Pelvic Floor Ultrasound Findings and Symptoms of Pelvic Floor Dysfunction During Pregnancy.

INTRODUCTION AND HYPOTHESIS: Pregnancy and childbirth predispose to pelvic floor dysfunction (PFD), coinciding with functional and anatomical changes in the pelvic floor. To some extent, these can be assessed by transperineal ultrasound (TPUS), yet the correlation between ultrasound findings and symptoms has not been well elucidated. We hypothesised that pregnant women with PFD would show different findings at TPUS. METHODS: This is a planned secondary analysis of a prospective cohort study. Pregnant women were asked to fill out standardised questionnaires on PFD and undergo TPUS at 12-14 weeks and 28-32 weeks of gestation. We compared bladder neck descent, urethral rotation, retrovesical angle, pelvic organ descent, genital hiatus dimensions and the presence of anal sphincter defects between women with and those without PFD using t test and Fisher's exact test. Linear mixed-effects models were used to assess the correlation between TPUS findings and PFD severity. As this is a secondary subgroup analysis of participants who underwent TPUS, no sample size was determined upfront. RESULTS: At Valsalva, women with urinary incontinence had more pronounced bladder neck descent (p = 0.02) and urethral rotation (p < 0.01), as well as wider retrovesical angles (p = 0.04) and larger genital hiatus areas (p < 0.01). After controlling for age, BMI and parity, the retrovesical angle was the only persistent predictor of urinary incontinence. No correlation was observed between any TPUS marker and symptoms of either prolapse or anorectal dysfunction. CONCLUSIONS: In pregnant women, symptoms of urinary incontinence, but not of prolapse and anorectal dysfunction, are associated with differences in pelvic floor anatomy at TPUS.

Ergot alkaloid consumption alters serotonin receptor-induced vasoactivity in ovine umbilical vasculature.

Consumption of ergot alkaloids during the second half of gestation has been shown to decrease umbilical artery vasoactivity resulting in decreased birth weights. Negative vascular effects of ergot alkaloids are mediated predominantly through serotonergic and adrenergic receptors in other tissues. Vasoactivity of serotonin (5-HT) receptors 5-HT2A and 5-HT1B/1D in umbilical artery and vein from ewes receiving endophyte-infected seed (E + 1.77 mg ergovaline/hd/d) or a control total mixed ration (CON; 0 mg ergovaline/hd/d) tall fescue seed at d-110 and d-133 of gestation was evaluated. Gravid reproduction tracts were collected from ewes. Two-mm sections of umbilical artery and vein were exposed to increasing concentrations of a 5-HT1B/1D agonist and 5-HT2A agonist. The 5-HT1B/1D agonist did not stimulate a contractile response in artery or vein or either gestation time point. 5-HT2A agonist caused large responses in artery with greatest occurring at d-110 and decreasing in magnitude as days of gestation increased (p < 0.05). On d-110 and 133 of gestation, arteries from CON ewes had greater contractile response than arteries collected from E+ ewes (p < 0.05). Veins responded to increasing concentrations of the 5-HT2A agonist. Maximal d-110 vein response was greater than d-133 when exposed to 5-HT2A agonist (p < 0.05). Unlike the artery, veins from E+ ewes had greater d-133 contractile response than CON (p < 0.05). Vascular contractions of umbilical artery and vein are induced by 5-HT2A receptor activity and not 5-HT1B/1D. Umbilical artery 5-HT2A receptor activity was more sensitive to seed treatment and could be responsible for ergot alkaloid-induced intra-uterine growth restriction.

Prediction of gestational diabetes mellitus by multiple biomarkers at early gestation.

