Fractional-Pixel CO2 Laser Treatment in Patients With Urodynamic Stress Urinary Incontinence: 1-Year Follow-Up.

BACKGROUND AND OBJECTIVES: Vaginal pixelated low power and long pulses (LPLP) CO2 laser has been suggested as an optional treatment for stress urinary incontinence (SUI) with many studies reporting short-term improvements. The objective of this study was to assess the 1-year subjective and objective efficacy of vaginal CO2 laser in women with urodynamic SUI. STUDY DESIGN/MATERIALS AND METHODS: This was a prospective multicenter study. Patients with confirmed urodynamic SUI graded as mild or moderate were included. We used three sessions of fractional pixelated CO2 laser for vaginal application and followed up the patients at 6 and 12 months. We used the following measures at follow-up: 1-hour pad test (ICS protocol), questionnaires including Pelvic Floor Distress Inventory 20 (PFDI-20), Pelvic Floor Impact Questionnaire (PFIQ), Patient Global Impression of Improvement (PGI-I), and a 3-day urinary diary. The urodynamic assessment was repeated at 6 months. RESULTS: Fifty-two patients with SUI had three laser treatments, of whom 48 completed a 6-month follow-up and 42 patients completed 12-month follow-up. No serious adverse events were recorded during the study period. A significant reduction on the 1-hour pad test was found from baseline (6.3 ± 1.6 g) to the 12-month follow-up (3.7 ± 1.4 g, P < 0.05) was found. PGI-I showed 75.0%, 61.9%, and 64.3% improvements at 3, 6, and 12 months, respectively. PFDI improved significantly and consistently from baseline until 12 months (37.2 ± 3.89 to 16.1 ± 3.7, P < 0.05). Similarly, PFIQ showed significant improvements from the first treatment up to 12 months. Urodynamic assessment at 6 months showed that 41.4% of patients had no stress incontinence. CONCLUSION: The vaginal CO2 laser was found to be effective for mild-to-moderate SUI over a follow-up period of 1 year, according to a variety of objective and subjective parameters. The wide range of parameters enables optimal patient consultation and subsequent treatment. Lasers Surg. Med. © 2020 Wiley Periodicals LLC.

Protein C global assay evaluation in naturally conceived vs. assisted reproduction-achieved twin pregnancies: a prospective longitudinal study.

PURPOSE: Protein C global assay tests the global function of the protein C pathway, the most clinically significant anticoagulant pathway in humans. The objective of this study is to assess the difference in protein C global assay levels, throughout twin gestation, in naturally conceiving and ART-treated women. METHODS: This is a prospective cohort longitudinal study of pregnant women with twin gestation. Protein C Global evaluation was performed on frozen blood samples. Ninety-eight women with twin pregnancy, thirty-eight naturally conceived and sixty following ART, were evaluated on four occasions: during the first, second, and third trimesters, and 6 weeks or later after delivery (baseline). RESULTS: Protein C global assay levels were lower throughout pregnancy as compared to basal levels in both the naturally conceived and ART-conceived groups. However, protein C global assay levels were similar between the ART-conceived and naturally conceived twin pregnancies in all three trimesters. Perinatal complications were associated with decreased protein C global assay levels during the third trimester, although no difference was encountered between naturally conceived and ART-complicated twin pregnancies. CONCLUSION: While protein C global assay levels drop during twin pregnancy, there is no difference between ART-conceived and naturally conceived gestations. Decreased levels of protein C global assay during the third trimester were similarly associated with perinatal complications in both groups. Our results imply that twin pregnancy of itself is a more dominant factor for perinatal complications as compared to other factors, such as subfertility or the exposure to ART per se.

Mycoplasma and Ureaplasma carriage in pregnant women: the prevalence of transmission from mother to newborn.

