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Singleton Pregnancies (singleton + pregnancy)
Kinds of Singleton Pregnancies Selected AbstractsFirst trimester maternal serum free , human chorionic gonadotrophin and pregnancy associated plasma protein A as predictors of pregnancy complicationsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 10 2000Charas Y. T. Ong Research Fellow (Fetal Medicine) Objective To examine the value of first trimester maternal serum free , human chorionic gonadotrophin (, hCG) and pregnancy associated plasma protein A (PAPP-A) as predictors of pregnancy complications. Design Screening study. Setting Antenatal clinics. Population Singleton pregnancies at 10,14 weeks of gestation. Methods Maternal serum free , hCG and PAPP-A were measured at 10,14 weeks of gestation in 5584 singleton pregnancies. In the 5297 (94.9%) pregnancies with complete follow up free , hCG and PAPP-A were compared between those with normal outcome and those resulting in miscarriage, spontaneous preterm delivery, pregnancy induced hypertension or fetal growth restriction and in those with pre-existing or gestational diabetes. Results Maternal serum PAPP-A increased and , hCG decreased with gestation. The multiple of median maternal serum PAPP-A was significantly lower in those pregnancies resulting in miscarriage, pregnancy induced hypertension, growth restriction and in those with pre-existing or gestational diabetes mellitus, but not in those complicated by spontaneous preterm delivery. The level was < 10th centile of the reference range in about 20% of the pregnancies that subsequently resulted in miscarriage or developed pregnancy induced hypertension or growth restriction, and in 27% of those that developed gestational diabetes. Maternal serum free , hCG was < 10th centile of the reference range in about 15% of the pregnancies that subsequently resulted in miscarriage or developed pregnancy induced hypertension or growth restriction, and in 20% of those that developed gestational diabetes. Conclusion Low maternal serum PAPP-A or , hCG at 10,14 weeks of gestation are associated with subsequent development of pregnancy complications. [source] A discrepancy between gestational age estimated by last menstrual period and biparietal diameter may indicate an increased risk of fetal death and adverse pregnancy outcomeBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 9 2000Tri huu Nguyen Research Fellow Objective To determine if the discrepancy between gestational age estimated by last menstrual period and by biparietal diameter (GALMP, GABPD) is associated with adverse pregnancy outcome. Design Population-based follow up study. Population Singleton pregnancies were studied when a reliable date of last menstrual period and biparietal diameter measured between 12 and 22 weeks of gestation was available (n= 16,469). Methods Logistic regression analysis and Kaplan-Meier survival analysis were used to analyse the association between GALMP, GABPD and adverse pregnancy outcome. Main outcome measures Adverse outcome was defined as abortion after 12 weeks of gestation, stillbirth or postnatal death within one year of birth, delivery < 37 weeks of gestation, a birthweight < 2500 g or a sex-specific birthweight lower than 22% below the expected. Results The risk of death was more than doubled if GALMP, GABPD of , 8 days was compared with GALMP, GABPD of < 8 days (OR 2.2; 95% CI 1.6,3.1). The risk of death was a factor of 6.1 higher if GALMP, GABPD of , 8 days was combined with increased (> 2 × multiple of median) maternal alphafetoprotein measured in the 2nd trimester. Conclusions A discrepancy between GALMP and GABPD generally reflects the precision of the two methods used to predict term pregnancy. However, a positive discrepancy of more than seven days, particularly with high maternal alpha-fetoprotein, might indicate intrauterine growth retardation and an increased risk of adverse perinatal outcome. [source] Maternal and neonatal outcomes and time trends of gestational diabetes mellitus in Sweden from 1991 to 2003DIABETIC MEDICINE, Issue 4 2010H. E. Fadl Diabet. Med. 27, 436,441 (2010) Abstract Aims, To determine maternal and neonatal outcomes for women with gestational diabetes mellitus (GDM) in Sweden during 1991,2003, and to compare the outcomes in the two time periods. Methods, This is a population-based cohort study using the Swedish Medical Birth Register data for the period 1991,2003. There were 1 260 297 women with singleton pregnancies registered during this time, of whom 10 525 were diagnosed with GDM, based on a 75 g oral glucose tolerance test. The main diagnostic criteria were fasting capillary whole blood glucose , 6.1 mmol/l and 2 h blood glucose , 9.0 mmol/l. Results, Maternal characteristics differed significantly between the GDM and non-GDM group. Adjusted odds ratios (OR) were as follows: for pre-eclampsia, 1.81 (95% confidence interval (CI) 1.64,2.00); for shoulder dystocia, 2.74 (2.04,3.68); and for Caesarean section, 1.46 (1.38,1.54). No difference was seen in perinatal mortality, stillbirth rates, Apgar scores, fetal distress or transient tachypnoea. There was a markedly higher risk of large for gestational age, OR 3.43 (3.21,3.67), and Erb's palsy, OR 2.56 (1.96,3.32), in the GDM group, and statistically significant differences in prematurity < 37 weeks, birth weight > 4.5 kg, and major malformation, OR 1.19,1.71. No statistically significant improvement in outcomes was seen between the two study periods. Conclusions, Women with GDM have higher risks of pre-eclampsia, shoulder dystocia and Caesarean section. Their infants are often large for gestational age and have higher risks of prematurity, Erb's palsy and major malformations. These outcomes did not improve over time. [source] First-trimester fetal heart rate in mothers with opioid addictionADDICTION, Issue 7 2010Maximilian Schmid ABSTRACT Aim To investigate the difference in fetal heart rate of opioid-dependent mothers compared to non-dependent mothers in the first trimester of pregnancy. Design The data of 74 consecutive singleton pregnancies of mothers enrolled in a maintenance programme for opioid-dependent women was matched to 74 non-exposed singleton pregnancies by maternal age, crown,rump length, smoking status, ethnic background and mode of conception. Measurement