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Aim: The aim of this study is to summarize the outcomes of transfers of mosaic embryos, which were classified according to guidelines and in strong collaboration of reproductologists, clinical geneticists and patients approved as suitable for transfer. Material and Methods: Retrospective data were collected from 70 patients from a private IVF center to whom embryos with mosaic changes in chromosomal material were transferred from 2015 to 2019. Results and Conclusion: Implantation outcomes and continuing pregnancies showed slight differences, when compared to fully normal embryos. Artifacts have to be differentiated from undeniable aberrations, and correct interpretation of results must be done with following patient counselling and prenatal testing if necessary.

Background. Abnormally invasive placentation (AIP) is a clinical term that describes situation when placenta does not separate spontaneously after delivery and its manual removal causes excessive bleeding (1). Historically, the treatment of choice for this condition is hysterectomy. Lately, the new treatment option, conservative management of the AIP, has proven itself an effective alternative to hysterectomy in carefully selected patients (2). However, the use of conservative AIP management is limited in many countries, the reasoning being the lack of doctors’ experience in this procedure and concerns regarding a high postpartum infection rate. Case reports. We present the first two cases of conservative management of AIP in Latvia. Most of prenatally diagnosed AIP cases country-wide are referred to the Paul Stradinš University Hospital, which is a tertiary referral hospital. The annual rate of AIP in the hospital varies from five to ten cases. Two pregnant women were diagnosed with AIP prenatally, both of them refused hysterectomy and therefore went for the conservative management of AIP. During Caesarean section operation, placentas were left in situ after delivery of the baby. During the follow-up period of 12 and 14 weeks, both women developed infection complications, but complete placental tissue resolution was diagnosed in the end. Conclusion. These two cases demonstrate that conservative management of AIP can be safely applied in small countries/areas with small AIP rate and management experience.

Introduction. Evaluation of the first trimester uterine artery flow can predict the development of obstetrical complications. A genotype, making women prone to microthrombi. constitutes the main known susceptibility factor for anomalous development of placenta. Our aim was to study whether polymorphisms of 10 genes leading to blood clotting abnormalities are related to abnormal uterine artery blood flow in the first trimester, and may predict placenta-related diseases. Material and methods. In primary analyses we included 19 singleton pregnancies with abnormal blood flow in the uterine arteries during the first trimester of gestation, and 24 matched control with normal flow patterns. All patients were genotyped for sequence variations in F5, F2, F11, MTHFR, SERPINE-1, CYP4V2, SELE, GP6, angiotensinogen (AGT) and fibrinogen gamma (FGG) genes and followed up until delivery. Results. There were no differences between groups regarding selected sequence variations in any of these genes. The co-occurrence of several polymorphisms in the same patient was also not related to the blood flow patterns in the uterine arteries. Conclusions. Although we found certain trends of genetic polymorphisms being related to preeclampsia and fetal growth, we failed to find an association between clotting gene polymorphisms, single or in combination, with the abnormal uterine flow in the first trimester.

Objective To conduct a literature review in search of possible preventable causes for fetal growth restriction. Methods We performed a systematic literature search regarding abnormal vaginal microflora and fetal growth encompassing the last 27-year (starting from 1986) in PubMed, Embase, and Cochrane Central to study the evidence that abnormal vaginal microflora is may be related to diminished fetal growth or small for date birth. Results Most of the 14 studies suggested a significant role of vaginal organisms in impaired fetal growth, unrelated to preterm birth. The neonatal outcome has shown to be largely linked to the preventable or foreseeable fetal factors, such as genetic abnormalities, but also ascending intrauterine infections. Our previous work suggested a role of vaginal organisms in adverse pregnancy outcome, not only preterm birth, but also impaired fetal growth. Conclusions There is a need for cohort studies designed to unravel this link between abnormal microflora and FGR, in order to enable preventive actions to protect these small babies from severe damage and death by early screening and treatment.

