Trimester-specific diagnostic accuracy of ultrasound for detection of placenta accreta spectrum: systematic review and meta-analysis.

OBJECTIVE: To assess the diagnostic accuracy of ultrasound for detecting placenta accreta spectrum (PAS) during the first trimester of pregnancy and compare it with the accuracy of second- and third-trimester ultrasound examination in pregnancies at risk for PAS. METHODS: PubMed, EMBASE and Web of Science databases were searched to identify relevant studies published from inception until 10 March 2023. Inclusion criteria were cohort, case-control or cross-sectional studies that evaluated the accuracy of ultrasound examination performed at < 14 weeks of gestation (first trimester) or ≥ 14 weeks of gestation (second/third trimester) for the diagnosis of PAS in pregnancies with clinical risk factors. The primary outcome was the diagnostic accuracy of sonography in detecting PAS in the first trimester, compared with the accuracy of ultrasound examination in the second and third trimesters. The secondary outcome was the diagnostic accuracy of each sonographic marker individually across the trimesters of pregnancy. The reference standard was PAS confirmed at pathological or surgical examination. The potential of ultrasound and different ultrasound signs to detect PAS was assessed by computing summary estimates of sensitivity, specificity, diagnostic odds ratio and positive and negative likelihood ratios. RESULTS: A total of 37 studies, including 5764 pregnancies at risk of PAS, with 1348 cases of confirmed PAS, were included in our analysis. The meta-analysis demonstrated that ultrasound had a sensitivity of 86% (95% CI, 78-92%) and specificity of 63% (95% CI, 55-70%) during the first trimester, and a sensitivity of 88% (95% CI, 84-91%) and specificity of 92% (95% CI, 85-96%) during the second/third trimester. Regarding sonographic markers examined in the first trimester, lower uterine hypervascularity exhibited the highest sensitivity (97% (95% CI, 19-100%)), and uterovesical interface irregularity demonstrated the highest specificity (99% (95% CI, 96-100%)). In the second/third trimester, loss of clear zone had the highest sensitivity (80% (95% CI, 72-86%)), and uterovesical interface irregularity exhibited the highest specificity (99% (95% CI, 97-100%)). CONCLUSIONS: First-trimester ultrasound examination has similar accuracy to second- and third-trimester ultrasound examinations for the diagnosis of PAS. Routine first-trimester ultrasound screening for patients at high risk of PAS may improve detection rates and allow earlier referral to tertiary care centers for pregnancy management. © 2024 International Society of Ultrasound in Obstetrics and Gynecology.

Longitudinal assessment of spiral and uterine arteries in normal pregnancy using novel ultrasound tool.

OBJECTIVES: To use superb microvascular imaging (SMI) to evaluate longitudinally spiral artery (SA) and uterine artery (UtA) vascular adaptation in normal human pregnancy, and to develop reference ranges for use at various gestational ages throughout pregnancy. METHODS: The data for this study were obtained from the National Institutes of Health (NIH)-funded Human Placenta Project. Women aged 18-35 years, with a body mass index < 30 kg/m2 , without comorbidities, with a singleton gestation conceived spontaneously, and gestational age at or less than 13 + 6 weeks were eligible for inclusion. The current analysis was restricted to uncomplicated pregnancies carried to term. Exclusion criteria included maternal or neonatal complications, fetal or umbilical cord anomalies, abnormal placental implantation or delivery < 37 weeks. Women who fulfilled the inclusion criteria formed the reference population of the Human Placenta Project study. Each participant underwent eight ultrasound examinations during pregnancy. The pulsatility index (PI) of both the left and right UtA were obtained twice for each artery and the presence or absence of a notch was noted. Using SMI technology, the total number of SA imaged was recorded in a sagittal placental section at the level of cord insertion. The PI and peak systolic velocity (PSV) were also measured in a total of six SA, including two in the central portion of the placenta, two peripherally towards the uterine fundal portion, and two peripherally towards the lower uterine segment. RESULTS: A total of 90 women fulfilled the study criteria. Maternal UtA-PI decreased throughout the first half of pregnancy from a mean ± SD of 1.39 ± 0.50 at 12-13 weeks' gestation to 0.88 ± 0.24 at 20-21 weeks' gestation. The mean number of SA visualized in a sagittal plane of the placenta increased from 8.83 ± 2.37 in the first trimester to 16.99 ± 3.31 in the late-third trimester. The mean SA-PI was 0.57 ± 0.12 in the first trimester and decreased progressively during the second trimester, reaching a nadir of 0.40 ± 0.10 at 24-25 weeks, and remaining constant until the end of pregnancy. SA-PSV was highest in early pregnancy with a mean of 57.16 ± 14.84 cm/s at 12-13 weeks' gestation, declined to a mean of 49.38 ± 17.88 cm/s at 20-21 weeks' gestation and continued to trend downward for the remainder of pregnancy, reaching a nadir of 34.50 ± 15.08 cm/s at 36-37 weeks' gestation. A statistically significant correlation was noted between SA-PI and UtA-PI (r = 0.5633; P < 0.001). Multilevel regression models with natural cubic splines were used to create reference ranges of SA-PSV and SA-PI for given gestational ages. CONCLUSION: From early gestation, we have demonstrated the ability to image and quantify SA blood flow in normal pregnancy, and have developed reference ranges for use at various gestational ages throughout pregnancy. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

B-meson decay constants from improved lattice nonrelativistic QCD with physical u, d, s, and c quarks.

