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1.
Development ; 151(8)2024 Apr 15.
Article in English | MEDLINE | ID: mdl-38657972

ABSTRACT

Advances in fluorescence microscopy and tissue-clearing have revolutionised 3D imaging of fluorescently labelled tissues, organs and embryos. However, the complexity and high cost of existing software and computing solutions limit their widespread adoption, especially by researchers with limited resources. Here, we present Acto3D, an open-source software, designed to streamline the generation and analysis of high-resolution 3D images of targets labelled with multiple fluorescent probes. Acto3D provides an intuitive interface for easy 3D data import and visualisation. Although Acto3D offers straightforward 3D viewing, it performs all computations explicitly, giving users detailed control over the displayed images. Leveraging an integrated graphics processing unit, Acto3D deploys all pixel data to system memory, reducing visualisation latency. This approach facilitates accurate image reconstruction and efficient data processing in 3D, eliminating the need for expensive high-performance computers and dedicated graphics processing units. We have also introduced a method for efficiently extracting lumen structures in 3D. We have validated Acto3D by imaging mouse embryonic structures and by performing 3D reconstruction of pharyngeal arch arteries while preserving fluorescence information. Acto3D is a cost-effective and efficient platform for biological research.


Subject(s)
Imaging, Three-Dimensional , Software , Imaging, Three-Dimensional/methods , Animals , Mice , Microscopy, Fluorescence/methods , Optical Imaging/methods , Image Processing, Computer-Assisted/methods , Embryo, Mammalian/diagnostic imaging
2.
J Hum Genet ; 67(5): 261-265, 2022 May.
Article in English | MEDLINE | ID: mdl-34974528

ABSTRACT

The incidence of chromosomal abnormalities in twin pregnancies is not well-studied. In this retrospective study, we investigated the frequency of chromosomal abnormalities in twin pregnancies and compared the incidence of chromosomal abnormalities in dichorionic diamniotic (DD) and monochorionic diamniotic (MD) twins. We used data from 57 clinical facilities across Japan. Twin pregnancies of more than 12 weeks of gestation managed between January 2016 and December 2018 were included in the study. A total of 2899 and 1908 cases of DD and MD twins, respectively, were reported, and the incidence of chromosomal abnormalities in one or both fetuses was 0.9% (25/2899) and 0.2% (4/1908) in each group (p = 0.004). In this study, the most common chromosomal abnormality was trisomy 21 (51.7% [15/29]), followed by trisomy 18 (13.8% [4/29]) and trisomy 13 (6.9% [2/29]). The incidence of trisomy 21 in MD twins was lower than that in DD twins (0.05% vs. 0.5%, p = 0.007). Trisomy 21 was less common in MD twins, even when compared with the expected incidence in singletons (0.05% vs. 0.3%, RR 0.15 [95% CI 0.04-0.68]). The risk of chromosomal abnormality decreases in twin pregnancies, especially in MD twins.


Subject(s)
Chromosome Disorders , Down Syndrome , Aneuploidy , Chromosome Aberrations , Chromosome Disorders/epidemiology , Chromosome Disorders/genetics , Down Syndrome/epidemiology , Down Syndrome/genetics , Female , Humans , Pregnancy , Pregnancy, Twin , Prevalence , Retrospective Studies , Trisomy/genetics
3.
Front Microbiol ; 12: 773062, 2021.
Article in English | MEDLINE | ID: mdl-34745080

ABSTRACT

Alternaria alternata virus 1 (AaV1) has been identified in the saprophytic fungus Alternaria alternata strain EGS 35-193. AaV1 has four genomic double-stranded (ds)RNA segments (dsRNA1-4) packaged in isometric particles. The 3' end of each coding strand is polyadenylated (36-50nt), but the presence of a cap structure at each 5' end has not previously been investigated. Here, we have characterized the AaV1 genome and found that it has unique features among the mycoviruses. We confirmed the existence of cap structures on the 5' ends of the AaV1 genomic dsRNAs using RNA dot blots with anti-cap antibodies and the oligo-capping method. Polyclonal antibodies against purified AaV1 particles specifically bound to an 82kDa protein, suggesting that this protein is the major capsid component. Subsequent Edman degradation indicated that the AaV1 dsRNA3 segment encodes the major coat protein. Two kinds of defective AaV1 dsRNA2, which is 2,794bp (844 aa) in length when intact, appeared in EGS 35-193 during subculturing, as confirmed by RT-PCR and northern hybridization. Sequence analysis revealed that one of the two defective dsRNA2s contained a 231bp deletion, while the other carried both the 231bp deletion and an additional 465bp deletion in the open reading frame. Both deletions occurred in-frame, resulting in predicted proteins of 767 aa and 612 aa. The fungal isolates carrying virions with the defective dsRNA2s showed impaired growth and abnormal pigmentation. To our best knowledge, AaV1 is the first dsRNA virus to be identified with both 5' cap and 3'poly(A) structures on its genomic segments, as well as the specific deletions of dsRNA2.

