mothers and infants, particularly in developing countries. The aim of the current study was designed to determine the rate and identify the indications and find out complications associated with C-sections in Omar AL-Mukhtar hospital. The descriptive retrospective study was carried out with data retrieved from statistics files from January 2018 to December 2018. A total of 754 births during the study period, out of the 226 were delivered by C-section. The overall C-section rate was 29.9%. The maximum number of C-sections was in the age group of 31-40 years (42%) followed by 41.2% of women in the age group of 21-30 years. The most common indication was elective repeated C-section (17%) followed by previous one C-section with other causes (10.6%), fetal distress (9.29%). The complications in our study were about 47 cases and were less accounted for (20.79%), like, postpartum and intraoperative hemorrhage, and anesthetic complications, which represented 5.75%, and 10.62% respectively. In conclusion: The cesarean delivery rate in this study was higher than the WHO recommendation, and elective repeat cesarean delivery was a major common indicator. Keywords: C-section; Indication; Complication of C- section

The Trend of the Distribution of Ectopic Pregnancy Sites and the Clinical Characteristics of Cesarean Scar Pregnancy

Objective: To investigate the distribution and its variation trend of the ectopic site and the clinical characteristics of cesarean scar pregnancy, to provide clues for further clinical practice. Methods: 3915 patients are brought into our study. To calculate the distribution of the implantation of ectopic pregnancy. Then analyze with trend χ2 test and calculate the quantity of each type of ectopic pregnancy during the year 2012-2015 and the year 2016-2019 to analyze the variation trend. Results: 1. The proportion of each site of ectopic pregnancy is as following: tubal pregnancy (84.70%), ovarian pregnancy (1.56%), cesarean scar pregnancy (8.63%), abdominal pregnancy (0.61%), cornual pregnancy (2.68%), cervical pregnancy (0.49%), heterotopic pregnancy (0.43%). 2. Through trend χ2 test, the ratio of cesarean scar pregnancy to ectopic pregnancy showed an increasing trend(P=0.005). From the year 2012-2015 to the year 2016-2019, the ratio of cesarean scar pregnancy to ectopic pregnancy increased from 5.74% to 11.81%(P<0.001). 3.72.78%(246/338) cesarean scar pregnancy patients had cesarean delivery once, 25.15%(85/338) had cesarean delivery twice, and 2.07%(7/338) had cesarean delivery three times. 80.18%(271/338) had aborted before. The most common clinical manifestations are amenorrhea (98.52%), abdominal pain (25.74%) and vaginal bleeding (67.76%), the most common sign is hysterauxesis (46.75%). Conclusion: As the increasing of the ratio of cesarean scar pregnancy to ectopic pregnancy, the cesarean delivery rate should be decreased to decrease the morbidity of cesarean scar pregnancy.

Perinatal Outcome and its Prediction Using Longitudinal Feto-Maternal Doppler Follow-Up in Late Onset Small for Gestational Age Fetuses – A Prospective Cohort Study

Purpose To describe the perinatal outcome of a prospective cohort of late-onset small-for-gestational-age (SGA) fetuses and to test adverse perinatal outcome (APO) prediction using Doppler measurements. Methods Singleton pregnancies from 32 weeks with suspicion of SGA (followed-up each 2 weeks) and randomly selected healthy controls at a university hospital were included. The whole SGA group was divided into the FGR subgroup or SGA percentile 3–10 subgroup. The following Doppler measurements were evaluated prospectively: umbilical artery (UA) pulsatility index (PI), middle cerebral artery (MCA) PI, cerebro-placental ratio (CPR), and mean uterine artery (mUtA) PI. APO was defined as arterial cord blood pH ≤ 7.15 and/or 5-minute Apgar ≤ 7 and/or emergency operative delivery and/or admission to the neonatal unit. Induction of labor was indicated according to a stage-based protocol. Results A total of 149 SGA and 143 control fetuses were included. The number of operative deliveries was similar between both groups (control: 29 %, SGA: 28 %), especially the cesarean delivery rate after the onset of labor (11 % vs. 10 %). Most SGA cases ended up in induction of labor (61 % vs. 31 %, p < 0.001). The areas under the curve (AUC) for APO prediction were similar using the last UA PI, MCA PI, CPR, and mUtA PI and barely reached 0.60. The AUC was best for the FGR subgroup, using the minimal CPR or maximum mUtA PI z-score of all longitudinal measurements (AUC = 0.63). Conclusion SGA fetuses do not have a higher rate of operative delivery if managed according to a risk stratification protocol. Prediction of APO is best for SGA and FGR using the “worst” CPR or mUtA PI but it remains moderate.

