Background: During viral outbreaks, pregnancy poses an increased risk of infection for women. Methods: In a prospective study, all patients admitted for delivery at term to Elena Doamna Obstetrics and Gynecology University Hospital in Iasi, Romania, between 1 April 2020 and 31 December 2020 were included. There were 457 patients, divided into two groups: group 1, SARS-CoV-2-positive patients (n = 46) and group 2, SARS-CoV-2-negative patients (n = 411). Among other tests, complete blood count was determined upon admittance, and the following values were studied: white blood cell count, lymphocytes, neutrophils, red blood cell count, hemoglobin, mean corpuscular hemoglobin concentration, mean corpuscular hemoglobin, mean corpuscular volume, red blood cell distribution width, hematocrit, platelet count, mean platelet volume, platelet distribution width, plateletcrit, and platelet large cell ratio. Results: in pregnant SARS-CoV-2-infected patients at term, there was a significant decrease in white blood cell, neutrophil, and lymphocyte count, and an increase in mean corpuscular hemoglobin concentration, compared to healthy pregnant women at term, although all still within normal limits. None of the other components of the complete blood count or fetal outcomes studied was significantly influenced by SARS-CoV-2 infection in pregnant patients at term.

The objective was to have a quantitative description of the normal position of the fetal midbrain in the first trimester, through defining the reference ranges for the mesencephalon to the occipital bone distance, in the axial plane. This was a prospective study that included normal fetuses screened between 11 and 13 weeks of gestation. The distance was measured between the posterior limit of the mesencephalon to the occipital bone in the same axial view as the one required for the biparietal diameter (BPD) assessment, at this gestational age (GA). The reference ranges using quantile regression, according to the crown-rump length (CRL), BPD, and GA were fitted. Data analysis included 428 ultrasound measurements. A good, linear correlation was observed between mesencephalon to occiput (MO) distance and CRL, BPD, or GA. It increased linearly with advancing gestation (log 10 MO = -0.1834 + 0.0092 x CRL, R 2 =0.48, P<0.0001) and was independent of maternal demographic characteristics and intracranial translucency (IT). In our study, the 1st percentile of the normal MO distance varies from 1.31 mm at a CRL of 45 mm to 2.08 mm at a CRL of 84 mm. The intraclass correlation coefficient (ICC) was 0.89 for intraobserver variability. A significant increase in the MO distance was found in the patients who did not receive folic acid in the first trimester of pregnancy [1.056 vs. 1.008 multiple of median (MoM), P=0.014]. A simple measurement is described between the midbrain and the occipital bone, obtained in the same axial view. It increases linearly with advancing gestation. Integration of this measurement into the routine ultrasound screening in association with the ‘crash sign’ and recognizing the lower extreme values could lead to an early diagnosis of open spina bifida (OSB).

Objectives: To examine the clinical impact of frequent antepartum surveillance (FAS) in pregnancies complicated by severe fetal CHD at risk for hydrops/demise. We hypothesised that perinatal outcomes would be improved in those that received FAS. Methods: We performed a retrospective chart review of pregnant women managed in our institution from 2003-2019 whose fetuses had severe CHD at risk for hydrops/demise (e.g. Ebsteins anomaly, absent pulmonary valve syndrome, cardiomyopathy), and were planned for active postnatal care. FAS was defined as occurring >1 time/week from 32 weeks of gestation. Results: Of 60 cases, 58% (35/60) had FAS and 42% (25/60) had less frequent surveillance (LFS). Significantly more of those with FAS had livebirths (34/35, 97%) compared with the LFS group (17/25, 68%, p = 0.02). Intrauterine demise (IUFD) and intrapartum death occurred in 12% (3/25) and 20% (5/25) in those with LFS compared with FAS with 3% (1/35) IUFD and no intrapartum deaths (p = 0.02). Neonatal deaths did not differ statistically between groups (LFS 2/17 vs. FAS 12/34, p = 0.08). However, of all high-risk CHD diagnoses, there was improved survival beyond the neonatal period in those with FAS 66%, 22/35 vs. 60%, 15/25, p = 0.05). In 55 with available results, antenatal surveillance was abnormal in 22% (8/35) with FAS compared with 30% (6/20) with LFS (p = 0.34). For those who had an abnormal fetal heart rate, 29% (4/14) had late deceleration/bradycardia with loss of variability and 29% (4/14) had a non-reactive test with either variable deceleration or decreased variability. Overall when surveillance testing was abnormal, there was no significant difference in livebirths (78%, 11/14 vs. 90%, 37/41, p = .24), however there were more neonatal deaths (55%, 6/11 vs. 22%, 8/37, p = 0.04). Conclusions: Our results indicate that abnormal surveillance occurs frequently in high-risk CHD fetuses, suggesting they merit FAS and that FAS may positively impact their perinatal outcomes. VP17.15 Ventricle and great vessel size discrepancy as a fetal aortic coarctation predictor

