Optical coherence tomography angiography evaluation of retinal and choroidal microvascular changes in pregnant women with a history of unexplained recurrent spontaneous abortions.

PURPOSE: To study retinal and choroidal microcirculation by optical coherence tomography angiography (OCTA) in pregnant women with unexplained recurrent spontaneous abortion (RSA) and to compare them with healthy pregnant and nonpregnant subjects. METHODS: Pregnant women with an unexplained history of RSA (group 1), healthy pregnant (group 2), and healthy non-pregnant women (group 3) were included in the study. After a thorough ophthalmologic examination:best-corrected visual acuity, intraocular pressure,slit-lamp biomicroscopy, fundus examination,autorefractometer, biometry, and axial length measurement; OCT and OCTA measurements were performed with Swept Source OCT-Angiography (Topcon Co, Japan). RESULTS: The nonpregnant group had higher values for central foveal superficial capillary plexus (SCP) and deep capillary plexus (DCP) vessel density (VD) and lower values for superior, inferior, and mean VD compared with pregnant groups (p < 0.001). Choriocapillaris values (CC) VD were higher in groups 1 and 2 than in group 3 (p < 0.001). The group with unexplained RSA had a relatively smaller FAZ (foveal avascular zone) area than the group of healthy pregnant women (p:0.047). There were no statistically significant differences between groups in the retina, retinal nerve fiber layer, ganglion cell layer, and choroidal thickness (p > 0.05). CONCLUSION: Although our study did not identify any etiology in pregnant women with RSA, we observed detectable differences in FAZ area and vessel density values using OCTA, when comparing them with healthy pregnant women and healthy nonpregnant controls. We believe that OCTA, as used in many pathologies such as diabetic and hypertensive retinopathy and retinal vascular occlusion, can also be extended to unexplained RSA both to detect etiology and to monitor treatment in studies with a larger number of patients.

Prenatal diagnosis of pulmonary arteriovenous malformations with a postnatal diagnosis of Osler-Weber-Rendu syndrome.

Hereditary Hemorrhagic Telangiectasia (HHT), commonly known as Osler-Weber-Rendu disease, is an autosomal dominant multisystemic vascular disease associated with approximately 70% of cases of pulmonary arteriovenous malformations (PAVMs). Prenatal cases of PAVMs typically present with pulmonary vein dilatation on ultrasonography. This study presents a prenatal diagnosis of PAVMs with enlarged right pulmonary vein, cardiomegaly, cystic-appearing areas in the right lung and subsequent confirmation of Osler-Weber-Rendu syndrome using autopsy and whole exom sequencing.

Optical coherence tomography angiography assessment of retinochoroidal microcirculation differences in preeclampsia.

BACKGROUND: To investigate microvascular changes in pregnant women with preeclampsia using optical coherence tomography angiography (OCTA) and compare the results with healthy pregnant and non-pregnant subjects. METHODS: Superficial capillary plexus (SCP), deep capillary plexus (DCP) choriocapillaris (CC) vessel density (VD) and foveal avascular zone area (FAZ), retina, retinal nerve fiber layer (RNFL), the ganglion cell layer (GCL) and the choroidal thickness were examined and compared in preeclamptic pregnant (group 1), healthy pregnant women (group 2) and non-pregnant, age-matched female controls (group 3). The correlations of the parameters with each other and with blood pressure were evaluated. RESULTS: No significant difference was found between the groups when retinal, RNFL and GCL thickness values (p> 0.05). The choroidal thickness values were significantly lower in group 1 than in group 2 (p = 0.029). The central foveal VD of the SCP and DCP was significantly lower in group 1 compared to groups 2 and 3 (p = 0.03, p< 0.01 respectively). The mean VD of the SCP was significantly higher in groups 1 and 2 than in group 3 (p = 0.01). The FAZ area was statistically significantly lower in group 3 than in group 2 (p = 0.032). The CC VD was lower in group 3 compared to the other groups in all measurements (p < 0.01).The FAZ area was positively correlated with systolic blood pressure in group 1. CONCLUSION: The use of OCTA, a non-invasive imaging technique, to assess the retinal microcirculation appears to have the potential to in the early diagnosis or follow up in preeclampsia before signs of hypertensive retinopathy.