4.
J Biochem ; 170(4): 489-500, 2021 Dec 04.
Article in English | MEDLINE | ID: mdl-34037771

ABSTRACT

The lipopolysaccharide (LPS)-triggered coagulation cascade in horseshoe crabs is composed of three zymogens belonging to the trypsinogen family: prochelicerase C, prochelicerase B (proB) and the proclotting enzyme (proCE). Trypsinogen-family members contain three conserved disulphides located around the active site. While it is known that proB evolutionarily lost one of the disulphides, the His-loop disulphide, the roles of the missing His-loop disulphide in proB remain unknown. Here, we prepared a proB mutant, named proB-murasame, equipped with a regenerated His-loop disulphide. The activation rate by upstream α-chelicerase C for proB-murasame was indistinguishable from that for wild-type (WT) proB. The resulting protease chelicerase B-murasame exhibited an 8-fold higher kcat value for downstream proCE than WT chelicerase B, whereas the Km value of chelicerase B-murasame was equivalent to that of WT chelicerase B. WT serpins-1, -2 and -3, identified as scavengers for the cascade, had no reactivity against WT chelicerase B, whereas chelicerase B-murasame was inhibited by WT serpin-2, suggesting that WT chelicerae B may trigger as-yet-unsolved phenomena after performing its duty in the cascade. The reconstituted LPS-triggered cascade containing proB-murasame exhibited ∼5-fold higher CE production than that containing WT proB. ProB-murasame might be used as a high value-adding reagent for LPS detection.


Subject(s)
Arthropod Proteins/metabolism , Blood Coagulation , Disulfides/metabolism , Enzyme Precursors/metabolism , Horseshoe Crabs/enzymology , Serine Proteases/metabolism , Animals , Catalytic Domain , Endopeptidases/metabolism , Enzyme Activation , Histones/metabolism , Lipopolysaccharides/metabolism , Serpins/metabolism , Trypsinogen/metabolism
5.
IJU Case Rep ; 4(1): 10-13, 2021 Jan.
Article in English | MEDLINE | ID: mdl-33426487

ABSTRACT

INTRODUCTION: Female urinary retention is rare. CASE PRESENTATION: Case 1, a 35-year-old nulliparous woman, and case 2, a 47-year-old nulliparous woman, had transient urinary retention. A urodynamics revealed increased bladder sensation in case 1 and detrusor underactivity with a large post-void residual in cases 1 and 2. Both women had a uterine leiomyoma of >10 cm in diameter. Soon after extraction of the tumor, retention episodes disappeared completely in case 1. CONCLUSION: Although rare, uterine leiomyoma should be listed as a cause of female detrusor underactivity.

6.
Case Rep Womens Health ; 27: e00236, 2020 Jul.
Article in English | MEDLINE | ID: mdl-32642449

ABSTRACT

Tetrasomy 18p syndrome (Online Mendelian Inheritance in Man 614290) is a rare chromosomal disorder that is seen in approximately 1 in every 180,000 live births. It is caused by the presence of isochromosome 18p, which is a supernumerary marker composed of two copies of the short arms of chromosome 18. Isochromosome 18p is one of the most commonly observed isochromosomes. We report tetrasomy 18p syndrome diagnosed prenatally after noninvasive prenatal testing (NIPT) was positive for trisomy 18. Tetrasomy 18p was finally diagnosed by G-banding and fluorescence in situ hybridization of chromosome 18p, before invasive confirmatory testing the karyotype findings by NIPT showed an increase in the DNA fragments from chromosome 18p, indicating duplication of chromosome 18p. NIPT can detect not only trisomy 13, 18, and 21, but also structural chromosomal anomalies, such as deletions and duplications. An NIPT report "positive for trisomy 18" indicates the possibility of tetrasomy 18p, and detailed analysis of NIPT data can reveal subchromosomal copy number variations, to a certain extent, before definitive diagnostic testing.

