Plasma motilin concentration in the second and third trimesters of pregnancy and postpartum

Plasma motilin concentrations were measured in 135 women during the second and third trimesters of pregnancy and 3～5 d after delivery and the results were compared with those of 20 healthy nonpregnant women.The mean plasma motilin concentration (323.96± 125.10 ng/L) in women during the second trimester of pregnancy was lower than in healthy nonpregnant women (366.12±96.23 ng/L) (P<0.05),but that was significantly higher than in women during the third trimester of pregnancy (121.04±27.00 ng/L) (P<0.01);the plasma motilin concentration in women during 3～5d after delivery (443.05±140.79 ng/L) was significantly higher than that in pregnant women (P<0.01).The results showed that pregnancy appears to have a profound inhibitory effect on plasma motilin,and this may partly be responsible for the gastrointestinal hypomotility associated with pregnancy.

Acquired methemoglobinemia in a third trimester puerpera and her premature infant with sodium nitrite poisoning:A case report

BACKGROUND The common cause of sodium nitrite poisoning has shifted from previous accidental intoxication by exposure or ingestion of contaminated water and food to recent alarming intentional intoxication as an employed method of suicide/exit.The subsequent formation of methemoglobin(MetHb)restricts oxygen transport and utilization in the body,resulting in functional hypoxia at the tissue level.In clinical practice,a mismatch of cyanotic appearance and oxygen partial pressure usually contributes to the identification of methemoglobinemia.Prompt recognition of characteristic mismatch and accurate diagnosis of sodium nitrite poisoning are prerequisites for the implementation of standardized systemic interventions.CASE SUMMARY A pregnant woman was admitted to the Department of Critical Care Medicine at the First Affiliated Hospital of Harbin Medical University due to consciousness disorders and drowsiness 2 h before admission.Subsequently,she developed vomiting and cyanotic skin.The woman underwent orotracheal intubation,invasive mechanical ventilation(IMV),and correction of internal environment disturbance in the ICU.Her premature infant was born with a higher-than-normal MetHb level of 3.3%,and received detoxification with methylene blue and vitamin C,supplemental vitamin K1,an infusion of fresh frozen plasma,as well as respiratory support via orotracheal intubation and IMV.On day 3 after admission,the puerpera regained consciousness,evacuated the IMV,and resumed enteral nutrition.She was then transferred to the maternity ward 24 h later.On day 7 after admission,the woman recovered and was discharged without any sequelae.CONCLUSION MetHb can cross through the placental barrier.Level of MetHb both reflects severity of the sodium nitrite poisoning and serves as feedback on therapeutic effectiveness.

Risk Stratification in Obstetrics: An Integrated Approach to Maternal Health

Introduction: Prenatal care is crucial for maternal and fetal health, highlighting the importance of obstetric risk stratification. This enables personalized care, avoiding unnecessary interventions and reducing costs. Conditions such as first trimester bleeding, spontaneous abortion, gestational trophoblastic disease, and ectopic pregnancy require specific approaches. Early identification of these complications is vital, especially in urgent and emergency obstetric cases, which demand immediate hospital attention. Objective: Comprehensive review of first trimester pathologies and gestational hypertension, focusing on obstetric risks and personalized prenatal management. Methods: Literature review on bleeding and gestational hypertension. Results: The study provides a detailed analysis of pathologies associated with first trimester uterine bleeding and hypertensive disorders, focusing on obstetric risk stratification. The main causes of maternal and fetal mortality are hypertensive disorders, hemorrhages, infections, childbirth complications, and abortion. Spontaneous abortion is common, with different classifications, ranging from threatened to missed abortion. Infected abortion is a severe complication. Brazil has restrictive abortion laws, but many unsafe abortions occur, resulting in high public health costs. Pharmacological treatment with misoprostol is a safe option. Other pathologies include gestational trophoblastic disease, ectopic pregnancy, and placenta previa. Preeclampsia and eclampsia are severe conditions requiring immediate treatment to avoid complications. Conclusion: Early identification and management of obstetric risk factors, such as uterine bleeding, are essential for positive maternal and fetal outcomes. A multidisciplinary approach is fundamental.

