The Associations of Caesarean Delivery With Risk of Wheezing Diseases and Changes of T Cells in Children

ObjectivesThis study aimed to assess the associations of caesarean delivery (CD) with risk of wheezing diseases and changes of immune cells in children.DesignThe cross-sectional study was conducted between May, 2020 and April, 2021.Setting and participantsThe study was conducted in Shanghai Children’s Medical Center, Shanghai, China. A total of 2079 children with a mean age of 36.97 ± 40.27 months and their guardians were included in the present study via face-to-face inquiry and physical examination by clinicians.MethodsLogistic regression was applied to estimate odds ratio (ORs) and 95% confidence intervals (CIs) for the association between CD and first episode of wheezing (FEW) or asthma. Models were adjusted for premature or full-term delivery, exclusive breastfeeding (at least 4 months) or not.ResultsAmong the 2079 children, 987 children (47.47%) were born by CD and 1092 (52.53%) by vaginal delivery (VD). Children delivered by caesarean had significantly lower gestational age (P<0.01) compared with those who delivered vaginally. Our results also showed that CD was related to increased risk of FEW by the age of 3(adjusted OR 1.50, 95%CI 1.06, 2.12) and increased tendency to develop asthma by the age of 4 (adjusted OR 3.16, 95%CI 1.25, 9.01). The subgroup analysis revealed that the negative effects of CD on asthma were more obvious in children without exclusive breastfeeding (adjusted OR 4.93, 95%CI 1.53, 21.96) or without postnatal smoking exposure (adjusted OR 3.58, 95%CI 1.20, 13.13). Furthermore, compared with children born through VD, a significant change of the T cells (increased proportion of CD4+ T cells and decreased number and proportion of CD8+ T cells) were observed before the age of one in the CD group. However, the changes were insignificant in children over 1 year old.ConclusionsThis study showed age-dependent associations of CD with asthma and FEW in offspring. Moreover, CD appeared to have an effect on the cellular immunity in infants, the disorder of which may contribute to the development of asthma in children.

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.

Pregnancy in Diabetics: Clinicobiological Features and Evolution

Background: The association between diabetes and pregnancy is a real public health problem due to the inherent maternal and fetal complications.Aims: To study the clinical and biological features of diabetic pregnancies.Methods: We conducted a retrospective descriptive study including pregnant diabetic women followed at the National Institute of Nutrition of Tunis.Results: We included 100 patients with a mean age of 32.87±5.3 years. In preconception, 63.6% of patients were overweight and had poorly balanced diabetes (HbA1c> 7%). The mean weight gain throughout the pregnancy was 8.62 ± 5.39 kg. Pregnancy was planned in 18% of cases.Significant improvement in HbA1c was observed in the second trimester. The average daily insulin dose increased from 0.68 u/kg/day in the first trimester to 0.87 u/kg/day in the third trimester (p <0.001). Full term delivery occurred in 72% of cases.The majority (93.3%) of our patients gave birth by caesarean section. Macrosomia was observed in 24% of cases. The main neonatal complications were neonatal respiratory distress and hypoglycemia in 26.7% and 20.5% of cases, respectively. Five newborns had deformities.Conclusion: Diabetic pregnancy is associated with an increased risk of maternal and fetal complications. An action on modifiable factors, before conception, could significantly improve its prognosis.

Urinary Congophilia Confirmed With the CapCord Test Is Associated With Pregnancy Outcomes in Women With Early-Onset Pre-eclampsia

Background: The association between misfolded proteins presented in the urine of pregnant women and pregnancy outcomes associated with early-onset pre-eclampsia (PE) remains unclear. This study aimed to investigate this association to examine the predictive value of urinary congophilia in the prognostication of pregnancy outcomes in this patient group in the Chinese population.Materials and Methods: This study included 1,397 patients, of which 46, 147, and 8 patients had gestational hypertension, PE, and chronic hypertension, respectively, and 1,196 were healthy controls undergoing the CapCord test for urinary congophilia. Patients with PE were divided into early- and late-onset groups. Patients with early-onset PE were further divided into iatrogenic prematurity and full-term delivery groups, the rates of urinary congophilia were compared between the groups; additionally, this patient group was divided into positive and negative urinary congophilia groups, clinical characteristics and pregnancy outcomes were compared between the groups. Univariate and multivariate logistic regression analyses were performed.Results: A total of 113 (76.9%) of 147 patients in the PE group had urinary congophilia; this rate was higher than that observed in the other three groups (χ2 = 780.892, p &lt; 0.001). Gestational age in the early-onset PE group at both onset and delivery was lower than that in the late-onset PE group (p &lt; 0.001). The rates of iatrogenic prematurity and hemolysis, elevated liver enzymes, and low platelet count syndrome were both higher in the early-onset PE group than in the late-onset PE group (p &lt; 0.001, p &lt; 0.05). In addition, the rate of urinary congophilia in the early-onset PE group was higher than that in the late-onset PE group (χ2 = 13.297, p &lt; 0.001). Urinary congophilia was an independent risk factor for iatrogenic prematurity among patients with early-onset PE in both univariate [odds ratio (OR) 17.143, 95% confidence interval (CI): 4.719–62.271; p &lt; 0.001] and multivariate (OR 18.174; 95% CI: 4.460–74.063; p &lt; 0.001) analyses. Patients with early-onset PE and urinary congophilia were more likely than their counterparts without urinary congophilia to deliver at a lower gestational age, present with iatrogenic prematurity, and have a shorter latency period between onset and delivery.Conclusion: Urinary congophilia confirmed with the CapCord test may help predict pregnancy outcomes in patients with early-onset PE.

