Vacuum-assisted delivery outcomes: is advanced maternal age a factor?

PURPOSE: This study evaluated age-related maternal outcomes of vacuum-assisted vaginal deliveries (VAD). METHODS: This retrospective cohort study included all nulliparous women with singleton VAD in one academic institution. Study group parturients were maternal age ≥ 35 years and controls < 35. Power analysis revealed that 225 women/group would be sufficient to detect a difference in the rate of third- and fourth-degree perineal tears (primary maternal outcome) and umbilical cord pH < 7.15 (primary neonatal outcome). Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between groups. RESULTS: From 2014 to 2019, 13,967 nulliparas delivered at our institution. Overall, 8810 (63.1%) underwent normal vaginal delivery, 2432 (17.4%) instrumental, and 2725 (19.5%) cesarean. Among 11,242 vaginal deliveries, 10,116 (90%) involved women < 35, including 2067 (20.5%) successful VAD vs. 1126 (10%) women ≥ 35 years with 348 (30.9%) successful VAD (p < 0.001). Rates of third- and fourth-degree perineal lacerations were 6 (1.7%) with advanced maternal age and 57 (2.8%) among controls (p = 0.259). Cord pH < 7.15 was similar: 23 (6.6%) study group and 156 (7.5%) controls (p = 0.739). CONCLUSION: Advanced maternal age and VAD are not associated with higher risk for adverse outcomes. Older, nulliparous women are more likely to undergo vacuum delivery than younger parturients.

Does decreased fetal growth estimation in the appropriate for gestational age range affect delivery outcomes?

PURPOSE: To study the effect of decreased estimated fetal weight (EFW) percentiles in appropriate for gestational age fetuses. METHODS: This retrospective cohort study included women who had second and third trimester ultrasound examinations. Delivery and neonatal outcomes of pregnancies with decreased EFW of ≥ 30 percentiles in EFW between ultrasound examinations (decreased growth group) and those without such a decrease (control group) were compared. Deliveries with EFW or birthweight below the 10th percentile were excluded. RESULTS: Among 1610 deliveries, 57 were in the decreased growth group and 1553 in the control group. Maternal characteristics did not differ between the groups except for higher rate of nulliparity in the decreased growth group. We found similar rates of Category II/III monitoring, cesarean deliveries due to non-reassuring fetal heart rate and adverse neonatal outcomes. Neonatal birthweight was lower in the decreased growth group as compared to controls. CONCLUSIONS: This study did not find association between the group of appropriate for gestational age fetuses with decreased growth, with adverse outcomes.

Does the gestational age at which the glucose challenge test (GCT) is conducted influence the diagnosis of gestational diabetes mellitus (GDM)?

PURPOSE: This study's objective is to investigate disparities in the rates of gestational diabetes mellitus (GDM) diagnosis, influenced by the timing of the glucose challenge test GCT. METHODS: This retrospective cohort study included women with singleton or twin pregnancies exhibiting abnormal GCT result between 24 and 28 weeks of gestation, followed by an oral glucose tolerance test OGTT during the same period. Data regarding pregnancy follow-up from patients' deliveries at a singular tertiary medical from 2014 to 2022 were retrieved. The probability of GDM diagnosis was stratified based on the gestational week of the GCT and the definition of a positive OGTT, delineated by one or two abnormal values. RESULTS: The study included 636 women with abnormal GCT between 24 and 28 weeks of gestation. Of them, 157 unerwent the GCT between 24.0 and 24.6 weeks, 204 between 25.0 and 25.6 weeks, 147 between 26.0 and 26.6 weeks, and 128 between 27.0 and 28.6 weeks. We found that the highest incidence of GDM, defined by one or two pathological values of the OGTT, following the initial screening with a GCT, where abnormal results were defined as values exceeding 140 mg/dL, was diagnosed in patients who underwent GCT between 26.0 and 26.6 weeks of gestation. Conversely, the lowest rates were observed in patients screened between 24.0 and 24.6 weeks of gestation. CONCLUSION: The timing of screening for GDM using the GCT significantly affects the rate of diagnosis. Clinicians managing pregnancies should consider this data when formulating treatment plans.

Adverse obstetric outcomes in cases of meconium-stained amniotic fluid complicated with intrapartum fever.

