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1.
J Perinat Med ; 52(7): 744-750, 2024 Sep 25.
Artículo en Inglés | MEDLINE | ID: mdl-38887817

RESUMEN

OBJECTIVES: To examine the fetal thymic-thoracic ratio (TTR) in intrahepatic cholestasis of pregnancy (ICP). METHODS: This prospective case-control study was conducted in a single tertiary center. The sample consisted of 86 pregnant women at 28-37 weeks of gestation, including 43 women with ICP and 43 healthy controls. TTR was calculated for each patient using the anterior-posterior measurements of the thymus and intrathoracic mediastinal measurements. RESULTS: The median TTR value was found to be smaller in the ICP group compared to the control group (0.32 vs. 0.36, p<0.001). The ICP group had a greater rate of admission to the neonatal intensive care unit (NICU) (p<0.001). Univariate regression analysis revealed that lower TTR values increased the possibility of NICU admission six times (95 % confidence interval: 0.26-0.39, p=0.01). A statistically significant negative correlation was detected between TTR and the NICU requirement (r: -0.435, p=0.004). As a result of the receiver operating characteristic analysis, in predicting NICU admission, the optimal cut-off value of TTR was determined to be 0.31 with 78 % sensitivity and 67 % specificity (area under the curve=0.819; p<0.001). CONCLUSIONS: We determined that the fetal TTR may be affected by the inflammatory process caused by the maternal-fetal immune system and increased serum bile acid levels in fetal organs in the presence of ICP. We consider that TTR can be used to predict adverse pregnancy outcomes in patients with ICP.


Asunto(s)
Colestasis Intrahepática , Complicaciones del Embarazo , Timo , Humanos , Femenino , Embarazo , Colestasis Intrahepática/sangre , Colestasis Intrahepática/diagnóstico , Estudios de Casos y Controles , Complicaciones del Embarazo/diagnóstico , Complicaciones del Embarazo/sangre , Adulto , Estudios Prospectivos , Timo/diagnóstico por imagen , Ultrasonografía Prenatal/métodos , Tórax/diagnóstico por imagen , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos
2.
J Obstet Gynaecol Res ; 50(6): 941-947, 2024 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-38491874

RESUMEN

AIM: To investigate the effects of levothyroxine and prednisolone treatment, or in combination, on positive thyroid autoantibodies in infertile patients undergoing in vitro fertilization (IVF) therapy. METHODS: This retrospective study included a total of 190 patients with positive thyroid autoantibodies (anti-T and anti-TPO) who underwent IVF treatment between January 2008 and March 2016. Patients were divided into four groups: group 1-levothyroxine group (n = 50), group 2-prednisolone group (n = 50), group 3-levothyroxine and prednisolone combination (n = 25), group 4-control group (n = 65). Anti-T and anti-TPO levels before IVF and at the time of embryo transfer (ET), b-hcg positivity, clinical and biochemical pregnancy, miscarriage rate, and live birth rate were compared among groups. RESULTS: In levothyroxine-treated group, mean anti-TPO levels significantly decreased at the time of ET compared to before IVF treatment levels (p = 0.036). In group 3, mean anti-T and anti-TPO levels significantly decreased at the time of ET compared to levels before IVF treatment (p < 0.05). Patients who became pregnant in group 1, mean anti-T anti-TPO levels significantly decreased compared to before IVF treatment levels (p < 0.05). The biochemical pregnancy rate was significantly higher in group 2 (p = 0.03). Abortion rates were the highest in group 3, but no significant difference was found among groups. The group treated with levothyroxine had a significantly increased rate of live birth compared to the control group (p = 0.02). CONCLUSIONS: Levothyroxine addition during IVF treatment of patients with positive thyroid antibodies in subclinical hypothyroidism increases the take-home baby pregnancy rate. Whether subclinical hypothyroidism or not in IVF treatment, levothyroxine is more effective than low-dose corticosteroids.


Asunto(s)
Autoanticuerpos , Fertilización In Vitro , Prednisolona , Tiroxina , Humanos , Femenino , Embarazo , Fertilización In Vitro/métodos , Tiroxina/uso terapéutico , Tiroxina/administración & dosificación , Tiroxina/farmacología , Autoanticuerpos/sangre , Adulto , Estudios Retrospectivos , Prednisolona/uso terapéutico , Prednisolona/administración & dosificación , Prednisolona/farmacología , Infertilidad Femenina/inmunología , Infertilidad Femenina/terapia , Índice de Embarazo , Quimioterapia Combinada
3.
J Clin Ultrasound ; 52(6): 745-752, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38655708