BACKGROUND: Mycoplasma and Ureaplasma have been extensively studied for their possible impact on pregnancy, and their involvement in newborn diseases. This work examined Mycoplasma and Ureaplasma carriage among gravidas women and newborns in Israel, as well as associations between carriage and demographic characteristics, risk factors, pregnancy outcomes, and newborn morbidity rates. METHODS: A total of 214 gravidas women were examined for vaginal pathogen carriage through standard culture and polymerase chain reaction assay. Pharyngeal swabs were collected from newborns of carrier mothers. Clinical and demographic data were collected and infected newborn mortality was monitored for 6 months. RESULTS: Nineteen mothers were carriers, with highest prevalence among younger women. Pathogen carriage rates were 2.32% for Mycoplasma genitalium (Mg), 4.19% for Ureaplasma parvum (Up) and 2.32% for Ureaplasma urealyticum (Uu). Arab ethnicity was a statistically significant risk factor (p = 0.002). A higher prevalence was seen among women residing in cities as compared to villages. Thirteen (68%) newborns born to carrier mothers were carriers as well, with a higher prevalence among newborns of women delivering for the first time, compared to women that had delivered before. Infection rates among newborns were 20% for Mg (p = 0.238), 100% for Up (p < 0.01), and 28.5% for Uu (p = 0.058), with more male than female newborns being infected. No association was found between maternal carriage and newborn morbidity. CONCLUSIONS: Maternal Mycoplasma or Ureaplasma carriage may be associated with ethnicity and settlement type. Further studies will be needed to identify factors underlying these associations and their implications on delivery.

Perinatal Outcome of Twin Pregnancies Complicated by Rupture of Membranes at 13-20 Weeks: Is Selective Termination an Appropriate Management Option?

OBJECTIVE: To evaluate the outcome of twin pregnancies that were complicated by rupture of membranes at 13-20 weeks of gestation and were managed by expectant management or by selective termination. METHODS: A retrospective cohort study of all bichorionic twin pregnancies that were referred to three fetal medicine units between 2001 and 2016, due to rupture of membranes of one sac at 13-20 weeks of gestation. Women without clinical signs of infection who opted for expectant management or selective termination were included. RESULTS: 20 patients met the inclusion criteria. 7 of them were managed expectantly and 13 underwent selective termination. In the expectant management group there was one case of fetal demise and two cases of neonatal death, resulting in a survival rate of 79 %. The median gestational age at delivery was 30 weeks. 3 neonates suffered from prematurity-related complications and 2 suffered from oligohydramnios-related orthopedic complications. Following selective termination the survival rate was 50 % (all fetuses that were not reduced), the median gestational age at delivery was 39 weeks, and the neonatal outcome was favorable. The maternal outcome was favorable in both groups. CONCLUSION: Selective termination in twin pregnancies complicated by rupture of membranes at 13-20 weeks has a favorable outcome and should be offered.

Does the empty follicle syndrome occur in cases of low number of maturing follicles in assisted reproduction?

The pathophysiology of the genuine empty follicle syndrome (EFS) is still debated. Ovarian aging has been contested as a cause of this condition. Our aim was to investigate the occurrence of the genuine EFS in cases of a low number of mature follicles in a prospective manner. Ninety-five infertile women were recruited and evaluated following conventional controlled ovarian stimulation (COS) with ≤ six follicles of ≥14 mm diameter on the day of hCG administration. Enrolled women were 37.5 ± 5.2 years of age with basal FSH level of 9.1 ± 3.7 mIU/L, antral follicle count (AFC) of 6.9 ± 4.6, and number of ≥14 mm follicles (on the day of hCG) of 3.4 ± 1.5. Among the 95 women, four were complicated by the genuine EFS (4.2%) with features of the depleted ovarian reserve. Comparison between these four cases and the 91 controls revealed significant differences between age, AFC, number of ≥14 mm follicles, and serum E2 level corresponding to 41.8 ± 1.7 versus 37.4 ± 5.2 years, 1.7 ± 0.6 versus 7.1 ± 4.5, 2.0 ± 0.8 versus 3.4 ± 1.5 follicles, and 356 ± 200 versus 975 ± 557 pg/mL, respectively. Post hoc analysis revealed that 56 among the 95 women fulfilled the Bologna criteria for poor ovarian response and all four cases matched the definition of the genuine EFS raising its incidence to 7.1% in this group. A logistic regression analysis showed that AFC was a significant factor in the development of the genuine EFS. We conclude that the genuine EFS complicates infertile women characterized by a low number of mature follicles. Our findings suggest that the mechanism behind this occurrence is associated with a more exhausted ovarian reserve.

The effect of LH supplementation to the GnRH antagonist protocol in advanced reproductive ageing women: a prospective randomized controlled study.