PURPOSE: Meconium-stained amniotic fluid (MSAF) often signifies colonization of the amniotic sac by microorganisms. This study investigated additional adverse obstetric outcomes associated with MSAF in deliveries complicated by maternal intrapartum fever (IF). METHODS: This retrospective study included all singleton pregnancies from 2014 to 2020, with intrapartum maternal fever ≥ 38 °C during a trial of labor. In accordance with departmental protocol, all patients received intravenous antibiotic therapy consisting of ampicillin and gentamicin in the absence of allergies to these medications. Subsequent antibiotic therapy was adjusted based on the culture results. Antibiotic treatment was discontinued postpartum after 48 h without fever. Swab cultures were obtained immediately postpartum from both the maternal and fetal sides of the placenta. Maternal and fetal outcomes, along with positive placental cultures, were compared between participants with MSAF&IF and those with clear amniotic fluid &IF (control group). RESULTS: In comparison to the control group (n = 1089), the MSAF&IF group (n = 264) exhibited significantly higher rates of cesarean delivery (CD) (p = 0.001), CD due to non-reassuring fetal heart rate (p = 0.001), and cord pH ≤ 7.1 (p = 0.004). Positive swab cultures from the placental maternal and fetal sides were more prevalent among the MSAF&IF group (23.1% vs. 17.6%, p = 0.041 and 29.2% vs. 22.9%, p = 0.032, respectively). Placental cultures yielding gastrointestinal pathogens and extended spectrum beta-lactamase were notably more common in the MSAF&IF group compared to controls (p = 0.023). However, there was no significant difference between groups regarding the rate of group B streptococcus positive placental cultures. CONCLUSIONS: Women experiencing IF and MSAF during labor face an elevated risk of CD compared to those with IF alone. The presence of MSAF heightens the risk of positive placental cultures, particularly with gastrointestinal and extended spectrum beta-lactamase pathogens.

Emergent cesarean section during active labor-does cervical dilatation matter?

PURPOSE: To compare the immediate and late complications associated with emergent cesarean sections (CS) performed during the first and second stages of active labor. METHODS: We conducted a retrospective analysis of electronic medical records from a single academic center, including data from 577 patients who underwent emergent cesarean sections at 4 cm or more of cervical dilatation. Patients were divided into two groups: those who had CS during the first stage of labor (4-9 cm dilatation) and those who had CS at complete dilatation (10 cm). Maternal and neonatal outcomes were compared, including rates of complications such as uterine atony, post-partum hemorrhage, infection, and neonatal intensive care unit (NICU) admission. RESULTS: Of the 577 patients, 352 underwent CS during active labor and 255 at complete dilatation. The complete dilatation group exhibited significantly higher rates of uterine atony (19.6% vs. 11.6%, p = 0.009) and uterine incision extension (34.2% vs. 16.5%, p = 0.0001). In addition, they had longer hospital stays (4.8 vs. 4.25 days, p = 0.003) and higher outpatient clinic visit rates (21.3% vs. 9.9%, p = 0.0001). Infection-related complications on readmission were more common in the complete dilatation group (20% vs. 9.7%, p = 0.001). Neonatal outcomes, including APGAR scores and NICU admissions, did not differ significantly between the groups. CONCLUSION: Emergent cesarean sections performed at complete cervical dilatation are associated with increased intra-operative and post-operative complications compared to those performed during active labor. These findings highlight the importance of considering the stage of labor when planning cesarean delivery to minimize risks and optimize outcomes for both mother and neonate.

Preliminary Assessment of Galectin-3 Expression in Serum and Follicular Fluid: Implications for Predicting In Vitro Fertilization Outcomes.

