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.

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.

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.

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.

Median mitral valve technique in the second trimester with zero contrast intraoperative nursing

Summarized a case of intraoperative nursing experience in a second-trimester patient with mitral bioprosthetic valve destruction undergoing median mitral valve technique with zero contrast agent.In this case,a patient with 18 weeks of intrauterine pregnancy after artificial insemination,who had a sudden palpitation,was sent to the hospital in an emergency and diagnosed with severe intravalvular regurgitation and severe pulmonary hypertension after mitral artificial biological valve replacement.A treatment plan was developed after the systematic and comprehensive evaluation of the condition of the patient under a multi-disciplinary combination.Intraoperative nursing cooperation,patient condition monitoring,fetal X-ray protection,prevention of massive bleeding,sudden arrhythmia,and other emergency rescue cooperation were implemented in the processing of surgery,and no intraoperative nursing complications occurred.The patient recovered and was discharged from the hospital.The pregnancy was terminated by cesarean section after full term and the newborn survived with no deformity.

Genetic counseling, prenatal screening and diagnosis of Down syndrome in the second trimester in women of advanced maternal age： a prospective study

Background The incidence of autosomal trisomy in livebirths is strongly dependent on maternal age. Special consideration is given to the provision of prenatal screening and cytogenetic testing to women of advanced maternal age （AMA）. The aim of this study was to evaluate the effectiveness of second trimester prenatal screening and amniocentesis for Down syndrome （DS） and compare the trends of choice of screening and amniocentesis among AMA women. Methods A total of 5404 AMA patients with natural singleton pregnancy were recruited for this prospective study from January 2008 to December 2010. The gestational weeks were from 15 weeks to 20~6 weeks. The patients referred were grouped into a screening group （2107 cases） and an amniocentesis group （3297 cases） by their own decision. The prevalence of DS was compared between the two groups by chi-square test. Choice rates for each maternal age with trends were compared by regression analysis. Results There were 18 cases of fetal DS detected in the screening group with a prevalence of 8.54%o （18/2107）. Twenty- five cases of fetal DS were diagnosed in the amniocentesis group with a prevalence of 7,58%0 （25/3297）. No statistical difference was observed in the prevalence of DS between the screening and amniocentesis group （P=0.928）. The invasive testing rate for DS in the amniocentesis group was 5.54 times higher than that of the screening group （1/131.88 vs. 1/23.78）. With the increase of the maternal age, the choice of amniocentesis increased while the choice of the screening showed an opposite trend. The choice of the AMA women between the screening and amniocentesis was significantly age relevant （P=0.012）. Conclusions The second trimester serum screening age alone to screen for DS. We suggest educating screening and amniocentesis options. in combination with maternal age was more effective than maternal the patients by recommending AMA women be informed of both

Clinical analysis of laparoscopic surgery for ovarian masses under different conditions during the second trimester

Background Laparoscopic surgery in pregnant women has become increasingly more common; however, the safety of laparoscopy in this population has been widely debated in emergent situations and big size at bigger pregnant weeks. This study was to determine the characteristics of laparoscopic surgery for adnexal masses in different conditions during the second trimester of pregnancy. Methods Between April 2002 and December 2011, 24 patients with suspected ovary cyst during the second trimester underwent laparoscopic surgery at the Peking Union Medical College Hospital retrospectively. Clinical data were collected retrospectively and patient＇s outcomes were analyzed. Results The incidence of laparoscopic surgery for ovarian cysts during pregnancy was 0.12% of all laparoscopic gynecological surgeries performed at the hospital. No patients required conversion. There were 9 （37.5%） patients whose gestational age was no less than 16 weeks, and 15 patients whose gestational age was less than 16 weeks; no difference was noted in the operation time between the two groups （P 〉0.05）. Emergency surgery due to abdominal pain was performed in 4 （16.7%） patients, 2 （8.3%） of whom underwent simple salpingo-oophorectomy because of ovarian necrosis. The other patients underwent enucleation of the ovarian cyst. There were no severe complications. Twenty （83.3%） pregnant women delivered healthy term infants and 4 （16.7%） cases were lost to follow up. Conclusion Laparoscopic surgery for ovary masses is a safe and feasible procedure for the treatment of ovary cyst in dif- ferent conditions during the second trimester, even if gestational age reaching 16-19 weeks or in emergency.

