Fetal sex plays an important role in modifying the course and complications related to pregnancy and may also have an impact on maternal health and well-being both during and after pregnancy. The goal of this article is to review and summarize the findings from published research on physiologic and pathologic changes that may be affected by fetal sex and the effect of these changes on the maternal and obstetrical outcomes. This will help create awareness that fetal sex is not just a random chance event but an interactive process between the mother, the placenta, and the fetus. The reported effects of male sex on the course of pregnancy and delivery include higher incidence of preterm labor in singletons and twins, failure of progression in labor, true umbilical cord knots, cord prolapse, nuchal cord, higher cesarean section rate, higher heart rate variability with increased frequency, and duration of decelerations without acidemia and increased risk of gestational diabetes mellitus through the poor beta cells function. Similarly, female fetal sex has been reported to modify pregnancy and delivery outcomes including altered fetal cardiac hemodynamics, increased hypertensive diseases of pregnancy, higher vulnerability of developing type 2 DM after pregnancy possibly because of influences on increased maternal insulin resistance. Placental function is also influenced by fetal sex. Vitamin D metabolism in the placenta varies by fetal sex; and the placenta of a female fetus is more responsive to the relaxing action of magnesium sulfate. Male and female feto-placental units also vary in their responses to environmental toxin exposure. The association of fetal sex with stillbirths is controversial with many studies reporting higher risk of stillbirth in male fetuses; although some smaller and limited studies have reported more stillbirths with female fetus pregnancies. Maternal status such as BMI may in turn also affect the fetus and the placenta in a sex-specific manner. There is probably a sex-specific maternal–placental–fetal interaction that has significant biological implications of which the mechanisms may be genetic, epigenetic, or hormonal. Determination of fetal sex may therefore be an important consideration in management of pregnancy and childbirth.

Antenatal midgut volvulus is a rare surgical emergency in which bowel is severely compromised. Rarely the etiology is a mesenteric defect. Early diagnosis is essential and lifesaving in the immediate newborn period. Typically upper gastrointestinal or ultrasound imaging can be suggestive of the diagnosis of volvulus in the neonate. Sometimes, however, the diagnosis may be elusive. Herein, we report on the use of neonatal magnetic resonance imaging to diagnose a midgut volvulus that occurred through a congenital mesenteric defect.

INTRODUCTION: Excisional cervical procedures and genital infections are independent risks for preterm birth (PTB). We evaluated if LEEP history and cervical Mycoplasma/Ureaplasma (Myco/Urea) co-infection increases risk of PTB. METHODS: Retrospective cohort study (1/2005 to 6/2016) of patients delivered under 37 weeks. Patients were selected by Myco/Urea admission cervical culture results. Medical record abstractions: demographics, cervical procedures history, pregnancy outcome. Exclusions: cerclage, knife cone, cryotherapy, multifetal gestations. CASES: LEEP history and positive Myco/Urea result, CONTROL GROUP A: LEEP history and negative Myco/Urea result, CONTROL GROUP B: without LEEP history and positive Myco/Urea result. Primary outcome: delivery gestational weeks (GW). Data analyzed by Fisher's exact, chi-square and Wilcoxon rank-sum tests. A linear regression model for comparison of CASES vs CONTROLS was adjusted for potential confounders. A p-value less than 0.05 (two-tailed) was significant. RESULTS: We identified 1755 patients with Myco/Urea results: 37 CASES, 17 GROUP A , 47 GROUP B. Delivery GW: Cases 32±3.8, Control A 30.6 ±4.4, Control B 31.6±3.3 (p more than 0.05 Cases vs Controls). No significant difference in percentage of PPROM, smoking, antibiotic use between Cases vs Controls (p more than 0.05). A history of PTB was greater in Cases (32%) vs Control A (18%, p=0.34) or Control B (13%, p= 0.04). However, cases delivered earlier than controls. Antibiotic use was not different in CASES (51%) vs CONTROL B (48%); p=0.95. CONCLUSION: LEEP history and co-infection with genital Myco/Urea is not associated with increased risk for PTB compared to patients with LEEP history alone or Myco/Urea infection alone.