Amir Wiser

Adiponectin and Leptin Concentrations in Dichorionic Twins with Discordant and Concordant Growth

CONTEXTnDiscordant twin gestation, in which one fetus is growth restricted, is a unique model that can elucidate the mechanism(s) by which the intrauterine environment affects fetal growth.nnnOBJECTIVEnThe objective of the study was to determine the cord blood adiponectin and leptin concentrations and evaluate their association with birth weight in dichorionic twins, with and without growth discordance. DESIGN, SETTING, PARTICIPANTS, AND MAIN OUTCOME MEASURE: In this cross-sectional study, arterial cord blood adiponectin and leptin concentrations were determined in two groups of newborns: 1) discordant twins, in which one of the twins is growth restricted (small for gestation age and abnormal umbilical arteries Doppler) and the other is appropriate for gestation age (AGA) (n = 14 pairs); and 2) concordant twins, in which both twins are AGA (n = 15 pairs).nnnRESULTSnResults were: 1) within the discordant twins group, the median adiponectin concentration was significantly lower in the growth-restricted newborns than in their cotwins (P = 0.004); 2) within the concordant twin group, there was no significant difference in the median cord blood adiponectin concentration between the two AGA twins; 3) the median leptin concentration did not differ between the twins pairs in both study groups; 4) a positive correlation between cord blood adiponectin concentrations and both birth weight (r = 0.7, P < 0.001) and gestational age (r = 0.6, P < 0.02) was found only in the small-for-gestational-age newborns; 5) linear regression model revealed that birth weight is independently associated with circulating adiponectin concentration.nnnCONCLUSIONSnLow circulating adiponectin concentrations, previously reported in adults, children, and infants who were born small for gestational age, characterize fetuses with growth restriction and are independently associated with birth weight.

C-reactive protein and the mode of onset of labor in term pregnancies

Objective. To evaluate whether C‐reactive protein (CRP) levels in maternal serum at post‐date follow‐up can predict the mode of onset of spontaneous delivery in term pregnancies and the interval to delivery. Study design. Women at 40 completed weeks of gestation were recruited. The interval from CRP sampling to delivery and mode of onset of delivery were noted. Results. Sixty women were divided into 3 groups according to the mode of onset of labor. Group A presented with spontaneous onset of contractions, Group B presented with pre‐labor ruptured membranes (PROM), and Group C completed 42 weeks without spontaneous initiation of labor. There was no association between CRP values and latency from time of sampling to delivery. Mean serum CRP in Group B (12.7 mg/l) was significantly higher than in either Group A (7.2 mg/l) or Group C (10.2 mg/l) (p = 0.01). In addition, CRP values in the upper quartile (>12.2 mg/l) had a 37.5% positive predictive value for PROM, with a negative predictive value of 93%. Conclusion. Women whose labor will start with PROM have higher CRP values at post‐date follow‐up than women whose labor starts otherwise.

Neutrophils to lymphocytes ratio and platelets to lymphocytes ratio in pregnancy: A population study

Background Neutrophils to lymphocytes ratio (NLR) and platelets to lymphocytes ratio (PLR) are both inflammatory ratios that can be easily calculated from a simple blood count. They are frequently reported and tested as prognostic factors in several medical disciplines. Pregnancy involves special reference values for laboratory assays. Objective The aim of this study was to define pregnancy-related reference values for NLR and PLR according to trimester, background morbidity and according to the patients age. Study design A retrospective analysis of a large cohort undergoing community-based pregnancy surveillance between the years 2011–2016. Data were analyzed according to high-risk patient versus normal-risk patient. Results A total of 11,415 patients were included. Mean PLR and NLR values were 136.3±44.3, 2.6±1, respectively during the first trimester, 144.6±47.1, 4.0±1.4 respectively during the second trimester and 118.1±42.0, 3.5±1.2 respectively during the third trimester. No difference was detected between the high-risk and the normal population (P-values 0.3, 0.5 and 0.4 for PLR in each trimester respectively and 0.3, 0.4, 0.6 for NLR in each trimester, respectively). No differences were detected among parity categories. The correlation between patient’s age and either PLR and NLR was a weak positive correlation (though statistically significant). Both PLR and NLR reached a maximum value during the second trimester. The differences between mean NLR and PLR between trimesters were significant (P <0.01 for all differences tested). PLR rises in the presence of anemia, reaching statistical significance (P-value for PLR in each trimester was <0.01). NLR showed an opposite trend (P-values for NLR were 0.4, 0.005 and 0.06 in each trimester, respectively). Conclusions In our cohort, there were generally no differences between the high-risk and the normal population, excluding patients with a fibroid uterus or inflammatory bowel disease who presented a significantly elevated PLR through all trimesters. Both PLR and NLR reached a maximum value during the second trimester and were positively correlated with age. We anticipate that the population-based data will assist in providing accurate reference values for future research testing NLR and PLR measures during pregnancy.

