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PURPOSE: The study aims to predict mother and fetus outcome based on the mother's lipid profile in the second and third trimester of pregnancy. MATERIAL AND METHOD: Blood and urinary samples were taken from 135 mothers that were prospectively monitored during the hole pregnancy. Total cholesterol (TC), triglycerides (TG), low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), together with other parameters, were used as predictors in a multilayer perceptron (MLP) artificial neural network (ANN). Small for gestational age (SGA) was used to assess the fetal outcome, while Gestational diabetes mellitus (GDM) and, Hypertensive disorders in pregnancy (HDP) to assess the mother's outcome. RESULTS: SGA prediction rate was 0.637±0.022 for the second trimester and 0.632±0.017 for the third trimester. GDM prediction rate was 0.897±0.006 for the second trimester and 0.632±0.017 for the third trimester. HDP prediction rate was 0.620±0.046 for the second trimester and 0.775±0.030 for the third trimester. When used with other parameters (hemoglobin, thrombocytes, uric acid, GOT, GPT, the presence of proteinuria, urea, and creatinine) the prediction rates raised, going over 90% for the GDM. CONCLUSIONS: Though individual lipid parameters do not statistically correlate with the output variables the use of ANN generated prediction rates raging from 60% to 90%. The lipid profile from the third trimesters seems to be a better prediction for both fetus and mother outcome.
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PURPOSE: To determine in uterine artery (UtA) the mean pulsatility index (PI), systolic/diastolic (S/D) ratio and the presence/absence of notch in the second trimester of pregnancy, with normal or abnormal pregnancy outcome. MATERIAL AND METHODS: We performed an analysis of 135 cases with high risk pregnancy in Obstetrics and Gynecology Department of The Municipal Hospital Filantropia, Craiova, between October 2016 and May 2020. The ultrasound evaluation in the second trimester was performed during the second trimester morphology scan, or after this, but up to 24 weeks of pregnancy. RESULTS: The study showed only in the case of early preeclampsia (PE) a statistical significance for mean PI-UtA percentiles in the second trimester. In the other studied categories of pregnancy outcome, even we did not have a statistical significance, we found a specificity of 75% and positive predictive value of 88.89% in late PE. The presence of notch in the second trimester was statistically significant (p value <0.05) in the case of premature birth (PB) and early PE. A positive predictive value of 77.50% we found only in case of late PE. CONCLUSIONS: Our results show that routine Doppler screening of the uterine arteries during the second trimester did not make an accurate prediction of fetal growth restriction, preeclampsia or preterm birth. However, we believe that the present study results prove that this screening may select a population with increased risk of adverse outcome, which would give them the opportunity to benefit from an early intervention.
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OBJECTIVE: Placental lesions and placental ischemia are typical elements of intrauterine growth restriction (IUGR). The aim of this study is to analyze histological and immunohistochemical (IHC) changes in the placentas of IUGR fetuses. MATERIALS AND METHODS: In this prospective study, 126 placentas from small for gestational age (SGA) pregnancies (newborns with birth weight <10th percentile) that formed the study group and 31 placentas from pregnancies without SGA representing control group, were included. Placentas were examined according to standard protocol. Histopathological and IHC examinations of placentas were performed for analysis. RESULTS: A certain type of lesion of placental injury is increased in placentas from SGA pregnancies. These placental lesions were placental infarction (over 5%), increased syncytial knots, intervillous fibrinoid deposition, villous thrombohematoma. Other common placental lesions were probably related to fetal adaptation to placental ischemia or represent a placental change characteristic of pregnancy evolution. CONCLUSIONS: It seems that although IUGR∕SGA fetuses are more commonly associated with histological placental abnormalities, it cannot be established whether these abnormalities certainly contribute to IUGR, as there are no specific placental lesions in SGA placentas. Pseudo-angiomatous aspect, associated with increased syncytial knots, was specific for vascular hypoxia. Especially the magnitude of modifications of the placental structure beyond the qualitative modifications, which also lead to functional changes, are involved in this pathology of pregnancy, the onset of lesions being triggered at the level of stem villi.