Correctional Medicine

women who developed APOs (Group 2¼APO group). APO was defined as the development of at least one of the followings: preeclampsia, fetal death in utero, neonatal death before hospital discharge, indicated preterm birth <36 weeks, and small for gestational age (<5th percentile) at birth. Stored samples of amniotic fluids were analyzed using mass spectrometry-based proteomics. In a discovery phase, we analyzed 9 patients (4 in Group 1 and 5 in Group 2) with data-dependent acquisition (DDA) approach. In a verification phase, we analyzed the remained 26 patients (15 in Group 1 and 11 in Group 2) using data-independent acquisition (DIA) method. Hierarchical clustering was performed based on the Euclidean distance and the average linkage. RESULTS: In the discovery phase, 44 proteins were differentially expressed between Group 1 and Group 2. In a verification phase, differentially expressed proteins (DEPs) were verified in independent samples using DIA method. Four proteins including FLNA (filamin A), SVEP1 (sushi, von Willebrand factor type A, EGF and pentraxin domain containing 1), LCAT (lecithin-cholesterol acyltransferase), and TGM2 (transglutaminase 2) were differentially expressed both in discovery and verification phase. In order to select the best combination of proteins for predicting adverse outcomes, threefold cross validation (CV) with repetition of 100 times was performed. The multi-marker model with 3 biomarkers (SVEP1, LCAT, TGM2) had a high discriminatory power to distinguish between the two groups (the area under the receiver operating characteristic, AUROC ¼ 0.855, p<0.001). CONCLUSION: Our result indicates that increased expression of SVEP1, LCAT, and TGM2 in mid-trimester amniotic fluid may predict APOs in women with SLE. A large scale prospective study is warranted to verify this finding.

Objective: Amniotic sac and extracelomic space changes occurring from 5 to 14 weeks of pregnancy were observed with transvaginal ultrasound to gain new insights into their normal relationships during this time period. Study Design: Ninety-seven women from 5 to 15 weeks’ gestation were enrolled in the study. Gestational age was determined by measuring embryonic crown-rump length. The embryo, amniotic sac, and gestational sac areas were measured using the best-fitted computer-generated elliptical view. The embryonic heart rate was measured using the M-mode function of the ultrasound equipment. Associations were determined using the least-squares method and Pearson’s correlation coefficient. Results: Mean (range) gestational age calculated from CRL was 9.6 (5.3–14.6) weeks, embryonic heart rate 153 (100–188) beats per minute, embryonic surface 699.6 (5–2,199) mm2, amniotic sac surface 1,383 (5–5,335) mm2 and gestational sac surface was 1,517 (110–5,335) mm2. Significant correlations be...

Objective: We sought to define the uterine and uterine cavity dimensions of subseptate uteri before and after hysteroscopic surgical incision, and compare them to those obtained in normal uteri with 3-D ultrasound. Methods: Two cohorts of consecutive women with normal-appearing uterine cavity and women diagnosed with uterine subseptations, before and after undergoing hysteroscopic incision. 3-D ultrasound was used to measure the uterine cavity width, length, and area on a frozen coronal view of the uterus. Results: A total of 215 women were included: 89 in the normal, and 126 in the subseptate uterus, groups. Uterine length and height were similar in the pre-operative, post-operative subseptate uteri, and in the normal uteri, while the uterine width was significantly greater in the pre-operative (5.1 + 0.8 cm) than post-operative (4.7 + 0.8 cm) and normal uterus (4.6 + 0.7 cm; p &lt; 0.001) groups. The pre-operative uterine cavity length (3.3 + 0.5 cm), width (3.2 + 0.7 cm), and are...

Citation: Siani E, Levi-D&#39;Ancona R, Nelson-Rigg R, et al. Developing A Hospital Specific and Evidence-Based Management Protocol for Pregnancies of Unknown Location and Ectopic Pregnancies: A Retrospective Chart Review and Quality Improvement Project. Gynecol Reprod Health. 2020; 4(4): 1-7. *Correspondence: Pallavi Khanna, MD, University of Tennessee Health Science Center, Regional One Health, Memphis, TN, USA.

Multiple observational studies have found an association of uterine prolapse with uterine retroversion. Mechanisms proposed to explain this apparent association assume that the cervix of a retroverted uterus will usually insert at the apex of the vagina, with resultant alignment of the cervix with the vagina. The angle of the axis of the cervix with the axis of the vagina was measured by two readers on 323 sagittal pelvic MRI scans and sagittal reconstructions of pelvic CT scans performed for clinical purposes. One reader observed and recorded the anatomic relations of the uterus that differed by insertion site and version: 44 of 49 retroverted uteri (89.8%) inserted at the vaginal apex, and 13 of 274 anteverted uteri (4.7%) inserted at the vaginal apex. This difference was found to be statistically significant (p &lt; 0.05) by the Chi square test. The urinary bladder, vaginal walls, and rectum were inferiorly related to anteriorly inserted anteverted uteri. Only the vaginal lumen a...