Objectives:The purpose of this study was to determine the relationship between placental thickness and pregnancy outcomes in the third trimester. Methods: We conducted a retrospective study of 5,386 singleton pregnancies presenting for routine ultrasonography at 32 weeks' gestation between January 2010 and December 2011. Each placenta was measured to a 1 mm precision, at its greatest thickness, which was perpendicular to the uterine wall. Thick placenta was determined as placenta that was above the 90th percentile. Thin placenta was determined below the 10th percentile. The control group included pregnant women with placental thickness between the 10th and 90th percentile. We assessed newborn weight, incidence of SGA (small for gestational age) and LGA (large for gestational age), low birthweight, macrosomia, preterm birth, hypertensive disorders of pregnancy and gestational diabetes mellitus. Results: Overall mean placental thickness was 37.5mm. The cutoff value of thick placenta was 47mm, and thin placenta was 29mm. Gestational diabetes mellitus was significantly more common in the thick placenta group than control group (7.3% vs 4.5%, P = 0.018). Incidence of preterm birth was 8.0% in the thick placenta group, 4.8% in the thin placenta group and 3.9% in the control group (P = 0.001, P = 0.357, respectively). Mean birthweight was 3247gm in the thick placenta group, 3186gm in the thin placenta group and 3269gm in the control group (P = 0.331, P < 0.001). Incidence of small for gestational age below 10th percentile was 11.3% in the thick placenta group, 13.4% in the thin placenta group and 8.8% in the control group (P = 0.081, 0.007). Birthweight above 4000gm was 5.6%, 2.0% and 4.1%, respectively (P = 0.089, P = 0.007). Conclusions: Gestational diabetes mellitus and preterm birth were significantly more common in pregnant women with thick placenta. Thin placentas were significantly associated with a decreased newborn weight.Objectives: To describe maternal and fetal characteristics in pregnancies with UA AREDF and evaluate neonatal morbidity.
The EVERREST programme proposes a clinical trial with maternal uterine artery vascular endothelial growth factor gene therapy to treat severe early-onset fetal growth restriction (FGR) in pregnant women. FGR is a major obstetric problem that has significant risk of stillbirth or very low birthweight baby. As a component of this programme a literature review on the ethical and legal issues of highly experimental treatments in pregnant women was conducted to evaluate the ethical and social acceptability of the proposed clinical trial. The review was followed by 34 qualitative interviews amongst key stakeholder groups in several European countries.
The literature considered two main questions; whether it is ethical to treat a pregnant woman with a potentially risky treatment when she herself has no benefit from the treatment, and secondly, whether it is ethical to treat this condition of the unborn who may otherwise have died but with the treatment may be born with a serious disability. The review concluded that there was no ethical or legal objection to the intervention under development nor to a trial of this intervention.
The main issues emerging in the empirical interviews turned on the psychological stress of the woman making a decision about trial participation after just having been informed of the diagnosis of severe FGR, and secondly, the need for accurate and adequate information together with psychological support as part of a continuous informed consent process. Further interviews will be conducted with women and their partners who have experienced a pregnancy affected by FGR.
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