Abstract Objectives: To find out if determination of IL-4, IL-13 and IL-6 in amniotic fluid (AF) and serum in mid-pregnancy can be used as predictors of preterm delivery. Material and methods: The research has comprised 88 pregnant women at 16-24 weeks of gestation, who were subjected to early amniocentesis. Levels of interleukins were determined by ELISA tests. Pregnant women had been monitored untill termination of pregnancy and divided in two groups: 68 term and 20 preterm deliveries. Results: IL-13 was not detectable at all in serum and amniotic fluid samples. IL-4 was not detectable in serum samples of both groups of women and it was detectable only in small number (20 %- 27 %) of AF samples. There was no statistically significant difference (p=0.665) in the mean values of AF IL-4 levels between the examined groups of women. Detectability for IL-6 was very low in serum specimens, while in AF it was detectable in 100% of cases and its levels was significantly higher (p<0.001) in preterm delivery group. Conclusions: The results obtained in this study suggest that the AF mid-pregnancy levels of IL-6 higher than 132 pg/ml may indicate preterm delivery.

Abstract OBJECTIVE-To evaluate the association between the vascular endothelial growth factor (VEGF) polymorphism and the risk of recurrent spontaneous miscarriage (RSM). METHODS-The participants enrolled included 227 RSM patients and 232 women with normal fertility. We examined the potential association between RSM and 13 single nucleotide polymorphisms (SNPs, rs699947, rs1570360, rs2010963, rs833068, rs833069, rs3024997, rs3024998, rs3025000, rs3025006, rs3025010, rs3025020, rs3025030, rs3025039) of VEGF gene using the MassARRAY system. RESULTS-The results showed that rs3025020 located at intron 6 of VEGF gene was significantly associated with RSM (χ(2)= 12.6385, P = 0.0004, odds ratio (OR)= 1.6109, 95% confidence interval (CI)= 1.2377 - 2.0967). Another significant association was observed for rs3025039 locatedin the 3' untranslated region (UTR) of VEGF gene (χ(2)= 9.7256, P = 0.0018, OR = 1.6492, 95% CI = 1.2023 - 2.2622). Furthermore, strong linkage disequilibrium (LD) was observed in three blocks (D'> 0.9), and significantly more T-G-C haplotypes (P = 0.0286) and fewer C-G-C haplotypes (P = 0.0006 after Bonferroni correction) residing in block 3 were found in RSM patients. CONCLUSION-These findings point to a role for VEGF gene polymorphisms in RSM, and may be informative for future genetic or neurobiological studies on RSM.

Abstract Objective: To find out the prevalence of thyroid peroxidase antibodies (TPO) in pregnant women with hypothyroidism and to analyse its effect on pregnancy outcome. Methods: The prospective study was conducted on well controlled hypothyroid pregnant patients attending the antenatal clinic at Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India from July 2009 to June 2011 and has delivered. The women were grouped into two groups depending on presence or absence of TPO antibody. Maternal complications during pregnancy and perinatal outcome were noted and compared between these two groups. Results: During the study period, 2479 women attended the high risk pregnancy clinic. Among which 196 women were found to be hypothyroidism making prevalence of hypothyroidism as 7.91%. A total of 140 were found to be well controlled (5.6%) and included for study. Amongst the women with hypothyroidism, 40% were TPO positive. Complications like threatened abortion, spontaneous abortion, preterm delivery, fetal malformations, intrauterine growth restriction and adverse fetal outcomes like poor apgar scores and prolonged nursery admissions were more in patients with positive TPO antibodies. Conclusion: TPO positivity is considered as high risk for pregnancy complications and hence those patients should be monitored more carefully.

Abstract Objective: To compare glycaemic control and pregnancy outcome in women with type 1 diabetes treated with the long-acting insulin analogues detemir or glargine. Methods: Retrospective study of singleton pregnancies from 2007 to 2011 in women with type 1 diabetes with a single living fetus at 22 weeks using either insulin detemir (n=67) or glargine (n=46) from conception. Results: Baseline characteristics were similar in the detemir and glargine groups. Haemoglobin A(1c) was comparable at 8 weeks (median 6.6%(range 5.6-9.8) vs. 6.8%(5.4-10.1), p=0.15) and at 33 weeks (6.1%(5.1-7.6) vs. 6.2%(4.8-7.2), p=0.38). The incidence of severe hypoglycaemia was comparable (15 (23%) vs. 10 (23%), p=0.98). Preeclampsia occurred in 9 (14%) vs. 8 (18%), p=0.52, preterm delivery in 21 (31%) vs. 16 (35%),(p=0.70) and 31 (46%) vs. 12 (26%) infants were large for gestational age (p=0.03). No perinatal deaths were observed. One offspring in each group was born with a major congenital malformation. Conclusions: Glycaemic control and pregnancy outcome were comparable in women using insulin detemir or glargine, except for a lower prevalence of large for gestational age infants in women on glargine. The use of both long-acting insulin analogues during pregnancy seems safe.