Fetal heart rate measured as part of first-trimester screening by Doppler ultrasound between 11+0 and 13+6 gestational weeks was compared retrospectively. Findings The mean fetal heart rate in opioid-dependent mothers was 156.0 beats per minute (standard deviation 7.3) compared to 159.6 (6.5) in controls. The difference in fetal heart rate was significant (P = 0.02). There was a significant difference in mean maternal body mass index (P = 0.01) but not in mean nuchal translucency (P = 0.3), gestational age (0.5), fetal gender (P = 0.3) and parity (P = 0.3) between both groups. Fifty-five per cent (41 of 74) of cases were taking methadone, 30% (22 of 74) buprenorphine and 15% (11 of 74) were taking slow-release morphines throughout the pregnancy. Conclusions In fetuses of opioid-dependent mothers a decreased fetal heart rate can already be observed between 11+0 and 13+6 gestational weeks. The effect of opioid intake needs to be taken into consideration when interpreting fetal heart rate in opioid-dependent mothers at first-trimester screening. [source] Community-based, Prospective, Controlled Study of Obstetric and Neonatal Outcome of 179 Pregnancies in Women with EpilepsyEPILEPSIA, Issue 1 2006Katriina Viinikainen Summary:,Purpose: This study evaluated obstetric and neonatal outcome in a community-based cohort of women with active epilepsy (WWAE) compared with the general pregnant population receiving modern obstetric care. Methods: We reviewed the total population who gave birth between January 1989 and October 2000 at Kuopio University Hospital. Obstetric, demographic, and epilepsy data were collected prospectively from 179 singleton pregnancies of women with epilepsy and from 24,778 singleton pregnancies of unaffected controls. The obstetric data from the pregnancy register was supplemented with detailed neurologic data retrieved from the medical records. The data retrieved were comprehensive because of a follow-up strategy according to a predecided protocol. Results: During pregnancy, the seizure frequency was unchanged, or the change was for the better in the majority (83%) of the patients. We found no significant differences between WWAE and controls in the incidence of preeclampsia, preterm labor, or in the rates of caesarean sections, perinatal mortality, or low birth weight. However, the rate of small-for-gestational-age infants was significantly higher, and the head circumference was significantly smaller in WWAE. Apgar score at 1 min was lower in children of WWAE, and the need for care in the neonatal ward and neonatal intensive care were increased as compared with controls. The frequency of major malformations was 4.8% (,0.6,10.2%; 95% confidence interval) in the 127 children of WWAE. Conclusions: Pregnancy course is uncomplicated and neonatal outcome is good in the majority of cases when a predecided protocol is used for the follow-up of WWAE in antenatal and neurologic care. Long-term follow-up of the neurologic and cognitive development of the children of WWAE is still needed. [source] Placental thickness in the first half of pregnancyJOURNAL OF CLINICAL ULTRASOUND, Issue 5 2004Theera Tongsong MD Abstract Purpose This study was conducted to establish normal values of placental thickness during the first half of pregnancy. Methods Normal pregnant women with singleton pregnancies between 8 and 20 weeks of gestation were recruited into the study. All the newborns were normal at birth. Placental thickness was measured perpendicularly through the thickest part of the placenta on transabdominal scans. The placental thickness data were analyzed for mean, standard deviation, 95% confidence interval, and 2.5th, 5th, 50th, 95th, and 97.5th percentile for each week of gestational age. The best-fit mathematical model was derived by regression analysis. Results The total number of measurements was 333 and the number of measurements for each week of gestational age ranged from 9 to 37. Regression analysis yielded the following linear equation of the relationship: placental thickness (in mm) = gestational age (in weeks) × 1.4,5.6 (r = 0.82). Conclusion We have established a nomogram for placental thickness. This resource may be a useful aid in the early detection of placental abnormalities, such as hydropic placenta secondary to hemoglobin Bart's disease. © 2004 Wiley Periodicals, Inc. J Clin Ultrasound 32:231,234, 2004; Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/jcu.20023 [source] The Effects of Mindfulness-Based Yoga During Pregnancy on Maternal Psychological and Physical DistressJOURNAL OF OBSTETRIC, GYNECOLOGIC & NEONATAL NURSING, Issue 3 2009Amy E. Beddoe ABSTRACT Objective: To examine the feasibility and level of acceptability of a mindful yoga intervention provided during pregnancy and to gather preliminary data on the efficacy of the intervention in reducing distress. Design: Baseline and post-treatment measures examined state and trait anxiety, perceived stress, pain, and morning salivary cortisol in a single treatment group. Postintervention data also included participant evaluation of the intervention. Setting: The 7 weeks mindfulness-based yoga group intervention combined elements of Iyengar yoga and mindfulness-based stress reduction. Participants: Sixteen healthy pregnant nulliparous women with singleton pregnancies between 12 and 32 weeks gestation at the time of enrollment. Methods: Outcomes were evaluated from pre- to postintervention and between second and third trimesters with repeated measures analysis of variance and post hoc nonparametric tests. Results: Women practicing mindful yoga in their second trimester reported significant reductions in physical pain from baseline to postintervention compared with women in the third trimester whose pain increased. Women in their third trimester showed greater reductions in perceived stress and trait anxiety. Conclusions: Preliminary evidence supports yoga's potential efficacy in these areas, particularly if started early in the pregnancy. [source] Evaluation of D-dimer during pregnancyJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2009Ayano Nishii Abstract Aim:, The purpose of the present study was to elucidate the change of D-dimer and the possibility of deep vein thrombosis screening by D-dimer during pregnancy. Methods:, One thousand, one hundred and