We present the first lattice QCD calculation of the decay constants f(B) and f(B(s)) with physical light quark masses. We use configurations generated by the MILC Collaboration including the effect of u, d, s, and c highly improved staggered quarks in the sea at three lattice spacings and with three u/d quark mass values going down to the physical value. We use improved nonrelativistic QCD (NRQCD) for the valence b quarks. Our results are f(B)=0.186(4) GeV, f(B(s))=0.224(4) GeV, f(B(s))/f(B)=1.205(7), and M(B(s))-M(B)=85(2) MeV, superseding earlier results with NRQCD b quarks. We discuss the implications of our results for the standard model rates for B((s))→µ(+)µ(-) and B→τν.

Unplanned Cesarean delivery is associated with risk for postpartum depressive symptoms in the immediate postpartum period.

PURPOSE: Postpartum depression (PPD) is a common pregnancy complication. The association between cesarean delivery (CD) and PPD has shown conflicting results in prior studies, although emergent CD appears to be a clear risk factor. Establishing PPD risk is critical and may, however, be related to the unplanned nature of the CD, rather than the surgery itself. Our objective was to determine whether women who underwent unplanned CD were more likely than those with vaginal delivery to have higher depressive symptoms and thus screen positive for PPD risk in the immediate postpartum period. MATERIALS AND METHODS: This cohort study was conducted at a community medical center using data for deliveries between 8/2015-1/2016. Women were screened in the hospital for depressive symptoms (PPD risk) using the Edinburgh Postnatal Depression Scale (EPDS) within 4 days post-delivery. Logistic regression, adjusting for maternal race/ethnicity and parity, was performed to evaluate the association between delivery route (vaginal vs planned vs unplanned CD) and PPD risk (EPDS ≥ 10). RESULTS: A total of 2094 women had complete data for analysis. Overall, 44 women (2.1%) screened positive for PPD risk. Logistic regression results showed that unplanned CD was significantly associated with PPD risk (OR = 2.28, 95% CI 1.13-4.57, p = .022), after adjusting for parity and race/ethnicity. Planned CD was not associated with PPD risk. CONCLUSION: Unplanned CD may be an independent risk factor for PPD risk in the immediate postpartum period. This finding might explain why some previous studies have demonstrated different results with regards to risk of CD where the unplanned nature of the delivery was not accounted for.

Radiative improvement of the lattice nonrelativistic QCD action using the background field method and application to the hyperfine splitting of quarkonium states.

We present the first application of the background field method to nonrelativistic QCD (NRQCD) on the lattice in order to determine the one-loop radiative corrections to the coefficients of the NRQCD action in a manifestly gauge-covariant manner. The coefficients of the σ·B term in the NRQCD action and the four-fermion spin-spin interaction are computed at the one-loop level; the resulting shift of the hyperfine splitting of bottomonium is found to bring the lattice predictions in line with experiment.

Precise charm to strange mass ratio and light quark masses from full lattice QCD.

By using a single formalism to handle charm, strange, and light valence quarks in full lattice QCD for the first time, we are able to determine ratios of quark masses to 1%. For m(c)/m(s) we obtain 11.85(16), an order of magnitude more precise than the current PDG average. Combined with 1% determinations of the charm quark mass now possible this gives m(s)(2 GeV)=92.4(1.5) MeV. The MILC result for m(s)/m(l)=27.2(3) yields m(l)(2 GeV)=3.40(7) MeV for the average of u and d quark masses.

The management of reduced fetal movements in an uncomplicated pregnancy at term: results from an anonymous national online survey in the Republic of Ireland.

There is currently inconsistent evidence and clinical guidance on how to best manage a pregnancy complicated by reduced fetal movements. This novel, web-based, anonymous questionnaire evaluated 96 assessment and management approaches from doctors working in obstetrics in the Republic of Ireland who were presented with a clinical scenario of a primigravida concerned about reduced fetal movements at 39+3 weeks' gestation. This study identified a lack of clinical practice guidelines available in maternity hospitals in the Republic of Ireland. We demonstrated that almost all clinicians applied more than one assessment method and that most incorporated a cardiotocograph into their assessment. There was a low uptake of simple symphysio-fundal height measurement and high usage of kickcharts. The minority of clinicians admitted or induced their patients. This survey identified the need for national and international guidelines to ensure safe antepartum care and delivery.

