https://obgyn-onlinelibrary-wiley-com.ezproxy.library.ubc.ca/doi/abs/10.1002/ijgo.12421

A nuchal cord entanglement as described by the authors of this paper is when “the umbilical cord…is wrapped 360 degrees about the fetal neck at least once”. This risk can result in many damaging outcomes during and after labour. For example, it can lead to an increase in the fetal heart rate because the fetus is essentially being choked. This can result in emergency surgical pregnancies and can be especially dangerous if the cord is wrapped around the fetus’ head more than once. As one can hypothsize, this leads to an increased chance of death of the fetus.

Depending on the tightness of the cord, physicians choose to use different methods to untangle the cord as swiftly as they can. They can be diagnosed confidently with a two-dimensional ultrasound scan, but with even more accuracy with colour Doppler sonography. While not all the risk factors have been determined, there are a few outlined in this paper.

If this has been diagnosed in earlier stages, then there can be preventative measures taken, such as closer monitoring leading to labour.

The researchers of this study examined maternity wards of two universities in Cameroon and the patients recruited for the study were singleton pregnancies. Table 1 displays the results of the questionnaire that was completed for every participant of the study, concerning the mother’s age, the type of pregnancy, cord length, as well as whether the physicians could fit their index finger between the infant’s neck and cord.

The research concluded that there was no dependence of maternal age, pregnancy duration, etc.. on the chance of cord entanglement. Multiple loops were less common than single loops around the neck, but not significantly less (in my opinion). Although, post-term pregnancies were found to be “significantly associated with nuchal cord formation”. The length of the nuchal cord had a role in the risk as well.  An explanation for the post-term pregnancy association is that once the pregnancy moves past 41 weeks, there is a reduction in the amount of amniotic fluid volume, and this may decrease the ability of the fetal head to move and free itself from the wrapping.

An interesting finding of this research is that the “male sex of the newborn was significantly associated with a nuchal cord at delivery” with the explanation that male fetuses more frequently thus resulting in the ability to increase the number of times the cord is wrapped around the neck.

I find this to be an interesting topic and with the interest in gynecology and hearing of nuchal cord entanglement as being more frequent than we’d assume, I thought it be a good idea to learn some more on it! I’m interested in looking for further research on the effects of twin nuchal cord entanglement and the different characteristics of that.

Link: https://doaj.org/article/9a2380214315480da590b1add9218ea1

ART (assisted reproductive techniques) have grown to be an alternative to conception for couples who are infertile. However, as it is not a natural procedure, it comes with certain risks that can affect the mother during pregnancy and the child during and after birth.

To increase the success rate of the pregnancy, usually more than one fertilized egg is implanted into the woman’s uterus for implantation and this can result in multiple (twins) births.

Going into a bit more detail, ART results in several pregnancy complications such as stillbirth and premature births. Along with these complications, there is an increased rate of ART infants needing more attention after birth to confirm proper development and healthy conditions. The number of death rate is also higher in ART conceived births.

This paper took their sample data for naturally and ART conceived births, from a woman’s hospital. They extracted details about the pregnancy outcomes and complications, number of deaths and related health conditions and input these into a logistics regression model and found the adjusted odds ratios to determine the association of the complications/outcomes/conditions with the form of pregnancy (natural or ART).

Table 4 presents what I think are the most important findings of the paper, which are the adjusted odds ratios and p values of the complications. These can help hypothesize which complications are more associated with ART pregnancies.

From the results, the researchers concluded that multiple birth pregnancies are at a greater risk of post-birth complications, if they were ART pregnancies. They found that multiple births are, “associated with four to ten times greater perinatal mortality compared to singleton gestations”. Due to these known complications, women who are giving birth to more than one child and has undergone ART treatment are more closely looked after in case of the need of surgical deliveries.

I chose this paper because I am interested in pregnancy complications and the effects of the fertilization methods on the development of the infant. Since ART is a developing method nowadays and with the desire to go into the field, I believe it is important to be aware of the most recent techniques in the field and gain knowledge on “what’s going on now”.

Link to paper: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3923652/

ERIKSSON, JOHAN G., et al. “Boys Live Dangerously in the Womb.” American journal of        human biology : the official journal of the Human Biology Council, U.S. National Library of Medicine, 13 Feb. 2014, www.ncbi.nlm.nih.gov/pmc/articles/PMC3923652/.

There is not very much known on this topic, which expresses the possibility of boys being at a greater risk than girls in the mother’s womb. This paper begins to shed some light on the differences that have risen and theories about why this might be.

There are a few distinguishing characteristics that differentiate boys and girls while in the mother’s womb. As a result, researchers have claimed that this puts boys at a risk of hypertension, along with other diseases later in life. Boys, have been found to grow faster in the womb than girls, due to this, they demand more from the placenta for nutrients to compensate, but during late gestation this can cause the placenta to grow more than it needs to – “compensatory placental enlargement”.

The paper emphasizes the importance of the mother’s diet, especially when they’re having a boy. The mother can improve her diet, however, her metabolism and how her body stores the ingested nutrients is also a contributing factor, as well as how well the placenta can “transport nutrients…to [the] fetus”.

Researchers found that the placentas of boys were more efficient, but they did not have a very large reserve capacity, which can be threatening if the mother’s diet does not fulfill the fetus’ nutritional needs.

A fascinating theory presented in the paper suggests that there is a “trade-off [of] visceral development to protect brain growth”! Although, this sounds like a very strategic trade-off, it can have serious effects on the physical health of the child in later years, that put them at risk of diseases characteristic of malnutrition in the womb. The paper describes that hypertension can be a result of a “lifetime reduction in the number of nephrons” because of the trade-off to protect the cranium, less significance is placed on other body parts.

Researchers found that a shorter length of the placenta “predicted later hypertension in women”. And it was not how high the birthweight of the men with a high placental weight, it was the “disproportion between the growth of the lesser diameter [of the placenta] and the fetus that predicted the disorder”. The greater the difference between the two, the greater the risk of hypertension in later years of their lives.

The researchers did not find a strong correlation between the placental weights and the men’s risk of hypertension. As well, a low birth weight linked to hypertension was found to be statistically significant in males and females, as described in Figure 1 and Table 2. Figure 1 presents the odds ratio for the association between placental area and hypertension, while controlling for the low birth weight. They did find that the boy’s placenta’s were smaller when they also considered the weight of the child at birth, “suggesting that boys placentas are more efficient than girls’ placentas”.

They also suggested that there may be a relation between the size of the placenta and pregnancy complications, such as preeclampsia, this may be a result of a change in the tissue development on one side of the placenta.

Researchers believe that boys are “more responsive to their mother’s current diet than girls” while girls focus more on the history of their mother’s health habits and homeostatic mechanisms, such as metabolism.

This research is of interest, a) because this area of research (obstetrics and gynaecology) is my future career path and I want to learn everything there is to know about fetal development and this paper puts a slight twist to the field of study and b) it is one of the papers that I have been assigned to review for a research project for the summer. We will be examining the differences between boys and girls in the womb and the effects of this on pregnancy outcomes.

By: Simran Grewal