Umbilical cord nuchal loops are associated with induction of labor, slow progress of labor, and shoulder dystocia.

This study investigates the relationship between leptin and fetal bone metabolism by measuring fetal blood levels of leptin, carboxy-terminal pro-peptide of type I pro-collagen (PICP; a marker of bone formation) and cross-linked carboxy-terminal telopeptide of type I collagen (ICTP; a marker of bone resorption). The median gestational age at the time of sampling was 23 weeks (range, 18-35). There was a positive correlation between leptin concentration and gestational age (r = 0.543, P < 0.001) and a negative correlation between both PICP and ICTP and gestational age (r = -0.592 and r = -0.550, respectively, and P < 0.001 for both). Also, there was a negative correlation between the concentrations of leptin and both PICP (r = -0.260, P = 0.022) and ICTP (r = -0.622, P < 0.001). Using multiple regression analysis, fetal leptin concentration was positively correlated to the gestational age (r = 0.240, P = 0.042) and negatively correlated to ICTP (r = -0.420, P = 0.001). The increase in leptin concentration with gestational age is consistent with adipose tissue development and the subsequent accumulation of fat mass. The negative correlation between fetal leptin and ICTP suggests that leptin may decrease bone resorption with the overall effect of increasing bone mass. Therefore, leptin may play a role in fetal bone metabolism as part of its effect on fetal growth and development.

Pregnant women with low-lying placentas in the second trimester have a higher incidence of postpartum hemorrhage and hence, it would be prudent to carefully manage the third stage of labor in these women.

The aim of the study was to investigate maternal thyroid function in pregnancy by monitoring the circulating concentrations of thyroid stimulating hormone (TSH), free thyroxine (fT 4 ) and human chorionic gonadotrophin (hCG) in multifetal pregnancies before and after embryo reduction. We studied two groups of women: group 1 comprised singleton (n=12) and twin (n=12) pregnancies achieved after superovulation and in vitro fertilisation and embryo transfer (IVF-ET), and group 2 were multifetal pregnancies (n=39) undergoing selective fetal reduction to twin pregnancies. Blood samples were obtained initially at 10-12 weeks gestation (before fetal reduction) and then 4 and 8 weeks afterwards. Before fetal reduction, the circulating concentrations of fT 4 in multifetal pregnancies were significantly greater than those in singleton or twin pregnancies (singleton, mean 16·49 pmol/l (interquartile range14·09-18·13 pmol/l); twins, 15·84 (15·36-16·95 pmol/l); multifetal, 21·08 (16·64-26·29 pmol/l); P<0·005 for singleton and twins), and in a multiple regression analysis, fT 4 was significantly related to the number of fetuses (F=23·739, P=0·0001), but not to hCG. After fetal reduction to twins, the circulating concentrations of fT 4 in multifetal pregnancies decreased progressively towards those in control twin pregnancies, but remained significantly greater at both 4 (P=0·003) and 8 weeks (P=0·050). This pattern of change in the concentrations of fT 4 is similar to, but lags behind, that of hCG, which attains twin levels 4 weeks after fetal reduction. This may represent a delayed thyroid response to the decreasing concentrations of hCG, but the alternative is that the maternal thyroid function is controlled by a fetal factor in addition to hCG.