BACKGROUND: It remains unclear which early gestational biomarkers can be used in predicting later development of gestational diabetes mellitus (GDM). We sought to identify the optimal combination of early gestational biomarkers in predicting GDM in machine learning (ML) models. METHODS: This was a nested case-control study including 100 pairs of GDM and euglycemic (control) pregnancies in the Early Life Plan cohort in Shanghai, China. High sensitivity C reactive protein, sex hormone binding globulin, insulin-like growth factor I, IGF binding protein 2 (IGFBP-2), total and high molecular weight adiponectin and glycosylated fibronectin concentrations were measured in serum samples at 11-14 weeks of gestation. Routine first-trimester blood test biomarkers included fasting plasma glucose (FPG), serum lipids and thyroid hormones. Five ML models [stepwise logistic regression, least absolute shrinkage and selection operator (LASSO), random forest, support vector machine and k-nearest neighbor] were employed to predict GDM. The study subjects were randomly split into two sets for model development (training set, n = 70 GDM/control pairs) and validation (testing set: n = 30 GDM/control pairs). Model performance was evaluated by the area under the curve (AUC) in receiver operating characteristics. RESULTS: FPG and IGFBP-2 were consistently selected as predictors of GDM in all ML models. The random forest model including FPG and IGFBP-2 performed the best (AUC 0.80, accuracy 0.72, sensitivity 0.87, specificity 0.57). Adding more predictors did not improve the discriminant power. CONCLUSION: The combination of FPG and IGFBP-2 at early gestation (11-14 weeks) could predict later development of GDM with moderate discriminant power. Further validation studies are warranted to assess the utility of this simple combination model in other independent cohorts.

Inflammatory pathways of Toxoplasmagondii infection in pregnancy.

Toxoplasma gondii (T. gondii), an obligate intracellular parasite, is considered as an opportunistic infection and causes toxoplasmosis in humans and animals. Congenital toxoplasmosis can influence pregnancy and cause mild to severe consequences for the fetal and neonatal. During early T. gondii infection, neutrophils as the most abundant white blood cells provide a front line of defense mechanism against infection. The activated dendritic cells are then responsible for initiating an inflammatory response via T-helper 1 (Th1) cells. As part of its robust immune response, the infected host cells produce interferon (IFN-γ). IFN-γ inhibits T. gondii replication and promotes its transformation from an active form to tissue cysts. Although anti- T. gondii antibodies play an important role in infection control, T-helper 2 (Th2) immune response, can facilitate the growth and proliferation of T. gondii in the host cell. In pregnant women infected with T. gondii, the expression of cytokines may vary and in response diverse outcomes are expected. Cytokine profiles serve as valuable indicators for estimating the patho-immunological effects of T. gondii infection. This demonstrates the intricate relationship between pro-inflammatory and anti-inflammatory cytokines, as well as their influence on the various pregnancy outcomes in T. gondii infection.

Assessing the Impact of Hematological Changes in Pregnancy on Maternal and Fetal Death: A Narrative Review.

Hematological changes during pregnancy encompass a wide range of alterations in blood composition and function, including variations in hemoglobin levels, red blood cell count, and coagulation factors. These changes can be physiological or pathological and may significantly impact maternal and fetal health outcomes. This narrative review examines the relationship between various hematological changes and disorders during pregnancy and their effects on maternal and fetal mortality and morbidity. We explore conditions such as anemia, sickle cell disease, thrombophilia, and blood-borne infections like malaria, as well as the impact of multiple pregnancies on hematological parameters. The review also discusses the effects of COVID-19 on maternal hematology. Key findings include the high prevalence of adverse perinatal outcomes associated with these conditions, including early miscarriages, preterm birth, low birth weight, intrauterine growth restriction, and increased risk of maternal complications. The importance of early screening, diagnosis, and appropriate management of hematological disorders during pregnancy is emphasized. This review highlights the need for a multidisciplinary approach to managing pregnant women with hematological changes to optimize maternal and fetal outcomes.

Effect of Dietary Sugarcane Bagasse on Reproductive Performance, Constipation, and Gut Microbiota of Gestational Sows.