Abstract Objectives: The position of the conus medullaris is considered abnormal if it ends below lumbar vertebrae three (L3) at birth. We used magnetic resonance imaging (MRI) to measure the position of the conus in post-mortem fetuses, to investigate the timing of normal ascent. Methods: The position of the conus in 84 post mortem fetuses (mean gestation 26.3 weeks; range 14 - 41 weeks) was identified using 3D MRI datasets. A numerical scale was used for vertebral levels, from 1 (S2) to 15 (T12). Results: There was significant ascent of the conus medullaris with increasing gestation. At 20 weeks gestation, an estimated 84.2%(95% Confidence interval: 72.9, 93.2%) of fetuses have a conus position of L4/5 or higher, but only 22.8%(95% CI 11.7, 34.9%) at L3 or higher. By 26 weeks, an estimated 50.7%(95% CI 34.1, 67.5) will have reached L3, and 94.8%(95% CI 87.0, 98.5%) reach L3 by 40 weeks. Conclusion: There is regular ascent of the conus throughout fetal life. Although growth for each individual fetus may be non-linear, most fetuses have a conus level within the normal adult range by 33 weeks gestation.

INTRODUCTION: Chorioamnionitis (CA) presents a risk for neonatal sepsis, but its diagnosis remains a challenge. Maternal fever is often used as a clinical predictor of infection, but may be affected by other factors. There is no consensus among neonatologists regarding the length of treatment of babies born to febrile mothers with negative blood culture, but whose placentas are positive for presence of histologic CA (HCA). OBJECTIVES: A prospective observational cohort study was conducted on term infants to determine the association of HCA with C-reactive protein (CRP) and elevated Immature/Total neutrophil (I/T) ratio and other perinatal factors. METHODS: I/T ratio, CRP, blood culture, and placental pathology were performed on 100 infants born to mothers with temperature >/= 100.4(o)F. Placental pathology performed on 100 control infants born to afebrile mothers. RESULTS: There was a significant association between HCA and MF. The presence of elevated CRP was associated with HCA. There was no significant association between HCA and anesthesia, mode of delivery, nor elevated I/T ratio. CONCLUSIONS: Maternal fever is associated with HCA. HCA in conjunction with an elevated CRP can guide the duration of antimicrobial therapy in infants born to febrile mothers.

Abstract Objective: To assess and compare fetal behavior and neurodevelopment (KANET) between low and high risk pregnancies. Methods: Prospective, comparative, cohort study. 152 consecutive pregnant women presenting for routine 2(nd) trimester and 3(rd) trimester scan had four dimensional ultrasound examinations (4D US) in order to assess fetal behavior and neurodevelopment. This was achieved by the study of:(1) isolated head movements,(2) isolated hand movements,(3) isolated leg movements,(4) cranial sutures,(5) hand to face/head movements,(6) finger movements,(7) yawning- mouthing,(8) facial expressions,(9) isolated eye blicking,(10)"Gestalt" perception. According to the maternal background risk, the population of the study was classified in low risk pregnancies (n=78) and high risk pregnancies (n=74) with IUGR fetuses (n=12), diabetes mellitus (n=24), and pre-eclampsia (n=38). Results: The neurodevelopmental score was statistically significant higher in the low risk group compared to the high risk group (p<0.0004). The diabetes subgroup score was statistically significantly higher compared to the IUGR and the pre-eclampsia subgroup (p=0.0001). Conclusions: The neurodevelopment fetal assessment by 4D ultrasound appears to be a feasible technique in the evaluation of high risk pregnancies. Further studies where any association between KANET score and neurological outcome of the childhood are warranted.

