The effect of maternal forced exercise on central disorders in offsprings has been shown but the mechanism is still unclear. In this study, the role of 5-HT2 and D2 receptors in neuroprotective effects of maternal forced exercise on offspring neurodevelopment and neurobehavioral symptoms is evaluated. Sixty pregnant rats were trained by forced exercise and some behavioral and molecular aspects in their offspring were evaluated in presence of 5-HT2 and D2 receptors agonists and antagonists. The results showed that maternal forced exercise causes increase of pain tolerability and increase latency of pain perception in offspring in hot plate test, writhing test and tail flick test. Also maternal forced exercise causes decrease of depression and anxiety like behavior in offsprings. On the other hand, treatment of mothers by forced exercise in combination with 5-HT2 and D2 receptor antagonists inhibited the protective effects of forced exercise and cause disturbance in pain perception and tolerability and increase depression and anxiety in offsprings. Also expression of cyclic AMP response element binding protein (CREB) was changed in all experimental groups. In conclusion, our data suggested that maternal forced exercise causes neurobehavioral protective effect on offsprings and this effect might probably be mediated by 5-HT2 and D2 receptors and activation of CREB gene expression. Keywords: Maternal forced exercise, Pain perception, Motor activity, Anxiety, Depression
To investigate the performance of first-trimester screening for chromosomal abnormalities by integrated application of nuchal translucency thickness (NT), nasal bone (NB), tricuspid regurgitation (TR) and ductus venosus (DV) flow combined with maternal serum free β-human chorionic gonadotropin (fβ-hCG) and pregnancy-associated plasma protein-A (PAPP-A) at a one-stop clinic for assessment of risk (OSCAR).In total, 13,706 fetuses in 13,437 pregnancies were screened for chromosomal abnormalities during a period of 5 years. Maternal serum biochemical markers and maternal age were evaluated in combination with NT, NT + NB, NT + NB + TR, and NT + NB + TR + DV flow data in 8581, 242, 236 and 4647 fetuses, respectively.In total, 51 chromosomal abnormalities were identified in the study population, including 33 cases of trisomy 21, eight of trisomy 18, six of sex chromosome abnormality, one of triploidy and three of other unbalanced abnormalities. The detection rate and false-positive rate (FPR) for trisomy 21 were 93.8% and 4.84%, respectively, using biochemical markers and NT, and 100% and 3.4%, respectively, using biochemical markers, NT, NB, TR and DV flow.While risk assessment using combined biochemical markers and NT measurement has an acceptable screening performance, it can be improved by the integrated evaluation of secondary ultrasound markers of NB, TR and DV flow. This enhanced approach would decrease the FPR from 4.8 % to 3.4 %, leading to a lower number of unnecessary invasive diagnostic tests and subsequent complications, while maintaining the maximum level of detection rate. Pre- and post-test genetic counseling is of paramount importance in either approach.
Objectives Shortening of the fetal long bones is a sonographic soft marker for screening of Down syndrome in the second trimester that can be influenced by ethnicity. The purpose of this study was to provide normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population. Methods This cross-sectional study was performed on 3011 singleton fetuses at 15 to 28 weeks' menstrual age. The relationship between menstrual age and both femur and humerus diaphysis length was determined, and percentile values for each menstrual week were provided. Results The median femur diaphysis length ranged from 18.05 mm at 15 menstrual weeks to 52.20 mm at 28 menstrual weeks, and the mean humerus diaphysis length ranged from 17.65 mm at 15 menstrual weeks to 48.10 mm at 28 menstrual weeks. There was a linear relationship between menstrual age and both femur diaphysis length (R2 = 0.957) and humerus diaphysis length (R2 = 0.941). Conclusions We have provided normal reference ranges for femur and humerus diaphysis length during the second trimester of pregnancy in an Iranian population.