Spontaneous Abortions in the Second Trimester of Pregnancy: Research and Analysis of Factors Associated at Laquintinie Hospital in Douala

Introduction: Spontaneous abortion of the second trimester is an interruption of pregnancy with complete expulsion or not of the product of conception between 15 and 28 weeks of pregnancy without any maneuvers. The objective of our study was to determine the factors associated with second trimester spontaneous abortions at Laquintinie Hospital in Douala. Methodology for this purpose: We conducted a case-control study from January to May 2019 on pregnant women who may or may not have had spontaneous second trimester abortions. Results: In total we recorded 1609 pregnancies and recruited 184 patients, including 46 cases and 138 controls;which gave a frequency of spontaneous abortion in the second trimester of pregnancy of 2.85%. A correlative analysis showed that spontaneous abortions in the second trimester were associated with housewife status (OR = 2.89;CI = 1.21 - 6.79;p = 0.010), gestation > 5 (OR = 4.09;CI = 1.02 - 17.66;p = 0.040), multiparity (OR = 3.81;CI = 1.59 - 9.16;p = 0.002), history of endouterine maneuvers (OR = 5.64;CI = 2.43 - 13 .03;p = 0.000), malaria in pregnancy (OR = 3.99;CI = 1.1 - 14.76;p = 0.030), incompleteness on the second trimester ultrasound (OR = 2.37;CI = 1.18 - 4.70;p = 0.010), jolts when traveling (OR = 46.04;CI = 17.29 - 123.66;p = 0.000), long car journeys (OR = 7.05;CI = 1.99 - 27.77;p = 0.000). After logistic regression eliminating the confounding factors, only the following were associated with abortions: Multiparity (OR = 13.90;CI = 2.96 - 65.18;p = 0.000), endo uterine maneuvers (OR = 3.69;CI = 1. 01 - 13.44;p = 0.047), jolts when traveling (OR = 72.63;CI = 19.47 - 270.96;p = 0.000), long car journeys (OR = 15.41;CI = 2.7 - 85, 95;p = 0.000). Conclusion: Our study reveals that a set of factors contribute to the occurrence of spontaneous abortions in the second trimester of pregnancy in our context.

Predictive Value of the Neutrophil to Lymphocyte Ratio (NLR) to Predict the Development of Preeclampsia and Pregnancy Induced Hypertension at 1st Trimester

Introduction: Hypertensive disorder in pregnancy affects 4 to 6 percent of all pregnancies and carries risks for the both baby and the mother. Only a few groups of women who are at high-risk pregnancies are received prophylaxis Aspirin, more than 15 percent of women develop pre-eclampsia with a single minor risk factor. Methods: This descriptive cross-sectional study was conducted to compare the 1st trimester NLR value of normotensive, pregnancy induced hypertensive and pre-eclamptic pregnant women. The study was conducted with a sample of 416, antenatal patients who were admitted to ward 25, at Colombo North Teaching Hospital Ragama. Data was collected as separated three groups. NLR value was calculated separately and ANOVA test was used to analyze the 3 categorical data. Post HOC test was done to assess the multiple comparison. Results: The prevalence rates of pregnancy induced hypertension and pre-eclampsia among the pregnant women were 8.6% and 5.7%. The mean NLR values of normotensive group was 2.708, pregnancy induced hypertensive group was 2.650 and pre eclamptic group was 3.789. There was a significant difference in NLR value between pre eclamptic group and other two groups with P value of Conclusion: The 1st trimester NLR value of pre eclamptic patients significantly increased compared to normotensive women.