thirty-one pregnant women were enrolled in the study from April 2006 to March 2007. D-dimer was measured by latex immunoassay at 6 to 14 and 30 to 36 weeks of gestation, respectively, and the veins of the lower extremities were examined by ultrasound at 30 to 36 weeks of gestation. Results:, The mean and standard error of D-dimer was 1.1 ± 1.0 µg/mL in the first trimester and 2.2 ± 1.1 µg/mL in the third trimester, and both values were significantly higher than adult values. In addition, D-dimer significantly increased during pregnancy. D-dimer was not significantly different between singleton and twin pregnancies in the first trimester, but in the third trimester, the values of twin pregnancies were higher than singleton pregnancies (2.2 ± 1.6 vs 3.7 ± 2.5 µg/mL). The mean value of D-dimer of ultrasonographically positive women was 2.6 ± 2.0 µg/mL, which was significantly higher than the value for negative woman during the third trimester (2.2 ± 1.6 µg/mL). The positive predictive value was 7.4% and negative predictive value was 95.5% for ultrasonographically positive women when D-dimer was set at 3.2 µg/mL. Conclusion:, We clearly found a change of D-dimer during pregnancy. When D-dimer was higher than 3.2 µg/mL, the percentage of ultrasonographically positive women was high. We propose that women with D-dimer higher than 3.2 µg/mL are closely monitored for prevention of pulmonary thromboembolism. [source] New frontiers of assisted reproductive technology (Chien Tien Hsu Memorial Lecture 2007)JOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 1 2009P. C. Ho Abstract Many significant advances have been made in assisted reproductive technology since the birth of the first baby conceived with in vitro fertilization and embryo transfer. The development of recombinant gonadotropins and gonadotropin releasing hormone antagonists helps to simplify the ovarian stimulation. Excessive ovarian stimulation should be avoided because of the risks of ovarian hyperstimulation syndrome and reduction in endometrial receptivity. Maturation of oocytes in vitro has been developed in some centers. It is still uncertain whether techniques such as assisted hatching, blastocyst transfer and pre-implantation aneuploidy screening can improve the live birth rates in assisted reproduction. The introduction of pre-implantation genetic diagnosis for selection of human lymphocyte antigens (HLA) compatible embryos for treatment of siblings has raised ethical concerns. There is a higher risk of obstetric complications and congenital abnormalities even in singleton pregnancies achieved with assisted reproduction. Because of the risks of multiple pregnancies, elective single embryo transfer is increasingly used in good-prognosis patients. With a good freezing program, the cumulative pregnancy rate (including the pregnancies from subsequent replacement of frozen-thawed embryos) is not adversely affected. Improvement in cryopreservation techniques has made it possible to cryopreserve slices of ovarian tissue or oocytes, thus helping women who have to receive sterilizing forms of anti-cancer treatment to preserve their fertility. It is important that the development of the new techniques should be based on good scientific evidence. Ethical, legal and social implications should also be considered before the introduction of new techniques. [source] Outcome of pregnancy after laser conization: Implications for infection as a causal link with preterm birthJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 5 2008Hitoshi Masamoto Abstract Objective:, To investigate a causal link between infection and preterm birth in women with a shortened cervix induced by prior laser conization. Methods:, We conducted a retrospective review of the outcomes of 47 singleton pregnancies with a history of laser conization. Cervical length was measured between 17 and 23 weeks of gestation. Receiver-operating characteristic curves were used to determine the best cut-off point for the cervical length for predicting spontaneous preterm birth. We measured infectious markers in 12 women who had experienced preterm labor. Results:, Nine women had had premature labors and three had had late abortions. The mean ± SD cervical length was 33.1 ± 9.1 mm. The optimal cut-off for predicting preterm delivery was 25 mm with a sensitivity and specificity of 75.0% and 97.1%, respectively. Concentrations of granulocyte elastase were positive in five of the six samples determined. The white blood cell count and C-reactive protein levels were elevated in four out of the six patients. Sixty-seven percent of the vaginal cultures were positive for bacteria. Chorioamnionitis was present in seven women. Conclusions:, For the prediction of preterm birth in patients with a history of conization, it is helpful to look for signs of local infection when the cervical length is less than 25 mm. [source] Fetal nasal bone length and Down syndrome during the second trimester in a Chinese populationJOURNAL OF OBSTETRICS AND GYNAECOLOGY RESEARCH (ELECTRONIC), Issue 4 2008Jeng-Hsiu Hung Abstract Objective:, The purpose of the present study was to build a database of reference ranges of fetal nasal bone length (NBL) in a Chinese population. The accuracy rate of detecting Down syndrome was also analyzed using fetal NBL as a marker. Methods:, The control group of fetuses included 342 normal singleton pregnancies with no chromosomal or congenital anomalies. The present study was a cross-section study and the control group was used to construct percentile values of NBL from 13 to 29 gestational weeks of age. Two-dimensional ultrasonography was used for the nasal bone studies. Measurements of NBL were collected and each fetus contributed a single value to the reference sample. During the study period, 14 fetuses with Down syndrome were examined. Measurement of fetal NBL was made during amniocentesis, with gestational age ranging from 13 to 19 weeks. Results:, From 342 normal fetuses with gestational age ranging from 13 to 29 weeks, reference ranges of NBL were constructed. The reference ranges were constructed from the 100(1 , p)% reference range: , where , = 25 , exp(3.58 , 0.044 × t + 0.0006 × t2), with , being the fitted mean of regression model and t being gestational age (weeks). Using fetal NBL, the regression model was Pr(Down