7.
BMC Pregnancy Childbirth ; 20(1): 112, 2020 Feb 17.
Article in English | MEDLINE | ID: mdl-32066398

ABSTRACT

BACKGROUND: Women who receive negative results from non-invasive prenatal genetic testing (NIPT) may find that they later have mixed or ambivalent feelings, for example, feelings of accepting NIPT and regretting undergoing the test. This study aimed to investigate the factors generating ambivalent feelings among women who gave birth after having received negative results from NIPT. METHODS: A questionnaire was sent to women who received a negative NIPT result, and a contents analysis was conducted focusing on ambivalent expressions for those 1562 women who responded the questionnaire. The qualitative data gathered from the questionnaire were analyzed using the N-Vivo software package. RESULTS: Environmental factors, genetic counseling-related factors, and increased anticipatory anxiety, affected the feeling of ambivalence among pregnant women. Furthermore, pregnant women desired more information regarding the detailed prognosis for individuals with Down syndrome and living with them and/or termination, assuming the possibility that they were positive. CONCLUSIONS: Three major interrelated factors affected the feeling of ambivalence in women. Highlighting and discussing such factors during genetic counseling may resolve some of these ambivalences, thereby enhancing the quality of decisions made by pregnant women.


Subject(s)
Emotions , Negative Results , Noninvasive Prenatal Testing , Parturition/psychology , Pregnant Women/psychology , Decision Making , Female , Genetic Counseling/psychology , Humans , Japan/epidemiology , Pregnancy , Qualitative Research , Social Environment , Surveys and Questionnaires
8.
Neurosci Lett ; 715: 134656, 2020 01 10.
Article in English | MEDLINE | ID: mdl-31794791

ABSTRACT

Tetrahydrobiopterin (BH4) is a cofactor for tyrosine hydroxylase and tryptophan hydroxylase, which are essential enzymes for the biosynthesis of dopamine, norepinephrine, and serotonin. It has been known that BH4 is a labile molecule and easily oxidized. As ascorbic acid (AsA) is an antioxidant that is rich in the brain, alteration in the AsA concentration in the brain may affect the proper metabolism of BH4. Here, we examined the effect of AsA deficiency on the concentration of BH4 using ODS rats, which are defective in the gene for AsA synthesis. Intake of an AsA-deficient diet for 2 weeks in ODS rats resulted in great reductions in the AsA levels up to 7 % in the liver and up to 55 % in the brain compared to animals fed a basal diet containing an adequate amount of AsA. The BH4 concentrations in ODS rats fed an AsA-free diet were decreased to 71 % in the liver and 88 % in the brain of those fed a basal diet. We found that the levels of dopamine, norepinephrine, and serotonin were also decreased compared with the ODS rats fed a basal diet. Our data showed that AsA deficiency can affect the BH4 concentrations in the liver and brain, resulting in decreases in the monoamine levels in the brain. These results suggest the importance of AsA in the pathophysiology of neuropsychiatric and cardiovascular disorders through alteration in the BH4 metabolism.


Subject(s)
Ascorbic Acid Deficiency/metabolism , Biopterins/analogs & derivatives , Brain/metabolism , Liver/metabolism , Animals , Biopterins/metabolism , Dopamine/metabolism , Norepinephrine/metabolism , Rats, Inbred Strains , Serotonin/metabolism
9.
Prenat Diagn ; 39(2): 100-106, 2019 01.
Article in English | MEDLINE | ID: mdl-30586157

