Objective.To investigate the correlation between sFlt-1/PlGF ratio, the 24-h urinary protein and the presence of maternal ascites in a population of women with new-onset hypertensive disorders of pregnancy (HPD).

OBJECTIVE:To investigate the relationship of umbilical vein flow (UVF) measured close to term with abnormal fetal growth and adverse perinatal outcome in a cohort of pregnancies at low risk of placental insufficiency. METHODS:This was a prospective multicenter observational study conducted across two tertiary maternity units. Patients with a singleton appropriate-for-gestational-age fetus between 35 and 38 weeks' gestation were included. Pregnancies at higher risk of placental insufficiency or with fetal anomalies were excluded. At ultrasound examination, the abdominal circumference (AC), umbilical vein diameter and peak velocity of the umbilical vein were measured, and, using these variables, a new variable, UVF/AC, was calculated. The primary outcome was the occurrence of severely stunted fetal growth, defined as a greater than 40-percentile drop between estimated fetal weight at the third-trimester ultrasound and birth weight. The occurrence of adverse perinatal outcome (defined as one of the following: neonatal acidosis (umbilical artery pH < 7.15 and/or base excess > 12 mmol/L) at birth, 5-min Apgar score < 7, neonatal resuscitation or neonatal intensive care unit admission) was analyzed as a secondary outcome. RESULTS:Between April 2021 and March 2023, 365 women were included in the study. The mean UVF/AC at enrolment was 6.4 ± 2.6 mL/min/cm, and 35 (9.6%) cases were affected by severely stunted fetal growth. Severely stunted fetal growth was associated with a lower mean UVF/AC (5.4 ± 2.6 vs 6.5 ± 2.6 mL/min/cm; P = 0.02) and a higher frequency of UVF/AC < 10th percentile (8/35 (22.9%) vs 28/330 (8.5%); P = 0.01). Moreover, UVF/AC showed an area under the receiver-operating-characteristics curve (AUC) of 0.65 (95% CI, 0.55-0.75; P = 0.004) in predicting the occurrence of severely stunted fetal growth, and the optimal cut-off value of UVF/AC for discriminating between normal and severely stunted fetal growth was 7.2 mL/min/cm. This value was associated with a sensitivity and specificity of 0.77 (95% CI, 0.60-0.90) and 0.33 (95% CI, 0.28-0.39), and positive and negative predictive values of 0.11 (95% CI, 0.07-0.15) and 0.93 (95% CI, 0.87-0.97), respectively. Regarding the occurrence of adverse perinatal outcome, this was associated independently with maternal age (adjusted odds ratio (aOR), 0.93 (95% CI, 0.87-0.99); P = 0.04), UVF/AC Z-score (aOR, 0.53 (95% CI, 0.30-0.87); P = 0.01) and augmentation of labor (aOR, 2.69 (95% CI, 1.28-5.69); P = 0.009). UVF/AC showed an AUC of 0.65 (95% CI, 0.56-0.73; P = 0.005) in predicting the occurrence of adverse perinatal outcome, and the optimal cut-off value of UVF/AC for discriminating between normal and adverse perinatal outcome was 6.7 mL/min/cm. This value was associated with a sensitivity and specificity of 0.70 (95% CI, 0.54-0.83) and 0.40 (95% CI, 0.34-0.45), and positive and negative predictive values of 0.14 (95% CI, 0.09-0.19) and 0.91 (95% CI, 0.85-0.95), respectively. CONCLUSIONS:Our data demonstrate an association between reduced UVF close to term, severely stunted fetal growth and adverse perinatal outcome in a cohort of low-risk pregnant women, with a moderate ability to rule out and a poor ability to rule in either outcome. Further studies are needed to establish whether the assessment of UVF can improve the identification of fetuses at risk of subclinical placental insufficiency and adverse perinatal outcome. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Oral communication abstractsthe diagnosis of engagement would be ruled out.The proposed threshold is 55 mm with a positive predictive value of 98.6%, a sensitivity of 86.7%, and a specificity of 94.1%.Conclusions: Ultrasound can be used to diagnose engagement by measuring the distance between the perineum and bony landmark of the fetal head via a transperineal approach.This new tool can be useful in the delivery room when the clinical examination is inconclusive, for example, due to the presence of a serosanguineous bulge.