BACKGROUND: Galactin-3 has been found to be involved in oocyte maturation, folliculogenesis, implantation, and placentation. The expression of Galactin-3 in the endometrium of women who have successfully undergone in vitro fertilization (IVF) has been suggested as a potential biomarker for predicting successful embryo implantation. OBJECTIVES: To evaluate the expression of Galactin-3 in the sera and follicular fluid of women during IVF cycles. METHODS: This prospective research included 21 women undergoing IVF treatments. Blood samples were taken at four points: day 2 before starting stimulation, trigger day, day of oocyte retrieval, and day of the ß-human chorionic gonadotropin level test. In addition, follicular fluid samples were taken on the day of oocyte retrieval. Galactin-3 protein levels were measured in serum and follicular fluid using enzyme-linked immunosorbent assay. RESULTS: Galactin-3 levels on the stimulation day were positively correlated to estradiol levels on the day of the trigger (0.59, P = 0.02). Among women who achieved pregnancy compared to those who did not, Galectin-3 serum levels were higher on the day of the trigger (17.93 ± 4.35 ng/ml vs. 11.01 ± 3.73 ng/ml, P = 0.015). CONCLUSIONS: These findings may imply a potential role of Galectin-3 on the success of IVF treatments, underscoring the potential importance of inflammatory processes in fertility.

Molecular pathways of senescence regulate placental structure and function.

The placenta is an autonomous organ that maintains fetal growth and development. Its multinucleated syncytiotrophoblast layer, providing fetal nourishment during gestation, exhibits characteristics of cellular senescence. We show that in human placentas from pregnancies with intrauterine growth restriction, these characteristics are decreased. To elucidate the functions of pathways regulating senescence in syncytiotrophoblast, we used dynamic contrast-enhanced MRI in mice with attenuated senescence programs. This approach revealed an altered dynamics in placentas of p53-/- , Cdkn2a-/- , and Cdkn2a-/- ;p53-/- mice, accompanied by histopathological changes in placental labyrinths. Human primary syncytiotrophoblast upregulated senescence markers and molecular pathways associated with cell-cycle inhibition and senescence-associated secretory phenotype. The pathways and components of the secretory phenotype were compromised in mouse placentas with attenuated senescence and in human placentas from pregnancies with intrauterine growth restriction. We propose that molecular mediators of senescence regulate placental structure and function, through both cell-autonomous and non-autonomous mechanisms.

Early, continuing exposure to cow's milk formula and cow's milk allergy: The COMEET study, a single center, prospective interventional study.

BACKGROUND: Cow's milk allergy (CMA) is a common food allergy among infants. Information regarding the best timing for first exposure to cow's milk formula (CMF) is controversial and more evidence is required. Few randomized control trials have tried to accurately assess the timing and preventive effect of exposure to CMF on small cohorts. OBJECTIVE: This study assessed the association between early, continuing exposure to CMF on the basis of the parents' preferences and the development of immunoglobulin E (IgE)-mediated CMA in a large birth cohort. METHODS: Newborns were prospectively recruited shortly before birth and divided into 2 groups according to parental feeding preference for the first 2 months of life: (1) exclusive breastfeeding (EBF); or (2) at least 1 meal of CMF (with or without breastfeeding) daily. Infants were followed up monthly until the age of 12 months. RESULTS: Among 1992 infants participating in the study, 1073 (53.86%) were in the EBF group until 2 months of age. IgE-mediated CMA was confirmed in 0.85% (n = 17); all were in the EBF group. Within this group, the prevalence of IgE-mediated CMA was 1.58% compared with 0 in the other groups (relative risk, 29.98; P < .001). Post hoc analysis revealed IgE-mediated CMA prevalence of 0.7% in the per-protocol EBF group vs 3.27% among breastfed infants who were exposed to a small amount of CMF during the first 2 months of life. A family atopic background did not affect the results. CONCLUSION: Early, continuing exposure to CMF from birth has the potential to prevent the development of IgE-mediated CMA and should be encouraged. However, the exposure needs to be consistent because occasional exposure increases the risk of developing IgE-mediated CMA and should be avoided.

Food allergy and infant feeding practices: Are they related?