Toxaemia is a pathological condition specific to the period of pregnancy which begins and is indissolubly related to the presence of placenta. Antiangiogenic factors, such as sFLT-1 (soluble tyrosine kinase receptor fms-like) and sEng (soluble endoglin) play an important role in the first part of pregnancy. They are linked to physiological vascular neoformation, and, in the second part of the pregnancy, grant the endothelial functionality and physiological vascular remodeling. The aim of the study is to try to establish the levels of the sFLT-1/PIGF ratio, as a prognostic tool in the patient with pre-eclampsia, depending on the influence of the cumulative risk factors. The sFLT-1 / PIGF report is a potential prognostic parameter in monitoring preeclampsia. The results of our study confirm the importance of deterring these markers for the diagnosis and monitoring of hypertensive pregnancies and at the same time to emphasize that the sFLT-1/PIGF ratio is a good predictor of preeclampsia Keywords: pregnancy, antiangiogenic factors, toxaemiaToxaemia is a pathological condition specific to the period of pregnancy which begins and is indissolubly related to the presence of placenta. The diseases is a multisystemic disorder, implying an increased incidence of morbidity and mortality for both the mother and the foetus[1].This condition starts even in the absence of the foetus (as is the case of the mola hydatiforme) and the symptoms usually dissapear at the time of delivery of the placenta. Toxaemia is a condition that begins at the placenta and ends in the maternal endothelium, being characterized by generalized endothelial dysfunction and affecting all susceptible vascular vessels from kidneys, central nervous system, liver to placenta [2][3][4].Antiangiogenic factors, such as sFLT-1 (soluble tyrosine kinase receptor fms-like) and sEng (soluble endoglin) play an important role in the first part of pregnancy. They are linked to physiological vascular neoformation, and, in the second part of the pregnancy, grant the endothelial functionality and physiological vascular remodeling. Soluble FLT-1 is a circulating anti-angiogenic protein that binds to the receptor of the PIGF and VEGF, thus preventing interaction with endothelial receptors, causing endothelial dysfunction. Endoglin is a surface co-receptor protein of TGF (transformig growth factor) β1 and β3 [5].The sEng factor is its soluble form, a novel anti-angiogenic factor that acts in synergy with sFLT-1. In normal pregnancy, a proangiogenic status appears, with low levels of sFLT-1 and increased levels of PIGF, by the end of the second trimester. Towards the end of the pregnancy these levels return to normal. In pregnant women with toxaemia, angiogenic profile abnormalities appear, with early changes in the prevalence of anti-angiogenic status leading to endothelial dysfunction. Thus PIGF and VEGF levels are lower than normal, and sFLT-1 and sEng levels are increased. sFLT-1 released from the placental circulation in large quantities will destroy the homeostasis of t...

To describe the sonographic appearance and size of the fetal aqueduct of Sylvius (AoS) in the first trimester of pregnancy. Methods: Single centre prospective study including a non-consecutive series of normal fetuses at 11-13 weeks gestational age (CRL between 45 and 84mm). A volume dataset was acquired by transvaginal ultrasound starting from the axial view of the fetal head. All acquired volumes were processed to evaluate the appearance and diameters of the AoS on the three orthogonal planes. Length, height and width of the AoS were measured by two different operators, and inter-observer repeatability was assessed (interclass correlation, IC). For each parameter, the mean of the two operators' measurements was used for further analysis. Results: Overall, 29 fetuses were included in the study. At off-line analysis of the acquired volumes the AoS was visible in all cases, with a mean length and height of 4,74 ± 0.36 mm and 1.97 ± 0.33 mm on the midsagittal plane. The AoS width was 1.92 ± 0.29 mm on the axial plane. For AoS length and width measurements an excellent interobserver repeatability was found, with IC coefficient (ICC) 0.911 and 0.920, respectively, whereas repeatability was good for width (ICC = 0.809). Conclusions: AoS may be measured at first trimester 3D ultrasound with good or excellent interobserver repeatability.