syndrome) = exp(W)/[1 + exp(W)], where W = 0.62,4.80 × NBL (multiples of the median) in predicting Down syndrome. Fetal NBL was found to have a sensitivity and specificity of 0.78 and 0.78, respectively, in predicting Down syndrome in the second trimester of pregnancy. Conclusions:, Fetal NBL measurement can provide a simple and useful algorithm to predict Down syndrome during the second trimester of pregnancy. [source] Changes of serum melatonin level and its relationship to feto-placental unit during pregnancyJOURNAL OF PINEAL RESEARCH, Issue 1 2001Yasuhiko Nakamura Serum melatonin concentrations were studied in normal pregnant women and in women with several types of pathologic pregnancies, e.g., twins, preeclampsia or intrauterine growth retardation (IUGR). Blood samples were collected from the maternal antecubital vein at 14:00 hr (daytime) and 02:00 hr (nighttime) during pregnancy, and also from the umbilical vein and artery immediately after delivery. Serum melatonin concentrations were measured by radioimmunoassay. Daytime serum melatonin levels in normal (single fetus; singleton) pregnancies were low. While the levels showed an increasing tendency toward the end of pregnancy, no statistically significant changes occurred. On the other hand, the nighttime serum melatonin levels increased after 24 weeks of gestation, with significantly (P<0.01) high levels after 32 weeks; these values decreased to non-pregnant levels on the 2nd day of puerperium. Nighttime serum melatonin levels were significantly (P<0.05) higher in twin pregnancies after 28 weeks of gestation than in singleton pregnancies, whereas the patients with severe preeclampsia showed significantly (P<0.05) lower serum melatonin levels than the mild preeclampsia or the normal pregnant women after 32 weeks of gestation. Melatonin concentrations in umbilical vessels showed a higher tendency in neonates who were born during at night compared with the other neonates; moreover, those in the umbilical artery were generally higher than those in the umbilical vein. The present results indicate that in humans, the maternal serum melatonin levels show a diurnal rhythm, which increases until the end of pregnancy, reflecting some pathologic states of the feto-placental unit. Fetuses may produce melatonin with a circadian rhythm. [source] Twin Pregnancies: Eating for Three?NUTRITION REVIEWS, Issue 9 2005Maternal Nutrition Update The incidence of multifetal pregnancies has increased, mainly because of assisted reproduction treatments. This trend is reflected in increased maternal and neonatal morbidity and mortality. While the optimum maternal nutrition and weight gain patterns for singleton pregnancies is well documented, there is a paucity of information for twin pregnancies. Although it is assumed that optimum nutritional requirements and weight gains would be greater for twin than for singleton gestations, research is needed to establish the optima. This article is a collation of available recommendations for maternal nutrition and weight gain patterns in twin pregnancies. [source] Psychological trauma associated with the World Trade Center attacks and its effect on pregnancy outcomePAEDIATRIC & PERINATAL EPIDEMIOLOGY, Issue 5 2005Stephanie Mulherin Engel Summary The destruction of the World Trade Center (WTC) on 11 September 2001 was a source of enormous psychological trauma that may have consequences for the health of pregnant women and their fetuses. In this report, we describe the impact of extreme trauma on the birth outcomes of women highly exposed to the WTC. We enrolled 187 women who were pregnant and living or working within close proximity to the WTC on 11 September. Among women with singleton pregnancies, 52 completed at least one psychological assessment prior to delivery. In adjusted multivariable models, both post-traumatic stress symptomatology (PTSS) and moderate depression were associated with longer gestational durations, although only PTSS was associated with decrements in infant head circumference at birth (, = ,0.07, SE = 0.03, P = 0.01). The impact of stress resulting from extreme trauma may be different from that which results from ordinary life experiences, particularly with respect to cortisol production. As prenatal PTSS was associated with decrements in head circumference, this may influence subsequent neurocognitive development. Long-term follow-up of infants exposed to extreme trauma in utero is needed to evaluate the persistence of these effects. [source] Placental Anomalies in Children with Infantile HemangiomaPEDIATRIC DERMATOLOGY, Issue 4 2007Juan Carlos López Gutiérrez M.D., Ph.D. We investigated the pathogenic significance of placental features and their relationship to the development of infantile hemangioma in order to obtain a better understanding of its cause. Placental specimens were reviewed from 26 singleton pregnancies of women whose offspring weighed less than 1500 g. A group of 13 neonates who developed infantile hemangioma in the immediate neonate period were compared with 13 healthy preterm infants of comparable postconception age who had no infantile hemangioma. Pathologic placental changes were analyzed in both groups. Gross lesions with disturbance of the utero-placental circulation were found in all placentas from children who developed infantile hemangioma, including massive retroplacental hematoma in two infants, extensive ischemic infarction in seven, and large dilatated vascular communications, severe vasculitis, chorioamnionitis and funiculitis in four. Placental features included percentages greater than 25% of avascular villi, platelet and fibrin aggregates, and multifocal disease involving more than one histologic section. Examination of 13 placentas of low-birth-weight infants without infantile hemangioma only showed abnormal placentation in one and isolated villous dismaturity in two. The higher ratio of placental pathologic findings in patients with infantile hemangioma suggests that reduced placental oxygen diffusive conductance contributes to fetal hypoxic stress and that hypoxic/ischemic changes in the placenta could be related to infantile hemangioma development via vascular endothelial growth factor and placental growth factor expression, among others, within the villious vessels and throphoblasts. [source] Risk factors