BACKGROUND: Immunoglobulin (Ig)E-mediated food allergy is a growing health problem affecting up to 10% of children. It is well-established that early introduction to peanuts and eggs from 4 months of age has a preventive effect. In contrast, there is no consensus about the effect of breastfeeding on food allergy development. OBJECTIVE: To evaluate the effect of breastfeeding and cows' milk formula (CMF) feeding on the development of IgE-mediated food allergy. METHODS: Infants in the Cow's Milk Early Exposure Trial were followed for 12 months. The cohort was divided according to parental feeding preferences for the first 2 months of life: group 1: exclusive breastfeeding (EBF); group 2: breastfeeding with at least 1 daily meal of CMF; and group 3: feeding with CMF only. RESULTS: Among a total of 1989 infants, 1071 were on EBF (53.8%), 616 were breastfed with addition of CMF (31%), and 302 were fed with CMF only (15.2%), from birth. By 12 months, 43 infants developed an IgE-mediated food allergy (2.2%); 31 in the EBF group (2.9%), 12 in the breastfeeding and CMF combined group (1.9%), and none in the CMF feeding-only group (P = .002). Family atopic comorbidity did not affect the results. CONCLUSION: In this prospective cohort, breastfed infants developed significantly higher rates of IgE-mediated food allergy during the first year of life. Perhaps the mechanism is related to compounds ingested by the mother and secreted in the breastmilk. Future larger cohorts should validate these results and offer the lactating mother recommendations. TRIAL REGISTRATION: The COMEET study and its derivatives were approved by the Ethics Committee of Meir Medical Center, IRB number 011-16-MMC. It was registered at the National Institutes of Health Clinical Trials Registry: NCT02785679.

Changes in maternal heart rate in delayed post-partum preeclampsia.

AIM: Delayed-onset postpartum preeclampsia (PET) is defined as a new diagnosis of preeclampsia presenting 48 h to 6 weeks postpartum. This disorder is infrequent and associated with a higher incidence of complications as compared to antepartum PET. There seems to be a need to further characterize this disorder. The aim of the study was to investigate the difference of maternal heart rate in women with delayed onset postpartum preeclampsia as compared to healthy controls. METHODS: The medical files of all women who were readmitted with delayed onset postpartum preeclampsia during 2014-2020 were reviewed. Data on maternal physiological characteristics were compared to healthy control group of women at the same post-partum day, with uncomplicated pregnancies. RESULTS: Included 45 women with the diagnosis of delayed onset of preeclampsia at 6.3 ± 2.86 post-partum day. As compared to controls (n = 49), women with delayed post-partum were older, 34.6 ± 5.4 vs. 32.3 ± 4.7 years, p = 0.003. There were no differences between groups regarding maternal gravidity, parity, BMI (kg/m2) or Hb level at delivery day. Women with delayed post-partum preeclampsia had lower mean pulse rate as compared to controls, 58 ± 15 bpm vs. 83 ± 11.6 bpm, respectively, P < 0.0001. Only 17% of the women in the delayed onset group had pulse rate above 70 bpm as compared to 83% in the control group. CONCLUSIONS: Maternal low heart rate in cases with delayed onset of post-partum preeclampsia is an important clinical characteristic that may reflect baroreceptors response to maternal hypertension.

Can Natural Language Processing Improve Adnexal Torsion Predictions?

STUDY OBJECTIVE: To create a decision support tool based on machine learning algorithms and natural language processing (NLP) technology, to augment clinicians' ability to predict cases of suspected adnexal torsion. DESIGN: Retrospective cohort study SETTING: Gynecology department, university-affiliated teaching medical center, 2014-2022. PATIENTS: This study assessed risk-factors for adnexal torsion among women managed surgically for suspected adnexal torsion based on clinical and sonographic data. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The dataset included demographic, clinical, sonographic, and surgical information obtained from electronic medical records. NLP was used to extract insights from unstructured free text and unlock them for automated reasoning. The machine learning model was a CatBoost classifier that utilizes gradient boosting on decision trees. The study cohort included 433 women who met inclusion criteria and underwent laparoscopy. Among them, 320 (74%) had adnexal torsion diagnosed during laparoscopy, and 113 (26%) did not. The model developed improved prediction of adnexal torsion to 84%, with a recall of 95%. The model ranked several parameters as important for prediction. Age, difference in size between ovaries, and the size of each ovary were the most significant. The precision for the "no torsion" class was 77%, with a recall of 45%. CONCLUSIONS: Using machine learning algorithms and NLP technology as a decision-support tool for the diagnosis of adnexal torsion is feasible. It improved true prediction of adnexal torsion to 84% and decreased cases of unnecessary laparoscopy.

Prenatal diagnosis of a likely pathogenic variant in ZBTB18: Natural evolution of fetal phenotype including the long bones and corpus callosum.