Gut microbiota dysbiosis in preeclampsia patients in the second and third trimesters

Background:Preeclampsia(PE)is a serious complication that affects maternal and perinatal outcomes.However,the mechanisms have not been fully explained.This study was designed to analyze longitudinal gut microbiota alterations in pregnant women with and without PE in the second(T2)and third trimesters(T3).Methods:In this nested case-control study,which was conducted at Nanjing Maternity and Child Health Care Hospital,fecal samples from 25 PE patients(25 fecal samples obtained in T2 and 15 fecal samples obtained in T3)and 25 matched healthy controls(25 fecal samples obtained in T2 and 22 fecal samples obtained in T3)were collected,and the microbiota were analyzed using 16S rRNA gene sequencing.The diversity and composition of the microbiota of PE cases and controls were compared.Results:No significant differences in diversity were found between the PE and control groups(P>0.05).In the control group,from T2 to T3,the relative abundances of Proteobacteria(median[Q1,Q3]:2.25%[1.24%,3.30%]vs.0.64%[0.20%,1.20%],Z=-3.880,P<0.05),and Tenericutes(median[Q1,Q3]:0.12%[0.03%,3.10%]vs.0.03%[0.02%,0.17%],Z=-2.369,P<0.05)decreased significantly.In the PE group,the relative abundance of Bacteroidetes in T2 was lower than in T3(median[Q1,Q3]:18.16%[12.99%,30.46%]vs.31.09%[19.89%,46.06%],Z=-2.417,P<0.05).In T2,the relative abundances of mircrobiota showed no significant differences between the PE group and the control group.However,in T3,the relative abundance of Firmicutes was significantly lower in the PE group than in the control group(mean±standard deviation:60.62%±15.17%vs.75.57%±11.53%,t=-3.405,P<0.05).The relative abundances of Bacteroidetes,Proteobacteria,and Enterobacteriaceae were significantly higher in the PE group than in the control group(median[Q1,Q3]:31.09%[19.89%,46.06%]vs.18.24%[12.90%,32.04%],Z=-2.537,P<0.05;1.52%[1.05%,2.61%]vs.0.64%[0.20%,1.20%],Z=-3.310,P<0.05;0.75%[0.20%,1.00%]vs.0.01%[0.004%,0.023%],Z=-4.152,P<0.05).Linear discriminant analysis combined effect size measurements analysis showed that the relative abundances of the phylum Bacteroidetes,class Bacteroidia and order Bacteroidales were increased in the PE group,while those of the phylum Firmicutes,the class Clostridia,the order Clostridiales,and the genus unidentified Lachnospiraceae were decreased in the PE group;and these differences were identified as taxonomic biomarkers of PE in T3.Conclusion:From T2 to T3,there was an obvious alteration in the gut microbiota.The gut microbiota of PE patients in T3 was significantly different from that of the control group.

Variation in Progesterone Levels and Urinary Tract Infections in Pregnant Women Attending Moi Teaching and Referral Hospital, Eldoret, Kenya

Background and Aims: Urinary tract infections (UTIs) are common among pregnant women and major predisposing factors for pyelonephritis linked to obstetrical complications including preterm labour and low infants’ birth weights. This study sought to determine the relationship(s) between pregnancy trimesters, UTIs and changes in progesterone levels among pregnant women. Materials and Methods: The study was conducted in 2016 at Moi Teaching and Referral Hospital (MTRH) antenatal clinic which is a referral facility that attends to patients from most Counties in western region of Kenya. A cross-sectional study design was used to collect blood and urine specimens from 78 participants. Blood was used to determine progesterone levels using ELISA technique and urine cultures with bacterial colony counts ≥ 105 were appropriately identified to species level. Trimester periods and participants’ demographic information were obtained using a structured questionnaire. Results: Culture results showed that the most abundant bacterial species isolated in urine from the pregnant women was Escherechia coli (63.7%). The more affected age-group was women between 30 - 39 years during trimester three, suggesting that bacterial colonization of genital track occurred more frequently in older compared to the younger women. There was an exponential increase in progesterone levels among the pregnant women during trimester three compared to other trimesters, although these increases occurred independent of age. However, high levels of progesterone among pregnant women in third trimester corresponded with increased number of E. coli causing UTI. Conclusion: The results showed that progesterone levels increase with trimester and the most prevalent bacteria associated with this was E. coli even though age and increase in progesterone levels had no significant impact on E. coli infection.