Abstract Background: Preterm and growth-restricted babies are at high risk of milk intolerance and necrotising enterocolitis, as well as post-natal growth failure. Objective: To evaluate the effects of an "early" enteral feeding regimen, starting on day 2 after birth compared to late enteral feeding, starting on day 6 after birth in preterm growth restricted babies with abnormal antenatal Doppler studies regarding the incidence of NEC and feeding intolerance. Patients and Methods: Babies with gestational age below 37 weeks, and with birth weight below 10th centile for gestational age, will be randomly allocated to an "early" or "late" enteral feeding regimen. Results: Hundred-thirty three infants enrolled in the study: 66 received early feeding and 67 received delayed feeding. The incidence of NEC and feeding intolerance was not significantly different between the two groups. Conclusion: Early minimal enteral feeding (MEF) of preterm infants with IUGR and abnormal antenatal Doppler results may not have a significant effect on the incidence of NEC or feeding intolerance.

Abstract Objective: To explore the relationship between overweight and obesity and breastfeeding behaviours, a cohort study was conducted among 22,131 women who delivered in Ontario hospitals between April 1 2008 and March 31 2010. Methods: Data regarding maternal characteristics, maternal body mass index (BMI), infant characteristics, and breastfeeding practices was obtained through the Better Outcomes Registry & Network birth records Database. Multivariate linear regression analysis was used to determine the rates of three outcome measures - intention to breastfeed, exclusive breastfeeding in hospital, and exclusive breastfeeding upon discharge from hospital- between non-obese, overweight and obese patients. Results: While overweight mothers have similar intentions to breastfeed compared to non-overweight mothers (OR 1.03 (0.87-1.21), obese mothers were less likely to intend to breastfeed (OR 0.84 (0.70- 0.99). Overweight and obese mothers were less likely to exclusively breastfeed in hospital compared to non-overweight mothers (aOR 0.67 (0.60- 0.75) and 0.67 (0.60-0.75) respectively), and overweight and obese mothers were less likely to exclusively breastfeed on discharge (aOR 0.68 (0.61-0.76) and 0.68 (0.61-0.76) respectively). Conclusions: This study highlights that while overweight and obese women may benefit more from exclusive breastfeeding compared to non-overweight women, they are less likely to exclusively breastfeed in the immediate post-partum period.

Abstract Objective: To evaluate the effects of major and minor depression during pregnancy on the maternal and neonatal immunities. Methods: Peripheral venous blood from depressed women and cord venous blood from their neonates taken simultaneously and immediately after parturition were used. The serum levels of immunoglobulins IgG, IgM and IgA and complements C(3) and C(4) were determined through single radial immunodiffusion with the kits manufactured by the Biogen company (Mashhad, Iran). To reduce error, all the ring diameters were measured by one experimenter unaware of the study groups. The blood leukocyte and lymphocyte counts and lymphocyte percentage were determined with a H1 counter and for more accuracy also with a Hycel counter. Results: The immune parameters of depressed women were not significantly different from controls. The lymphocyte counts in neonates of women with major and minor depression were increased, whereas ratio of the cord blood level of IgG to the maternal blood level of IgG in neonates of women with major depression were decreased compared to controls. Conclusions: Major depression during pregnancy reduces the prenatal transfer of IgG from mother to neonate. The low prenatal transfer of IgG may have clinical significance, because it can compromise immune competence in neonates.

Abstract AIM: In this study, it is aimed to investigate total oxidant and anti-oxidant status of newborns and their breast milks.METHODS: Totally, 184 infants who were born in our hospital were included in the study. Study group was divided into two main study groups, including term and preterm groups; main study groups were also divided into two sub-groups, AGA and SGA. TOS and TAC levels were measured in cord blood of all newborns and in mother milks. Groups were statistically compared with each other in terms of TOS, TAC and OSI levels.RESULTS: The study included 92 preterm newborns (Group I) and 92 term newborns (Group II). TOS, TAC and OSI levels were found significantly higher in Group I than Group II (p<0,0001, p=0,17, p<0,0001, respectively ). When sub-groups of Group I and Group II, namely TAGA, TSGA and PAGA and PSGA, were compared with each other. TOS and OSI levels were significantly higher and TAC levels were significantly lower in TSGA group relative to TAGA group (p<0,0001; p=0,001; p<0,0001, respectively). No statistically significant difference was found between Group I and Group II and between sub-groups of Group I and II with regards the TOC, TAC and OSI levels of mother milkCONCLUSION: In preterm newborns and term SGA infants, total oxidant stress is increased and anti-oxidant capacity is low. No significant difference was found between mother milks of preterm and term AGA and SGA infants.