OBJECTIVE: Although the fundamental significance of both LH and FSH for adequate ovarian folliculogenesis and steroidogenesis has been extensively discussed, the clinical implication of recombinant (r) LH to rFSH for ovarian stimulation employing the GnRH antagonist protocol remains to be elucidated. The aim of this prospective randomized controlled study was to explore whether rLH supplementation to rFSH following GnRH antagonist has an added value to the late follicular ovarian steroidogenesis in the advanced reproductive aged women. DESIGN AND SUBJECTS: Sixty-three consecutive infertile women above 35 years of age and/or with a previous low ovarian response admitted for IVF/ICSI treatment were prospectively randomized. Women in the study and control groups were similarly treated employing the rFSH 300 IU/day and the flexible GnRH antagonist 0·25 mg/day protocol. On the day of antagonist initiation, rLH 150 IU/day was added only to the study group and continued till the hCG day. RESULTS: Serum E2 level on hCG day did not significantly differ between the study and control groups, corresponding to 1268 ± 1006 and 1113 ± 669 pg/mL, respectively (P = 0·9). In the study group, the duration of GnRH antagonist administration was significantly lower than the control group corresponding to 5·0 ± 1·5 to 4·0 ± 1·5 days, respectively (P < 0·05). The total dosage of rFSH administration did not differ between the two groups. CONCLUSIONS: rLH supplementation to rFSH following GnRH antagonist administration employing the flexible protocol does not seem to significantly augment serum E2 level on the day of hCG administration in the advanced reproductive ageing women. This suggests that endogenous serum LH levels following GnRH antagonist initiation are sufficient for adequate late follicular ovarian steroidogenesis in this setting.

The association between multinucleated blastomeres and poor ovarian response under the Bologna criteria.

PURPOSE: To investigate the occurrence of multinucleated blastomeres (MNB) in poor ovarian response (POR) women defined under the Bologna criteria. METHODS: This observational study was designed in a prospective controlled manner. Among 380 cases evaluated for eligibility, 102 women were found suitable and recruited; 51 with POR in accordance with the Bologna criteria defined as the study group and 51 with normal ovarian response defined as the control group. RESULTS: Among the 51 women in each group, 8 and 2 did not achieve embryos in the study and control group, respectively (P < 0.05). The percentage of women that had at least one embryo with one MNB was significantly higher in the study as compared to the control group, corresponding to 49 and 29 %, respectively. The total number of embryos evaluated was 416; 167 in the study and 249 in the control groups. Among these embryos, the MNB rate was significantly higher in the study as compared to the control group, corresponding to 19 and 8 %, respectively. CONCLUSIONS: Blastomere multinuclearity is significantly more common in women and embryos of POR cases, defined under the Bologna criteria. Future studies are warranted to substantiate our observation that has the potential to be clinically implemented in this sub-group of women undergoing assisted reproductive technologies (ART) treatment.

Reduced protein C Global assay level in infertile women prior to IVF-ET treatment.

PURPOSE: In the last few years more robust evidence is emerging to point out at an increased rate of prematurity and low birth weight in singleton pregnancies following ART. Whether this increased rate is related to ART practice or to infertility per se, is still an open question. Our aim in this study was to explore this question by evaluating Protein C (ProC) Global assay in infertile women before ART treatment. METHODS: A cohort of 95 unselected and consecutive infertile women, eligible for ART, was prospectively recruited for the study. The control group included 77 matched healthy fertile women with a history of spontaneous conceptions. Pro C Global assay was evaluated in both groups. A full thrombophilic work-up was performed in the study group. RESULTS: ProC Global assay level was found to be significantly lower in the study as compared to the control group, corresponding to 0.78 ± 0.16 and 0.88 ± 0.16, respectively (P < 0.01). As well, abnormal ProC Global assay level of ≤ 0.8 was significantly higher in the study as compared to control group corresponding to 53 % and 29 %, respectively. ProC Global assay level was significantly lower in women within the study group found to have APCR, factor V Leiden and high factor VIII level, any thrombophilia or combined thrombophilia when compared to women without these thrombophilic risk factors. CONCLUSIONS: Reduced ProC Global assay level is encountered in infertile women prior to ART treatment. This finding may suggest a unique anticoagulation Protein C pathway in infertile as compared to fertile women. Further studies are encouraged to explore this finding.

Effect of mild pressure applied by the ultrasound transducer on fetal cephalic measurements at 20-24 weeks' gestation.