This experiment aimed to evaluate the effects of using sugarcane bagasse (SB) as a substitute for soybean hulls and wheat bran in the diet of pregnant sows on their reproductive performance and gut microbiota. A total of seventy-two primiparous sows were randomly divided into four treatment groups, with eighteen replicates of one sow each. The sows were fed a basal diet supplemented with 0% (CON), 5%, 10%, and 15% SB to replace soybean hulls from day 57 of gestation until the day of the end of the gestation period. The results showed that SB contains higher levels of crude fiber (42.1%) and neutral detergent fiber (81.3%) than soybean hulls, and it also exhibited the highest volumetric expansion when soaked in water (50 g expanding to 389.8 mL) compared to the other six materials we tested (vegetable scraps, soybean hulls, wheat bran, rice bran meal, rice bran, and corn DDGS). Compared with the CON, 5% SB significantly increased the litter birth weight of piglets. Meanwhile, 10% and 15% SB significantly increased the rates of constipation and reduced the contents of isobutyric acid and isovaleric acid in feces. Furthermore, 10% and 15% SB significantly disturbed gut microbial diversity with increasing Streptococcus and decreasing Prevotellaceae_NK3B31-group and Christensenellaceae_R-7-group genera in feces. Interestingly, Streptococcus had a significant negative correlation with isobutyric acid, isovaleric acid, and fecal score, while Prevotellaceae_NK3B31-group and Christensenellaceae_R-7-group had a positive correlation with them. In conclusion, our study indicates that 5% SB can be used as an equivalent substitute for soybean hulls to improve the reproductive performance of sows without affecting their gut microbiota.

Maternal Supplementation with Dietary Betaine during Late Gestation Increased Ewe Plasma Creatine and Lamb Thermoregulation under Field Conditions.

Twin lamb mortality is a significant economic problem impacting the Australian sheep industry. Maternal betaine supplementation improved lamb vigour and early post-natal survival when ewes and lambs were housed indoors, suggesting that betaine may be beneficial to feed under extensive pasture systems. This study investigated whether maternal betaine supplementation during late gestation would improve Merino twin lamb live weight, thermoregulation, vigour and survival to weaning under field conditions. Ewes received dietary betaine at either 0 g/day (CTL; n = 115) or 4 g/day from day 110 of gestation (dG 110) until ~49 days post-partum (pp) (BET; n = 115). Measures indicative of lamb viability and survival were collected within 4-24 h of birth and at ~49 days pp and ~93 days pp. BET ewes had higher creatine and creatinine concentrations at dG 130 than CTL ewes (p < 0.05). BET lambs had a higher rectal temperature within 4-24 h following birth than CTL lambs (p < 0.05). CTL lambs were heavier at ~49 days pp and grew faster from birth to ~49 days pp than BET lambs (both p < 0.05). The time taken after release from the researcher to first suckling was quicker in the CTL lambs than BET lambs (p < 0.05). This study demonstrated that supplementing betaine increased creatine concentration in twin-bearing ewes and thermoregulatory capacity in neonatal lambs under extensive grazing systems.

Effects of Interactions between Feeding Patterns and the Gut Microbiota on Pig Reproductive Performance.

The feeding mode is an important factor affecting the reproductive performance of pigs. The composition and expression of the intestinal microbiota are closely related to the physiological and biochemical indicators of animals. Therefore, to explore the impact of different feeding patterns on the reproductive performance of pigs, this study collected reproductive performance data from 1607 Yorkshire pigs raised under different feeding patterns and conducted a fixed-effect variance analysis. Among them, 731 were in the artificial feeding (AM) group and 876 were in the feeding station feeding (SM) group. Additionally, 40 Yorkshire sows in the late gestation period were randomly selected from each feeding mode for intestinal microbiota analysis. The results of the analysis showed that, in the AM group, both the number of birth deformities (NBD) and the number of stillbirths (NSB) were significantly greater than they were in the SM group (p < 0.05). Additionally, the total number born (TNB) in the AM group was significantly lower than that in the SM group (p < 0.05). The results of the intestinal microbiota analysis revealed that at the phylum level, there were significant differences in nine bacterial taxa between the AM and SM groups (p < 0.05). At the genus level, the abundance of a variety of beneficial bacteria related to reproductive performance in the SM group was significantly greater than that in the AM group. Finally, fecal metabolomic analysis revealed that the contents of butyric acid, isovaleric acid, valeric acid, and isobutyric acid, which are associated with reproductive performance, in the feces of sows in the SM group were significantly higher than those in the AM group (p < 0.05). These results indicate that different feeding methods can affect the gut microbiota composition of Yorkshire pigs and further influence the reproductive performance of pigs through the gut microbiota-metabolic product pathway. The results of this study provide valuable insights for further exploring the relationships between feeding modes, intestinal microbial composition, and host phenotypes.