A rare case scenario: spontaneous diaphragmatic rupture during labor

Diaphragmatic rupture during labor is not a very common presentation and usually occurs in patients with prior history of traumatic chest or abdominal injury or any congenital abnormality. We presented a case of a 29 year old woman who presented with sudden breathing difficulty two days after a full-term delivery by caesarean section. e-FAST scan suggested the presence of a massive pleural effusion over right side. CT scan of chest revealed large rent in right diaphragm with superior migration of liver and hepatic flexure. Patient was taken for emergent surgical intervention, inter coastal drainage (ICD) tube was placed and surgical repair was performed, patient was further treated in critical care unit, the patient recovered well and was discharged. Though diaphragmatic hernia rupture during labor are not reported often it is life threatening complication that requires immediate surgical intervention to prevent major complications and mortality.

A successful full term delivery in a case of robotic assisted insertion of transabdominal cerclage in an obese woman with multiple uterine fibroids

Cervical incompetence is not an uncommon presentation in an obstetric emergency unit. Some of these patients will be managed with a cervical cerclage. While the management of patients presenting with first time cervical incompetence is relatively established, the management of patient with repeated cervical incompetence might require an abdominal cerclage. Abdominal cerclages can be inserted traditionally via laparotomy or via a minimally invasive approach (MIS). We present a case of an obese patient presenting with 3 previous second trimester miscarriages despite 2 cervical cerclage complicated by multiple uterine fibroids who underwent a robotic assisted insertion of transabdominal cerclage (RTAC) pre-pregnancy. She subsequently conceived spontaneously and carried the pregnancy to term and delivered a healthy baby via caesarean section. There have been multiple published studies showing that an MIS approach for abdominal cerclage insertion is safe and viable. Robotic assisted procedures allow for better visualisation and manipulation of tissue especially in patients anticipating a complex procedure. For our patient we feel that a robotic assisted procedure would be more beneficial given her profile and the complexity of her case.

Live birth achieved despite the absence of ejaculated spermatozoa and mature oocytes retrieved: a case report

The most common reason for in vitro fertilization (IVF) cycle cancelation is a lack of quality gametes available for intracytoplasmic sperm injection (ICSI). Here we present the successful fertility treatment of the couple affected by obstructive azoospermia combined with suboptimal response to controlled ovarian stimulation. Since the conventional approach appeared ineffective to overcome both partnersˈ specific problems, the targeted interventions, namely, (1) pharmacological enhancement of sperm motility and (2) polarized light microscopy (PLM)-guided optimization of ICSI time, were applied to rescue the cycle with only immature oocytes and immotile testicular sperm retrieved. The treatment with theophylline aided the selection of viable spermatozoa derived from cryopreserved testicular tissue. When the traditional stimulation protocol failed to produce mature eggs, non-invasive spindle imaging was employed to adjust the sperm injection time to the maturational stage of oocytes extruding a polar body in vitro. The fertilization of 12 late-maturing oocytes yielded 5 zygotes, which all developed into blastocysts. One embryo was transferred into the uterus on day 5 post-fertilization, and another 3 good quality blastocysts were vitrified for later use. The pregnancy resulted in a full-term delivery of a healthy child. This case demonstrates that the individualization beyond the standard IVF protocols should be considered to maximize the chance of poor-prognosis patients to achieve pregnancy with their own gametes.

Obstetric History and Risk of Short Cervix in Women with a Prior Preterm Birth

Objective We aimed to assess the relationship between obstetric history and incidence of short cervical length (CL) at <24 weeks gestational age (GA) in women with a prior spontaneous preterm birth (PTB). Study Design Women with a singleton gestation and a history of spontaneous PTB on progesterone who received prenatal care at a single center from 2011 to 2016 were included. Those who did not undergo screening or had a history-indicated cerclage were excluded. The associations between short CL (<25 mm) before 24 weeks and obstetrical factors including: number of prior PTBs, history of term birth, and GA of earliest spontaneous PTB were estimated through modified Poisson regression, adjusting for confounding factors. Multiple pregnancies for the same woman were accounted for through robust sandwich standard error estimation. Results Among 773 pregnancies, 29% (n = 224) had a CL <25 mm before 24 weeks. The number of prior PTBs was not associated with short CL, but a prior full-term delivery conferred a lower risk of short CL (absolute risk reduction or aRR 0.79, 95% CI 0.63–1.00). Earliest GA of prior spontaneous PTB was associated with short CL. The strongest association was observed in women with a prior PTB at 160/7 to 236/7weeks (aRR 1.98, 95% CI: 1.46–2.70), compared with those with deliveries at 340/7 to 366/7 weeks. Yet, even women whose earliest PTB was 340/7 to 366/7 weeks remained at risk for a short CL, as 21% had a CL <25 mm. The number of prior PTBs did not modify the effect of GA of the earliest prior PTB (interaction test: p = 0.70). Conclusion GA of earliest spontaneous PTB, but not the number of prior PTBs, is associated with short CL. Nevertheless, women with a history of later PTBs remain at sufficiently high risk of having a short CL at <24 weeks gestation that we cannot recommend modifications to existing CL screening guidelines in this group of women. Key Points