Iron versus Iron and Vitamin B6 Supplementation in Treatment of Iron Deficiency Anemia during Second Trimester of Pregnancy: Quasi Experimental Trial

Background: Anemia is one of the most prevalent complications during pregnancy. It is commonly considered a risk factor for poor pregnancy outcomes and can result in complications that threaten the life of both mother and fetus, such as preterm birth, and low birth weight. There is clear evidence to support prompt treatment in all patients with iron deficiency anemia because it is known that treatment improves quality of life and physical condition as well as alleviates fatigue and cognitive deficits. Objective: The aim of the study was to evaluate the value of addition of vitamin B6 to iron in treatment of iron deficiency anemia in pregnant women during the second trimester. Patients and Methods: The study was done by giving anemia pregnant women iron therapy and vitamin B6 which represent group A and iron therapy alone which represents group B. For each pregnant woman, age, parity and gestational history were taken before treatment. All pregnant women took their allocated treatment regularly for three weeks after diagnosis of iron deficiency anemia with complete blood picture and followed up after three weeks. Results: Results of the study revealed that there was no statistically significant difference between the two groups of therapy according to the hemoglobin level before treatment (p-value = 0.734), statistically significant higher mean value in after treatment than before treatment (p-value = 0.048), there was a significant difference in the rate of change of hemoglobin (p-value = 0.011) and body mass index (p-value 0.001). Conclusion: Iron and vitamin B6 seems to increase hemoglobin level more than iron only. Thus, in pregnant women with iron deficiency anemia iron plus vitamin B6 may be considered as a more effective alternative treatment than iron only.

Sex Hormones Secretion Pattern in Pregnant Sickle Cell Subjects in Niger Delta Region, South of Nigeria

Sickle cell anemia (SCA) patients are reported with infertility and low rate of pregnancies. This is associated with wide range of reproductive issues that are still relevant because of the complications and problems of the disease that still persist till date. This study was carried out to establish the secretion pattern of the sex hormones (Progesterone and Estradiol) in the three trimesters of pregnant sickle cell disease subjects in the Niger Delta Region, south of Nigeria. The study included twenty (20) pregnant sickle cell anemia subjects with average age of 27.4 years and twenty (20) apparently healthy (Hemoglobin AA) subjects with average age of 28.2 years. Their samples collection started when they registered for antenatal care at the clinics within the first trimester of pregnancy. The Enzyme Linked Immunosorbent assay (ELISA) method was used in the measurement of the hormones in the plasma of the subjects. The result showed a statistical significant reduction (P < 0.05) in the values of the hormones in the three trimesters obtained for the sickle cell disease (SCD) subjects when compared with apparently healthy subjects with the same age range. Statistical analysis showed a strong positive correlation ((r = 0.8151 for Estradiol and r = 0.8793) for Progesterone) between the secretion of the sex hormones, in the sickle cell subjects and the control. The result is attributed to the sickle cell gene abnormality and the treatment of SCA that affects the endocrine system by inhibiting the production of gonadotropins from the pituitary gland. The SCD itself does not directly damage the reproductive system;however it can affect other systems which will eventually cause harm to the reproductive system. The study concluded that the sickle cell anemia patients require the administration of the hormone drugs during pregnancy to prevent to a certain extent, complications arising from hormonal imbalance.

Validity of Different Methods to Prenatal Screening for Down’s Syndrom During First and Second Trimester Pregnancy of Chinese Women