Evaluation of long-COVID symptoms in women infected with SARS-CoV-2 during pregnancy.

OBJECTIVE: To evaluate the symptoms of Long COVID (LC), frequency of symptoms, and possible risk factors in women diagnosed with coronavirus disease 2019 (COVID-19) during pregnancy. METHODS: We conducted a single-center, cross-sectional, retrospective study in 99 pregnant women who were polymerase chain reaction-positive (PCR+) for COVID-19 between March 1, 2020 and April 30, 2022. The control group consisted of 99 women who gave birth between these dates and did not have COVID-19. We evaluated the clinical manifestations, symptom prevalence, and symptom characteristics of acute COVID-19 and the LC in the PCR+ group as well as questioned the control group for LC symptoms. RESULTS: Of the women in the PCR+ group, 74 (74.7%) had at least one LC symptom, and the most common symptoms were fatigue (54; 72.9%), myalgia/arthralgia (49; 66.2%), and anosmia/ageusia (31; 41.9%). The rate of LC symptoms in the control group was 14 (14.1%). The prevalence of LC symptoms was higher in severely/critically symptomatic patients (23; 100%) in the acute period of disease than in asymptomatic/mildly symptomatic (51; 67.1%) (P = 0.005). Hospitalization during acute infection (adjusted odds ratio [aOR] = 13.30), having one or more symptoms (aOR = 4.75), and having symptoms such as cough (aOR = 6.27) and myalgia/arthralgia (aOR = 12.93) increased the likelihood of LC. CONCLUSION: Many women experienced LC after suffering acute COVID-19 in pregnancy, but LC prevalence was similar to the general population. LC correlates with severity, type, and number of symptoms of acute COVID-19.

The Association between Placental Abruption and Platelet Indices.

Objective: Placental abruption (PA) is an obstetric emergency. This study investigated the use of platelet indices in PA in its early stages to determine if it could aid in diagnosis. Materials and Methods: Sixty-two pregnant women with PA and 130 pregnant women who delivered due to idiopathic preterm delivery were included in this case-control study. Blood samples including platelet indices, biochemical, and coagulation parameters were obtained before cesarean section. Maternal and neonatal outcomes were recorded. Results: There was no significant difference between the groups as to hemoglobin, hematocrit, and white blood count. Platelet, mean platelet volume (MPV), and platelet to lymphocyte ratio (PLR) were significantly lower, platelet distribution width (PDW) was significantly higher in the PA patients. Conclusion: In the current study, MPV and PLR were lower and PDW was higher in PA patients. These parameters may be useful in assessment of PA.

Analysis of Myomectomy during Cesarean Section: A Tertiary Center Experience.

PURPOSE: This study analyzed the safety of myomectomy during the cesarean section (CS). METHODS: Pregnant women who underwent myomectomy during CS in a tertiary center between January 2015 and November 2019 were included in the study in Group A, and pregnant women who did not have myoma and who underwent only CS were included in the study in Group B. The following information was obtained from patient files in hospital archives and was then recorded and compared: age, gravidity, parity, gestational week, characteristics of the myomas (i.e., location, size, number, and type), duration of surgery, perioperative complications, need for blood transfusion, preoperative and postoperative hemoglobin (Hb) values, duration of surgery, and hospital stay duration. RESULTS: A total of 83 patients underwent CS plus myomectomy (Group A), and 80 patients (without myoma) underwent only CS (Group B).There were no statistically significant differences between the groups in terms of preoperative and postoperative Hb values or blood transfusion rates (p > 0.05). Hospitalization and surgery duration were significantly higher in the group that underwent CS myomectomy (p = 0.001 and p = 0.001, respectively). The mean myoma size was 8.3 ± 4.1 cm in Group A. There was a statistically significant and inverse correlation between the size of the myoma and the delivery week (p = 0.035). There was a statistically significant and positive correlation between the myoma size and hospital stay (p = 0.01). CONCLUSION: Myomectomy during CS is safe and can be applied regardless of the location, size, type, and number of myomas. However, to make myomectomy routine during CS, multi-center studies that include more cases are needed.