VACTERL association includes at least three of the following congenital anomalies: vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal and limb abnormalities. The objective of article is to demonstrate the perinatal outcome of VACTERL case in 38-year-old pregnant woman with a history of infertility. Pregnancy has occurred after intracytoplasmic sperm injection and embryoscopy before embryo transfer. The 1st trimester ultrasound demonstrated right forearm anomaly-aplasia of the right radius and thumb. The normal female karyotype (46XX) was obtained. Increasing amniotic fluid index and invisible stomach from 26 weeks confirmed the suspicion of VACTERL association. After reduction of 900 ml of amniotic fluids at 34 +4 weeks of gestation the symptoms of premature separation of placenta occurred. The newborn weight was 2,360 g according to Apgar scale assessment 5/5 at 1 st and 5 th minutes. Multiple reconstructive operations were performed after birth. Among them sigmostomy, gastrostomy, ezofageotraheal fistulae plastic, that were followed by bronchoscopy and fibrogastroscopy. VACTERL association is a sporadic phenomenon, but among ICSI pregnancies fetal structural abnormalities occurrence is slightly higher. Our case demonstrates that the different components included into VACTERL association can be visualized at different gestational age, allowing to suspecting this association later in the pregnancy and often not prior to delivery. The family must has to understand the consequences of complications and their impact on the quality of child life.

OBJECTIVES The purpose of this study was to determine whether a low splenic artery pulsatility index (PI) and reduced flow through the left portal vein are involved in redistribution of fetal growth restriction. METHODS Forty-two women with prenatally diagnosed intrauterine growth restriction of singleton fetuses were included. The next pregnant woman with an appropriately growing fetus, matched for gestational age, was selected as a control. Blood flow velocities were measured in the splenic artery and left portal vein. Obstetric and perinatal information was obtained from standardized medical records. RESULTS The blood flow through the left portal vein was significantly reduced compared with the controls (P < .0001). Placental impairment in fetal growth restriction was clearly linked to a decreased splenic artery PI (P = .0004). In growth-restricted fetuses with reduced left portal vein flow and a splenic artery PI below the 5th percentile, perinatal mortality, a low 5-minute Apgar score, and neonatal metabolic acidosis were observed significantly more often (P = .04, .01, and .004; P = .03, .03, and .006, respectively). CONCLUSIONS Reduced blood flow through the left portal vein and low resistance in the splenic artery can be found in growth-restricted fetuses with adverse neonatal outcomes.

One of the causes of intrauterine fetal growth restriction (FGR) can be pathology of the placenta. The aim of this study was to compare macroscopic and microscopic changes of the placentas from intrauterine growth restricted fetuses with those from normally developed fetuses, in order to test the hypothesis that vascular damage due to decreased maternal vascular perfusion may be responsible for FGR.Between May 2007 and December 2008 we performed detailed macroscopic and histological examination of singleton placentas of 50 consecutive neonates with fetal growth restriction (FGR group) and compared them to 50 normal fetuses, born next to an FGR case, as a control group.Gestational age, birth weight, spontaneous delivery rate, mean weight of the placenta and the fetal-placental weight ratio were all lower in the FGR group than in the control group (p0.05). Thickening of the villous trophoblastic basal membrane, incidence of villous infarction, presence of thrombi or haematomas and the incidence of villitis were more common in the FGR group than in the controls (p0.05). There were, however, no significant differences in perivillous fibrin deposition, stromal fibrosis and cytotrophoblast proliferation between the groups. In FGR women who smoked, intervillous haematomas and villous infarction were more common (p0.05) than in controls.All macroscopic and microscopic pathological changes associated with FGR were directly linked to reduction of placental blood flow. As smoking is a main risk factor for these placental abnormalities these results emphasize the need to persuade women to quit smoking not only during pregnancy, but even better long before pregnancy.

Objective. To assess different bacterial and epidemiological factors associations with increased vaginal pH in the pregnant women population during the first trimester. Design. A cross-sectional, observational study. Setting. Three outpatient clinics in Riga. Population. From July 2009 until January 2010, 139 unselected consecutive pregnant women at the first prenatal visit. Methods. Pregnant women were submitted to an interview, vaginal examination and vaginal specimen collection for pH measurement and native microscopy. Main outcome measures. Vaginal pH ≥4.5 was considered as elevated. Abnormal bacterial microflora was classified according to Donders. Results. Elevated vaginal pH was significantly associated with bacterial vaginosis (p < 0.001), aerobic vaginitis (p < 0.001) and mixed aerobic vaginitis and bacterial vaginosis flora (p < 0.001) and presence of sperm cells in the smears (p = 0.024). Most cases with sperm were associated with abnormal vaginal flora. Normal lactobacillary morphotypes were more often found in the pH ≤4.4 group (p < 0.001), while leptosomic and short types were found more frequently with increased pH. Conclusions. Elevated vaginal pH is associated with different types of abnormal vaginal flora and the presence of sperm cells.