Objective To identify and determine the optimal method to screening for fetal Down＇s syndrome （DS）. Methods Three large cohorts with 17 118, 39 903, 16 646 subjects were enrolled for the first trimester double marker （pregnancy-associated plasma protein A and free [B-human chorionic gonadotropin） screening （FTDMS）, second trimester double marker （c{-fetoprotein and free B-human chorionic gonadotropin） screening （STDMS）, and second trimester triple marker （a-fetoprotein, free 13-human chorionic gonadotropin and unconjugated estriol 3） screening （STTMS）, respectively. The sensitivity, specificity, false positive rate （FPR）, false negative rate （FNR） and the areas under ROC curves （AUCs） were estimated in order to determine the optimal screening method in women under or above 35 years old. Results For women under 35 years old, STTMS was the best method with a detection rate of 68.8% and FPR of 4.3% followed by the STDMS with a detection rate （sensitivity） of 66.7% and FPR of 4.9%. The FTDMS had a lower detection rate of 61.1% and FPR of 6.3%. For women above 35 years old, the detection rate of all the methods was similar, but STTMS method had a lowest FPR of 15.9%. For women under 35 years old AUCs were 0.77 （95% CI, 0.64 to 0.91）, 0.81 （95% CI, 0.71 to 0.91）, and 0.82 （95% CI, 0.69 to 0.96） for FTDMS, STDMS, and STTMS methods, respectively; for those above 35 years old, AUCs were 0.70 （95% CI, 0.56 to 0.83）, 0.70 （95% CI, 0.59 to 0.82）, 0.78 （95% Cl, 0.58 to 0.97） for FTDMS, STDMS and SITMS, respectively. Conclusion Findings from our study revealed that STDMS is optimal for the detection of fetal DS in pregnant women aged under 35. For individual women, if economic condition permits, STFMS is the best choice, while for women aged above 35, STTMS is the best choice in this regard.

Osteoprotegerin,interleukin and hepatocyte growth factor for prediction of diabetes and hypertension in the third trimester of pregnancy

BACKGROUND Gestational diabetes mellitus(GDM)raises the risk of high blood pressure and may cause a series of life-threatening complications in pregnant women.Screening and management of GDM and gestational hypertension(GH)in pregnancy helps to control and reduce these risks and prevent adverse effects on mothers and their fetuses.Currently,the majority criteria used for screening of diabetes mellitus is oral glucose tolerance tests,and blood pressure test is usually used for the screening and diagnosis of hypertension.However,these criteria might not anticipate or detect all GDM or GH cases.Therefore,new specific predictive and diagnostic tools should be evaluated for this population.This study selected three biomarkers of osteoprotegerin(OPG),interleukin(IL)and hepatocyte growth factor(HGF)for GDM and GH predication and diagnosis.AIM To explore the feasibility of changes in placental and serum OPG,IL and HGF as tools for prediction and diagnosis of diabetes and hypertension in pregnant women.METHODS From January 2018 to January 2019,44 pregnant women with GDM and GH were selected as an observation group,and 44 healthy pregnant women were selected as a control group in the same period.Serum OPG,IL and HGF were compared between the two groups.RESULTS The levels of OPG and HGF in the observation group were lower than in the control group,and the level of IL-1βwas higher in the observation group than in the control group(all P<0.05).Furthermore,OPG and HGF were negatively associated with gestational diabetes and gestational hypertension,while IL-1βwas positively associated with GDM complicated with GH(all P<0.05).CONCLUSION The evaluation of serum OPG,HGF and IL-1βlevels in patients with coexistent gestational diabetes complicated with hypertension can predict the degree of disease and play an important role in the follow-up treatment and prognosis prediction.

The Effects of Fetal Movement Counting on Mental Health of Mother in Third Trimester A Randomized Controlled Trial

Anxiety is one of the psychological problems in pregnant women that sometimes takes the form of pathological and affects the mental health of mother. The aim of this study was to determine the effects of fetal movement counting on mental health of mother. In a randomized-controlled trial, 208 nulliparous women were randomly divided into two groups. At 28th weeks, both groups completed the GHQ-28. Then the intervention group started to count fetal movements from 28th to 37th weeks of gestation and the control group received routine prenatal care. Again, both groups completed the questionnaire at 37 weeks＇ gestation and the results were compared. Analysis was performed by SPSS and a P value 〈 0.05 was considered significant. The mean scores of mental health of mothers in 28th and 37th of pregnancy was respectively 23.52 ± 10.23 and 21.09 ± 10.12 in the intervention group and the difference was significant （P = 0.025）. The mean in the control group was 23.69 ± 9.43 and 23.88± 8.60 respectively, and the difference was not significant （P = 0.52）. In comparing the mean scores between the two groups, it was found that the difference was not significant at 28th weeks of gestation （P = 0.37）, but it was significant in 37th week （P = 0.002） and the counting of fetal movements could improve the mental health of mothers compared to control group. The women who had fetal movements counting at weeks 28 to 37 Of gestation reported better mental health than the control group. The mother renorted concerns about decreased fetal movement was similar in the two grouns.