Objective.To evaluate the accuracy of hemodynamic parameters in predicting the risk of LVH in women with CH. Materials and Methods.A prospective study including a cohort of singleton pregnancies with a diagnosis of CH according to ISSHP guidelines.A non-invasive hemodynamic evaluation by USCOM-1A and a trans-thoracic echocardiography were performed before 16 weeks of gestation.We also calculated the ratio between the Mean Arterial Pressure and the maternal Heart Rate (MAP/HR Ratio).LVH was diagnosed when Left Ventricular Mass Index was over 95 g/m 2 .An adverse pregnancy outcome (APO) was defined in presence of one of the following complications: delivery < 32 weeks, superimposed preeclampsia, Intrauterine Growth Restriction, stillbirth.Results.49 women were included.Cardiac Output and Systemic Vascular Resistance showed the highest accuracy in predicting the risk of LVH (AUC 94.4 95%CI 0.86-0.99cut-off 5.8 and AUC 94.0% 95%CI 0.86-0.99cut-off 1387, respectively).The MAP/HR ratio also showed a good accuracy (AUC 80.6 95%CI 0.68-0.93,cut-off 1.20) while maternal age showed a fair accuracy (AUC 71.8%, 95%CI 0.57-86.0,cut-off 37.0).The incidence of an APO was significantly higher in those women with LVH (50% vs 18.5%, p = 0.019, OR 4.4, 95%CI 1.2-15.8).Conclusions.Hemodynamic parameters by USCOM-1A can stratify the risk of pregnant woman with CH in presenting LVH and to identity those who are likely to have an increased risk of an APO.

Objective.To evaluate perinatal outcomes of late-onset FGR fetuses showing cerebral redistribution in relation to modifications of Doppler components of cerebroplacental ratio (CPR).Materials and Methods.Multicentre retrospective study including non-anomalous singleton pregnancies complicated by late-onset FGR featuring CPR < 5° P. Perinatal outcomes were compared across four subgroups: 1. fetuses showing UAPI < 95° P and MCAPI > 5° P; 2. UAPI > 95° P and MCAPI > 5° P; 3. UAPI < 95° P and MCAPI < 5° P; 4. UAPI > 95° P and MCAPI < 5° P. Results.308 cases were included: 33.4% belonged to group 1, 28.8% group 2, 20.5% group 3, 17.2% group 4. Group 2 was associated with lower gestational age at delivery (37+0+2+1 vs 38+0+1+6, 37+5+1+6 and 37+5+1+6 weeks for groups 1,

To compare the blood pressure control in women receiving an appropriate or inappropriate antihypertensive therapy in accordance with the baseline hemodynamic findings

Objective . To assess the relationship between adverse perinatal outcome and the presence of pre-gestational or gestational diabetes (DM or GDM), in a cohort of late-onset FGR fetuses. Materials and Methods . A retrospective case control study was conducted in two tertiary maternity hospitals. A cohort of diabetic women with late FGR fetuses was included as the case group and compared with a control group of non-diabetic women with late FGR fetuses. The following criteria were used for the definition of late FGR: abdominal circumference (AC) or estimated fetal weight (EFW) < 10 percentile > 32 weeks or a reduction of more than 50 percentiles of CA compared to second trimester ultrasound scan. A composite adverse perinatal outcome (CAO) was defined in the presence of one of the following outcomes: newborn with pH < 7.1, Apgar at 5 min < 7, respiratory support at birth, neonatal hypoglycaemia, neonatal jaundice, admission

HLA-G molecule is considered to be involved in the regulation of the maternal-foetal interface immune tolerance, thus contributing to a healthy placentation. Some polymorphisms of the gene encoding for HLA-G are suggested to affect transcription and correlate with low levels of the soluble and membrane bound HLA-G protein. Patients affected with these polymorphisms are low secreting and may have pregnancy complications. We investigated the prevalence of 3’UTR 14-base pair insertion (I)/deletion (D) and of the single nucleotide polymorphisms (SNPs) 5’URR-725 C/G in recurrent miscarriage and healthy controls. A total of 286 couples affected with recurrent pregnancy loss (RPL) and 17 healthy couples were investigated for both polymorphisms. Couples underwent an accurate diagnostic flow chart in order to exclude causal factor of RPL and 137 couples were diagnosed as unexplained (URPL). The prevalence of the 3’UTR 14bp I/D polymorphism heterozygous was similar between URPL and control group. 3’UTR 14 bp D/D homozygotes were statistically higher in control group. Surprisingly, the prevalence of 3’UTR 14bp I/I homozygotes was similar between groups. Regarding 5’URR-725 C/G polymorphism in URPL the most prevalent haplotype was healthy homozygote C/C in combination with C/G. No association was found between the presence of homozygotes for the low secreting 5’URR-725 G/G polymorphism and URPL. Our results indicate that the evaluation of HLA-G polymorphisms is not adequately supported in clinical practice. SOMMARIO La molecola HLA-G è coinvolta nella regolazione della tolleranza immunitaria dell’interfaccia materno-fetale, contribuendo così a una sana placentazione. Si ipotizza che alcuni polimorfismi del gene che codifica per HLA-G influenzino la trascrizione e siano correlati a bassi livelli della proteina HLA-G solubile legata alla membrana. I pazienti affetti da questi polimorfismi sono a bassa secrezione e possono avere complicazioni durante la gravidanza. Abbiamo studiato la prevalenza dell’inserzione/delezione di 3’UTR a 14 paia di basi e dei polimorfismi a singolo nucleotide (SNP) 5’URR-725 C/G in aborti spontanei ricorrenti e controlli sani. Un totale di 286 coppie affette da interruzione di gravidanza ricorrente (RPL) e 17 coppie sane sono state studiate per entrambi i polimorfismi. Le coppie sono state sottoposte a un accurato diagramma di flusso diagnostico per escludere il fattore causale di RPL e 137 coppie sono state diagnosticate come inspiegabili (URPL). La prevalenza del polimorfismo I/D 3’UTR 14 paia di basi eterozigote era simile tra URPL e gruppo di controllo. 3’UTR 14 paia di basi D/D omozigoti erano statisticamente più alti nel gruppo di controllo. Sorprendentemente, la prevalenza di omozigoti 3’UTR 14 paia di basi I/I era simile tra i gruppi. Per quanto riguarda il polimorfismo 5’URR-725 C/G in URPL, l’aplotipo più diffuso era C/C omozigote sano in combinazione con C/G. Non è stata trovata alcuna associazione tra la presenza di omozigoti per il polimorfismo 5’URR-725 G/G a bassa secrezione e URPL. I nostri risultati indicano che la valutazione dei polimorfismi HLA-G non è adeguatamente supportata nella pratica clinica.