An overview of proteomic and metabolomic technologies and their application to pregnancy research.

'Omic' technologies represent a strategy towards high-throughput, simultaneous analysis of thousands of biological molecules. Their development has been accelerated in the post-genomic era since these molecules represent the interaction of genes and environment or the 'functional genome'. Omic domains are of particular interest in the search for predictive disease biomarkers and have additional relevance in understanding pathophysiology and the development of molecularly targeted therapeutics. This review examines the fields of proteomics and metabolomics in the context of obstetrics and gynaecology, including a discussion of methodology, challenges, potential applications and current research.

The decline of hysterectomy for benign disease.

Hysterectomy is one of the most common gynaecological surgical procedures performed but there appears to be a decline in the performance of this procedure in Ireland in recent times. We set out to establish the extent of the decline of hysterectomy and to explore possible explanations. Data for hysterectomy for benign disease from Ireland was obtained from the Hospital In-Patient Enquiry Scheme (HIPE) section of the Economic and Social Research Institute for the years 1999 to 2006. The total number of hysterectomies performed for benign disease showed a consistent decline during this time. There was a 36% reduction in the number of abdominal hysterectomy procedures performed.

The decline of laparoscopic sterilisation.

Female sterilisation is an extensively used method of contraception all over the world but there appears to be a decline in the performance of this procedure in Ireland. There also appears to be an increased uptake of safe, long-acting contraceptive alternatives. We set out to establish the extent of the decline of laparoscopic sterilisation and to explore possible explanations. Data for female sterilisation from Ireland was obtained from the Hospital In-Patient Enquiry Scheme (HIPE) section of the Economic and Social Research Institute for the years 1999 to 2004. Recent sales figures for long acting reversible contraceptives, specifically the levo-norgestrel-loaded intrauterine system (LNG-IUS) (Mirena) and the etonogestrel implant (Implanon) were also obtained. Laparoscopic tubal ligations reduced from 2,566(1999) to 910 (2004). In the corresponding period the use of Mirena coils increased from 4,840 (1999) to 17,077 (2004).

Alterations of Endogenous Cytokinins in Transgenic Plants Using a Chimeric Isopentenyl Transferase Gene.

Cytokinins, a class of phytohormones, appear to play an important role in the processes of plant development. We genetically engineered the Agrobacterium tumefaciens isopentenyl transferase gene, placing it under control of a heat-inducible promoter (maize hsp70). The chimeric hsp70 isopentenyl transferase gene was transferred to tobacco and Arabidopsis plants. Heat induction of transgenic plants caused the isopentenyl transferase mRNA to accumulate and increased the level of zeatin 52-fold, zeatin riboside 23-fold, and zeatin riboside 5[prime]-monophosphate twofold. At the control temperature zeatin riboside and zeatin riboside 5[prime]-monophosphate in transgenic plants accumulated to levels 3 and 7 times, respectively, over levels in wild-type plants. This uninduced cytokinin increase affected various aspects of development. In tobacco, these effects included release of axillary buds, reduced stem and leaf area, and an underdeveloped root system. In Arabidopsis, reduction of root growth was also found. However, neither tobacco nor Arabidopsis transgenic plants showed any differences relative to wild-type plants in time of flowering. Unexpectedly, heat induction of cytokinins in transgenic plants produced no changes beyond those seen in the uninduced state. The lack of effect from heat-induced increases could be a result of the transient increases in cytokinin levels, direct or indirect induction of negating factor(s), or lack of a corresponding level of competent cellular factors. Overall, the effects of the increased levels of endogenous cytokinins in non-heat-shocked transgenic plants seemed to be confined to aspects of growth rather than differentiation. Since no alterations in the programmed differentiation pattern were found with increased cytokinin levels, this process may be controlled by components other than absolute cytokinin levels.

Path integrals for stiff polymers applied to membrane physics.

Path integrals similar to those describing stiff polymers arise in the Helfrich model for membranes. We show how these types of path integrals can be evaluated and apply our results to study the thermodynamics of a minority stripe phase in a bulk membrane. The fluctuation induced contribution to the line tension between the stripe and the bulk phase is computed. Also the effective interaction between the interfaces of the two phases can be computed. Explicit forms are given for this Casmir-like interaction in the tensionless case where the two phases have differing bending rigidities.

Renormalization of membrane rigidity by long-range interactions.

We consider the renormalization of the bending and Gaussian rigidity of model membranes induced by long-range interactions between the components making up the membrane. In particular we analyze the effect of a finite membrane thickness on the renormalization of the bending and Gaussian rigidity by long-range interactions. Particular attention is paid to the case where the interactions are of a van der Waals type.