Assessment of fetus during second trimester ultrasonography using HDlive software:What is its real application in the obstetrics clinical practice?

AIM To show imaging results from application of fourdimensional(4D) ultrasound lightening technique(HDlive^(TM)) in clinical obstetrics practice. METHODS Normal and abnormal fetuses at second and third trimester of pregnancy undergoing routine scan with 4D HDlive^(TM)(5DUS) in the rendering mode are described. Realistic features of fetal structures were provided by 5DUS in the rendering mode. Normal anatomy as well as pathology like cleft lip, hypoplastic face, micrognathia, low-set ears, corpus callosum, arthrogryposis, aortic arch, left congenital diaphragmatic hernia are highlighted in this study. Anatomical details of the fetuses were provided by 5DUS with higher quality imaging modality compared to those obtained using conventional 2D/3D ultrasound. RESULTS Realistic views of fetal anatomy details were displayed by means of 5DUS in the rendering mode, with high image quality obtained either in low-risk or in high-risk obstetrics population. Corpus callosum, esophagus, and aortic arch were obtained in normal fetuses. Cleft lip, cleft lip and palate, micrognathia, hypoplastic face, lowset ears, arthrogryposis, left congenital diaphragmatic hernia, exomphalos, and clitoris hypertrophy were clearly rendered by 5DUS application.CONCLUSION The use of 5DUS in the rendering mode, when clinical available, was diagnostic in a variety of congenital anomalies, aided understanding of the parents-tobe and improved prenatal counseling and perinatal management.

Role of Oral Misoprostol in First Trimester Abortion: A Prospective Study at CMH, Dhaka, Bangladesh

Background: Misoprostol has been used for medical abortion. We conducted this prospective study to see the efficacy of oral misoprostol in our tertiary Hospital. Objective: Objective of this study was to assess the efficiency, safety and compliance of misoprostol in first trimester abortion. Materials and Methods: This prospective study was undertaken in obstetrics and gynecology dept of CMH Dhaka, Bangladesh from July 2014 up to Dec 2014. A total 50 patients of incomplete abortion (54%), missed abortion (30%), anembryonic pregnancy (14%) and inevitable abortion (2%) of s of gestation were the targeted population. Study population was diagnosed from history, physical examination and ultrasonogram had received 600 microgram misoprostol orally. If the pregnancy was not completely evacuated at this time another dose of misoprostol was given. All women returned for follow-up care 7 days later. If the pregnancy was not completely evacuated at this time, women underwent immediate surgical evacuation. Efficacy was defined as the percent of women discharged from the study without need for surgical intervention. Results: 30 patients had complete evacuation after 1st dose, 12 cases needed 2nd dose and only 2 cases needed 3rd dose. Remaining 6 cases needed surgical evacuation. Efficacy was satisfactory (85%) and analysis revealed statistically significant (p 0.05). Conclusion: Management of first trimester abortion with oral misoprostol is highly effective and highly acceptable.