Exposure to parenteral nutrition (PN) is one major factor in the development of cholestasis. The aim of this retrospective study was to compare the effect of these two different PN regimens on PN associated cholestasis. The files of the patients who have received different PN regimens for > 14 days in 2005 and 2009 were retrospectively reviewed. 133 patients have received PN more than 14 days. 22 (16.5%) patients had parenteral nutrition associated cholestasis. 90 neonates were in Group LDpn and 43 neonates in Group HDpn. Mean gestational age and birth weight were statistically significantly lower in LDpn Group (p=0.016, p=0.434). Cholestasis rate was significantly higher in high dose group.(p=0.023). Although several risk factors for PNAC are unavoidable, research is still needed to define the optimal parenteral amino acid solution for neonatal patients. Individualized parenteral nutrition may be more affective in allowing growth and minimizing side effects.

Background and Objectives: Patent ductus arteriosus (PDA) is a significant cause of morbidity and mortality in preterm infants. This case series was conducted to investigate the usefulness of paracetamol as a first choice for the treatment of PDA in preterm infants. Subjects and Methods: Preterm infants were prospectively enrolled. Treatment with oral paracetamol was started at a dose of 15 mg/kg every 6 h for 3 days, with echocardiographic evaluation performed at the end of the treatment and two days after the treatment. Serum paracetamol levels were also evaluated 24 h after the first dose to ensure the absorption and reaching the therapeutic level. Results: A total of 6 preterm infants were prospectively enrolled. Five infants with PDA were successfully treated with oral paracetamol. Only one patient did not respond to paracetamol treatment whereas another one received a second cure due to reopening of the ductus. Conclusion: Paracetamol may be a useful treatment option for the primer treatment of PDA in preterm infants. If paracetamol is shown to be effective in a large series, because of low risk of side effects, low cost and preparation is available in enteral form, it may be an advantageous alternative at PDA treatment.

Abstract OBJECTIVE: To assess the role of the referees in assisting with the peer review process of systematic reviews and meta-analyses. STUDY DESIGN: A one-page questionnaire was mailed to 1,391 referees of two journals, the American Journal of Obstetrics and Gynecology and Obstetrics and Gynecology. The referees were asked how often they verified by their own independent analysis 11 key items related to the methodology and statistical analysis of systematic reviews and meta-analyses. Response categories included "always","frequently"(> 50% of the time),"infrequently"(< 50% of the time) and "never". A second and a third mailing was sent to the non-respondents. RESULTS: 42 mailings were returned because of change of address. Of the remaining 1,349 referees, 272 responded (response rate 20%). Of the 272 respondents, 159 (58%) had previously reviewed articles dealing with systematic reviews or meta-analyses. The responses varied according to the key items in the questions but the referees used their own independent analyses "always" in only 2-17% of the time. The rates of "infrequently" or "never" responses combined together ranged from 51% to 86% for the various key items. CONCLUSION: The overwhelming majority of the referees do not verify, by their own independent analysis, key items related to methodology and statistical analysis of submitted systematic reviews and meta-analyses.(Key words: evidence based medicine, peer-review, questionnaire, survey).

Abstract Objective: The aim of this study was to investigate risk factors associated with spontaneous early preterm delivery. Methods: The study included 1865 singleton pregnancies with 31 spontaneous deliveries between 23-35 weeks' gestation compared to 1834 deliveries at term analyzed between 2008 and 2009. Both groups were 100% Caucasian. Results: Spontaneous early delivery occurred in 31(1.2%) of the 2528 pregnancies. In the preterm delivery group, compared with unaffected pregnancies, there was an increased incidence of maternal anaemia (OR 2.8, 95%CI: 1.8 - 4.5; p<0.001). Previous preterm delivery between 23 to 34 weeks' gestation (OR 10.7, 95%CI 5.2 - 21.7; p<0.001) as well as vaginal bleeding beyond the first trimester (OR 3.8, 95%CI: 1.2 - 12.1; p=0.039), assisted conception (4.1, 95%CI: 2.0 - 8.4; p=0.001) and fetal loss before 16 weeks' gestation (OR 4.2, 95%CI: 2.5 - 7.1; p<0.001) are strongly associated with spontaneous preterm delivery. Conclusions: Previous preterm delivery as well as fetal loss before 16 weeks' gestation, assisted conception, vaginal bleeding beyond the first trimester and maternal anaemia are strongly associated with an increased risk for spontaneous early preterm delivery.