Non-invasive methods characterise the world's largest tiger shark aggregation in Fuvahmulah, Maldives.

Tiger sharks are apex predators with a circumglobal tropical and warm-temperate distribution, with a general lack of population data for the central Indian Ocean. In Fuvahmulah, Maldives, tiger sharks display frequent use of the harbour area, attracted by discarded fish waste. Here, we document the population structure, residency, and reproductive characteristics of the world's largest known tiger shark aggregation in a geographically-restricted area. Using non-invasive methods, photo identification and laser photogrammetry, we identified 239 individual tiger sharks over a 7-year study period. The aggregation was female-dominated (84.5%), with both large juveniles and adults present. Adult females were resighted over the entire study period displaying strong inter- and intra-annual site fidelity. Modelled residency using maximum likelihood methods suggests they spent 60.7 ± S.E. 7.5 days in Fuvahmulah, with a larger aggregation size, shorter residence periods and longer absence periods compared to juvenile females. Prolonged abdominal distensions of adult females indicate they likely stay near Fuvahmulah during gestation and reproduce biennially. Fuvahmulah seems to provide suitable conditions for gestation given the year-round provision of food and warm waters, exhibited by strong site fidelity and temporal residency. Our results show indications of a thriving population within the confines of protected waters.

Overexpression of Igf2-derived Mir483 inhibits Igf1 expression and leads to developmental growth restriction and metabolic dysfunction in mice.

Mir483 is a conserved and highly expressed microRNA in placental mammals, embedded within the Igf2 gene. Its expression is dysregulated in a number of human diseases, including metabolic disorders and certain cancers. Here, we investigate the developmental regulation and function of Mir483 in vivo. We find that Mir483 expression is dependent on Igf2 transcription and the regulation of the Igf2/H19 imprinting control region. Transgenic Mir483 overexpression in utero causes fetal, but not placental, growth restriction through insulin-like growth factor 1 (IGF1) and IGF2 and also causes cardiovascular defects leading to fetal death. Overexpression of Mir483 post-natally results in growth stunting through IGF1 repression, increased hepatic lipid production, and excessive adiposity. IGF1 infusion rescues the post-natal growth restriction. Our findings provide insights into the function of Mir483 as a growth suppressor and metabolic regulator and suggest that it evolved within the INS-IGF2-H19 transcriptional region to limit excessive tissue growth through repression of IGF signaling.

The Role of Physical Fitness in Emotional Well-Being and Distress during Pregnancy: The GESTAFIT Project.

Pregnancy involves various physiological, physical, and social changes that can impact the mental health of the woman, causing her to have a stressful experience. Physical fitness (PF) is postulated as a powerful marker of health in this population. Therefore, this longitudinal study examined the association of PF with maternal emotional well-being and ill-being outcomes at 16th and 34th gestational weeks (g.w.) in a sample of 158 pregnant women (32.9 ± 4.7 years old). Self-reported PF was assessed with the valid and feasible International Fitness Scale [i.e., overall PF, cardiorespiratory fitness (CRF), muscular strength, speed-agility, and flexibility]; positive and negative affect, emotional intelligence, and resilience were measured using validated questionnaires specifically designed for this purpose. The results showed that women with greater overall PF and its components showed higher positive affect and lower negative affect (all, p < 0.05); greater emotional intelligence (all, p < 0.05); and greater resilience (all, p < 0.05), with similar results both in the 16th and the 34th g.w. These findings underscore the pivotal role of PF in promoting emotional health and resilience during pregnancy, thereby highlighting the need for integrating PF enhancement strategies in prenatal care programs.