RESUMEN

PURPOSE: To examine the cerebro-placental-uterine ratio (CPUR) in pregnant women with pregestational diabetes and determine its role in predicting adverse prenatal outcomes. METHODS: This prospective, cohort study conducted at a tertiary hospital included 65 patients with pregestational diabetes (25 with type1 diabetes, 40 with type2 diabetes) and 130 low-risk patients in the control group. The cerebroplacental (CPR) ratio and the CPUR were calculated. Composite adverse perinatal outcome (CAPO) is defined as the presence of any of the following: (1) Neonatal intensive care unit (NICU) admission, (2) Apgar at 5 min <7, and (3) umbilical cord arterial pH <7.10. The relationship of CPR and CPUR with CAPO was investigated. RESULTS: CPR and CPUR were significantly lower in the pregestational diabetes group than in the control group. The NICU admission was higher in the case group. In receiver operating characteristic analyses, the optimal cut-off value of CPUR was 1.46 (AUC = 0.72, p = 0.003, 80% sensitivity, and 69% specificity) to predict CAPO and the optimal cut-off value of CPUR was 1.50 for NICU admission (AUC = 0.70, p = 0.013, 77% sensitivity, and 66% specificity). CONCLUSION: Low CPUR values were found to be associated with adverse perinatal outcomes in women with pregestational diabetes. With the increasing number of studies, CPUR is expected to be utilized more widely in routine obstetric practice.


Asunto(s)
Resultado del Embarazo , Embarazo en Diabéticas , Ultrasonografía Prenatal , Humanos , Femenino , Embarazo , Estudios Prospectivos , Adulto , Ultrasonografía Prenatal/métodos , Placenta/diagnóstico por imagen , Valor Predictivo de las Pruebas , Estudios de Cohortes , Diabetes Mellitus Tipo 2/complicaciones , Recién Nacido , Diabetes Mellitus Tipo 1/complicaciones
4.
Cytokine ; 170: 156343, 2023 10.
Artículo en Inglés | MEDLINE | ID: mdl-37632985

RESUMEN

INTRODUCTION: To estimate the possible role of VEGF-A in predicting poor early pregnancy outcomes including threatened abortion and early pregnancy loss. METHODS: We conducted a prospective case-control study with three groups of pregnant women diagnosed with threatened abortion, early pregnancy loss, and uncomplicated healthy pregnancies between 01 March 2023 and 15 March 2023. Maternal serum VEGF-A concentration was measured using the Sandwich-ELISA method in accordance to the commercial kit's instructions. There were 30 patients in each 3 group and the gestational age of the patients was between 6 and 14 weeks. The Kruskal-Wallis test was performed for comparing the median values between the groups. Mann-Whitney U test was conducted for pairwise comparisons. RESULTS: VEGF-A levels were compared between 3 groups and a statistically significant difference was found (p = 0.007). There was a moderately significant correlation between VEGF-A levels and poor early pregnancy outcomes. For poor early pregnancy outcomes, the area under the curve (AUC) was 0.75 (95% CI: 0.64-0.85). The best balance of sensitivity/specificity in ROC curves was 0.60 (63.3% sensitivity, 74.3% specificity). DISCUSSION: In conclusion, this study pointed out the increased VEGF concentrations in pregnant women with threatened miscarriage and early pregnancy loss. VEGF-A may be a potential biomarker for the indication of poor early pregnancy outcomes.


Asunto(s)
Aborto Espontáneo , Amenaza de Aborto , Factor A de Crecimiento Endotelial Vascular , Femenino , Humanos , Lactante , Embarazo , Aborto Espontáneo/sangre , Amenaza de Aborto/sangre , Área Bajo la Curva , Estudios de Casos y Controles , Factor A de Crecimiento Endotelial Vascular/sangre
5.
Echocardiography ; 2023 Sep 12.
Artículo en Inglés | MEDLINE | ID: mdl-37698467

RESUMEN

AIM: We aimed to investigate fetal cardiac output (CO) in pregnancies with preterm premature rupture of membranes (PPROM) and its relationship with umbilical cord pH. METHODS: This was a prospective study in total 90 pregnancies at 24-37 weeks gestation including 42 pregnancies with PPROM and 48 that healthy controls. Fetal cardiac function including combined, left and right CO z-scores were compared. The neonates in the PPROM group were separated with umbilical cord pH above and below 7.25, and cardiac output was compared between groups. RESULTS: In PPROM group, CCO z-score, left cardiac output (LCO) z-score, and right cardiac output (RCO) were significantly lower compared to healthy pregnancies (p = .036, p = .001, p = .032, respectively), while RCO z-score showed no significant differences between the two groups. The aortic annulus and pulmonary artery annulus z-scores were measured smaller in the PPROM group (p = .000 and p = .001, respectively). In PPROM group, the fetal LCO z-score was significantly lower in neonates with an umbilical cord pH of 7.25 or less (p = .048). CONCLUSION: This study provides evidence that fetal CCO is lower in PPROM compared with healthy pregnancies. Reduced LCO z-scores may be useful for predicting adverse neonatal outcomes in pregnancies with PPROM.