Pathogenic variants in ZBTB18 gene have been described only postnatally with a variable phenotypic spectrum that includes intellectual disability, microcephaly, hypotonia, poor growth, corpus callosum abnormalities, seizures, and dysmorphic facial features. These features overlap with the phenotype of 1q43-q44 deletion syndrome (OMIM #612337). There are several genes within the 1q43-q44 deletion region, and ZBTB18 is of particular interest due to its known involvement in neuronal differentiation and migration. We describe here a fetus presenting with an intrauterine growth restriction, diminished long bones growth, single umbilical artery, and a short corpus callosum. On mid pregnancy ultrasound, all biometric parameters including the corpus callosum were relatively small but still within the normal range. Only a targeted follow-up during the third trimester, including neurosonographic and MRI exams, revealed the full extent of the malformation, leading to amniocentesis and a genetic workup that led to the identification of a de novo likely pathogenic variant in ZBTB18 gene. This is the first description of the evolving phenotype of a ZBTB18-related disorder in a fetus, which emphasizes the challenging diagnosis of subtle findings, that mandates a high level of clinical suspicion and a targeted follow-up throughout pregnancy.

Prenatal work-up, associated anomalies and postnatal outcomes of foetuses with 9-9.9 mm cerebral ventricular atria width.

OBJECTIVE: To analyse prenatal work-up, associated anomalies and postnatal outcomes of foetuses with cerebral lateral ventricular width 9-9.9 mm. METHOD: This retrospective, observational, case-control study included 121 foetuses with initial presentation of isolated cerebral lateral ventricular width 9-9.9 mm detected during routine ultrasound scans, 21-24 weeks' gestation, in a tertiary referral centre, January 2001-December 2018. Controls included 123 foetuses with lateral ventricular width <9 mm measured under the same parameters. Clinical characteristics, obstetrical history, ultrasound findings, prenatal work-up and pregnancy outcomes were collected from medical records. Information about postnatal functional and neurodevelopmental sequelae were obtained from telephone-based questionnaires. RESULTS: The study group had more males (82/116 (70.6%) versus 65/123 (52.8%), p = 0.004), more prenatal testing, including brain magnetic resonance imaging (28/116 (24.1%) versus 0/123 (0%), p < 0.001), echocardiography (46/116 (39.7%) versus 15/123 (12.2%), p < 0.001) and targeted anomaly scans (102/116 (87.9%) versus 1/123 (0.008%), p < 0.001). Long-term follow-up did not reveal more neurodevelopmental sequelae compared to controls. Gender-based analysis found more males with ventricular dilatation 9-9.9 mm treated for developmental delay compared to females with similar findings (15/82 (18.2%) versus 1/34 (2.9%), p = 0.010). CONCLUSION: Foetuses with 9-9.9 mm cerebral lateral ventricular width versus <9 mm underwent more prenatal testing but had similar rates of neurodevelopmental sequelae.

Do maternal albumin levels affect post-operative complications after cesarean delivery?

BACKGROUND: This study explored the correlation between maternal serum albumin levels prior to elective cesarean delivery (CD) and postoperative complications. METHODS: This retrospective cohort study included women admitted for elective CD at term to our tertiary referral center, during the years 2016-2018. Blood samples were collected during the preoperative admission. Information collected included maternal demographics, pregnancy and postoperative complications. Data between patients with preoperative serum albumin levels < 3.3 g/dL or ≥ 3.3 g/dL were compared. RESULTS: Among 796 women admitted for an elective CD, 537 met the inclusion criteria. There were 250 (46.6%) women in the low albumin level group (< 3.3 g/dL) and 287 (53.4%) with serum albumin level ≥ 3.3 g/dL. Patients with serum albumin ≥ 3.3 g/dL had increased rates of surgical site infection (SSI) (5.6% vs. 1.6% respectively; p = 0.02), need for antibiotics during the post-partum period (10.8% vs 3.2%, respectively; p = 0.001), surgical intervention (2.1% vs. 0%, respectively; p = 0.03) and higher rate of rehospitalization (5.2% vs. 0.4%, respectively; p = 0.001). Multivariant analysis showed that albumin level ≥ 3.3 g/dL was independently associated with composite postoperative adverse maternal outcome. CONCLUSIONS: High serum albumin levels among women undergoing CD, might be associated with abnormal postoperative outcomes. Larger prospective studies, with a heterogenous population are needed to validate these observations.