Effects of feeding a negative dietary cation and anion difference diet to twin-bearing Merino ewes in late gestation on parturition outcomes.

In Australia, dystocia is responsible for 53% of lamb mortalities, and calcium deficiencies may be a contributing factor. A negative dietary cation anion difference (DCAD) diet can increase calcium concentrations in sheep. Therefore, this study aimed to investigate the effects of a negative DCAD diet on metabolic state, mineral status and parturition duration in ewes compared with those fed a positive DCAD diet. At approximately day 130 of gestation (dG), 71 twin-bearing ewes were placed in the following treatment groups; ewes receiving a positive DCAD TMR (total mixed ration) (DCAD of total diet = 281.8 mEq/kg DM; n = 35) and twin-bearing ewes receiving a negative DCAD TMR (DCAD of total diet = -89.0 mEq/kg DM; n = 36). Urine and blood were sampled on dG 130, 140, and 145, and blood was also sampled at the onset of parturition and 4 h post-partum. Urine was analysed for pH and blood was analysed for metabolites, mineral concentration and acid-base balance. Lamb liveweight, rectal temperature, blood glucose and lactate, and body morphology were measured. Serum phosphate concentrations at dG 145 were significantly lower for negative DCAD ewes compared with positive DCAD ewes (1.9 ± 0.1 versus 2.1 ± 0.1 mmol/L, P = 0.047). Ionised calcium (P = 0.09) and serum magnesium (P = 0.09) pre-partum were marginally greater in the negative DCAD ewes (1.35 ± 0.06 and 1.06 ± 0.03 mmol/L respectively) compared with the positive DCAD ewes (1.18 ± 0.08 and 0.98 ± 0.04 mmol/L respectively). Urine pH was lower in the negative DCAD ewes compared with positive DCAD ewes at both dG 140 (7.38 ± 0.17 versus and 8.10 ± 0.19. P = 0.01) and dG 145 (and 7.20 ± 0.19 versus 8.25. P < 0.01). The birth interval between the first the second-born lamb was shorter in the negative DCAD ewes compared with the positive DCAD ewes (P = 0.02), but no differences in lamb survival or lamb viability (P > 0.05) were seen. The negative DCAD diet reduced parturition duration, most likely due to the marginally greater ionised calcium and magnesium concentrations. Despite this improvement, the negate DCAD ewes did not reach urinary acidification, indicating that the marginally significant greater ionised calcium and serum magnesium concentrations was due to the magnesium in the diets and not metabolic acidosis. Further research testing a negative DCAD diet that can achieve the target urine pH is required to determine whether this diet can decrease parturition duration and improve lamb viability.

First trimester maternal serum PAPP-A and free ß-hCG levels and risk of SGA or LGA in women with and without GDM.

BACKGROUND: Maternal gestational diabetes (GDM), small (SGA) and large (LGA) for gestational age neonates are associated with increased morbidity in both mother and child. We studied how different levels of first trimester pregnancy associated plasma protein-A (PAPP-A) and free beta human chorionic gonadotropin (fß-hCG) were associated with SGA and LGA in GDM pregnancies and controls. METHODS: Altogether 23 482 women with singleton pregnancies participated in first trimester combined screening and delivered between 2014 and 2018 in Northern Finland and were included in this retrospective case-control study. Women with GDM (n = 4697) and controls without GDM (n = 18 492) were divided into groups below 5th and 10th or above 90th and 95th percentile (pc) PAPP-A and fß-hCG MoM levels. SGA was defined as a birthweight more than two standard deviations (SD) below and LGA more than two SDs above the sex-specific and gestational age-specific reference mean. Odds ratios were adjusted (aOR) for maternal age, BMI, ethnicity, IVF/ICSI, parity and smoking. RESULTS: In pregnancies with GDM the proportion of SGA was 2.6% and LGA 4.5%, compared to 3.3% (p = 0.011) and 1.8% (p < 0.001) in the control group, respectively. In ≤ 5th and ≤ 10th pc PAPP-A groups, aORs for SGA were 2.7 (95% CI 1.5-4.7) and 2.2 (95% CI 1.4-3.5) in the GDM group and 3.8 (95% CI 3.0-4.9) and 2.8 (95% CI 2.3-3.5) in the reference group, respectively. When considering LGA, there was no difference in aORs in any high PAPP-A groups. In the low ≤ 5 percentile fß-hCG MoM group, aORs for SGA was 2.3 (95% CI 1.8-3.1) in the control group. In fß-hCG groups with GDM there was no association with SGA and the only significant difference was ≥ 90 percentile group, aOR 1.6 (95% CI 1.1-2.5) for LGA. CONCLUSION: Association with low PAPP-A and SGA seems to be present despite GDM status. High PAPP-A levels are not associated with increased LGA risk in women with or without GDM. Low fß-hCG levels are associated with SGA only in non-GDM pregnancies.