Serial measurement of soluble endoglin for risk assessment at the diagnosis of fetal growth restriction.

AIM: In this study, we aimed to investigate the soluble endoglin (sEng) levels in pregnant women with fetal growth restriction (FGR) and to examine the possible relation of the sEng levels with the time remaining to delivery and maternal and fetal complications. METHODS: A total of 42 pregnant women diagnosed with FGR were retrospectively reviewed. Using the maternal blood samples it is at the collected 24-37 gestational weeks, the sEng levels were measured. Fetal biometry measurements, umbilical artery, uterine artery, middle cerebral artery Doppler indices were documented. RESULTS: Of all patients, 17 (40%) were diagnosed with early-onset FGR, while 25 (60%) were diagnosed with late-onset FGR. Abnormal Doppler findings were present in 25 (60%) patients. Of 42 newborns, 18 (42%) were hospitalised in the neonatal unit. The mean sEng level calculated by taking the average of the first and second blood samples was 63.24 ± 49.83 ng/mL. There was no statistically significant difference in the mean sEng levels between those who gave birth within four, three, and two weeks after the diagnosis of FGR and those who did not. There was a positive significant correlation between the mean sEng levels and systolic blood pressure (r = 0.319, P = .04). CONCLUSIONS: We did not find a statistically significant relationship between the sEng level and the time remaining to the time of delivery in pregnant women with FGR. We found no statistically significant difference in sEng level between the groups in pregnant women with fetuses with FGR with or without maternal and fetal complications.

Does time change the anxiety and depression scores for pregnant women on Covid-19 pandemic?

OBJECTIVE: Post-traumatic stress disorder, the tip form of stress disorder, is considered as delayed onset if the symptoms occur at least 6 months after the main effect. The aim of our study was to evaluate the severity of anxiety and depression in pregnant women during the coronavirus disease (COVID-19) pandemic, in addition to investigating the demographic and economic aspects affecting maternal anxiety and depression scores, 6 months after the onset of the COVID-19 pandemic. METHODS: Our study was a cross-sectional descriptive study. Pregnant women who had presented to the Akdeniz University, Gynecology and Obstetrics Department, Pregnancy Outpatient Clinic, and Kepez State Hospital, Pregnancy Outpatient Clinic between September 2020 and October 2020 were included in the study. The Spielberger State-Trait Anxiety Inventory (STAI) was used to evaluate the state of anxiety, and the Beck Depression Inventory-II (BDI-II) was used to assess the state of depression. Patients who had encountered any obstetric and/or fetal abnormality that could cause anxiety and depression during pregnancy follow-up and pregnant women previously diagnosed with a psychiatric disease were not included in the study. RESULTS: A total of 322 pregnant women who agreed to participate in the study and fulfilled the study criteria within the afore-mentioned timeframe were included in the study and the relevant forms were filled out. The mean age of the pregnant women was found to be 29 ± 5.64 years, the mean number of gravida was 1.84 ± 0.86, and the mean gestational age was 29.06 ± 9.80 weeks. The mean score of the state anxiety scale was 41.7 ± 5.56 and the mean trait anxiety score was 47.68 ± 5.85. The mean state-trait anxiety score was determined as 42.5 in primigravid women and as 41.1 in multigravid women. The State-trait anxiety score was statistically significantly higher in primigravid women compared to multigravid women (p = 0.027). The mean state-trait anxiety score did not demonstrate a significant difference according to the occupational status, having a chronic disease, educational level, and the income level. The mean trait anxiety score did not differ statistically and significantly according to the occupational status, having a chronic disease, being primigravid, educational status, and the income level. According to BDI-II, 69.3% of pregnant women were evaluated to have minimal depression, 12.4% as mild depression, 12.4% as moderate depression, and 5.9% as severe depression. CONCLUSION: Although more than 6 months have passed since the onset of the COVID-19 pandemic, pregnant women still have increased anxiety and depression scores. In addition, it should be kept in mind that pregnant women are at risk in terms of post-traumatic stress disorder during the antenatal and the postnatal periods, and it should be considered that psychological and social support should be provided.