INTRODUCTION: The aim of this study was to assess the effect of mild pressure applied on the abdominal wall by the ultrasound transducer on fetal cephalic indices. MATERIAL AND METHODS: We examined by ultrasound 60 fetuses of healthy women, at 20-24 weeks of pregnancy, during routine prenatal evaluation. For every fetus biparietal diameter and head circumference were measured, with and without applying mild pressure by the ultrasound transducer. The weight and gestational age (GA) were calculated. RESULTS: The pressure applied by the transducer had a significant effect on the cephalic indices and on the weight and GA evaluations (p < 0.001). Fetal positioning significantly affected the impact that applied pressure had on head circumference and on the weight evaluation derived from it (p < 0.05). DISCUSSION: Applied pressure by an abdominal ultrasound probe affects cephalic indices and the derived weight and GA estimations. This may lead to incorrect diagnoses or hide pathological findings. The effect of applied pressure depends on fetal positioning. The examiner must be aware of this effect when evaluating the results of the measurements.

Prospective evaluation of early follicular ovarian stromal blood flow in infertile women undergoing IVF-ET treatment.

BACKGROUND: To evaluate the role of early follicular stromal flow studies in predicting ovarian response during IVF-ET treatment and to assess their correlation with ovarian reserve parameters and clinical pregnancy achievement. MATERIALS & METHODS: One hundred and sixty-eight consecutive and unselected infertile women undergoing their first IVF-ET treatment were included in the study. Basal ovarian reserve and stromal Doppler flow studies were performed in a natural cycle before starting treatment. Four Doppler indices were measured; peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI) and systole/diastole ratio (S/D). Following completion of IVF-ET treatment Pearson's correlation analysis was performed to examine the correlation between Doppler indices, ovarian response, basal ovarian reserve parameters and clinical pregnancy achievement. RESULTS: A positive correlation was found between the number of ≥14 mm follicles on hCG day and PSV. The number of ≥14 mm follicles and retrieved oocytes had a significant negative correlation with RI and S/D ratio. As well, the number of fertilized oocytes had a significant negative correlation with S/D ratio. Absence of a Doppler signal in one or both ovaries was significantly higher in the women with poor response (31%) as compared to women with normal response (16%). In addition, RI correlated positively with basal FSH as well as FSH/LH ratio and negatively with AFC. The S/D ratio had a negative correlation with AFC (p = 0.027). A significant positive correlation between PSV, total ovarian volume (p = 0.011) and mean ovarian volume (p = 0.019) was detected. However, no correlation between all four Doppler indices and age was detected. Moreover, Doppler indices did not differ significantly between conception and non-conception cycles following IVF-ET treatment. CONCLUSIONS: Early follicular stromal Doppler signals is correlated with ovarian response as well as basal ovarian reserve parameters, but have no correlation with age neither with clinical pregnancy achievement in infertile women undergoing IVF-ET treatment.

Successful monozygotic twin pregnancy fathered by a male 46,XY true hermaphrodite.

This report presents an unusual case of absolute non-obstructive azoospermia revealed to be a male 46,XY true hermaphrodite who was successfully treated to father healthy monozygotic twins. A 27-year-old infertile male with non-obstructive azoospermia previously underwent an unsuccessful testicular sperm extraction procedure and refused donor sperm insemination.Revising the patient's old records revealed that he was born with ambiguous genitalia. He had a 46,XY karyotype and was raised as a male. During childhood he underwent ambiguous genitalia reconstruction, right orchiopexy and left salpingo-oophorectomy that revealed a gonadoblastoma. A new treatment was employed performing testicular fine needle aspiration leading successfully to a monozygotic twin pregnancy. As far as is known, this is the first reported case of healthy twins fathered by a male 46,XY true hermaphrodite.

Evaluation of normal fetal atrio-ventricular septum dimensions during pregnancy.