One-Carbon Metabolites Supplementation and Nutrient Restriction Alter the Fetal Liver Metabolomic Profile during Early Gestation in Beef Heifers.

Maternal nutrition is pivotal for proper fetal development, with one-carbon metabolites (OCM) playing a key role in fetal epigenetic programming through DNA and histone methylation. The study aimed to investigate the effects of nutrient restriction and OCM supplementation on fetal liver metabolomics in pregnant beef-heifers, focusing on metabolites and pathways associated with amino-acid, vitamin and cofactor, carbohydrate, and energy metabolism at day 63 of gestation. Thirty-one crossbred Angus heifers were artificially inseminated and allocated to four nutritional treatments in a 2 × 2 factorial arrangement of treatments, with the two factors being dietary intake/rate of gain (control-diet [CON]; 0.60 kg/day ADG, vs. restricted-diet [RES]; -0.23 kg/day ADG) and OCM supplementation (supplemented [+OCM] vs. not supplemented [-OCM]). The resulting treatment groups-CON-OCM, CON+OCM, RES-OCM, and RES+OCM were maintained for 63 days post-breeding. Following this period, fetal liver tissues were collected and subjected to metabolomic analysis using UPLC-tandem mass-spectrometry. We identified 288 metabolites, with the majority (n = 54) being significantly influenced by the main effect of gain (P ≤ 0.05). Moreover, RES showed decreased abundances of most metabolites in pathways such as lysine metabolism; leucine, isoleucine and valine metabolism; and tryptophan metabolism, compared to CON. Supplementation with OCM vs. no OCM supplementation, resulted in greater abundance of metabolites (P ≤ 0.05) affecting pathways associated with methionine, cysteine, S-adenosylmethionine and taurine metabolism; guanidino and acetamido metabolism; and nicotinate and nicotinamide metabolism. Notably, OCM supplementation with a moderate rate of gain increased the concentrations of ophthalmate, N-acetylglucosamine, and ascorbic-acid 3-sulfate, which are important for proper fetal development (P ≤ 0.05). Nutrient restriction reduced the majority of liver metabolites, while OCM supplementation increased a smaller number of metabolites. Thus, OCM supplementation may be protective of metabolite concentrations in key developmental pathways, which could potentially enhance fetal development under nutrient-restricted conditions.

Disease burden comparison and associated risk factors of early- and late-onset neonatal sepsis in China and the USA, 1990-2019.

BACKGROUND: The morbidity and mortality rates of neonatal sepsis are high, with significant differences in risk factors and disease burden observed between developing and developed countries. OBJECTIVE: To provide evidence to support recommendations on improving public health policies using a comparative systematic analysis of the disease burden. METHODS: Using data from the Global Burden of Disease Study 2019, the prevalence and incidence of early- and late-onset neonatal sepsis and the disability-adjusted life years (DALYs) due to both countries in both China and the United States of America (USA) were assessed. Furthermore, the DALYs and summary exposure values for the primary risk factors (short gestation and low birthweight) were analysed. Joinpoint regression models were used to analyse temporal trends in epidemiological indicators of neonatal sepsis. RESULTS: Between 1990 and 2019, the incidence and prevalence of neonatal sepsis demonstrated a significant upwards trend in China, whereas both were largely stable in the USA. A decreasing trend in the DALYs due to neonatal sepsis caused by short gestation and low birthweight in both sexes was observed in both countries, whereas a fluctuating increasing trend in years lived with disability was observed in China. CONCLUSIONS: The aim of the Chinese public health policy should be to control risk factors, learning from the advanced health policy planning and perinatal management experiences of developed countries.