Plasma Endocan Levels in Early and Late-Onset Preeclampsia.

BACKGROUND: Preeclampsia (PE) may represent an inflammatory process. Endocan (ESM-1) is a marker of endothelial inflammation. We compared plasma endocan levels between PE and control groups and between early and late-onset PE. Study design: Maternal plasma endocan levels were measured in 41 preeclampsia (PE) pregnancies - 25 early-onset (<34 weeks); 16 late-onset (≥34 weeks), and 37 non-complicated pregnancies (22 matched with early-onset PE, 15 with late onset). Results: There was no significant differences between plasma endocan levels of patients with PE and control group (468.8(IQR: 169.7)ng/L vs 462.4(IQR: 321.1)ng/L, p > 0.05), between early and late-onset PE (458.8(221.8)ng/L vs 469.8(122.6)ng/L, p > 0.05), between early-onset PE and corresponding control group (458.8(221.8)ng/L vs 506.2(1481.9)ng/L, p > 0.05), or late-onset PE and corresponding control group (469.8(122.6)ng/L vs 451.0(85.1)ng/L, p > 0.05). Conclusion: There was no significant difference between endocan levels of early or late-onset PE compared with their corresponding control groups, nor between early and late-onset preeclampsia groups.

Turkish reference ranges for the left fetal modified myocardial performance index.

BACKGROUND: This study aimed to assess fetal cardiac left ventricular function in healthy pregnant women by calculating the modified myocardial performance index (Mod-MPI) and to construct reference ranges for the Turkish population. METHODS: One-hundred-two randomly selected healthy singleton pregnant women ranging between 25 and 39 gestational weeks were included in the study. Left fetal Mod-MPI was measured for each pregnant woman. Women with chronic systemic diseases or fetuses with chromosomal or structural abnormalities were excluded from the study. Mitral valve (MV) and aortic valve (AoV) clicks were used as landmarks to define the following time periods that were used to calculate the Mod-MPI: isovolumetric contraction time (ICT), isovolumetric relaxation time (IRT), and ejection time (ET). RESULTS: The mean Mod-MPI was 0.42±0.10. The mean IRT, ICT, and ET were 43.5±10.2, 27.27±8.1, and 170.5±16.9, respectively. A significant correlation was found between Mod-MPI and gestational age, umbilical artery systolic/diastolic (UA S/D) ratio and the middle cerebral artery pulsatility index (MCA PI) values (r=0.199, p=0.047, r=-0.328, p=0.001, and r=-0.0349, p=0.001, respectively) Conclusions. The current study`s results will be a reference for future studies, especially studies investigating pathological conditions that impact fetal cardiac function.

Low serum vitamin D level is associated with intrahepatic cholestasis of pregnancy.

