A Comparative Study to Assess the Knowledge and Attitude Regarding Intra Uterine Growth Retardation and its Prevention Among Antenatal Mothers in Rural and Urban Areas

Intra Uterine Growth Retardation is an important cause of fetal and neonatal morbidity and mortality. The present study was undertaken to compare the knowledge and attitude regarding intra uterine growth retardation and its prevention among antenatal mothers in rural and urban areas Khammam, Telangana. The objectives of the study were to describe the levels of knowledge and attitude, to compare the levels of Knowledge and attitude in rural and urban areas, to find out the association between knowledge and attitude scores with their selected socio-demographic variables. A quantitative survey approach and comparative descriptive design was used for this study. The sample for current study is antenatal mothers who were residing at Raghunadhapalem rural area and Ballepalli urban area, Khammam. The sample size was 100((50 rural+50 urban) and the sample was selected by non-probability convenience sampling technique. Data was collected by using structure interview schedule. The Findings revealed that the knowledge means of antenatal mothers in rural and urban areas were 14.10 and 16.68 respectively. Standard deviations were 3.29 and 3.3 respectively. The ‘t’ calculated value was 3.89 which is significant at 0.05. The attitude means of antenatal mothers in rural and urban areas were 36.08 and 36.02 respectively. Standard deviations were 2.15 and 2.48 respectively. The ‘t’ calculated value was 0.12 which is significant at 0.05. The study concluded that the level of knowledge is low in rural area by comparing with urban area. There is an increased need for awareness program regarding intra uterine growth retardation and its prevention in selected setting in order to promote the health of the fetus and the mother.

MRI Angiography of Physiological and Pathological Pregnancy Placentas Ex-Vivo (MAPLE): protocol for a prospective pilot study. (Preprint)

BACKGROUND Preeclampsia (PE) and intra-uterine growth restriction (IUGR) are two major pregnancy complications due to abnormal placental vasculogenesis. Data on whole fetoplacental vasculature are still missing to better understand these pathologies. Ex-vivo magnetic resonance imaging (MRI) angiography has been developed to characterize the human placental vasculature by injecting contrast within the umbilical cord. OBJECTIVE The primary objective is to compare the vascular architecture of placenta between physiological and pathological pregnancies. Secondary objectives are (i) to analyse vascularization indices and texture features according to the group and within comparable gestational age (ii) to compare de vascularization indices to histological analysis. METHODS This is a prospective controlled study. We expect to include 100 placentas: 40 from normal pregnancies and 60 from pathological pregnancies with 30 for IUGR and 30 for PE. Ex-vivo MRI acquisition will be performed shortly after delivery and with preparation by injection within the umbilical cord. The vascular architecture will be quantitatively described by vascularization indices measured from ex-vivo MRI angiography data. Comparisons of vascularization indices and texture features according to the group and within comparable gestational age will be also performed. After MR acquisition, placental histopathological analysis will be performed. RESULTS The enrolment of women began in November 2019. In view of the recruitment capacity of our institution and the availability of the MRI, the recruitment should be completed by March 2022. As of November 2021, we enrolled 70% of the population. CONCLUSIONS This study protocol aims to provide information about the fetal side of placental vascular architecture in normal and pathological placenta with MRI. CLINICALTRIAL NCT 04389099 (Clinical Trial)

Uterine artery Doppler analysis at 11-14 weeks as a predictor of intra-uterine growth restriction

Background: Successful pregnancy results from reciprocity between placental and maternal cardiovascular system. Intra-uterine growth restriction (IUGR) is a condition which arises from insufficiency of placenta and can be seen as variations in waveforms in uterine artery (UtA). In our study, we studied, whether predictive accuracy of various UtA Doppler indices for IUGR in first trimester early enough to provide an intervention for prevention of IUGR, as it was a leading cause of neonatal morbidity and mortality.Methods: The study design was a prospective observational study. UtA Doppler was done at 11-14 weeks in 120 pregnancies attending the outpatient and inpatient department of obstetrics and gynaecology, PCMS, Bhopal. The left and right UtA velocity waveforms were studied. Mean pulsatility index (PI), mean resistive index (RI) and diastolic notch were noted. Results obtained were analyzed and tabulated.Results: Amongst these, 25.86% developed IUGR. First trimester UtA mean RI and PI were remarkably elevated in patients who developed IUGR on follow up. No relationship was noted between diastolic notch and IUGR. Mean RI and PI were found to be good predictors of IUGR. Using receiver operating characteristics (ROC) curve, the best cut-off of mean RI and mean PI to detect IUGR was 0.68 and 1.56 respectively.Conclusions: UtA Doppler at 11-14 weeks of gestation recognizes a huge proportion of women who will develop IUGR.