Main findings Disability-adjusted life years (DALYs) attributed to short gestation and low birth-weight for neonatal sepsis have been decreasing in both China and the USA; years lived with disability (YLDs) and summary exposure values (SEVs) have been increasing in China.Added knowledge This study provides new knowledge about the disease burden of neonatal sepsis attributable to short gestation and low birthweight and suggests possible interventions.Global health impact for policy and action Public health policies in developing countries need to focus on moderating risk factors, learning from the advanced health policy planning and perinatal management experiences of developed countries, and improving neonatal follow-up and rehabilitation interventions.

Invasive ventilation at the boundary of viability: A respiratory pathophysiology study of infants born between 22 and 24 weeks of gestation.

BACKGROUND: Invasive ventilation of infants born before 24 weeks of gestation is critical for survival and long-term respiratory outcomes, but currently there is a lack of evidence to guide respiratory management. We aimed to compare respiratory mechanics and gas exchange in ventilated extremely preterm infants born before and after 24 weeks of gestation. METHODS: Secondary analysis of two prospective observational cohort studies, comparing respiratory mechanics and indices of gas exchange in ventilated infants born at 22-24 weeks of gestation (N=14) compared to infants born at 25-27 weeks (N=37). The ventilation/perfusion ratio (VA/Q), intrapulmonary shunt, alveolar dead space (VDalv) and adjusted alveolar surface area (SA) were measured in infants born at the Neonatal Unit of King's College Hospital NHS Foundation Trust, London, UK. RESULTS: Compared to infants of 25-27 weeks, infants of 22-24 weeks had higher median (IQR) intrapulmonary shunt [18 (4 - 29) % vs 8 (2 - 12) %, p=0.044] and higher VDalv [0.9 (0.6 - 1.4) vs 0.6 (0.5 - 0.7) ml/kg, p=0.036], but did not differ in VA/Q. Compared to infants of 25-27 weeks, the infants of 22-24 weeks had a lower adjusted SA [509 (322- 687) vs 706 (564 - 800) cm2, p=0.044]. The infants in the two groups did not differ in any of the indices of respiratory mechanics. CONCLUSION: Ventilated infants born before 24 completed weeks of gestation exhibit abnormal gas exchange, with higher alveolar dead space and intrapulmonary shunt and a decreased alveolar surface area compared to extreme preterms born after 24 weeks of gestation.

Peripartum Subtotal Hysterectomy in Multifetal Gestation.

Peripartum hysterectomy (PH) is usually undertaken in cases of life-threatening obstetric haemorrhage to prevent the death of the mother. Obstetric haemorrhage, a leading indication for PH, is a major cause of maternal deaths globally, particularly in regions with limited access to advanced medical care. The cause of the per vaginal bleeding was due to the patient in labour with a cervical stitch, and immediate action was taken in the form of a lower segment caesarean section. After the patient's abdominal drain is noticed with fresh blood collection, an emergency obstetric hysterectomy is done.

Comparison of Factors Influencing Gestational Outcomes in Healthy Versus Hypothyroid Women from Karachi, Pakistan.