ABSTRACT

OBJECTIVE: To evaluate the reasons for nonreportable cell-free DNA (cfDNA) results in noninvasive prenatal testing (NIPT), we retrospectively studied maternal characteristics and other details associated with the results. METHODS: A multicenter retrospective cohort study in pregnant women undergoing NIPT by massively parallel sequencing (MPS) with failed cfDNA tests was performed between April 2013 and March 2017. The women's data and MPS results were analyzed in terms of maternal characteristics, test performance, fetal fraction (FF), z scores, anticoagulation therapy, and other details of the nonreportable cases. RESULTS: Overall, 110 (0.32%) of 34 626 pregnant women had nonreportable cfDNA test results after an initial blood sampling; 22 (20.0%) cases had a low FF (<4%), and 18 (16.4%) cases including those with a maternal malignancy, were found to have altered genomic profile. Approximately half of the cases with nonreportable results had borderline z score. Among the women with nonreportable results because of altered genomic profile, the success rate of retesting using a second blood sampling was relatively low (25.0%-33.3%). Thirteen (11.8%) of the women with nonreportable results had required hypodermic heparin injection. CONCLUSIONS: The classification of nonreportable results using cfDNA analysis is important to provide women with precise information and to reduce anxiety during pregnancy.


Subject(s)
Genetic Testing/methods , High-Throughput Nucleotide Sequencing , Prenatal Diagnosis/methods , Research Design , Trisomy/diagnosis , Adult , False Negative Reactions , Female , High-Throughput Nucleotide Sequencing/methods , High-Throughput Nucleotide Sequencing/standards , High-Throughput Nucleotide Sequencing/statistics & numerical data , Humans , Predictive Value of Tests , Pregnancy , Pregnancy Trimester, First/blood , Pregnancy Trimester, First/genetics , Pregnancy Trimester, Second/blood , Pregnancy Trimester, Second/genetics , Reproducibility of Results , Research Design/standards , Research Design/statistics & numerical data , Retrospective Studies , Risk Factors , Trisomy/genetics
11.
Clin Pract ; 8(2): 1038, 2018 Mar 28.
Article in English | MEDLINE | ID: mdl-30069297

ABSTRACT

Having a uterine scar places a woman at increased risk of complications, such as Cesarean scar pregnancy (CSP), uterine rupture, placenta previa, and placenta accreta, in subsequent pregnancies. We report a case of uterine rupture at 11 weeks of gestation in a woman with a previous Cesarean section. A 43-year-old woman with a history of abdominal myomectomy and Cesarean section had her pregnancy induced by in vitro fertilization with donor eggs. The exact location of the gestational sac was identified on her first day of hospitalization, and her pregnancy was suspected to be a CSP. The following day, the patient complained of sudden lower abdominal pain. A uterine scar rupture was diagnosed, and an emergency surgery was required. It may be that first-trimester screening could allow the early recognition of patients at risk for these perinatal complications.

12.
J Obstet Gynaecol Res ; 44(9): 1832-1835, 2018 Sep.
Article in English | MEDLINE | ID: mdl-29974567

ABSTRACT

Transverse uterine fundal cesarean section in cases of total placenta previa reduces blood loss, but its influence on subsequent pregnancies, including the uterine rupture risk, remains unclear. We report a case of uterine rupture due to placenta percreta in the first trimester in a 43-year-old woman who underwent transverse uterine fundal incision in a previous pregnancy (at 40 years old). The patient did not undergo assessment of the uterine scare after the previous operation. Oocyte donation and in vitro fertilization at another institution resulted in the current pregnancy. At 11 weeks 3 days, she was admitted to the emergency department because of sudden severe abdominal pain. Ultrasound showed massive accumulation of free fluid in the peritoneal cavity and the fetus was outside the uterine cavity; uterine rupture was diagnosed. During emergency laparotomy, the uterine rupture was detected at exactly the previous incision site; a total hysterectomy was performed. Pregnancy after a transverse uterine fundal cesarean section is at high risk. As uterine scar dehiscence might have caused the uterine rupture, wounds should be evaluated before allowing subsequent pregnancies.


Subject(s)
Cesarean Section/adverse effects , Hysterectomy/methods , Placenta Accreta , Uterine Rupture/diagnostic imaging , Uterine Rupture/surgery , Adult , Cesarean Section/methods , Female , Humans , Pregnancy , Pregnancy Trimester, First , Uterine Rupture/etiology
13.
Eur J Obstet Gynecol Reprod Biol ; 224: 165-169, 2018 May.
Article in English | MEDLINE | ID: mdl-29605711