AIM: Intrahepatic cholestasis of pregnancy (ICP) is a unique hepatic disorder of pregnancy and is related to adverse maternal and perinatal outcomes. The pathogenesis of the disease is not clear and appears to be multifactorial. There is increasing evidence that vitamin D (Vit D) plays a role in hepatobiliary homeostasis and in various liver diseases. We aimed to investigate the association between serum Vit D level and ICP. METHODS: A total of 40 pregnant women with ICP and 40 healthy pregnant women were included in this controlled cross-sectional study. Their demographic characteristics, including age, body mass index (BMI), gestational week, gravidity and parity, and laboratory parameters, including 25(OH) Vit D3 levels, liver function tests, fasting and postprandial bile acid concentrations, were recorded. Gestational age at delivery, birth weight (BW), neonatal intensive care unit (NICU) admission, meconium staining of amniotic fluid and appearance pulse grimace activity respiration (APGAR) score at 5 min were obtained from medical records for assessment of perinatal outcomes. RESULTS: There was no significant difference between groups in terms of demographic characteristics. The mean serum 25(OH) Vit D3 level was significantly lower in pregnant women with ICP compared to control pregnant women (8.6 ± 4.9, 11.3 ± 6.1; P =0.033), and it was significantly lower in severe disease than mild disease (6.9 ± 2.1, 10.3 ± 6.2, respectively; P =0.029). We also found that lower serum 25(OH) Vit D3 levels were significantly and inversely correlated with fasting and postprandial bile acid levels. However, in subgroup analyses in ICP pregnant women, there was no difference in mean 25(OH) Vit D3 levels for women with or without perinatal complications. CONCLUSION: Our study suggests that low levels of 25(OH) Vit D3 were associated with ICP disease and its severity. However, further larger studies are needed to evaluate the effect of Vit D in the pathogenesis and outcome of the disease.

An alternative method for measuring oxidative stress in intrahepatic cholestasis of pregnancy: thiol/disulphide homeostasis.

PURPOSE: The aim of our study was to evaluate the oxidative stress (OS) in pregnant women with intrahepatic cholestasis of pregnancy (ICP) by evaluating thiol/disulphide homeostasis using an alternative technique. METHODS: A total of 57 pregnant women with ICP were compared with 50 gestational age and body mass index matched controls. A recently defined method was used for the measurement of plasma native-total thiol and disulphide levels. The independent two-sample t test, Mann-Whitney-U test, Chi-square test, binary logistic regression with backward elimination and receiver operating characteristic (ROC) curve was performed for statistical analyses. RESULTS: Pregnant women with ICP (n = 57) versus controls (n = 50) had significantly lower serum levels of native thiol (233.8 ± 47.4 µmol/L vs. 308.5 ± 51.7 µmol/L, p < .001), total thiol (258.4 ± 46.5 µmol/L vs. 328.0 ± 52.0 µmol/L, p < .001) and higher levels of disulphide (12.3 ± 3.6 µmol/L vs. 9.7 ± 3.4 µmol/L, p < .001). Binary logistic regression showed that the most important variables related to ICP were native thiol and total thiol. According to the ROC curve, the optimal cut-off level for native thiol was 280.0 µmol/L (sensitivity: 86%, specificity: 84.2%, area under the curve (AUC):0.896, 95% CI: 0.831-0.962, p < .001), and the optimal cut-off level for total thiol was 300.0 µmol/L (sensitivity: 86%, specificity: 80.7%, AUC: 0.883, 95% CI: 0.815-0.951, p < .001). CONCLUSIONS: To our knowledge, this is the first study in the literature exploring thiol/disulphide balance in ICP. We found that thiol/disulphide balance indicate OS in pregnant woman with ICP.

We can Diagnose it if we Consider it. Diagnostic Pitfall for Placenta: Placental Mesenchymal Dysplasia.

Placental mesenchymal dysplasia is an increasingly recognizable abnormality. Early cases have been confused with partial hydatidiform mole. Placental mesenchymal dysplasia is probably under-diagnosed because of being an unfamiliar clinical entity and also mistaken for gestational trophoblastic disease due to the similar sonographic findings of two entities. In this report, we describe the clinical, gross, and histopathological findings of placental mesenchymal dysplasia in two cases. The 33-week-preterm baby of a 26-year-old woman with cardiovascular disease and 342 gram placenta and the 19-week fetus with trisomy 21 of a 40 year-old woman were terminated. Macroscopically thick-walled vessels and microscopically hydropic villous with peripherally localized thick-walled vessels without trophoblastic cell proliferation were observed in both cases. These two cases represent a rare placental anomaly that is benign but it is challenging to distinguish placental mesenchymal dysplasia from an incomplete mole. Placental mesenchymal dysplasia should be included in the differential diagnosis of sonographic findings that show a normal appearing fetus and a placenta with cystic lesions. Placental mesenchymal dysplasia is associated with pregnancy-related hypertension. In conclusion, the most important point is "you can diagnose it if you consider it".