Frequency and preciseness of prenatal detection of foetal tumours increases due to improvement of sophisticated imaging methods. As correct diagnosis impacts the course of care in utero, it is essentially to improve diagnostic workout in a case of detected foetal anomalies. Here we report the case of partly involuting congenital haemangioma of foetus, which antenataly caused foetal secondary cardiomegaly. Pregnant woman was referred to Riga Maternity Hospital with unexplained tumour on the surface of foetal head at 24+2 weeks of gestation. Ultrasound exam revealed tubular structure without solid components between calvarium and skin under the left ear with very rich vascularization. Magnetic Resonance Image demonstrated enhancing multi-cystic lobulated mass. Hypertrophic secondary cardiomegaly was present without any additional structural abnormality. The foetus remained stable until 36+4 weeks of gestation, when the size of tumour succeeded 85 mm × 46 mm. Haemangioma was confirmed after delivery as round raised and infiltrating vascular lesion. After birth MRI demonstrated its connection with a. carotis externa. Propranolol was recommended with continuing follow-up. At 2 years and 3 months of age the lesion decreased by size noticeably, but still persists. Accurate diagnosis lets obstetricians to optimize antenatal care by providing an opportunity for planning deliveries, preparing family and medical staff for appropriate postpartum therapy and management.

Introduction: Maternal risk factors may interfere with mechanisms regulating fetal growth. The aim of the present study was to determine which sociodemographic and reproductive risk factors may be related to fetal growth restriction (FGR), with a special focus on determinants possible for preventive intervention. Materials and Methods: The study period is from May 2007 until December 2009. Data about lifestyle habits were collected by use of a detailed questionnaire in 65 women who attended Riga Maternity Hospital with the confirmed diagnosis of intrauterine FGR of a singleton fetus, and in 65 matched controls with normal pregnancies. Results: Being unmarried (p = 0.04), having pregnancy-related blood pressure rise (p = 0.02), current (p = 0.01) and pre-pregnancy smoking (p = 0.01) and history of more than 3 pregnancy failures (p = 0.04) were more frequent in women with FGR than controls. Surprisingly, the finding of genital infection (STI) during pregnancy (p = 0.006) was also strongly associated with FGR. Conclusions: Obviously, several maternal risk factors play an important role in FGR. Besides refraining from smoking, screening and treating for STI may not only prevent preterm birth, but also FGR. Identifying such anticipating factors would likely have the potential impact if detected before conception, or as early as possible in gestation.

Predicting Fetal Prognosis by Assessing Fetal and Maternal Blood Flow Patterns in Pregnancies with Fetal Growth Restriction Introduction. Fetal growth restriction (FGR) is associated with prematurity and a number of complications, as well as long-term impact on metabolic or cardiac function in adults. Aim of the Study. To study the prognostic value of staging maternal and fetal Doppler blood flow velocities in women with FGR; and evaluate prenatal characteristics as possible risk factors for severe vascular abnormalities. Materials and methods. 70 singleton pregnancies complicated by FGR were included in prospective follow-up study. Blood flow velocities in the uterine (UtA), umbilical (AU), middle cerebral (ACM) arteries and ductus venosus (DV) were measured. FGR neonates grouped as follows: I) normal blood velocity waveforms; II) abnormal UtA velocimetry and/or presence of early diastolic "notch"; III) abnormal AU without signs of "brain sparing"; IV) abnormal AU and ACM pulsatility index (PI) and V) AU absent or reversed end diastolic flow and an abnormal DV. Prenatal risk factors and perinatal outcome were assessed in relation to these Doppler blood flow patterns and compared with Fisher exact and Pearson c2 test. Results. There was a strong correlation between the severity of grouping and birth weight (p