6.
Reprod Sci ; 31(6): 1565-1572, 2024 06.
Artículo en Inglés | MEDLINE | ID: mdl-38438777

RESUMEN

The systemic inflammation response index (SIRI) and systemic immune inflammation index (SII) have recently been investigated as new prognostic markers for obstetric morbidities. However, there are few studies on their predictive role in patients with pregnancy loss. Predicting miscarriages may be useful to support and prevent selected cases.The aim of this study was to investigate the role of SIRI and SII in the prediction of pregnancy loss. A total of 800 patients were included in the retrospective case-control study at a tertiary hospital.Group 1 consisted of 200 patients who had a pregnancy loss for the first time; group 2 consisted of 200 patients with recurrent pregnancy loss; the control group consisted of 400 patients who had a healthy pregnancy. The groups were compared in terms of maternal characteristics, SIRI and SII. Receiver operating characteristic analysis was performed to determine optimal cut-off values for SIRI and SII in predicting pregnancy loss. SIRI and SII were higher in the group with recurrent pregnancy loss than in the control group (p < 0.001).SIRI was higher in the first pregnancy loss group than in the control group (p < 0.001).To predict recurrent pregnancy loss, optimal cut-off values were 1.57 (80% sensitivity, 70% specificity) and 924.12 (74% sensitivity, 57% specificity) for SIRI and SII, respectively. For first pregnancy loss prediction, the optimal cut-off value was 1.38 for SIRI, with 75% sensitivity and 60% specificity. SIRI and SII may be used as inflammatory markers to predict recurrent pregnancy loss. High SIRI values can also help to predict first pregnancy loss.


Asunto(s)
Inflamación , Humanos , Femenino , Embarazo , Adulto , Estudios de Casos y Controles , Estudios Retrospectivos , Inflamación/inmunología , Inflamación/sangre , Inflamación/diagnóstico , Valor Predictivo de las Pruebas , Aborto Habitual/inmunología , Aborto Habitual/sangre , Aborto Habitual/diagnóstico , Aborto Espontáneo/inmunología , Aborto Espontáneo/sangre , Pronóstico , Biomarcadores/sangre , Curva ROC
7.
Pregnancy Hypertens ; 37: 101148, 2024 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-39146696

RESUMEN

OBJECTIVES: To examine the role of the cerebro-placental-uterine ratio (CPUR) in predicting composite adverse perinatal outcomes (CAPO) in patients with pregnancy-induced hypertension (PIH). STUDY DESIGN: This prospective, case-control study was conducted at a tertiary hospital with 110 cases of PIH, including 70 patients with preeclampsia and 40 with gestational hypertension, and 110 healthy controls. The middle cerebral artery pulsatility index (MCA-PI), umbilical artery pulsatility index (UA-PI), and uterine artery pulsatility index (UtA-PI) were measured, and the cerebro-placental ratio (CPR=MCA-PI/UA-PI) and CPUR (CPR/UtA-PI) were calculated. MAIN OUTCOME MEASURE: The role of CPUR in predicting CAPO in preeclampsia and gestational hypertension. RESULTS: The CPR and CPUR values were lower in the PIH group compared to the control group (p < 0.001). CAPO had a negative correlation with CPR and CPUR (p < 0.001). Univariate regression analysis revealed that the likelihood of CAPO was increased four times by a low CPR value and six times by a low CPUR value. In the ROC analysis, the optimal cut-off value of CPR in predicting CAPO was 1.33 with 74 % sensitivity and 66 % specificity (area under the curve [AUC] = 0.778; p < 0.001) in PIH. For CPUR, the optimal cut-off value was 1.32, at which 82 % sensitivity and 79 % specificity in predicting CAPO (AUC=0.826; p < 0.001). CONCLUSION: CPUR was determined to be successful with high sensitivity in predicting adverse perinatal outcomes in the presence of PIH. In addition, CPUR was more effective in predicting CAPO in patients with preeclampsia compared to gestational hypertension. CPUR can be used to predict adverse outcomes in patients with PIH.


Asunto(s)
Hipertensión Inducida en el Embarazo , Arteria Cerebral Media , Ultrasonografía Prenatal , Arterias Umbilicales , Arteria Uterina , Humanos , Femenino , Embarazo , Estudios de Casos y Controles , Adulto , Estudios Prospectivos , Hipertensión Inducida en el Embarazo/fisiopatología , Arteria Cerebral Media/diagnóstico por imagen , Arteria Cerebral Media/fisiopatología , Arteria Uterina/diagnóstico por imagen , Arteria Uterina/fisiopatología , Arterias Umbilicales/diagnóstico por imagen , Arterias Umbilicales/fisiopatología , Flujo Pulsátil , Valor Predictivo de las Pruebas , Placenta , Preeclampsia/fisiopatología , Resultado del Embarazo
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