Disruption of Glucocorticoid Action on CD11c+ Dendritic Cells Favors the Generation of CD4+ Regulatory T Cells and Improves Fetal Development in Mice

A wealth of innate and adaptive immune cells and hormones are involved in mounting tolerance towards the fetus, a key aspect of successful reproduction. We could recently show that the specific cross talk between the pregnancy hormone progesterone and dendritic cells (DCs) is significantly engaged in the generation of CD4+ FoxP3+ regulatory T (Treg) cells while a disruption led to placental alterations and intra-uterine growth restriction. Apart from progesterone, also glucocorticoids affect immune cell functions. However, their functional relevance in the context of pregnancy still needs clarification. We developed a mouse line with a selective knockout of the glucocorticoid receptor (GR) on DCs, utilizing the cre/flox system. Reproductive outcome and maternal immune and endocrine adaptation of Balb/c-mated C57Bl/6 GRflox/floxCD11ccre/wt (mutant) females was assessed on gestation days (gd) 13.5 and 18.5. Balb/c-mated C57Bl/6 GRwt/wtCD11ccre/wt (wt) females served as controls. The number of implantation and fetal loss rate did not differ between groups. However, we identified a significant increase in fetal weight in fetuses from mutant dams. While the frequencies of CD11c+ cells remained largely similar, a decreased expression of co-stimulatory molecules was observed on DCs of mutant females on gd 13.5, along with higher frequencies of CD4+ and CD8+ Treg cells. Histomorphological and gene expression analysis revealed an increased placental volume and an improved functional placental capacity in mice lacking the GR on CD11c+ DCs. In summary, we here demonstrate that the disrupted communication between GCs and DCs favors a tolerant immune microenvironment and improves placental function and fetal development.

Impact of Fetal Growth Restriction on the Neonatal Microglial Proteome in the Rat

Microglial activation is a key modulator of brain vulnerability in response to intra-uterine growth restriction (IUGR). However, the consequences of IUGR on microglial development and the microglial proteome are still unknown. We used a model of IUGR induced by a gestational low-protein diet (LPD) in rats. Microglia, isolated from control and growth-restricted animals at P1 and P4, showed significant changes in the proteome between the two groups. The expression of protein sets associated with fetal growth, inflammation, and the immune response were significantly enriched in LPD microglia at P1 and P4. Interestingly, upregulation of protein sets associated with the oxidative stress response and reactive oxygen species production was observed at P4 but not P1. During development, inflammation-associated proteins were upregulated between P1 and P4 in both control and LPD microglia. By contrast, proteins associated with DNA repair and senescence pathways were upregulated in only LPD microglia. Similarly, protein sets involved in protein retrograde transport were significantly downregulated in only LPD microglia. Overall, these data demonstrate significant and multiple effects of LPD-induced IUGR on the developmental program of microglial cells, leading to an abnormal proteome within the first postnatal days.

Fetal Outcomes of Abnormal Placental and Birth Weight Ratio

Objective: To find out the fetal complications of abnormal placental and birth weight ratio. Materials and methods: This is a cross sectional study conducted from January 2019 to January 2020 at department of Gyn/Obs PMCH Nawabshah. Total 110 patients who met the criteria were included in this study. After history, clinical examination and required radiological and biochemical investigations, participants were delivered and weight of placenta and bay was measured and ratio was recorded. Results were made and conclusion was drawn. Results: Age difference was also seen in participants. Maternal age ranged from 18-35 years. 65(59%) patients ranged from 18 to 25 years. 30(27%) patients were of age between 26-30 years. 16(14%) aged from 31-35 years. Regarding fetal outcomes, Intra Uterine Growth Retardation (IUGR) was found to be among 30(27.27%), IUD in 3(2.72%), fetal distress in10 (9.09%), low APGAR in 7(6.36%), respiratory distress in 6(5.45%) and Cardio Vascular Diseases in 0% patients. Conclusion: To sum up, it is concluded that in our study, the common fetal outcome due to abnormal Abnormal Placental And Birth Weight Ratio (PBWR) was intra uterine growth retardation (IUGR) followed by IUD, fetal distress and low APGAR.