Objective: Amniocentesis and chorionic villus sampling (CVS) are the most widely used prenatal diagnostic methods. Despite their benefits, they can be associated with adverse pregnancy effects, but the exact prevalence of these complications especially in twin pregnancies is not exactly known. Therefore, the present study was conducted to determine post-amniocentesis or CVS complications in twin pregnancies. Materials and methods: This retrospective observational study was conducted on 187 pregnant women who underwent amniocentesis or CVS in the perinatology department of Yas Hospital affiliated with Tehran University of Medical Sciences from January 2011 to March 2020. All participants were evaluated with amniocentesis or CVS by an expert perinatologist. The study outcomes were considered as the occurrence of vaginal bleeding, rupture of the membranes, chorioamnionitis, and abortion. Results: The mean age of women was 33.5 ± 6.5 years. About 90 % of pregnant women underwent amniocentesis and the others underwent CVS. In 132 (70.6%) pregnant women, the most common indication for diagnostic prenatal tests was having high-risk first/second-trimester screening followed by abnormal ultrasound anomaly scan in 31 (16.6%) cases. It was also found that in 80 (42.8%) patients, the placenta site was in the anterior part and 65 (34.8%) in the posterior part. The diagnostic test results were normal in 170 (90.4%) cases, while trisomy 21 was detected in 13 (7%) cases and trisomy 13 in 4 (2.1%) cases. The rate of abortion following CVS or amniocentesis in twin pregnancies was 3.7%, which was not associated with the study variables. Conclusion: The results of the present study showed that the rate of miscarriage following amniocentesis and CVS in twin pregnancies is 3.7%. Therefore, reassuring the parents about the benefits of amniocentesis or CVS rather than their rare complications is necessary.
Predicting late-onset foetal growth restriction (FGR) has proven to be rather challenging. In this study, we propose a new parameter, cerebral-placental-uterine (CPU) ratio and umbilico-cerebral (UC) ratio for this matter. Results of this study which included a total of 227 nulliparous women showed that an increase in CPU ratio (OR = 0.45; 95% CI: 0.23-0.88; p=.020) was associated with lower odds of foetal weight above the 10th percentile at birth. CPU ratio measured at 35-37 weeks of gestation had an AUC of 0.78 (95% CI: 0.58, 0.98), sensitivity of 0.62 (95% CI: 0.24, 0.91) and specificity of 0.90 (95% CI: 0.79, 0.96) for prediction of late-onset FGR, which showed higher accuracy than UC ratio. As some cases of the late-onset FGR are not diagnosed by foetal biometry, it is important to find Doppler parameters that can help us predict these cases and CPU ratio may help physicians in detection of high-risk foetuses that will benefit from earlier intervention. Impact StatementWhat is already known on this subject? Late-onset foetal growth restriction (FGR) defined by an FGR diagnosis after 32 weeks of gestational age, can lead to short- and long-term morbidities and early diagnosis is the key to prevent these complications.What do the results of this study add? Results showed that each unit increase in numeric variables including CP ratio (OR = 0.29, p=.006), and CPU ratio (OR = 0.40, p=.006) was associated with lower odds of the foetal weight above the 10th percentile in the second ultrasound at 35-37 weeks. In other words, CPU ratio can prove to be useful marker in prediction of late-onset FGR.What are the implications of these findings for clinical practice and/or further research? Our prospective cohort study confirms the added value of low CPU ratio, with higher predictive accuracy than UC ratio, in predicting late-onset FGR. Detection of late FGR remains poor, but it is important to prevent stillbirth so further studies on the role of CPU ratio in predicting FGR and perinatal outcomes are needed.
Our aim was to compare different thresholds of middle cerebral artery peak systolic velocity (MCA-PSV) and amniotic fluid delta optical density (Delta-OD) with fetal hemoglobin (Hb) during first and second intrauterine transfusions (IUT).We determined serial MCA-PSV and Delta-OD in 27 red blood cell alloimmunized fetuses who needed IUT. Before the second IUT, MCA-PSV was measured. The sensitivity and specificity of MCA-PSV and Delta-OD were calculated and compared with fetal hemoglobin levels.From 27 fetuses, first time IUT MCA-PSV with a normal median value (MOM) cutoff of > 1.29 detected 60% of the moderate and 100% of the severe anemia cases. MCA-PSV of MOM > 1.5 detected none of the moderate and 93% of severe anemia cases. Delta-OD detected 50% of moderate anemic and 80% of severe anemic cases. At the second IUT, 91% of severe anemia cases were confirmed by MCA-PSV with MOM > 1.5 whereas MCA-PSV with MOM > 1.29 confirmed all cases. One case of moderate anemia was de-tected by MCA-PSV of MOM > 1.29 and none were detected by MCA-PSV with MOM > 1.5.Different thresholds of MCA-PSV have higher sensitivity and specificity for detecting moderate and severe fetal anemia compared with Delta-OD. It also has a high sensitivity at the second IUT.