The Impact of a Plant-Based Diet on Gestational Diabetes: A Review

Gestational diabetes mellitus (GDM) represents a challenging pregnancy complication in which women present a state of glucose intolerance. GDM has been associated with various obstetric complications, such as polyhydramnios, preterm delivery, and increased cesarean delivery rate. Moreover, the fetus could suffer from congenital malformation, macrosomia, neonatal respiratory distress syndrome, and intrauterine death. It has been speculated that inflammatory markers such as tumor necrosis factor-alpha (TNF-α), interleukin (IL) 6, and C-reactive protein (CRP) impact on endothelium dysfunction and insulin resistance and contribute to the pathogenesis of GDM. Nutritional patterns enriched with plant-derived foods, such as a low glycemic or Mediterranean diet, might favorably impact on the incidence of GDM. A high intake of vegetables, fibers, and fruits seems to decrease inflammation by enhancing antioxidant compounds. This aspect contributes to improving insulin efficacy and metabolic control and could provide maternal and neonatal health benefits. Our review aims to deepen the understanding of the impact of a plant-based diet on oxidative stress in GDM.

SARS-CoV-2 Infection during Pregnancy in a Rural Midwest All-delivery Cohort and Associated Maternal and Neonatal Outcomes

Objective This study aimed to estimate the prevalence of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among pregnant patients at the time of delivery in a rural Midwest tertiary care hospital and to examine demographics, clinical factors, and maternal and neonatal outcomes associated with SARS-CoV-2 infection during pregnancy. Study Design This prospective cohort study included all delivering patients between May 1 and September 22, 2020 at the University of Iowa Hospitals and Clinics. Plasma SARS-CoV-2 antibody testing was performed. SARS-CoV-2 viral reverse-transcription polymerase chain reaction (RT-PCR) results and maternal and neonatal outcomes were collected from the electronic medical record. Data were analyzed using univariate statistical methods with clustering for multiple births. Results In total, 1,000 patients delivered between May 1 and September 22, 2020. Fifty-eight (5.8%) were SARS-CoV-2 antibody positive. Twenty-three also tested viral positive during pregnancy. Three of 1,000 (0.3%) were viral positive on admission but antibody negative. The median age was 30 years (interquartile range [IQR]: 26–33 years) and body mass index was 31.75 kg/m2 (IQR 27.7–37.5 kg/m2). The cesarean delivery rate was 34.0%. The study population was primarily white (71.6%); however, 41.0% of SARS-CoV-2 infected patients identified as Black, 18.0% as Hispanic/Latino, 3.3% as Native Hawaiian/Pacific Islander, and only 27.9% as White (p < 0.0001). SARS-CoV-2 infection was more likely in patients without private insurance (p = 0.0243). Adverse maternal and/or neonatal outcomes were not more likely in patients with evidence of infection during pregnancy. Two SARS-CoV-2 infected patients were admitted to the intensive care unit. There were no maternal deaths during the study period. Conclusion In this largely rural Midwest population, 6.1% of delivering patients had evidence of past or current SARS-CoV-2 infection. Rates of SARS-CoV-2 during pregnancy were higher among racial and ethnic minorities and patients without private insurance. The SARS-CoV-2 infected patients and their neonates were not found to be at increased risk for adverse outcomes. Key Points