OBJECTIVES: Ebstein anomaly and atrio-ventricular septal defect involve a profound change in the appearance of the atrio-ventricular septum (AVS). AVS is the area between the insertion of the mitral valve and the tricuspid valve leaflets to the ventricular septum. In normal fetuses, the tricuspid valve has an apical displacement relative to the mitral valve. We aimed to create a nomogram of its normal dimensions, beginning in the 11th gestational week. METHODS: Measurement of the length of the AVS was performed during ultrasonographic fetal echocardiography, in the four-chamber view from 11 to 34 gestational weeks in otherwise normal pregnancies. In addition, standard fetal biometry was measured. Linear regression analysis was used to evaluate the correlation between variables. RESULTS: Two hundred and ninety-two examinations of normal fetuses were included. A positive correlation was found between AVS length and gestational age (r(2) = 0.96, P < 0.001), each week adding 0.165 mm (ß = 0.165, P < 0.001). AVS length was also proportional to inter-ventricular septum (IVS) length with increasing gestational age (r(2) = 0.882, ß = 0.94, P < 0.001). Positive linear correlation was obtained between AVS length and fetal biometry (P < 0.001). CONCLUSION: We provide a nomogram for AVS length which can be used as a reference when either Ebstein anomaly or atrio-ventricular septal defects are suspected.

Prenatal sonographic evaluation of the penile length.

OBJECTIVE: To construct cross-sectional reference range of the penile length during pregnancy, measuring it from the proximal edge of the corpus cavernosum to the tip of the glans penis. METHODS: Fetal penile length was measured by high resolution transvaginal ultrasound at 14 to 16 weeks and by transabdominal ultrasound at 17 to 35 weeks' gestation. RESULTS: Fetal penile length increased significantly with gestational age (GA), from 7 mm at 14 weeks' to 50 mm at 35 weeks' gestation. Penile length measurements were strongly related to the biometric fetal measurements. CONCLUSIONS: A reference range of the fetal penile length was constructed, measured from the proximal edge of the corpus cavernosum to the tip of the glans penis at 14 to 35 gestational weeks. This reference range can assist in early identification of true penile maldevelopment, which obligate further diagnostic workup, as opposed to the benign disorder of buried or concealed fetal penis.

Sonographic evaluation of the fetal conus medullaris at 20 to 24 weeks' gestation.

OBJECTIVE: To determine the normal level of the conus medullaris (CM) of the spinal cord of normal fetuses at 20 to 24 weeks' gestation using abdominal sonography. METHODS: Using a 4 to 8 MHz ultrasound abdominal transducer, CM was imaged in the midsagittal plane with the fetal spine facing toward the transducer. The CM ending level was located by counting the vertebrae caudal starting at T12, which was identified by lowest fetal rib. The CM locations were defined according to their positions relative to the vertebrae. RESULTS: One hundred and ten consecutive pregnant women were included in the study. The CM was clearly demonstrated in 78 (71%) of these cases. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2-3 inter-space and L3 (73/78, 93%). The L1-2, L2, L2-3, and L3 vertebral groups did not differ in mean gestational weeks, maternal age, or fetal gender. CONCLUSION: The level of the CM can be determined at 20 to 24 weeks' gestation in about 70% of fetuses. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2-3 vertebral space, and L3 (73/78, 93%). When detected lower than the third lumbar vertebra it should prompt prenatal and postnatal surveillance.

Outcome of twin pregnancies complicated by early second trimester rupture of membranes in one sac.

The aim of this study was to present the outcome of bichorionic twin pregnancies complicated by early second trimester rupture of membranes in one sac. Data regarding all cases of ruptured membranes at 13-20 weeks in bichorionic twin pregnancies were collected retrospectively from three fetal medicine units. Patients who have chosen to terminate the pregnancy were excluded from the study. Between January 2003 and July 2009, nine patients met inclusion criteria. Three out of nine couples decided on expectant management, and six preferred selective feticide. With expectant management one fetus died in utero and take home baby rate was 83% (5 of 6 fetuses), delivered at 27-32 weeks. When selective termination was performed, all non-reduced fetuses were born alive at 33-40 weeks. Two survivors of rupture of membranes had limb contractures, none had lung hypoplasia. One patient had clinical signs of amnionitis, which was ruled out later on pathological examination. Her post partum course was uncomplicated. Our data suggest that rupture of membranes in one sac of bichorionic twins at 13-20 weeks has favorable prognosis whether an intervention is preformed or not. Nonetheless, selective termination may have an advantage over expectant management, since gestational age at delivery was higher when selective termination was performed.

Does first polar body morphology predict oocyte performance during ICSI treatment?