Can sonographic changes in cervical length during pregnancy predict the need for cervical ripening in term pregnancies?

PURPOSE: To evaluate the effect of changes in sonographic cervical length (CL) measured at 14-16 and 21-24 weeks of gestation, on cervical ripening in term pregnancies. METHODS: This retrospective, cohort study included term pregnancies with CL measured with transvaginal sonography (CL1 at 14-16 weeks gestation and CL2 at 21-24 weeks). History of preterm labor, multiple gestations, planned caesarean section, fetal anomalies and stillbirths were excluded. Participants were grouped based on ≥ 10% vs. < 10% CL shortening between measurements. The primary outcome was whether cervical shortening < 10% between CL1 and CL2 was associated with increased use of cervical ripening. Secondary outcomes were gestational age at delivery, delivery mode and birthweight. RESULTS: Among 267 women who met the inclusion criteria, CL decreased ≥ 10% between scans in 70 (26.3%) and < 10% in 197 (73.7%). Baseline characteristics were similar between groups. Fewer women with ≥ 10% shortening between scans, underwent cervical ripening (7.1% vs. 16.8%, p < 0.05). In addition, in the ≥ 10% group, although CL2 was in the normal range, it was shorter than in the < 10% group (34.3 ± 6.7 mm vs. 40.1 ± 6.4 mm, p < 0.01). CONCLUSION: Decrease in cervical length > 10% between 14-16 and 21-24-weeks' gestation is associated with lower use of cervical ripening at term.

Adverse outcomes in vacuum-assisted delivery after detachment of non-metal cup: a retrospective cohort study.

PURPOSE: To evaluate neonatal and maternal outcomes associated with detachment of non-metal vacuum cup during delivery and to identify risk factors for these detachments. METHODS: This retrospective cohort study included women with singleton pregnancy, who underwent vacuum-assisted vaginal delivery with a non-metal vacuum cup in a single academic institution, January 2014-August 2019. Failed vacuum deliveries were excluded. Primary outcomes were defined as subgaleal hematoma (SGH) and cord blood pH < 7.15. Secondary outcome included other neonatal complications and adverse maternal outcomes. Outcomes were compared between vacuum-assisted deliveries with and without cup detachment during the procedure. RESULTS: A total of 3246 women had successful VAD and met the inclusion criteria. During the procedure, the cup detached at least once in 665 (20.5%) deliveries and did not detach in 2581 (79.5%). The cup detachment group experienced higher rates of SGH (8.9% vs. 3.5%, p = 0.001) and cord blood pH < 7.15 (9.8% vs. 7.1%, p = 0.03). There were also more neonatal intensive care unit admissions (NICU) (4.4% vs. 2.7%, p = 0.03) and more fetuses with occiput posterior position (70.8% vs. 79.4%, p = 0.001), the vacuum duration was slightly longer (6 ± 3.7 vs. 5 ± 2.9 min) and more neonates had birth weights > 3700 g (14.1% vs, 10.3%, p = 0.006). Interestingly, there were more males in that group (60.6 vs. 54.6, p = 0.005). All these factors remained significant after controlling for potential confounders. CONCLUSIONS: Vacuum cup detachment has several predictive characteristics and is associated with adverse neonatal outcomes that should be incorporated into decisions made during the procedure.

Fetal weight estimation in tall women: is ultrasound more accurate than clinical assessment? A prospective trial.