Prediction of the length of repeat post C-section hospital stay and comparison of perinatal outcomes in patients with ≥3 versus <3 previous C-section.

OBJECTIVE: To create a model for prediction of repeat post cesarean section (CS) length of hospital stay (LOHS) in patients undergoing repeat CS. Our other aim was to compare the perinatal outcomes in patients with ≥3 versus <3 previous CS procedures. METHODS: Individual characteristics, pre-, intra- and post-operative data of 186 pregnant women who had ≥3 previous CS were compared with 195 pregnant women with <3 previous CS. RESULTS: Regression analyses revealed that models can be used to predict the dependents "postpartum LOHS" and "needed units of erythrocyte suspension", both pre-operatively and intra-operatively. Patients with ≥3 previous CS procedures were older, delivered earlier and had lower Apgar 1 and Apgar 5 values than patients with <3 previous CS. The rate of elective CS operations was lower in patients with ≥3 previous CS. Pregnant women ≥3 previous CS had significantly more severe intraperitoneal adhesion (IPA) and higher rate of bladder injury. CONCLUSIONS: Prediction models can be conducted for LOHS and other perinatal and operative parameters in patients with previous CS. Pregnancy and repeat CS, even in patients with ≥3 previous CS procedures, are both safe conditions with optimal follow-up and management.

Assessment of fetal myocardial performance index in women with pregestational and gestational diabetes mellitus.

AIM: Fetal cardiac left ventricular function in pregnant women with pregestational or gestational diabetes mellitus was investigated by exploring fetal myocardial performance index (MPI) and E wave/A wave peak velocity (E/A) ratio. METHODS: Seventy pregnant women with either pregestational or gestational diabetes mellitus and with no other systemic or pregnancy related disorders were compared with 70 gestational age matched healthy controls by means of fetal left ventricular MPI and E/A ratio. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods: ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT), which were employed in the calculation of MPI (MPI = [ICT + IRT]/ET). Statistical analyses were conducted using receiver operating characteristic analysis and independent two-sample t, Mann-Whitney U and chi-square tests. RESULTS: Fetal left ventricular MPI values were significantly higher in the diabetic group compared with controls (0.56 ± 0.09 vs 0.36 ± 0.04, P < 0.001), whereas E/A ratio was lower (0.66 ± 0.11 vs 0.69 ± 0.09, P = 0.049). The adverse perinatal outcome rate was also higher in the diabetic group. Receiver operating characteristic analysis revealed > 0.39 as the optimal cut-off level for MPI in perinatal adverse outcome prediction (sensitivity: 90.9%, specificity: 47.7%, area under the curve: 0.690, 95% confidence interval: 0.598-0.782, P < 0.001). CONCLUSIONS: We conclude that fetuses of diabetic mothers have significant left ventricular systolic and diastolic dysfunction. MPI may be used in the prediction of adverse perinatal outcome in diabetic pregnancies.

Levels of serum vitamin D and calcium in pregnancies complicated with fetal congenital diaphragmatic hernia and normal pregnancies.