To detect early modifications in pregnancies complicated by premature rupture of the membranes (pPROM) and identify predictive parameters of adverse maternal and fetal outcomes. 10 patients with pPROM and ninety-three controls were enrolled and submitted to hemodynamic assessment with UltraSonic cardiac output monitor method (USCOM); at the hospital admission for pPROM we collected blood tests performed to check white blood cells and C-reactive protein (CRP) values. We followed these patients until delivery to identify fetal/neonatal and maternal outcomes. Patients with pPROM shows higher values of cardiac output (CO) (9.52 ± 2.43 vs 7.82 ± 1.35 l/min, p = 0.0008), lower total vascular resistances (TVR) (775.3 ± 246.4 vs 914.1 ± 155.4 d.s.cm-5, p = 0.013), higher minute distance (MD) (33.5 ± 7.85 vs 27.56 ± 4.78 m/min, p = 0.0007), lower P/K ratio (PKR) (15.5 ± 6.46 vs 20.13 ± 6.98, p = 0.0047), higher heart rate (HR) (96.1 ± 8.29 vs 85.57 ± 13.35 bpm, p = 0.016) and higher oxygen delivery (DO2)(1370.4 ± 375.8 vs 1162.6 ± 214.04 ml/min, p = 0.043) compared to controls. TVR and PKR are lower in pPROM with adverse outcomes compared to uncomplicated ones, as shown on table 1. Altered hemodynamic parameters, such as TVR, CO, PKR and DO2 especially, suggest that these women have hyperdynamic circulation due to the premature rupture of the membranes which is strictly connected to systemic inflammatory state; moreover hemodynamic worsening in pregnancies complicated by pPROM seems to be related to worse maternal and fetal outcomes. VP48.01: Table 1. Uncomplicated outcomes N:4 Adverse outcomes N:6

To identify hemodynamic profiles in a population of pregnant women affected by type 1, type 2 and gestational diabetes (GDM). To evaluate the fetal and maternal outcome at delivery. 113 diabetic women and 86 controls underwent a non-invasive hemodynamic measurement throughout the USCOM Method: among cases, 83 patients were diagnosed GDM and 30 women had type 1 and type 2 diabetes mellitus (T1DM/T2DM) matched for gestational age. Hemodynamic assessments were repeated every 4 weeks until delivery. T1DM/T2DM and GDM showed higher systemic vascular resistance (SVR) and potential to kinetic ratio (PKR) and lower cardiac output (CO) and inotropy index (INO) vs controls. According to the occurrence of obstetric complications (pPROM and preterm labour, Caesarean section or operative delivery for fetal distress, low Apgar, NICU admission) patients with gestational diabetes had a higher value of SVR and a lower cardiac index (CI) and stroke volume (SV). We didn't find statistically significant differences in hemodynamic profiles of T1/T2DM pregnant women who had adverse maternal and fetal outcomes. In gestational diabetes group, we found higher values of SVR (1242 vs 1036, p 0.04) and lower CI (2.9 vs 3.4, p 0.04) between 34 and 39 weeks of gestation in women who had obstetric complications. Binary logistic regression analysis was performed for the SVR values: we found an odds ratio of 5.1 (CI 95% 1.677 to 16.089, p 0.004) for SVR values > 1149 dyne/sec/cm-5. Our results show that women affected by diabetes showed an abnormal underlying hemodynamic adaptation compared to physiological population with a normal development of pregnancy. In addition, patients with an altered hemodynamic profile were associated with higher incidence of labour complication. Cardiovascular analysis in diabetes-complicated pregnancies, associated with metabolic monitoring, might be an important tool to identify those patients at greater risk of complications, in order to modify the treatment and to define an individualised obstetric management.