PURPOSE: Estimated fetal weight (EFW) is crucial for clinical decision-making during pregnancy and labor. Maternal habitus impacts its accuracy. This study compared the accuracy of clinical versus ultrasound EFW in tall pregnant women (height ≥ 172 cm, 90th percentile). METHODS: In this prospective study, tall pregnant women at term, who arrived for a prenatal visit and delivered within a week, underwent clinical and ultrasound assessments of estimated fetal weight. Each woman served as her own control. After delivery, birth weight was compared to the clinical and ultrasound EFW. The primary outcome was the accuracy of each method in predicting the actual birth weight. RESULTS: All 100 women included in this trial underwent clinical and ultrasound estimations of fetal weight. Mean maternal height was 175.7 ± 3.3 (172-185) cm. More clinical EFW swere inaccurate compared to ultrasound (25 (25%) vs. 6 (6%), respectively, p < 0.001). Both clinical (3583 g) and ultrasound (3490 g) evaluations underestimated the fetal weights compared to the birth weights (3664 g, p < 0.001). In the macrosomic fetal group, both the clinical (3983 g) and ultrasound (3767 g) estimates were significantly inaccurate compared to the birth weights (4237 g, p < 0.001). CONCLUSION: Among tall women, ultrasound EFW is more accurate than clinical EFW. TRIAL REGISTRATION NUMBER AND DATE OF REGISTRATION: IRB-0016-17-MMC, Clinical-Trials.gov identifier NCT03206281.

Enhanced expression of Galectin-3 in gestational diabetes.

BACKGROUND AND AIMS: Gestational diabetes mellitus (GDM), hyperglycemia diagnosed during pregnancy, is one of the most common medical complications of pregnancy, treated primarily by diet and pharmacotherapy, if indicated. It is well-established that GDM increases the risk of adverse pregnancy outcomes and long-term complications in mothers and infants. Galectin-3 (Gal-3) is important in processes of cell growth, differentiation, inflammation, and fibrosis. We evaluated Gal-3 expression in pregnancies complicated by GDM as a parameter that might explain how GDM influences early onset of future complications. METHODS AND RESULTS: Forty-four women with GDM and 40 with normal pregnancy (NP) were recruited during delivery admission. Blood samples were obtained from parturients and umbilical cords blood, as well as placental tissue for analysis. Gal-3 mRNA expression was increased in maternal blood samples and placental tissue of women with GDM compared to NP. In GDM, Gal-3 mRNA was decreased in cord blood compared to maternal blood and placental tissue. Gal-3 GDM placental protein expression was increased compared to NP. Immunostaining revealed that Gal-3 is upregulated in GDM placental extravillous trophoblast. ELISA of Gal-3 maternal serum levels between GDM and NP were similar. CONCLUSION: Gal-3 is strongly expressed at molecular levels (mRNA and protein expression) in GDM maternal blood and placental tissue, and decreased in cord blood. These findings highlight the role of the placenta in protecting the fetus from potential Gal-3 damage. Gal-3 expression at mRNA and protein levels might be influenced by diabetes, even if blood glucose is balanced by medication or diet.

Can we improve our ability to interpret category II fetal heart rate tracings using additional clinical parameters?

OBJECTIVES: This study examined predictive factors, in addition to Category II Fetal Herat Rate (FHR) monitoring that might imply fetal acidosis and risk of asphyxia. METHODS: This retrospective cohort study compared three groups of patients with Category II FHR monitoring indicating need for imminent delivery. Groups were divided based on fetal cord blood pH: pH≤7.0, 7.0

The role of mediolateral episiotomy during vacuum-assisted vaginal delivery with soft cup devices.

PURPOSE: This study evaluated whether episiotomy during vacuum-assisted delivery leads to fewer third- and fourth-degree tears. METHODS: This was a retrospective cohort study of all nulliparas who underwent a singleton, soft cup, vacuum-assisted vaginal delivery in one institution, from January 2014 to August 2019. Failed vacuum deliveries were excluded. Based on power analysis calculation, a sample size of 500 women in each group was sufficient to detect an advantage of episiotomy, if present. Primary outcome was third- or fourth-degree perineal tear. Secondary outcomes were other maternal complications, and low neonatal cord pH and Apgar scores. Outcomes were compared between women with and without episiotomy. RESULTS: During the study period, 2370 nulliparas had a vacuum-assisted vaginal delivery using soft vacuum cup and met the study inclusion criteria. Episiotomy was performed in 1868 (79%) women, and 502 (21%) delivered without episiotomy. Background characteristics were similar in both groups. There were no significant differences in the rates of third and fourth grade perineal lacerations between the two groups. Episiotomy was associated with higher rate of postpartum hemorrhage (p < 0.01) CONCLUSIONS: Using selective episiotomy for patients delivering vaginally with the assistance of soft cap vacuum does not increase third- or fourth-degree perineal tears.