associated with preterm birth according to gestational age at birth,PHARMACOEPIDEMIOLOGY AND DRUG SAFETY, Issue 6 2008Benjamin D. Ofori PhD Abstract Purpose To identify and quantify risk factors associated with preterm birth, stratified by gestational age at birth. Methods Three case-control analyses were done. Controls were pregnancies of ,37,weeks of gestational age at birth. Cases were defined as: <28, 28,32, 33,,<37,weeks of gestational age at birth respectively in the three case-control analyses. Women were categorized according to whether they carried single or multiple infants. Results Obstetrical conditions (placenta previa, placental abruption), and maternal hypertension were significantly associated with preterm delivery in all case-control analyses (adjusted OR between 1.34,19.56, p,<,0.05). Leading risk factors for preterm delivery in singleton pregnancies were placental abruption and placenta previa (adjusted ORs 4.85 and 4.13, p,<,0.05). For multiple pregnancies they were polyhydramnios and maternal hypertension (adjusted ORs 4.39 and 2.45, p,<,0.05). Conclusions Obstetrical conditions during the pregnancy and maternal hypertension are important risk factors for preterm birth. Copyright © 2008 John Wiley & Sons, Ltd. [source] Sex differences in fetal growth responses to maternal height and weightAMERICAN JOURNAL OF HUMAN BIOLOGY, Issue 4 2010Michelle lampl Sex differences in fetal growth have been reported, but how this happens remains to be described. It is unknown if fetal growth rates, a reflection of genetic and environmental factors, express sexually dimorphic sensitivity to the mother herself. This analysis investigated homogeneity of male and female growth responses to maternal height and weight. The study sample included 3,495 uncomplicated singleton pregnancies followed longitudinally. Analytic models regressed fetal and neonatal weight on tertiles of maternal height and weight, and modification by sex was investigated (n = 1,814 males, n = 1,681 females) with birth gestational age, maternal parity, and smoking as covariates. Sex modified the effects of maternal height and weight on fetal growth rates and birth weight. Among boys, tallest maternal height influenced fetal weight growth before 18 gestational weeks of age (P = 0.006), and prepregnancy maternal weight and body mass index subsequently had influence (P < 0.001); this was not found among girls. Additionally, interaction terms between sex, maternal height, and maternal weight identified that males were more sensitive to maternal weight among shorter mothers (P = 0.003) and more responsive to maternal height among lighter mothers (P , 0.03), compared to females. Likewise, neonatal birth weight dimorphism varied by maternal phenotype. A male advantage of 60 g occurred among neonates of the shortest and lightest mothers (P = 0.08), compared to 150 and 191 g among short and heavy mothers, and tall and light-weight mothers, respectively (P = 0.01). Sex differences in response to maternal size are under-appreciated sources of variation in fetal growth studies and may reflect differential growth strategies. Am. J. Hum. Biol., 2010. © 2009 Wiley-Liss, Inc. [source] Fetal sex determination using circulating cell-free fetal DNA (ccffDNA) at 11 to 13 weeks of gestationPRENATAL DIAGNOSIS, Issue 10 2010Ranjit Akolekar Abstract Objective To examine the performance of a mass spectrometry-based detection platform using three Y-chromosome sequences for fetal sex determination from circulating cell-free fetal DNA (ccffDNA) in maternal blood in the first trimester of pregnancy. Methods We extracted ccffDNA for the determination of fetal sex from stored maternal plasma obtained at 11 to 13 weeks' gestation from singleton pregnancies with documented fetal gender. Mass spectrometry was used to examine 236 specimens for the presence of three Y-chromosome sequences (SRY, DBY and TTTY2). The sample was classified as male, female or inconclusive depending on the detection of three, one/none and two sequences, respectively. Results Three (1.3%) of the 236 cases were classified as invalid due to the absence of a well-defined spectral peak for TGIF and 22 (9.3%) were reported as inconclusive. In the 211 cases with a valid result, the fetal sex was correctly identified in 90 of 91 male babies and 119 of 120 female babies giving an accuracy of 99.1% and sensitivity and specificity for prediction of male fetuses of 98.9 and 99.2%, respectively. Conclusion Fetal sex determination can be accurately determined from maternal ccffDNA in the first trimester of pregnancy using mass spectrometry analysis. Copyright © 2010 John Wiley & Sons, Ltd. [source] Ultrasound screening for fetal aneuploidy using soft markers in the overweight and obese gravida,PRENATAL DIAGNOSIS, Issue 9 2010Lily J. Tsai Abstract Objective To determine the completion rate of ultrasound surveys for aneuploidy markers by maternal body mass index (BMI). Methods A retrospective review of ultrasounds on midtrimester singleton pregnancies was performed. Subjects were grouped as normal, overweight (BMI 25,29.9 kg/m2), and obese: class I (30,34.9 kg/m2), class II (35,39.9 kg/m2), and class III (, 40 kg/m2). Examinations with visualization of at least seven of eight markers were considered complete. Results Of 14 353 ultrasounds reviewed, 5690 patients were eligible: 43% normal, 29% overweight, 27% obese. Completion rates differed significantly between groups (64% normal, 64% overweight, 61% class I, 55% class II, 47% class III, p < 0.001). The screen positive rates (,1 marker) differed significantly overall (16% normal, 13% overweight, 15% class I, 12% class II, 10% class III, p < 0.02), but not for complete examinations (p = 0.42). Conclusions Since completion rates for ultrasound aneuploidy screening are inversely related to maternal obesity, obese women are underscreened. Copyright © 2010 John Wiley & Sons, Ltd. [source] Fetal tricuspid valve Doppler at 11,13 weeks and 6 days: reference values and reproducibilityPRENATAL DIAGNOSIS, Issue 8 2010Milena Almeida Prado Ninno Abstract Objective To determine normal blood flow velocities across the fetal tricuspid valve (TV) at 11,13 weeks and 6 days of gestation and to examine the reproducibility of these measurements. Methods A prospective study involving 166 normal singleton pregnancies