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Physiologic Changes
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Pregnancy-specific hormones include human chorionic gonadotropin (hCG) and relaxin. Relaxin is detectable in maternal serum by the time of missed menses and peaks at 10 weeks’ gestation, then declines over the course of the second and third trimesters [18]. Relaxin is secreted by the corpora lutea of pregnancy and is thought to have an important role in early pregnancy maintenance that has not yet been clearly elucidated [19]. hCG also peaks at approximately 10 weeks’ gestation. The reproductive hormones estradiol, progesterone, testosterone, prolactin, and 17-hydroxyprogesterone all increase significantly during gestation. Initially the corpus luteum and maternal ovarian tissue make the greatest contribution to steroid hormone concentrations, but as of 9 weeks’ gestation, aromatization of dehydroepiandrosterone sulfate by the placenta becomes the predominant source of maternal steroids [20]. The elevated estradiol levels stimulate increased hepatic production of sex hormone–binding globulin and thyroxin-binding globulin. Estrogen also induces hypertrophy and hyperplasia of pituitary lactotrophs with a resultant increase in prolactin levels corresponding to the increase in estradiol levels throughout gestation [20]. Meanwhile, there is a reflexive decrease in follicle-stimulating hormone and luteinizing hormone to almost undetectable levels, as would be expected.
Hypertensive Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Since a history of early-onset hypertensive disorders of pregnancy increases the risk of recurrence in subsequent pregnancies, long-term counseling should involve review of recurrence, and preventive measures (see “Complications”). The risk of complications in the subsequent pregnancy depends on how early in gestation and how severe the complications were, other underlying medical conditions, age of the woman at future pregnancy, same versus different partner, and many other variables (see section “Risk Factors”). Several studies tried to identify prediction tests for recurrent hypertensive disease in pregnancy, but there is insufficient evidence to assess the clinical usefulness of these tests [140].
The newborn baby
Published in Ajay Sharma, Helen Cockerill, Lucy Sanctuary, Mary Sheridan's From Birth to Five Years, 2021
Ajay Sharma, Helen Cockerill, Lucy Sanctuary
Primitive reflexes are intricate automatic movement patterns generated by the lower brain (brainstem). They commence as early as the 25th week of gestation and are fully present at birth in term infants. They become more difficult to elicit over the coming months as the cortical inhibition emerges, and protective postural reactions appear. Persistence and asymmetry of primitive reflexes indicate an underlying neurological impairment.
The Role of Insulin-like Growth Factor-Axis and Mitotic Index in South Indian Neonates with Small for Gestational Age
Published in Fetal and Pediatric Pathology, 2023
Nithya M. N., Krishnappa J., Sheela S. R., Venkateswarlu Raavi
Development of the fetus is an important stage during gestation where the interaction between fetal, placental, maternal, growth factors, nutrition, hormones, environmental, and genetic factors determine the outcome of pregnancy [2]. The imbalance in any of those factors might result in low birth weight/SGA, which is a major problem in developing countries. The importance of the GH/IGF-axis in fetal growth and SGA has been proven by gene knockout studies in animals [26]. Recent studies reveal that there are contrasting results and the impact of nutrition, environment, and genetic makeup on low birth weights and SGA. To determine if there were any differences in the levels of IGF-axis components and mitotic index in SGA and AGA neonates of the south Indian population, we measured the levels of IGF1, IGF2, and IGFBP3 proteins and mitotic index in cord blood, and IGFR1 and IGFR2 mRNA expression in the placenta of AGA and SGA neonates.
Does Maternal Vitamin D Level Affect the Ovarian Reserve of Female Newborn Infants?
Published in Fetal and Pediatric Pathology, 2022
Ebru Sahin Gulec, Esra Bahar Gur, Secil Kurtulmus, Banu Isbilen Basok, Duygu Cebecik Ozmus, Veli Iyilikci, Ahmet Demir
Pregnant volunteers between the ages of 18–42 and having a female fetus at term were included in the study. All the participants were fully informed about the study and written informed consent was obtained. Term pregnancy was defined as 37–42 weeks of gestation. Exclusion criteria were intrauterine fetal growth restriction, fetal anomaly, multi-fetal pregnancy, maternal hypertension, diabetes mellitus, chronic liver or renal disease, gastrointestinal disease, rheumatic disease, current tobacco and alcohol use, or any ongoing chronic medical therapies. Maternal age, socio-demographic data, vitamin D supplementation status, and weight gain during pregnancy were recorded. Body mass index (BMI) and anthropometric measurements of the newborns were recorded. BMI [weight (kg)/height (m)2] was calculated by measuring the height and the body weight.
Serum kisspeptin, to discriminate between ectopic pregnancy, miscarriage and first trimester pregnancy
Published in Journal of Obstetrics and Gynaecology, 2022
Semra Yuksel, Fatma Ketenci Gencer
Ectopic pregnancy affects 2% of all clinical pregnancies and seen mostly in women aged between 35 and 44 years (Cagnacci et al. 1999; Marion and Meeks 2012). The symptoms mostly occur at early weeks of gestation (6–8 weeks). Patients with ectopic pregnancy mainly complain about vaginal bleeding and abdominal pain especially when the location of pregnancy presents at the tuba. Uterine bleeding in patients with ectopic pregnancy usually occurs as miscarriage or abortus imminens of early gestation. In case of hCG levels below 1500–2000 IU/mL, it is hard to make differential diagnosis in a short time period between ectopic pregnancy and miscarriage or early pregnancy. Consecutive serum hCG measurements after transvaginal ultrasound (TVUS) are often required for confirming the diagnosis. Slower doubling times of hCG may both occur in miscarriage and ectopic pregnancy. Hence, the patients usually wait for definite diagnosis at a certain time when the gestational week is early (4–6 weeks) in routine gynaecologic practice.