ABSTRACT

OBJECTIVE: The purpose of this study is to compare the fetal fractions during non-invasive prenatal testing (NIPT) in singleton pregnancies according to gestational age and maternal characteristics to evaluate the utility of this parameter for the prediction of pregnancy complications including gestational diabetes mellitus (GDM) and hypertensive disorders of pregnancy (HDP). STUDY DESIGN: This study was a multicenter prospective cohort study. The present data were collected from women whose NIPT results were negative. The relationships between the fetal fractions and the gestational age, maternal weight and height, and incidences of miscarriage, preterm delivery, and pregnancy complications including GDM, HDP and placental abruption were assessed. RESULTS: A total of 5582 pregnant women with verified NIPT negative results were registered in the study. The demographic characteristics of the study populations were statistically analyzed, and the women with HDP tended to have a low fetal fraction in samples taken during early gestation. The area under the curve (AUC) in a receiver operating characteristic curve (ROC) analysis was 0.608 for women with HDP. CONCLUSION: A low fetal fraction on NIPT might be correlated with future HDP. However, predicting HDP during early pregnancy in women with a low fetal fraction might be difficult.


Subject(s)
Cell-Free Nucleic Acids/blood , Maternal Serum Screening Tests , Pregnancy Complications/blood , Adult , Case-Control Studies , Female , Humans , Pregnancy , Prospective Studies
14.
Reprod Med Biol ; 16(2): 152-156, 2017 04.
Article in English | MEDLINE | ID: mdl-29259463

ABSTRACT

Aim: To clarify the effects of small endometriomas on in vitro fertilization (IVF) outcomes. In the present study, the potential impact of small ovarian endometriomas on the quantitative and qualitative outcomes of IVF was evaluated in the same individual. Methods: A retrospective analysis was performed, in which 118 infertile women with unilateral endometriomas that were <40 mm in size and who underwent IVF or intracytoplasmic sperm injection were evaluated. Single frozen embryo transfer cycles were performed, with separate data collections for both the affected and the unaffected ovaries, which allowed for an evaluation of the implantation rate. Results: The mean antral follicular count and the number of follicular flushings, retrieved oocytes, and obtained embryos were significantly lower for the endometrioma-containing ovary than for the contralateral, intact ovary. No significant difference was observed regarding the blastocyst retrieval and good-quality blastocyst retrieval rates, pregnancy rate, and clinical pregnancy or live birth rate. Conclusion: Although the patients with a small endometrioma had a decreased ovarian reserve, they had lower pregnancy rates. The decision to transfer an embryo from an endometrioma-containing ovary or from a contralateral, intact ovary also might not influence the pregnancy rate.

15.
J Obstet Gynaecol Res ; 43(8): 1245-1255, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28586143

ABSTRACT

AIM: The purpose of this study was to report the 3-year experience of a nationwide demonstration project to introduce non-invasive prenatal testing (NIPT) of maternal plasma for aneuploidy, and review the current status of NIPT in Japan. METHODS: Tests were conducted to detect aneuploidy in high-risk pregnant women, and adequate genetic counseling was provided. The clinical data, test results, and pregnancy outcomes were recorded. We discuss the problems of NIPT on the basis of published reports and meta-analyses. RESULTS: From April 2013 to March 2016, 30 613 tests were conducted at 55 medical sites participating in a multicenter clinical study. Among the 30 613 women tested, 554 were positive (1.81%) and 30 021 were negative (98.1%) for aneuploidy. Of the 289, 128, and 44 women who tested positive for trisomies 21, 18, and 13, respectively, and underwent definitive testing, 279 (96.5%), 106 (82.8%), and 28 (63.6%) were determined to have a true-positive result. For the 13 481 women with negative result and whose progress could be traced, two had a false-negative result (0.02%). The tests were performed on the condition that a standard level of genetic counseling be provided at hospitals. CONCLUSION: Here, we report on the 3-year nationwide experience with NIPT in Japan. It is important to establish a genetic counseling system to enable women to make informed decisions regarding prenatal testing. Moreover, a welfare system is warranted to support women who decide to give birth to and raise children with chromosomal diseases.


Subject(s)
Aneuploidy , Maternal Serum Screening Tests/trends , Female , Genetic Counseling , Humans , Japan , Maternal Serum Screening Tests/ethics , Maternal Serum Screening Tests/methods , Pregnancy
16.
J Obstet Gynaecol Res ; 43(4): 775-778, 2017 Apr.
Article in English | MEDLINE | ID: mdl-28418207

ABSTRACT

Pyoderma gangrenosum (PG) is a rare ulcerative skin disease that usually starts as a pustular lesion and rapidly progresses to a painful ulcer with undermined violaceous borders. The occurrence of PG during pregnancy is uncommon. We describe a case of a pregnant patient with PG who was diagnosed as having ulcerative colitis after delivery. Obstetricians need to understand the pathogenesis of PG and its associated conditions because it is important to make a proper diagnosis and provide targeted therapy.