Abstract Background To evaluate the perinatal outcomes in women with complicated monochorionic diamniotic twins who underwent selective reduction using radiofrequency ablation (RFA). Methods This retrospective study included patients with complicated monochorionic diamniotic twins between 16 to 28 weeks who underwent selective reduction using RFA. Results During the study period, 143 women with complicated monochorionic twins underwent RFA including 52 with selective fetal growth restriction (sFGR), 48 with twin to twin transfusion syndrome (TTTS), 33 with major fetal anomalies in one of the twins, and 10 with reversed arterial perfusion sequence (TRAP). The overall survival was 71.3% (102/143). The procedures were technically successful in achieving selective termination in all cases. The mean ± SD of gestational age at the time of the procedure was 21.0 ± 2.3 weeks. The mean ± SD of gestational age at delivery was 34.6 ± 3.3 weeks. The mean ± SD of overall procedure-to-delivery time was 12 ± 1.7 weeks. The pregnancy success rates among sFGR, TRAP, TTTS and anomaly groups were 82.7, 80, 73 and 60.7% respectively. There were no maternal complications. Conclusion Radiofrequency ablation for fetal reduction in complicated monochorionic twin pregnancies appears to be a reasonable option. The pregnancy success rate following RFA selective reduction was highest among sFGR and TRAP groups and lowest in the anomaly group.
As widespread prophylaxis with anti-D Antibodies has dramatically diminished anti-D-associated hemolytic disease of the newborn (HDN), other antibodies-associated HDN has become relatively more significant. Two genes encode Rh proteins: the RhD gene coding for the D and the Rh CcEe gene coding for Cc Ee Antigens. D is a rare Rh phenotype in which RBCs lack Cc/Ee antigens while D antigen is strongly expressed. Anti R17 antibodies are important monomorphic antibodies acting against all previously mentioned antigens. It can pass through the placenta as a G immunoglobulin, leading to fetal or neonatal hemolysis. Here, we reported an immunized pregnant female with D- - phenotype and a history of intrauterine fetal death who had high titer of anti-Rh17 antibodies in her subsequent pregnancy. We would discuss our management strategy which led to good perinatal outcomes. To the best of our knowledge, this is the second case of HDN reported in English written literature in Iran.
Diffusion-weighted imaging (DWI) measures water molecules diffusivity through tissues and can be quantitatively expressed as an apparent diffusion coefficient (ADC) value. Changes anticipated in the brain tissue following death are initial tissue ischemia followed by cell lysis and membrane breakdown. However, there is limited data about brain ADC changes in fetal post mortem setting especially in delayed phase. We collected intrauterine magnetic resonance imaging (MRI) of all monochorionic pregnancies underwent radiofrequency ablation (RFA), referred to our centre from April 2018 to November 2020 because the exact time of intrauterine death can be achieved in RFA setting. Two large regions of interests (ROI) were manually placed on bilateral hemispheres of both dead and living fetuses on ADC map while avoiding adjacent structures (as CSF space) and average of ADCs were calculated. The fetuses were classified based on the post mortem interval (PMI) between MRI and RFA into two groups: A) Early (≤3 weeks) and B) late. We included 46 fetuses (37 in group A and 9 in group B). All dead fetuses in group A showed brain restriction with mean ADC values of 744±310×10-6 mm2/s (ADC values of living fetuses in this group was 1640±202×10-6 mm2/s). Mean ADC values in group B was 951±394.1 ×10-6 mm2/s (ADC values of living fetuses in this group was 1578.6±189.2×10-6 mm2/s). The mean of PMI in group A was 5.9±1.3 days (range: 1-17 days) and in group B was 34± 9.2 days (range: 20-46 days). Only two (22.2%) fetuses in group B showed no brain restriction and PMI in these fetuses was about 6–7 weeks. These data indicate that in post mortem brain as in post stroke setting, parenchymal restriction and low ADC values can persist long time after brain death. Although the ADC values were higher in group B, we did not find significant difference between ADC values of two groups.
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