Quality Control of First Trimester Ultrasound Examinations in the Gynecology and Obstetrics Department of the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou, Burkina Faso

Objective: To evaluate the quality of first trimester ultrasound examinations in patients consulting in the gynecology and obstetrics department at the University Teaching Hospital Yalgado Ouedraogo (UTH-YO) of Ouagadougou. Method: Our study took place from January 1st to March 31st 2017, in the department of Obstetrics and Gynecology of the University Teaching Hospital Yalgado Ouedraogo of Ouagadougou. This was a descriptive study on the records of the first trimester ultrasound of pregnancy, with analysis of the iconography. We used the criteria of the Technical Committee of Fetal Echography (TCFE) of France to analyse all the ultrasound reports brought by the patients. Results: Two hundred reports were collected in three months. In terms of ultrasound identification, only 2 reports out of 200 mentioned the brand and date of first circulation and 4 specified the type of device. The study of the quality of the appointment showed that only 52% of the ultrasounds had been performed at the right time, between 11SA - 14SA of amenorrhea. For the nuchal translucency quality, we rated by the Herman score, 41.67% of the scores were of “unacceptable” quality and only 58.33% were of “acceptable” quality we did not achieve “excellent” quality. The analysis of the biparietal diameter (BIP) cuts revealed that 1/4 only anatomical cuts had been well made. Analysis of the cranio caudal length (CCL) cuts showed that only 14.58% of the CCLs had been well done. Elements of early morphology had been explored to less than 5%. Conclusion: The results revealed the acceptable quality of the NC measurements, but a small proportion of NC achieved. The quality of the ultrasound, morphological analysis and biometrics period is not very acceptable.

Methods of Abortion in First and Second Trimester

Background: Medical and surgical methods are available for abortions in both the first and second trimester. Aim: To review the evidence base and current recommendations for available methods of abortions in first and second trimesters. Methods: Extensive literature search and review of available guidelines?were?done. Results: In the first trimester, medical methods are recommended below 7 weeks gestation while vacuum aspiration is an appropriate method between 7 to 12 weeks gestation. In the second trimester, the three methods of abortion available are dilatation and evacuation, intrauterine instillation of abortifacients and administration of systemic abortifacients. Conclusion: The choice of techniques depends on many factors including uterine volume, operator experience, patient preference, medical history and indication for abortion.

The Third Trimester Bleeding at the Department of Obstetrics and Gynecology of the Teaching Hospital Souro Sanou of Bobo Dioulasso. About 105 Cases and Review of Literature

Objective: To learn the epidemiological, clinical, paraclinical, therapeutical aspects and prognosis of haemorrhage of the third trimester during pregnancy. Methodology: It is about a transversal and descriptive study, realized at the department of obstetrics and gynaecology from January 1st to June 30th 2020. Was included in the study any pregnant patient showing the third trimester bleeding (≥28 Weeks gestation) received for bleeding during our study period and has been taken in charge in our department. The parameters studied were on the socio-demographic characteristics, the clinical and para clinical aspects, the noted diagnosis, the therapeutic aspects, maternal and perinatal prognosis. The information was collected from an inquiry document, the clinical files, the register of delivery room and childbirth, surgery protocols. The type and the analysis of the data were done by the softwares Word, Excel 2013 and Epi Info version 7.2.3. Results: We registered 2159 deliveries and 105 cases of third trimester bleeding, so a frequency of 4.86%. The average age was 30.14 ± 6.57 [16 - 49 years old] and the average parity was 3 [0 - 10]. Married women represented 87.62% of all. They were in a bad condition in 41.90% of cases. Fetal heart-sound was absent in 65.76% of cases. The diagnosis checked was abruptio placenta, placenta previa and the uterus rupture. A blood transfusion of concentrated red blood cells Isogroup and Isorhesus was performed to 45.72% of cases. Caesarean section was performed in 54.29% of cases. Complications were observed in 74.28% of cases. The maternal lethality rate was 13.33% with a perinatal mortality of 74.77%. Conclusion: The third trimester bleeding is frequent in developing countries because of poor obstetric coverage in this country. The perinatal prognosis is often bad because of late diagnosis, difficult access to Health Center with adequate technical platforms, miss of blood products and miss of qualified staff to take in charge these emergencies.