BACKGROUND: Gestational outcomes are known to be negatively correlated with hypothyroidism. This study was designed to compare the maternal factors affecting gestational outcomes in women with and without hypothyroidism. METHODS: This retrospective analysis was carried out in a tertiary hospital in Karachi, Pakistan, between 2008 and 2016. A standardized form was used to collect information on the age of the mother, gestational duration at the prenatal appointment, gestational diabetes mellitus (GDM), hypertension, and past records of miscarriages in hypothyroid and healthy pregnant women. Gestational outcomes were recorded as live birth or pregnancy loss. Statistical analysis was performed to examine overt versus sub-clinical hypothyroidism and among those diagnosed before versus during gestation. RESULTS: A collective of 708 women were enlisted in the hypothyroid pregnant group and 759 were recruited in healthy controls. Pregnancy loss was 9.9% (n=70) in hypothyroid women, whereas it was 14.3% (n=108) in the control group. The age of the mother, gestational duration at the prenatal appointment, and past records of miscarriages were discovered to be related to a higher chance of pregnancy loss in a multivariable analysis, but GDM (OR 0.04, CI 0.06-0.32, P=0.002) and hypothyroidism (OR 0.62, CI 0.43-0.89, P=0.01) exhibited a protective effect. CONCLUSION: This study found the age of the mother, gestational duration at a prenatal appointment, and past records of miscarriages to be associated with negative outcomes in hypothyroidism. These factors remained significant in overt as well as subclinical hypothyroid women.

The toxic effects and mechanisms of maternal exposure to Bisphenol F during gestation and lactation on lungs in female offspring mice.

Epidemiologic studies suggest that prenatal exposure to bisphenols may increase the risk of respiratory disease in children. Bisphenol F (BPF), a member of the bisphenol family, is widely used in industrial production. However, the potential pulmonary toxic effects and mechanisms of BPF exposure on offspring remain unclear. In this study, maternal mice were exposed to 0, 40, 400, and 4000 µg/kg BPF during gestation and lactation. The results showed that an inflammatory response was observed in lungs of BPF-exposed female offspring mice, characterized by peribronchial inflammatory cell infiltration and an increase in the number of inflammatory cells in BALF. Subsequent transcriptome analysis identified a total of 685 differentially expressed genes (DEGs) were in lungs of female offspring mice exposed to high-dose BPF, with 526 upregulated genes and 159 downregulated genes. Among upregulated DEGs of top 10, most of the upregulated genes were associated with inflammatory responses. In addition, enrichment analysis showed that immunosuppression and oxidative damage were significantly enriched in lungs of female offspring mice, suggesting that BPF could induce immunosuppression and oxidative stress in lungs of female offspring mice. Overall, our findings provide mechanistic insights into the potential pulmonary toxicity associated with BPF exposure during gestation and lactation.

Adverse pregnancy outcomes and effect of treatment in Wilson disease during pregnancy: Systematic review and meta-analysis.

BACKGROUND AND AIMS: Wilson disease (WD) is a rare disorder of copper metabolism, leading to liver and neurological disease. Existing literature on WD in pregnancy is scarce, limiting preconception and obstetrical counselling. In this systematic review with meta-analysis, we determine the prevalence of various adverse pregnancy and neonatal outcomes in WD, as well as evaluate the impact of WD treatment on these outcomes. METHODS: Scopus, MEDLINE and EMBASE were searched until 12 May 2023, for studies of pregnant individuals with WD and at least one pregnancy or neonatal outcome of interest. Meta-analysis of single proportions was conducted to pool prevalence data for each outcome. Outcome rates were compared between treated and untreated groups in a meta-analysis of dichotomous events. RESULTS: Sixteen studies, published from 1975 to 2022, were included in the systematic review. Thirty-seven percent of pregnancies reported at least one adverse pregnancy outcome. Spontaneous abortions (20%), liver diseases of pregnancy (4.5%) and preterm births (2%) were the most frequent adverse pregnancy outcomes in patients with WD. The prevalence of spontaneous abortions was significantly lower in pregnant individuals with WD who received treatment during pregnancy (OR: .47, 95% CI: 35%-63%). The prevalence of any adverse pregnancy outcome was also significantly lower with treatment (OR: .53, 95% CI: .37-.76), which appears to be mostly driven by the reduction of spontaneous abortions. CONCLUSIONS: There is low to moderate quality evidence to suggest that preconception and obstetrical counselling for patients with WD should include a discussion on the potentially high frequency of adverse pregnancy outcomes in this population, as well as the importance of continuing WD treatment during pregnancy to ensure satisfactory pregnancy course and potentially minimize the risk of spontaneous abortions.