OBJECTIVE: Vitamin D (VD) deficiency is a common public health problem worldwide in all age groups. Receptors and enzymes related to VD metabolism have been shown in many cells and tissues of the body. VD plays a crucial role in cellular growth and differentiation during embryogenesis. It has been suggested that VD deficiency may be associated with various diseases, and that lower maternal serum levels may be associated with adverse perinatal outcomes. In this study, we aimed to compare serum VD levels of pregnant women whose pregnancies complicated by congenital diaphragmatic hernia (CDH) with healthy pregnant women. We also evaluated perinatal outcomes of these pregnancies. METHODS: Total of 77 patients was included in this prospective and cross-sectional case-controlled study. 24 pregnant women having a fetus with CDH diagnosed prenatally formed the study group, and 53 healthy pregnants were eligible for the control group. Demographics and clinical characteristics of the cases with some laboratory parameters were recorded. Perinatal outcomes were also investigated. RESULTS: No significant differences were observed between two groups in terms of demographics and clinical features. Mean maternal serum VD levels were significantly lower in the study group than in the controls (p: 0.019). Ionized calcium and corrected calcium levels were also found to be lower in pregnant women with CDH (p < 0.001). Moreover, the calcium-rich dietary habits were also more common in the control group. Four (16.7%) patients chose termination and one (4.2%) experienced a stillbirth. Fourteen (58.3%) infants died in the early neonatal period; although some had undergone surgical interventions, only 5 (20.8%) were still alive after surgery. CONCLUSIONS: Maternal serum VD and calcium levels were significantly lower in pregnancies complicated by CDH than healthy pregnant women. Hipovitaminosis D may play a vital role in the pathogenesis of CDH.

Can fetal left ventricular modified myocardial performance index predict adverse perinatal outcomes in intrahepatic cholestasis of pregnancy?

OBJECTIVE: To investigate fetal left ventricular function using the left ventricular modified myocardial performance index (mod-MPI) and E wave/A wave peak velocity (E/A) ratio, and to explore the success of mod-MPI in the prediction of adverse perinatal outcomes in intrahepatic cholestasis of pregnancy (ICP). METHODS: Forty-one ICP cases were compared with 41 gestational age-matched healthy controls. Opening and closing clicks of the mitral and aortic valves were used to define the three time periods [ejection time (ET), isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT)], which were employed in the calculation of mod-MPI [mod-MPI = (ICT + IRT)/ET]. The E/A ratio was calculated as well. RESULTS: Fetal left ventricular mod-MPI values were significantly higher in the ICP group compared to controls (0.56 ± 0.09 versus 0.37 ± 0.04, p < 0.001), whereas the E/A ratio was lower (0.62 ± 0.11 versus 0.69 ± 0.10, p = 0.011). The optimal cutoff level for mod-MPI in prediction of adverse perinatal outcomes was >0.48 [sensitivity: 81.8%, specificity: 67.6%, area under the curve (AUC): 0.750, 95% CI: 0.613-0.887, p = 0.008]. CONCLUSIONS: Fetuses of ICP cases have significant left ventricular dysfunction. Mod-MPI can be used in the prediction of adverse perinatal outcomes in ICP.

Clinical significance of fasting plasma glucose in patients with normal 50-g glucose challenge test in pregnancy: Is 100 bigger than 92?

The present study aimed to analyse the perinatal outcomes in patients with normal 50-g Glucose Challenge Test but who are considered retrospectively to have gestational diabetes mellitus based on elevated fasting plasma glucose (FPG) levels according to recent criteria. The study was conducted between January 2010 and December 2014 to identify patients with FPG values >92 mg/dl and GCT values <130 mg/dl. The patients were divided into two groups: those with FPG values between 92 and 99 mg/dl (Group 1) and those with FPG values >99 mg/dl (Group 2). The rate of obstetric complications was similar in the three groups, except for a higher rate of preeclampsia in Group 2 than in the control group (8.3% versus 3.1%; p = 0.031). The rate of large for gestational age neonates in Group 2 was 15%, which was higher than the rate in Group 1 (5.5%) and control group (7.4%) (p = 0.046 and p = 0.047, respectively). The rate of neonatal intensive care unit admissions in Group 2 was 11.7%, which was higher than the rate in Group 1 (3.1%) and in the control group (2.4%). Our findings indicate that there is a clinically recognisable difference in perinatal outcomes when a threshold of 100 mg/dl is used for FPG instead of 92 mg/dl.