PURPOSE: To gain insight into the morphology of the first polar body (1 PB) in ICSI patients and to explore whether it could predict mature oocyte viability and performance in this setting. METHODS: Seventy two consecutive women planned to perform ICSI treatment were prospectively recruited for this study. All oocytes retrieved underwent evaluation for nuclear maturity and accurate assessment of 1 PB morphology. MII oocytes were cultured in separate groups in each woman in accordance with two different categories of 1 PB morphology. Category A included normal intact round or ovoid 1 PB and category B included abnormal fragmented 1 PB. Each oocyte was followed throughout fertilization, embryo cleavage and embryo transfer. Cycles that reached embryo transfer, were divided into three groups in accordance with 1 PB morphology. Group I included only category A 1 PB embryos, group II included categories A and B 1 PB embryos, whereas group III included only category B 1 PB embryos. RESULTS: A total of 687 oocytes were aspirated and 553 MII oocytes underwent ICSI leading to 410 zygotes showing normal fertilization on day one. Three hundred ninety seven embryos cleaved on day two and a total of 176 embryos were replaced into the uterus. Clinical implantation and pregnancy rates were significantly correlated with the morphology of the 1 PB corresponding to 31%, 9% and 2% and 61%, 24% and 5%, in groups I, II and III respectively. CONCLUSIONS: Our findings demonstrate that 1 PB morphology is related to mature oocyte viability and it has the potential to predict oocyte performance and pregnancy achievement in infertile women undergoing ICSI treatment.

Prenatal diagnosis of fetal cardiac right ventricular diverticulum disappearing at three months of age. A case report and literature review.

Congenital cardiac diverticula are transmural localized protrusions within the free wall of the ventricles. Right ventricular diverticula are rarely diagnosed during the fetal period, and due to their rarity, their natural history remains unclear. We present a case of prenatal diagnosis of right ventricular diverticulum at 22 weeks' gestation. No other pathological findings were detected, the pregnancy and delivery were uneventful, and the diverticulum disappeared before the age of 3 months. Echocardiography of the infant at 1 year of age revealed no cardiac diverticulum or any cardiac anomaly and showed normal heart function. Literature review of all cases published to date reveal good outcome of right ventricular diverticula. We suggest reassuring our patients about the good prognosis of this cardiac anomaly.

[The genetic sonogram].

Mid-trimester soft sonographic markers have been linked with aneuploidies. This article describes the individual sonographic markers used in the genetic sonograms, and reviews the current relevant Literature. The significant soft markers are: nuchal thickness, echogenic bowel, shortened limbs and absence of nasal bone. The soft markers which are not significant as an isolated finding in young patients but are significant in combination with the biochemical markers, or in older age are: intracardiac echogenic focus, choroid pLexus cyst, pyelectasis and single umbilical artery. There are several other reported findings which might be linked to chromosomal abnormalities including hypoplasia of the middle phalanx of the fifth digit, sandal gap, ear size, brachycephaly, cervical cyst, iliac angle and others. These findings shouLd not be considered as soft markers since they were reported only in small series or case reports. The aneuploidy risk should be calcuLated on the basis of age, nuchal translucency, biochemical screening and anomaly scan. If the calculated risk for aneupLoidy exceeds 1:380, an invasive karyotyping procedure should be recommended. Adoption of this approach will reduce the unnecessary invasive tests, reduce abortion rate and will increase the detection rate of aneuploidy.

[Correlation of maternal serum and amniotic fluid leptin and insulin levels with neonatal birth weight].

BACKGROUND: Numerous studies correlated maternal serum and fetal cord Leptin Levels in pregnancy with new born weight (NBW) and maternal body mass index (BMI). However, there are only a few published studies concerning amniotic fluid leptin and its possible relationship to fetal growth and NBW. OBJECTIVES: To correlate leptin and insulin in amniotic fluid and maternal serum collected at 16-20 gestational weeks to NBW. METHODS: This was an observational study in which maternal serum Leptin, insulin, and amniotic fluid Leptin and insulin, studied from 70 healthy pregnant women undergoing amniocentesis for karyotyping, at 16-20 weeks gestation. NBW was correlated with maternal BMI and leptin and insulin Levels in maternal serum and amniotic fluid. RESULTS: Maternal serum leptin was detected as the best predictor of NBW. Squared correlation coefficient, r2 = 0.09, was statistically significant (P < 0.01). Maternal BMI correlated significantly with serum Levels of insulin and leptin r2 = 0.16 and 0.27 respectively, P < 0.01. CONCLUSION: In normal pregnancies, amniotic fluid Leptin correlates partially with NBW. Maternal serum leptin correlates significantly with NBW.