Abstract Objective: To investigate the potential value of maternal serum concentration of tumour necrosis factor receptor 1 (TNF-R1) at 30-33 weeks' gestation in the prediction of preeclampsia (PE) developing at or after 34 weeks. Methods: Serum TNF-R1 was measured at 11-13 and at 30-33 weeks' gestation in a case-control study of 50 cases that developed PE at or after 34 weeks and 250 unaffected controls. The measured values of TNF-R1 were converted into multiples of the unaffected median (MoM) and the MoM values in the PE and control groups were compared. Results: The median MoM TNF-R1 was significantly increased at both 11-13 weeks (1.094 MoM vs. 1.003 MoM) and at 30-33 weeks (1.101 MoM vs. 1.006 MoM). In screening for PE by a combination of maternal characteristics and serum TNF-R1 at 30-33 weeks the estimated detection rates of PE, at false positive rates of 5% and 10%, were 32.0% and 40.0%, respectively. Conclusion: Screening by maternal characteristics and serum TNF-R1 at 30-33 weeks could be effective in identifying some of the cases that will subsequently develop PE.

Abstract Objectives: To systematically review the literature on the use of probiotics in pregnancy and their impact on maternal outcomes. Methods: Online databases were searched in April 2012 using the following terms to identify eligible studies:"probiotics","pregnancy","maternal outcomes" and "metabolism". Primary outcomes of selected studies were maternal fasting glucose during pregnancy and rates of gestational diabetes mellitus (GDM). Secondary outcomes were rates of pre-eclampsia, maternal inflammatory markers and lipid profiles and gestational weight gain. Studies whose primary outcomes were bacterial vaginosis, pre-term delivery and infant atopy were excluded. Only English-language articles were included. The limited number of eligible studies and varying outcomes precluded formal meta-analysis of these data. Results: Initially, 189 articles were identified and screened. Seven articles met inclusion criteria and are included in the present review. Results demonstrated that probiotic use in pregnancy can significantly reduce maternal fasting glucose, incidence of GDM and pre-eclampsia rates and levels of C-reactive protein. Conclusions: Probiotics hold potential as a safe therapeutic tool for the prevention of pregnancy complications and adverse outcomes related to maternal metabolism. Further randomised controlled trials are urgently required, particularly among those at high risk of metabolic disorders, such as overweight and obese pregnant women.

Abstract Objective: To investigate the potential value of maternal serum concentration of activin-A at 30-33 weeks' gestation in the prediction of preeclampsia (PE) developing at or after 34 weeks. Methods: Serum concentrations of activin-A were measured at 11-13 and at 30-33 weeks' gestation in a case-control study of 50 cases that developed PE and 250 unaffected controls. The measured values of activin-A were converted into multiples of the unaffected median (MoM), after adjustment for maternal characteristics, and the MoM values in the PE and controls were compared. Results: The median activin-A MoM at 30-33 weeks was higher in the PE group (1.47, IQR 1.14-2.38 vs. 0.99, IQR 0.72-1.42), but at 11-13 weeks there was no significant difference between the groups. In screening by a combination of maternal characteristics and activin-A at 30-33 weeks the detection rate of PE was 50.0%, at a false positive rate of 10%. Conclusion: Screening by maternal characteristics and activin-A at 30-33 weeks could identify half of the pregnancies that will subsequently develop PE.

Abstract Objectives: To compare vaginal with intramuscular progesterone administration to prevent preterm labor in women with singleton pregnancies and at increased risk of preterm birth. Study design: Prospective comparative clinical trial. Population: One hundred and sixty pregnant women at 20-24 weeks gestation at risk of preterm labor were classified into: 80 women who received micronized progesterone tablets 200 mg vaginally daily (Group A) and 80 women who received 100 mg progesterone in the form of intramuscular every 3 days (Group B). Methods: Estimation of gestational age, assessment of fetal growth and fetal biophysical profile by trans-abdominal ultrasonographic examination was done every 4 weeks till delivery. Measurement of cervical length was achieved by transvaginal ultrasonography, done every 4 weeks till delivery. Main outcome measures: Incidence of preterm delivery, mean gestational age and the incidence of adverse events of intramuscular versus vaginal route of progesterone administration. Results: The incidence of preterm delivery in Group A was 20% and in Group B was 27.5%. The difference between both groups was statistically insignificant. In addition, the rate of adverse events reported in women received injectable progesterone was significantly higher than the rate of adverse events reported in women who received vaginal progesterone therapy. Conclusion: Vaginally administrated progesterone was nearly as equally effective as intramuscular progesterone in the prevention of PTL in women at risk and in the meantime has less undesirable events.