examined at 11,13 weeks and 6 days was carried out. Descriptive analysis of E- and A-waves' maximum velocities, E/A ratio, duration of the cardiac cycle (C) and diastole (D) and D/C ratio were calculated. Intraobserver and interobserver agreement analysis was performed in a subgroup of 12 cases. Results Average ( ± SD) flow velocities were: E-wave, 25.0 ( ± 4.6) cm/s; A-wave, 42.9 ( ± 5.9) cm/s; E/A, 0.58 ( ± 0.07); cardiac cycle, 390 ( ± 21.1) ms; diastole, 147 ( ± 18) ms and D/C, 0.38 ( ± 0.04). Significant correlation was observed between all parameters (except A-wave) and gestational age but not with nuchal translucency (NT). Intraclass correlation coefficients (interobserver, intraobsever examiner 1 and intraobserver examiner 2) were: E-wave, 0.53, 0.53 and 0.64; A-wave, 0.45, 0.46 and 0.49; cardiac cycle, 0.70, 0.79 and 0.84 and diastole, 0.63, 0.85 and 0.82, respectively. Conclusions The present study establishes normal Doppler parameters for blood flow across the TV at 11,13 weeks and 6 days and demonstrates that these parameters do not correlate with NT measurement and have good/moderate reproducibility. Copyright © 2010 John Wiley & Sons, Ltd. [source] First-trimester serum marker distribution in singleton pregnancies conceived with assisted reproductionPRENATAL DIAGNOSIS, Issue 4 2010M. A. J. Engels Abstract Objective To evaluate marker distribution of free ,-human chorionic gonadotrophin (f,-hCG) and pregnancy-associated plasma protein-A (PAPP-A) in singleton pregnancies conceived by assisted reproduction techniques (ART). Methods In vitro fertilization (IVF) (n = 203) and intracytoplasmic sperm injection (ICSI) (n = 192) cases from a database of 14 645 first-trimester combined tests (overall study group) were selected and matched to 1164 controls for gestational age at sample date and maternal age. Results In the IVF group and ICSI group, lnPAPP-A was lower (IVF 6.74 vs 7.08; P = 0.0001; ICSI 6.59 vs 7.07; P = 0.0001) compared with the matched controls. Lnf,-hCG was lower in the IVF group (3.75 vs 3.90; P = 0.005) but not significantly different in the ICSI group (3.87 vs 3.93; P = 0.27). The computed correction factors for PAPP-A and f,-hCG were 1.42 and 1.17 for the IVF group and 1.56 and 1.05 for the ICSI group. The false-positive rate (FPR) in the IVF and ICSI group compared with the matched controls was higher (IVF 10.3% vs 8.6% and ICSI 10.9% vs 7.5%). In the overall age-biased [maternal age significantly lower compared with all ART and control groups] study group the FPR was 6.8%. Conclusion The increase in FPR in the ART groups can be explained by decreased PAPP-A values. Therefore, an adjustment in risk analysis for Down syndrome is suggested. Copyright © 2010 John Wiley & Sons, Ltd. [source] Fetal eyeball volume: relationship to gestational age and biparietal diameterPRENATAL DIAGNOSIS, Issue 8 2009Marwan Odeh Abstract Objective To measure and determine normal values of the fetal eyeball volume between 14 and 40 weeks of gestation. Methods The volume of the fetal eyeball was measured with three-dimensional ultrasound between 14 and 40 weeks of gestation using the VOCAL software. Only singleton pregnancies without fetal growth restriction, diabetes mellitus, hypertension or major fetal malformation were included. Results Over all, 203 women were studied. In 125 both eyeballs were measured while in 78 only one eyeball was measured. The volume of the eyeball correlated strongly with gestational age (right: R = 0.946, P < 0.001, n = 171. left: R = 0.945, P < 0.001, n = 156), and with the biparietal diameter (BPD) (right: R = 0.949, P < 0.001, n = 171. left: R = 0.953, P < 0.001, n = 156). Using regression analysis the best correlation between eyeball volume and the BPD were: square of right eyeball = ,0.180 + 0.187 BPD, square of left eyeball = ,0.182 + 0.187 BPD. Conclusions The volume of the eyeball has strong positive correlations with gestational age and BPD. Our data may be helpful in fetuses suspected of having eye anomalies. Copyright © 2009 John Wiley & Sons, Ltd. [source] Physiological distribution of placental growth factor and soluble Flt-1 in early pregnancyPRENATAL DIAGNOSIS, Issue 3 2008George Makrydimas Abstract Objective To examine the distribution of placental growth factor (PlGF), vascular endothelial growth factor (VEGF) and soluble VEGF receptor-1 (sFlt-1) in maternal and embryonic fluid compartments in early pregnancy. Method The concentrations of PlGF, VEGF and sFlt-1 were measured in coelomic fluid and maternal serum from 16 singleton pregnancies at 7.0,9.3 weeks. In six cases, amniotic fluid was also examined. Results The median concentration of PlGF was 14.1 (range 8.9,27.6) pg/mL in maternal serum, 13.9 (range 9.5,31.4) pg/mL in coelomic fluid and 8.9 (range 3.9,15.3) pg/mL in amniotic fluid. The concentration of PlGF increased between 7.0 and 9.3 weeks in maternal serum (p = 0.001) and decreased in coelomic and amniotic fluid (p = 0.001). The median concentration of sFlt-1 was 8561 (range 6724-10 673) pg/mL in coelomic fluid, 523 (range 244,986) pg/mL in maternal serum, 30 (range 12,83) pg/mL in amniotic fluid (p = 0.0001), and it did not change significantly with gestation. VEGF was undetectable in most of the samples, and therefore, no further analysis was performed. Conclusion PlGF and sFlt-1 are present in the maternal and fetal fluid compartments in very early pregnancy, and their distribution is consistent with their site of production and the local conditions of transport. Copyright © 2008 John Wiley & Sons, Ltd. [source] Maternal serum free-,-chorionic gonadotrophin, pregnancy-associated plasma protein-A and fetal nuchal translucency thickness at 10,13+6 weeks in relation to co-variables in pregnant Saudi womenPRENATAL DIAGNOSIS, Issue 4 2007Mohammed-Salleh M. Ardawi Abstract Objective To establish normative values and distribution parameters of first-trimester screening markers, namely, fetal nuchal translucency (NT), maternal serum free ,-human chorionic gonadotrophin (,-hCG) and pregnancy-associated plasma protein-A (PAPP-A), at 10 to 13+6 weeks of gestation in Saudi women and to evaluate the effect of co-variables including maternal body weight, gravidity, parity, fetal gender, twin pregnancy, smoking and ethnicity on these markers. Methods A cohort of Saudi women (first cohort n = 