Influence of Vitamin D Level in the Second Trimester of Pregnancy on the Complications of Chinese Pregnant Women and Fetuses

Background:Vitamin D has been found to have more biological effects beyond the traditional research range,which involve in immunoregulation,occurrence,and development of tumor,reproduction,cell differentiation,and so forth.Herein,the influence of Vitamin D level in the second trimester of pregnancy on the Chinese pregnant women and fetal weight was investigated.Methods:Totally 1,612 pregnant women were followed up during the study,the 25-hydroxyvitamin D(25(OH)D)level was measured with ELISA at the 16th gestational week,and the fasting blood glucose was measured with hexokinase method using an automatic biochemistry analyzer at the same time.At week 24,oral glucose tolerance test(OGTT)was performed to test the blood glucose level(fasting blood glucose,1 h and 2 h after oral administration of glucose).Besides,other indices(e.g.,fetal birth weight)were recorded and analyzed by SPSS version 19.0 software.Results:Pearson’s correlation analysis indicated that the serum 25(OH)D had a negative correlation with blood glucose at 1 h after oral glucose administration at week 24 in OGTT(correlation coefficient:−0.03,P=0.01).However,it did not have correlations with the fasting blood glucose at weeks 16 and 24 as well as the blood glucose at 2 h after oral glucose administration at week 24.The Pearson’s correlation analysis was used to analyze the correlation between Vitamin D level in the pregnant women and fetal birth weight,and there was no correlation between them.Conclusion:The Vitamin D level in the second trimester of pregnancy had a negative correlation with blood glucose glucose at 1 h after oral glucose administration and had no correlation with fetal birth weight.

Maternal Thyroid-Stimulating Hormone Level and Thyroid Peroxidase Antibody Status in the First and Second Trimester of Pregnancy and Their Relationship with the Risk of Gestational Diabetes Mellitus

Objective:To investigate thyroid-stimulating hormone(TSH)levels and thyroid peroxidase antibody(TPOAb)in early pregnancy and to estimate the risk of development of gestational diabetes mellitus(GDM).Methods:The levels of TSH,free thyroxine,free triiodothyronine,and TPOAb were retrospectively evaluated in 2333 pregnant women.All women recruited were divided into groups of TSH high(H),TSH low(L),TSH(H)TPOAb positive(+),TSH(H)TPOAb negative(-),TSH normal(N)TPOAb(+),TSH(L)TPOAb(+),TSH(L)TPOAb(-),and estimated the risk of GDM.Results:TSH level(X^(2)=13.0024,P=0.0015)and TSH combined TPOAb(X^(2)=20.0038,P=0.0012)were correlated to development of GDM.The level of TSH in 95 women was increased,and in 216 women were decreased.Of the 2333 pregnant women,546 patients were diagnosed with GDM,with a prevalence of 23.40%.The prevalence of GDM was 35.78%and 28.70%for the TSH high(H)and TSH low(L)pregnant women,respectively.The increased TSH(P=0.0013,odds ratio:2.09,confidence interval:1.34-3.28)was correlated to increase GDM incidence.TSH(H)TPOAb(+)(n=29),TSH(H)TPOAb(-)(n=58),TSH normal(N)TPOAb(+)(n=265),TSH(L)TPOAb(+)(n=30),TSH(L)TPOAb(-)(n=154)were in this study.The prevalence of GDM was 51.72%,29.31%,23.02%,26.67%,and 29.87%for the TSH(H)TPOAb(+),TSH(H)TPOAb(-),TSH(N)TPOAb(+),TSH(L)TPOAb(+),and TSH(L)TPOAb(-)pregnant women,respectively.Only the TSH(H)TPOAb(+)pregnant women had a significant higher incidence of GDM(P=0.0018,odds ratio:3.63,confidence interval:1.62-8.16).Trimester specific results showed that only second trimester had higher GDM risk either analyze TSH or the combination of TSH and TPOAb.Conclusion:Elevated TSH level and TPOAb positive in the second trimester of pregnancy were correlated to an increased risk of GDM.