Subject(s)
Pregnancy Complications/diagnosis , Pyoderma Gangrenosum/diagnosis , Adult , Female , Humans , Pregnancy , Pregnancy Complications/pathology , Pregnancy Complications/physiopathology , Pyoderma Gangrenosum/pathology , Pyoderma Gangrenosum/physiopathology
17.
Phys Chem Chem Phys ; 19(3): 2060-2066, 2017 Jan 18.
Article in English | MEDLINE | ID: mdl-28044171

ABSTRACT

Heterodyne-detected (phase-sensitive) vibrational sum frequency generation spectroscopy was used to investigate molecular structures of 1,2-dipalmitoyl-sn-glycero-3-phosphocholine (DPPC) monolayers on water (Langmuir monolayer) and monolayers on a fused silica substrate (Langmuir-Blodgett [LB] monolayer). The spectral features in the CH stretching region depended on the phase of the Langmuir monolayer, which was controlled by the molecular area on water. From the spectral changes, the molecular structure of the monolayer in each phase was deduced at the molecular level. We discovered that when we compared Langmuir and LB monolayers, both of which correspond to a similar surface pressure, the LB monolayer tended to have fewer gauche defects and have less tilted terminal methyls in the n-pentadecyl groups than the corresponding Langmuir monolayer. In addition, weak vibrational bands, which have been hardly seen by the conventional (homodyne-detected) VSFG spectroscopy, were clearly observed with their phases, or arguments, for the first time.

19.
Clin Pract ; 6(3): 852, 2016 Aug 08.
Article in English | MEDLINE | ID: mdl-27777709

ABSTRACT

A 41-year old pregnant woman underwent amniocentesis to conduct a conventional karyotyping analysis; the analysis reported an abnormal karyotype: 46, XY, add(9)(p24). Chromosomal microarray analysis (CMA) is utilized in prenatal diagnoses. A single nucleotide polymorphism microarray revealed a male fetus with balanced chromosomal translocations on 9p and balanced chromosomal rearrangements, but another chromosomal abnormality was detected. The fetus had microduplication. The child was born as a phenotypically normal male. CMA is a simple and informative procedure for prenatal genetic diagnosis. CMA is the detection of chromosomal variants of unknown clinical significance; therefore, genetic counseling is important during prenatal genetic testing.

20.
J Hum Genet ; 61(12): 995-1001, 2016 Dec.
Article in English | MEDLINE | ID: mdl-27604555

ABSTRACT

The purpose of this study is to summarize the results from a survey on awareness of genetic counseling for pregnant women who wish to receive non-invasive prenatal testing (NIPT) in Japan. As a component of a clinical study by the Japan NIPT Consortium, genetic counseling was conducted for women who wished to receive NIPT, and a questionnaire concerning both NIPT and genetic counseling was given twice: once after pre-test counseling and again when test results were reported. The responses of 7292 women were analyzed. They expressed high satisfaction with the genetic counseling system of the NIPT Consortium (94%). The number of respondents who indicated that genetic counseling is necessary for NIPT increased over time. Furthermore, they highly valued genetic counseling provided by skilled clinicians, such as clinical geneticists or genetic counselors. The vast majority (90%) responded that there was sufficient opportunity to consider the test ahead of time. Meanwhile, women who received positive test results had a poor opinion and expressed a low-degree satisfaction. We confirmed that the pre-test genetic counseling that we conducted creates an opportunity for pregnant women to sufficiently consider prenatal testing, promotes its understanding and has possibilities to effectively facilitate informed decision making after adequate consideration. A more careful and thorough approach is considered to be necessary for women who received positive test results.


Subject(s)
Genetic Counseling , Health Knowledge, Attitudes, Practice , Prenatal Diagnosis , Surveys and Questionnaires , Adult , Awareness , Comprehension , Female , Humans , Japan , Middle Aged , Patient Satisfaction , Pregnancy , Prenatal Diagnosis/methods , Young Adult
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