Objective In the context of the planned International Society of Ultrasound in Obstetrics and Gynecology–World Health Organization multicenter study for the development of fetal growth standards for international application, we conducted a systematic review and meta-analysis to evaluate the safety of human exposure to ultrasonography in pregnancy. Methods A systematic search of electronic databases, reference lists and unpublished literature was conducted for trials and observational studies that assessed short- and long-term effects of exposure to ultrasonography, involving women and their fetuses exposed to ultrasonography, using B-mode or Doppler sonography during any period of pregnancy, for any number of times. The outcome measures were: (1) adverse maternal outcome; (2) adverse perinatal outcome; (3) abnormal childhood growth and neurological development; (4) non-right handedness; (5) childhood malignancy; and (6) intellectual performance and mental disease. Results The electronic search identified 6716 citations, and 19 were identified from secondary sources. A total of 61 publications reporting data from 41 different studies were included: 16 controlled trials, 13 cohort and 12 case–control studies. Ultrasonography in pregnancy was not associated with adverse maternal or perinatal outcome, impaired physical or neurological development, increased risk for malignancy in childhood, subnormal intellectual performance or mental diseases. According to the available clinical trials, there was a weak association between exposure to ultrasonography and non-right handedness in boys (odds ratio 1.26; 95% CI, 1.03–1.54). Conclusion According to the available evidence, exposure to diagnostic ultrasonography during pregnancy appears to be safe. Copyright © World Health Organization (2009).

Background: Preterm births occur in approximately 12% of pregnancies worldwide and in 5.6% of pregnancies in Latvia, and the incidence has increased. Prematurity poses the major challenge in perinatology and pediatrics, accounting for 75% of perinatal mortalities and 50% of long-term complication. The placenta is a unique organ in explaining the incomprehensible pathogenesis of prematurity. Methods: The retrospective case-control study was conducted to determine placental histological and microbiological findings associated with gestational age and neonatal morbidity. Results: Histological chorioamnionitis was the most prevalent lesion in extremely preterm and very preterm birth groups compared with moderate to late preterm and term birth groups (P=0.027). A higher rate of funisitis was detected among extremely preterm and very preterm birth cases (P=0.001). Microbiological examination of placentas in preterm birth cases most commonly revealed Streptococcus agalactiae , Staphylococcus epidermidis , Staphylococcus haemolyticus . Umbilical cord vessels thrombosis and placental thrombotic vasculopathy were found mostly in moderate to late preterm birth category (P=0.032; P=0.008, respectively). Intrauterine growth restriction was linked to chorionic villous edema (P=0.007) and chorionic villous fibrinoid necrosis (P=0.014). Chorion-decidual hemorrhage and deciduitis were significantly associated with respiratory distress syndrome (P=0.036; P=0.022, respectively). Chorion-decidual hemorrhage was the main predisposing factor for hypoxic-ischemic encephalopathy (P=0.058). Conclusions: Comprehension of the pathogenic mechanisms of prematurity of the placenta and preterm births, and the impact of placental prematurity on neonatal morbidity may lead to improved prenatal diagnostic and enhanced preventive care for both the mother and the child.

To evaluate the impact of vaginal ascorbic acid (vitamin C) as a treatment/maintenance regimen on increased vaginal pH and abnormal microflora on wet mounts in premenopausal women. A randomized study of 140 asymptomatic, low-risk pregnant and non-pregnant premenopausal women with vaginal pH a parts per thousand yen 4.5 and a variety of partly/completely disrupted Lactobacillus microflora patterns on wet mounts in five outpatient clinics was carried out. Participants were randomized to the intervention group [250 mg vitamin C tablets vaginally at bedtime once a day for 6 days (treatment phase), followed by a one tablet per week, for 12 weeks (maintenance phase)] or the control group (no treatment). Outcomes were evaluated 4 months after randomizing, i.e., 2-3 weeks after the last vitamin C tablet insertion. Normalization to normal flora was observed in 51.4 % of all ascorbic acid and in 24.3 % of control group patients (difference 27.1 %, 95 % CI 11.7-42.6, p < 0.05, ITT population). In the per protocol population, normalization was confirmed in 53.5 % of the intervention and 22.4 % of the control group (difference 31 %, 95 % CI 14.3-47.8, p < 0.05). Results of pregnant subgroup analysis showed better outcomes for the subgroup: difference of normalization rate between ascorbic acid and control group was 41.2 % (95 % CI 21.8-60.1, p < 0.05). Itching occurred in 19 %; 23 % of women reported irritation and 10 % stopped the treatment because of side effects. Vaginal ascorbic acid improves abnormal vaginal pH and microflora, especially in pregnant women, but is not well tolerated by all women.

TRAP sequence-is a rare, serious malformation with reported incidence 0.3 in 10.000 pregnancies. The prognoses is lethal for the recipient, whereas perinatal mortality and malformation risks are up to 50 % and 10% in pumping twin. We present three cases of TRAP sequence diagnosed and followed at our institution from August to October 2011. Outcome of TRAP sequence depends on the time of diagnoses, treatment modality and timely delivery.