1616) with singleton pregnancies prospectively participated in the present study, and fetal NT together with maternal serum free ,-hCG and PAPP-A were determined at 10 to 13+6 weeks of gestation. The distribution of gestational age-independent multiples of the median (MoM) of the parameters was defined and normative values were established, and correction for maternal body weight was made accordingly. The influence of various co-variables was examined using the data collected from the first and the second (n = 1849) cohorts of women and 62 twin pregnancies, and compared with other studies. Results All markers exhibited log-normally distributed MoMs. Gestational age-independent normative values were established. Maternal body weight was corrected, particularly for maternal free ,-hCG and PAPP-A using standard methods. Fetal NT showed a negative relationship with increasing gravidity (r = ,0.296) or parity (r = ,0.311), whereas both free ,-hCG and PAPP-A exhibited a significant positive relationship. There was a significant increase in the MoM of free ,-hCG in female fetuses. Smoking decreased MoM values of free ,-hCG (by 14.6%; P < 0.01) and PAPP-A (by 18.8%; P < 0.001). Twin pregnancy showed significant increases in MoM values of free ,-hCG (by 1.87-fold) and PAPP-A (by 2.24-fold), with no significant changes in fetal NT MoM values. Fetal NT MoM values were lower in Africans and Asians but higher in Orientals, as compared to Saudi women (P < 0.05; in each case). MoM values (body weight-corrected) of free ,-hCG were 25.2% higher in Africans and 19.4% higher in Orientals but 6.8% lower in other Arabian and Asian (by 5.8%) women as compared to Saudi women (P < 0.05; in each case). Conclusions The normative values and distribution parameters for fetal NT, maternal serum free ,-hCG and PAPP-A were established in Saudi singleton pregnancies, the maternal body weight together with smoking, twin pregnancy and ethnicity being important first-trimester screening co-variables. Gravidity, parity and fetal gender are also considered to influence one or more of the first-trimester markers examined. Copyright © 2007 John Wiley & Sons, Ltd. [source] ADAM12-s in coelomic fluid and maternal serum in early pregnancyPRENATAL DIAGNOSIS, Issue 13 2006George Makrydimas Abstract Objectives ADAM12-s is a placental protein. In early pregnancy, reduced maternal levels of ADAM12-s have been reported in association with foetal trisomy 21 or 18 and in cases that subsequently develop pre-eclampsia and foetal growth restriction. The aim of this study is to investigate the distribution of ADAM12-s in early pregnancy by comparing its concentration in maternal serum, amniotic fluid and coelomic fluid. Methods Coelomic fluid was obtained by coelocentesis from 13 singleton pregnancies with live foetuses at 6.9,9.3 weeks of gestation. Maternal serum was also obtained in all cases and in six cases amniotic fluid was also obtained. The concentration of ADAM12-s was measured by dissociation enhanced lanthanide fluoro-immunoassay. Results The median concentration of ADAM12-s in maternal serum was 132.7 (range 33.8,254.5) ng/mL and in coelomic fluid it was 10.5 (range 1.3,15.8) ng/mL; there were no detectable levels in five of the six amniotic fluid samples. The concentration of maternal serum ADAM12-s increased significantly with gestation (r = 0.862, p < 0.0001). There was no significant association between coelomic fluid ADAM12-s and either gestation (r = 0.255, p = 0.401) or maternal serum ADAM12-s (r = 0.302, p = 0.316). Conclusion The distribution of ADAM12-s in maternal serum and the early embryonic fluid compartments is consistent with its syncytiotrophoblastic origin. Copyright © 2006 John Wiley & Sons, Ltd. [source] Maternal serum ADAM12 levels in Down and Edwards' syndrome pregnancies at 9,12 weeks' gestationPRENATAL DIAGNOSIS, Issue 8 2006Jennie Laigaard Abstract Background Maternal serum ADAM12 is reduced, on average, in early first-trimester Down and Edwards' syndrome pregnancies but the extent of reduction declines with gestation. Here we study levels at 9,12 weeks when the marker might be used concurrently with other established markers. Methods Samples from 16 Down and 2 Edwards' syndrome cases were retrieved from storage and tested together with 313 unaffected singleton pregnancies using a semi-automated time-resolved immuno-fluorometric assay. Results were expressed in multiples of the gestation-specific median (MoM) based on regression. Results The median in Down syndrome was 0.94 MoM with a 10th,90th centile range of 0.22,1.63 MoM compared with 1.00 and 0.33,2.24 MoM in unaffected controls (P = 0.21, one-side Wilcoxon Rank Sum Test). The two Edwards' syndrome cases had values 0.31 and 2.17 MoM. Conclusions ADAM12 cannot be used concurrently with other markers in the late first trimester. However, it does have the potential to be used earlier in pregnancy either concurrently with other early markers or in a sequential or contingent protocol. More data will be required to reliably predict the performance of either approach. Copyright © 2006 John Wiley & Sons, Ltd. [source] Nuchal translucency in dichorionic twins conceived after assisted reproductionPRENATAL DIAGNOSIS, Issue 6 2006P. W. Hui Abstract Objectives As opposed to biochemical markers of Down syndrome, nuchal translucency (NT) was once thought to be a more reliable screening marker for high order multiple pregnancies and pregnancies conceived after assisted conception. Recent data suggested that NT in singleton fetuses from assisted reproduction technology (ART) was thicker than those from singleton pregnancies. The present study compared the thickness of NT in dichorionic twins from natural conception and assisted reproduction. Methods A retrospective analysis for comparison of NT thickness on 3319 spontaneous singletons, 19 pairs of spontaneous twins and 27 pairs of assisted reproduction twins was performed. Results The median NT multiple of median (MoM) of spontaneous singletons was 1.00. For twins, the median NT MoM for pregnancies after assisted reproduction and natural conception were 1.02 and 1.07 respectively. There was no statistical difference in the NT thickness among the three pregnancy groups. Conclusion Contrary to the observed increase in NT in singleton pregnancies from assisted reproduction, the