Termination of a partial hydatidiform mole and coexisting fetus: A case report

BACKGROUND We describe the treatment strategy for a patient who was found to have a partial hydatidiform mole and coexisting fetus(PHMCF)during the second trimester.The patient was a 38-year-old Chinese woman who had become pregnant following in vitro fertilization and embryo transplantation.We wanted to determine the safest therapeutic strategy to terminate the PHMCF during the second trimester.CASE SUMMARY In this case,we present a patient who was found to have a PHMCF complicated with serious continuous vaginal bleeding and pre-eclampsia during the second trimester.After careful evaluation,the pregnancy was considered to be unsustainable and was terminated via caesarean section(CS).An infant with weak vital signs and a partially cystic placenta measuring 110 mm×95 mm×35 mm were delivered by CS.The patient was discharged after 4 d.The serum levels ofβ-human chorionic gonadotropin decreased to within a normal range 5 wk after the operation,and no evidence of persistent trophoblastic disease or lung metastases was noticed at the 6-mo follow-up.CONCLUSION CS termination of PHMCF during the second trimester may be a relatively safe therapeutic strategy.

Cervical Ripening in the Third Trimester of Pregnancy with Intravaginal Misoprostol: A Double-blind, Randomized,Placebo-controlled Study

To evaluate the safety and efficacy of intravaginal misoprostol for cervical ripening in the third trimester, a randomized, double-blind, placebo-controlled trial was conducted in 85 patients indicated for induction of labor and with unfavorable cervices. They were randomly assigned to receive either intravaginal misoprostol (100 mg) or placebo placed in the posterior vaginal fornix. The Bishop score, fetal heart rate and Doppler blood flow velocity waveforms were measured before and 12 h after drug administration. Placenta and decidu were histopathologically observed in some cases. Among 85 patients enrolled, 43 received misoprostol and 42 received placebo. Whereas the mean initial Bishop scores were not significantly different between the two growps, the mean Bishop score in misoprostol group was significantly better than those in placebo group.The mean change in Bishop score was also significantly different (4. 4 for misoprostol versus 1. 0 for placebo, P<0.01 ). The prevalence of spontaneous onset of labor within 12 h after drug insertion in misoprostol group (67. 4%, 29/43)was significantly higher than that in placebo group (14. 3%, 6/42), P<0.01.The average DOppler velocity systolic to diastolic (S/D) ratios of umbilical artery,middle cramal artery, renal artery were not significantly different before and 12 h after drug insertion between both groups. There was no significant difference in frequency of abnormal fetal heart rate tracings or fetal distress and in the mean Apgar scores between the two groups. Except the presence of vasodilation in villi vessels in the misoprostol group, the placental and decidual histopathological changes had no significantly difference between two groups. It is concluded that intravaginal misoprostol may be an effective and safe cervical ripening agent in the third trimester of pregnancy.

Association between exposure to particulate matter during pregnancy and birthweight:a systematic review and a metaanalysis of birth cohort studies

Studies of the associations between maternal exposure to particulate matter(PM) and risk of adverse effects on fetal growth are inconsistent and inconclusive. This question can be well answered by carefully designed birth cohort studies; however, so far the evidence from such studies has not come to the same conclusion. We sought to evaluate the association between maternal exposures to PM and low birthweight(LBW) enrolling 14 studies from 11 centers,and to explore the influence of trimester and exposure assessment methods on between-center heterogeneity in this association. Data were derived from PubMed, Embase, Google Scholar, CNKI, and WanFang database, references from relevant articles, and results from published studies until March 2017. Using a random-effects meta-analysis, we combined the coefficient and odds ratios(OR) of individual studies conducted among 14 birth cohort studies.Random-effect meta-analysis results suggested that a 17% and 6% increase in risk of LBW was relevant to a 10 μg/m^3 rise in PM_(2.5) and PM_(10) exposure concentrations at the 3 rd trimester(pooled odds ratios(OR), 1.17 and 1.06; 95%confidence interval(CI), 0.94-1.46 and 0.97-1.15, respectively), but the null value was included in our 95% CI. Our results showed that exposure to PM_(2.5) and PM_(10) during pregnancy has a positive relevance to LBW based on birth cohort studies. However, neither reached formal statistical significance. Negative impacts on outcomes of birth is implied by maternal exposure to PM. Further mechanistic researches are needed to explain the connection between PM pollution and LBW.