Thermal Casimir effect in lipid bilayer tubules.

We calculate the thermal Casimir effect for a dielectric tube of radius R and thickness delta formed from a membrane in water. The method uses a field-theoretic approach in the grand canonical ensemble. The leading contribution to the Casimir free energy behaves as -k(B)TLkappa(c)/R giving rise to an attractive force which tends to contract the tube. We find that kappa(c) approximately 0.3 for the case of typical lipid membrane t tubules. We conclude that except in the case of a very soft membrane this force is insufficient to stabilize such tubes against the bending stress which tends to increase the radius.

Ascertaining women's preferred mode of address and preferred choice of title during pregnancy and childbirth.

To determine how women in pregnancy would like to be addressed and to ascertain their preferred choice of title during pregnancy. A questionnaire was administered to 925 antenatal women. Midwifery and medical staff (183) were invited to respond to a similar questionnaire. The response rate was 71.2% from the survey of pregnant women. The vast majority (82.1%) preferred to be addressed by their first name. Women were in favour of being called 'patient' (32.8%) as their first choice. The staff survey yielded a response rate of 77%. The majority (81.8%) of health professionals preferred to address women by their first name. 'Mother' (28.7%) was the most popular first choice. We conclude that women in pregnancy do have a preference on how they would like to be addressed and this is predominantly by first name. Health professionals also prefer to call pregnant women by their first name. The term 'patient' was the most popular first choice of title of women in pregnancy but the term 'mother' was the preferred choice of the health professionals. Medical staff were more likely to choose 'patient' than midwives.

A novel strategy for production of a highly expressed recombinant protein in an active form.

Under standard growth conditions, E. coli transformed with the high-level expression vector pMON5525 produces recombinant DMAPP/AMP transferase in inactive, insoluble complexes. We have produced large amounts of active, soluble protein by growing and inducing the cells under osmotic stress in the presence of sorbitol and glycyl betaine. This caused an increase of up to 427-fold in the active yield, and the disappearance of the protein from the pelletable fraction of cell extracts. This treatment may have wide applicability.

Prevalence and correlates of mixed-handedness in schizophrenia.

Increased rates of nonright-handedness have been reported in schizophrenia, but a clear distinction has not been made between left- and mixed-handedness. Handedness preferences in 96 patients fulfilling DSM-III criteria for schizophrenia and 43 normal comparison subjects were assessed with the Edinburgh Handedness Inventory. A 100% criterion was used to establish left- and right-handedness. Results were analyzed with mantel-Haenszel odds ratios adjusted for age and sex. The schizophrenic group showed a significant increase in the proportion of mixed-handers compared with the normal group. There was no increase in pure left-handedness in the schizophrenic relative to the normal group. Mixed-handedness in the schizophrenic patients was significantly associated with chronicity of illness. Mixed-handed patients were less likely to have a family history of psychotic illness than patients with strong right- or left-handedness. The results indicate a neurodevelopmental rather than a genetic origin for anomalous lateralization in schizophrenia.

Weak nonlinear surface-charging effects in electrolytic films.

A simple model of soap films with nonionic surfactants stabilized by added electrolyte is studied. The model exhibits charge regularization due to the incorporation of a physical mechanism responsible for the formation of a surface charge. We use a Gaussian field theory in the film but the full nonlinear surface terms which are then treated at a one-loop level by calculating the mean-field Poisson-Boltzmann solution and then the fluctuations about this solution. We carefully analyze the renormalization of the theory and apply it to a triple-layer model for a thin film with Stern layer of thickness h. For this model we give expressions for the surface charge sigma(L) and the disjoining pressure P(d)(L) and show their dependence on the parameters. The influence of image charges naturally arises in the formalism, and we show that predictions depend strongly on h because of their effects. In particular, we show that the surface charge vanishes as the film thickness L-->0. The fluctuation terms in this class of theories contribute a Casimir-like attraction across the film. Although this attraction is well known to be negligible compared with the mean-field component for model electrolytic films with no surface-charge regulation, in the model studied here these fluctuations also affect the surface-charge regulation leading to a fluctuation component in the disjoining pressure which has the same behavior as the mean-field component even for large film thickness.

Resummed two-loop calculation of the disjoining pressure of a symmetric electrolyte soap film.

In this paper we consider the calculation of the disjoining pressure of a symmetric electrolytic soap film correct to two loops in perturbation theory. We show that the disjoining pressure is finite when the loop expansion is resummed using a cumulant expansion and requires no short distance cutoff in order to give a finite result. The loop expansion is resummed in terms of an expansion in g= lB / lD where lD is the Debye length and lB is the Bjerrum length. We show that there there is a nonanalytic contribution of order g ln(g). We also show that the two-loop correction is greater than the one-loop term at large film thicknesses suggesting a nonperturbative correction to the one-loop result in this limit.