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.

Comparison of second-trimester maternal serum free-p-human chorionic gonadotropin and a-fetoprotein between normal singleton and twin pregnancies： a population-based study

Background The second-trimester maternal serum screening in twin pregnancy is still controversial, as the serum marker levels in twins are not as clear as those in singletons. This study aimed to evaluate the relationship between the levels of the second-trimester maternal serum free β-human chorionic gonadotropin （free β-HCG） and a-fetoprotein （AFP） in normal twin and singleton pregnancies and to estimate feasible analysis methods for utilizing these markers in second trimester screening for twin pregnancy. Methods On the basis of a prospective population-based study of second-trimester maternal serum screening, the concentrations of maternal serum AFP and free β-HCG of 195 normal twin pregnancy and 26 512 singleton controls at gestational weeks 15 to 20 were measured by time-resolved fluoroimmunoassay in one laboratory. The levels of markers were compared between the twins and singletons using weight-correction and gestational age-specific model. Results According to the research protocol, 95 communities were randomly sampled, which covered the whole Jiangsu province, the east of China. A total of 26 803 pregnant women （98%）, from the target population accepted prenatal screening for maternal serum AFP, β-HCG detection, and all babies were followed up for at least six months. There were 197 （0.73%） twin pregnancies, of which one case had fetal trisomy 18, and one case with fetal anencephaly. The others were normal twin pregnancy. From a total enrollment of 26 803 women participants, 26 512 women with normal singleton pregnancies were selected as the model controls. The other 291 pregnancies, including trisomy 21, neural tube defect （NTD）, trisomy 18, and other fetal abnormalities, were excluded. No significant differences were found in the medians of gestational age-specific maternal serum free β-hCG and AFP in normal twin pregnancy comparing with twice those in model controls with the exception of the medians for free β-hCG during the 16th gestational week （P=0.012）. Conclusion The weight-correction and gestational age-specific levels of Chinese Han population maternal serum free β-hCG and AFP in normal twins were twice the levels as those in the singleton controls during the 17-19 gestational weeks.

Adhesive ileus in pregnant women

A female patient was of the pregnancy for less than 24 weeks and suffered from adhesive ileus. The conservative treatment with acupuncture was selected to keep the fetus alive. A single-used filiform needle,0.30 mm x 40 mm was used. Zúsānlǐ(足三里ST 36), Shàngjùxū(上巨虚 ST 37), Tàichōng(太冲 LR 3) and Zhigōu(支沟TE 6) were selected bilaterally. At each acupoint, the needle was inserted rapidly and manipulated with the twisting, lifting and thrusting techniques to induce mild stimulation. Additionally, the electric stimulation was added at ST 36 and ST 37, with the continuous wave, 60 times per minute in frequency. The needles were retained for 25 min in each treatment. During the hospital stay, the treatment was given once every day and the condition of the disorder was observed carefully. The patient was discharged from the hospital in her 30 weeks of pregnancy. Afterward, acupuncture treatment was given once every one or two days in clinic till the weeks 34 of pregnancy. After acupuncture treatment,the conditions of abdominal distention, enteric flatus and defecation were relieved sustainably through to the cesarean section in weeks 34 of pregnancy. Both the patient and her infant were healthy when discharged. It was proved that acupuncture therapy was applicable and effective in the pregnant patient with ileus.

Chronic hypertension superimposed on preeclampsia at 13 gestational weeks： a case report with review

Preeclampsia is represented by hypertension and proteinuria in pregnancy. It usually occurs after 20 gestational weeks. There are few reports on preeclampsia before 20 gestational weeks. In this case, we report a patient with chronic hypertension superimposed with preeclampsia at 13 gestational weeks.