Correlation between the Length of Ovarian Ligament and Ovarian Torsion: A Prospective Study

Study Objective: The study aimed to evaluate whether there is an association between the ovarian ligament length and ovarian torsion. Design: This is a prospective cohort study. Design Classification: II.2. Setting: The study was conducted in the gynecology department of a university affiliated hospital. Intervention: We measured the length of the ovarian ligaments during laparoscopy. Patients: A total of 56 women were recruited, of which 28 women were operated for ovarian torsion (torsion group) and 28 others for other gynecologic conditions (control group). Measurement and Main Results: The study found correlations between ovarian ligament length and ovarian torsion. The length of the right (2.2 ± 0.6 cm) and left ovarian ligament (2.3 ± 0.8 cm) in the control patients were similar. Ovarian torsions occurred mainly on the right side (67.9 %). The right ovarian ligament was significantly longer in the torsion group (3.2 ± 0.9 cm) than in the control group (2.2 ± 0.6 cm; p < 0.001). Even after exclusion of patients with ovarian cyst, the ovarian ligament was still significantly longer in the torsion group as compared to the control group (3.2 ± 1.1 vs. 2.2 ± 0.6 cm respectively, p = 0.01). Conclusion: Our results suggest that increased length of ovarian ligament might be correlated with the development of ovarian torsion. This could be a basis for ovarian ligament fixation or oophoropexy at the time of conservative surgery for ovarian torsion.

Predictors of twin pregnancy after ovarian stimulation and intrauterine insemination in women with unexplained infertility

Abstract Multi-foetal gestation is a well-known, adverse outcome of infertility treatment. Maternal and obstetrical complications are more frequent in multiple pregnancies compared to singletons. The aim of this study was to determine parameters that affect the risk for multiple pregnancies after ovarian stimulation (OS) with intrauterine insemination (IUI). We retrospectively evaluated all cases of OS with IUI cycles that ended with successful clinical pregnancy. A total of 259 pregnancies were analysed (175 singletons, 63 twins and 21 triplets). Significant parameters predicting multiple pregnancies were gravidity and number of follicles at least 15u2009mm in diameter on day of hCG. A previous pregnancy increased the risk for multiple gestation by a factor of 1.86 (95% CI 1.03–3.37, pu2009=u20090.04). Each follicle ≥15u2009mm increased the odds ratio for multiple gestation by 1.3 (95% CI 1.03–1.65, pu2009=u20090.027). In conclusion, women with more than one previous pregnancy and three or more than three follicles ≥15u2009mm at hCG are at risk for multi-foetal pregnancy after OS and IUI.

Number of Oocytes Retrieved as a Criterion for “Freeze-All” Strategy versus a Single “Rescue” Bolus of Low-Dose Human Chorionic Gonadotropin Following GnRH Agonist for Ovulation Triggering: A Pilot Study

Aim: To evaluate the number of oocytes retrieved as a criterion - when to use a “freeze-all” or low-dose “rescue human chorionic gonadotropin (hCG)” strategy. Methods: A retrospective study. Instead of the classic hCG trigger, an E2 level of ≥3,000 pg/mL was used to trigger ovulation with GnRH agonist. The decision whether to “freeze all” or perform fresh embryo transfer (ET) with a bolus of hCG was made based on a maximum number of 20 oocytes retrieved. Beyond this cut off, a “freeze-all” strategy was implemented. Below this cut-off value, a fresh ET using a single bolus of 62.5 µg hCG on day 3 following oocyte pick-up was performed. The main outcome measures were clinical pregnancy rates and ovarian hyperstimulation syndrome (OHSS). Results: E2 and progesterone levels increased after the rescue hCG bolus administration (E2 from 643.4 ± 311.1 to 1,086.1 ± 574.7 pg/mL, p = 0.003 and progesterone from 13.1 ± 4.8 to 39.2 ± 28.7 ng/mL, p < 0.0001). The clinical pregnancy rates were 25% in the freeze-all group and 32% in the rescue hCG group (p = 0.57). OHSS was not reported in either group. Conclusions: Both strategies seem to be efficacious and safe. An upper limit of 20 retrieved oocytes appears to be safe for applying a rescue hCG strategy.

Fertility treatment and dichorionic discordant twins - are they related?

Abstract Objective: This prospective cohort study evaluated the relationship between fertility treatments and the prevalence and outcomes of dichorionic discordant twins. This issue has gained importance due to twin gestations resulting from fertility treatments. Study design: Mothers of dichorionic twin pregnancies achieved in a single fertility clinic by assisted reproduction techniques, who had completed the first trimester of the pregnancy, were prospectively enrolled. Pregnancies with major fetal anomalies were excluded. Data regarding concordant and discordant twins based on the fertility treatments given to achieve the pregnancies were analyzed to determine the prevalence of discordance and pregnancy outcomes. Results: A total of 571 dichorionic twin pregnancies were available for evaluation. Fertility treatments modalities, sperm quality and implantation of cultured and thawed embryos did not influence the rate and severity of discordant twins. Increased hospitalization rates were found among discordant (n=108) compared to concordant (n=463) twins (47.2% vs. 31.3%, P<0.0001) and higher rates of betamethasone treatment (65.7% vs. 28.9%, P<0.0001). Secondary analysis of discordant pregnancies with a growth restricted twin, revealed the same results. We found no association between various fertility treatments and twin discordance. Conclusions: Our data suggest that fertility treatments do not play a major role in the pervasiveness and outcome of discordant twin pregnancies.