NT in dichorionic twins was comparable to the spontaneous ones. The mode of conception appears to impose differential influence on singletons and twins. Copyright © 2006 John Wiley & Sons, Ltd. [source] How painful are amniocentesis and chorionic villus sampling?,PRENATAL DIAGNOSIS, Issue 1 2006Akos Csaba Abstract Objectives To compare the levels of pain and anxiety associated with amniocentesis (AC), transabdominal chorionic villus sampling (TA-CVS), and transcervical chorionic villus sampling (TC-CVS). Methods We prospectively administered a questionnaire about pain and anxiety to 124 women undergoing AC, 40 undergoing TA-CVS, and 24 undergoing TC-CVS for singleton pregnancies. The level of pain was quantified with numerical and pictorial scales and the degree of anxiety was quantified with a numerical scale (0,100 in increments of 10). Results The mean pain score for TA-CVS, 41.4 ± 18.1, was significantly higher than that for TC-CVS, 26.4 ± 25.3, p = 0.008. The mean pain score for AC, 35.1 ± 27.6, was intermediate. A higher degree of anxiety was associated with younger maternal age and nulliparity. A higher degree of anxiety was associated with a higher level of pain. Conclusion In general, each procedure is associated with a tolerable amount of pain. TA-CVS appears to be the most painful procedure while TC-CVS appears to be the least painful procedure. In certain groups of patients, the procedures may be associated with higher levels of pain and/or anxiety. Copyright © 2006 John Wiley & Sons, Ltd. [source] Maternal serum biochemistry at 11,13+6 weeks in relation to the presence or absence of the fetal nasal bone on ultrasonography in chromosomally abnormal fetuses: an updated analysis of integrated ultrasound and biochemical screeningPRENATAL DIAGNOSIS, Issue 11 2005Simona Cicero Abstract Background Screening for trisomy 21 by a combination of maternal age, fetal nuchal translucency (NT) thickness and maternal serum free ,-hCG and pregnancy associated plasma protein-A (PAPP-A) at 11,13+6 weeks of gestation is associated with a detection rate of 90%, for a false-positive rate of 5%. Recent evidence suggests that in about 70% of fetuses with trisomy 21 the nasal bone is not visible at the 11,13+6 week scan and that the frequency of absence of nasal bone differs in different ethnic groups. In addition, there is a relationship between absent nasal bone and nuchal translucency thickness. In a preliminary study we showed that while PAPP-A levels were lower and free ,-hCG levels were higher in trisomy 21 fetuses with an absent nasal bone, this difference was not statistically different. In fetuses with trisomy 13 and trisomy 18, there is also a high (57 and 67%) incidence of an absent nasal bone. The aim of this present study was to extend our examination of whether the level of maternal serum biochemical markers is independent of the presence or absence of the nasal bone in cases with trisomy 21 and to ascertain if any differences exist in cases with trisomies 13 and 18. Methods This study data comprised 100 trisomy 21 singleton pregnancies at 11,13+6 weeks of gestation from our previous study and an additional 42 cases analysed as part of routine OSCAR screening. A total of 34 cases with trisomy 18 and 12 cases with trisomy 13 were also available. Ultrasound examination was carried out for measurement of fetal NT and assessment of the presence or absence of the fetal nasal bone. Maternal serum free ,-hCG and PAPP-A were measured using the Kryptor rapid random access immunoassay analyser (Brahms Diagnostica AG, Berlin). The distribution of maternal serum free ,-hCG and PAPP-A in chromosomally abnormal fetuses with absent and present nasal bone was examined. Results The nasal bone was absent in 29 and present in 13 of the new trisomy 21 cases and in 98 (69%) and 44 respectively in the combined series. For the trisomy 18 cases, the nasal bone was absent in 19 (55.9%) cases and in 3 (25%) of cases of trisomy 13. There were no significant differences in median maternal age, median gestational age, NT delta, free ,-hCG MoM and PAPP-A MoM in trisomy 21 fetuses with and without a visible nasal bone, and similarly for those with trisomies 13 or 18. For a false-positive rate of 5%, it was estimated that screening with the four markers in combination with maternal age would be associated with a detection rate of 96% of cases with trisomy 21. For a false-positive rate of 0.5%, the detection rate was 88%. Conclusions There is no relationship between an absent fetal nasal bone and the levels of maternal serum PAPP-A or free ,-hCG in cases with trisomies 13, 18 or 21. An integrated sonographic and biochemical test at 11,13+6 weeks can potentially identify about 88% of trisomy 21 fetuses for a false-positive rate of 0.5%. Copyright © 2005 John Wiley & Sons, Ltd. [source] Reference ranges for umbilical vein blood flow in the second half of pregnancy based on longitudinal dataPRENATAL DIAGNOSIS, Issue 2 2005Ganesh Acharya Abstract Objectives To construct new reference ranges for serial measurements of umbilical vein (UV) blood flow. Methods Prospective longitudinal study of blood flow velocities and diameter of the UV measured at four-weekly intervals during 19 to 42 weeks' gestation in 130 low-risk singleton pregnancies. Regression models and multilevel modeling were used to construct the reference ranges. Results On the basis of 511 sets of longitudinal observations, we established new reference percentiles of UV diameter, blood flow velocities, volume flow, and blood flow normalized for fetal weight and abdominal circumference. They reflected some of the developmental patterns of previous cross-sectional studies, but with important differences, particularly near term. The UV blood flow showed a continuous increase until term, whereas the flow normalized per unit fetal weight, a corresponding reduction. Calculating the blood flow on the basis of intensity-weighted mean velocity or 0.5 of the maximum velocity gave almost interchangeable results for most fetuses. Conclusion New reference ranges for UV blood flow based on longitudinal observations appear slightly different from cross-sectional studies, and should be more appropriate for serial evaluation of fetal circulation. Copyright © 2005 John Wiley & Sons, Ltd. [source] | ||||||||||||||||||||||||||||