33rd Week Research Articles

A Uterine Fibroid Presenting as an Incarcerated Umbilical Hernia During Pregnancy

Abstract Background: The incidence of uterine fibroid entrapped in umbilical hernias during pregnancy is very low. Only 3 case reports of this kind have been published to date. Case: This article discusses the case of a 38-year-old woman in the 33rd week of gestation, who presented with an incarcerated umbilical hernia, and underwent emergency surgical repair. A pedicled uterine fibroid was found in the hernia sac, which was mobilized and resected. The hernia defect was repaired by the Mayo technique. Results: No complications were observed during the postoperative period and she subsequently delivered a full-term baby boy. Conclusions: The possibility of a fibroid entrapped in a hernia sac should be taken into consideration in the evaluation of incarcerated hernias during pregnancy. If the contents of the hernia sac cannot be reduced safely into the abdominal cavity by manual reduction, emergency surgical repair should be considered as a means to prevent further pregnancy-related complications. (J GYNECO...

Three-Dimensional Volumetric Spatially Angle-Corrected Pixelwise Fetal Flow Volume Measurement

Early attempts to calculate fetal global perfusion used 2 D images. The results were not sufficiently reliable. That's why RI measurements are still in use despite the fact that they do not reflect the amount of blood passing through the fetus. We present a novel three-dimensional approach to overcome these limitations. In 124 singleton pregnancies between the 23rd and 4st gestational week, a three-dimensional color Doppler sonographic record of the umbilical cord was made, resulting in 281 volume data sets. With dedicated software (PixelFlux) the spatial angle of the umbilical vein was calculated and the true global fetal perfusion was calculated from its horizontal transection as the product of the area of all pixels and the spatial angle-corrected velocity. To validate the PixelFlux technique, phantom flow measurements were carried out. Phantom flow measurements revealed a highly significant correlation of actual flow volumes and those measured by the PixelFlux technique (p < 0.001; rPearson = 0.987 - 0.991) with an even higher interobserver correlation (p < 0.001; rPearson = 0.997). We found a significant correlation of fetal volume flow to gestational age and weight (r = 0.529 at spatial angles below 30° to r = 0.724 at spatial angles below 5°) and a significant influence of the spatial angle on this correlation (p = 0.003; r = -0.865). Spatial angle-corrected global fetal perfusion measurement improves existing approaches to fetal perfusion evaluation, and is feasible, simple and fast. Thus, it can be recommended to explore the relationship of fetal perfusion and disturbances of fetal development.

Monitoring of herbivore's feeding activity in three different elevations of Mt. Jirisan National Park, a Korea long‐term ecological research site

The purpose of the present study is to monitor diverse herbivore's feeding activity in Mt. Jirisan National Park, a Korea LTER site in a part of investigation of plant‐insect‐bird interactions. We selected nine tree species at three survey sites in three different elevations (300 m, 900 m, and 1200 m). We measured the herbivore's feeding activity by an indirect method that calculates feeding area per leaf by diverse but unknown herbivores (ankertrass area) every two weeks from April to June. We found that the peak and duration differ along the elevation: at a low elevation site (300 m), pattern of ankertrass area increased continuously from 16thJulian week to 22nd week; at middle elevation site (900 m), pattern of ankertrass area increased continuously from 20thJulian week to 25th week; andat high elevation site (1,200 m), pattern of ankertrass area sharply increased from 22nd Julian week to 23rd week. It showed that late May (22∼23 Julian week) was the peak timing of ankertrass in all elevation site. We expected that the peak or duration of herbivore activity can be changed followed by environmental change and this can be monitored in a long term ecological monitoring.

Reference Intervals for Fetal Ear Length Between 19 and 24 Weeks of Pregnancy on 3-Dimensional Sonography

The purpose of this study was to establish reference intervals for fetal ear length using 3-dimensional sonography in the rendering mode. A cross-sectional study was conducted on 114 women from 19 weeks to 23 weeks 6 days of normal pregnancy. Fetal ear length measurement was performed in the rendering mode, obtained from 2-dimensional mode reconstruction. To determine the correlation between ear length and gestational age, scatterplots were constructed, and the Pearson correlation coefficient was calculated. Mean, median, SD, maximum, and minimum values and percentiles for each gestational age were calculated. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient. The mean ear length ± SD increased from 14.43 ± 1.28 mm (range, 12.80-16.50 mm) in the 19th week of pregnancy to 19.72 ± 1.87 mm (range, 17.20-22.40 mm) in the 23rd week. Three-dimensional sonographic ear length measurements were correlated with gestational age, with the best adjustment represented by the following exponential equation: ear length = exp(1.215 × gestational age - 8.692) (R(2) = 0.423). The intraobserver reproducibility was excellent, resulting in an intraclass correlation coefficient of 0.967 (95% confidence interval, 0.939-0.982). Reference intervals for fetal ear length using 3-dimensional sonography in the rendering mode from 19 weeks to 23 weeks 6 days of pregnancy were determined and proved reproducible.

Spontaneous prelabor uterine rupture in a primigravida: a case report and review of the literature

A rare case of prelabor uterine rupture in a primigravida was reported. A woman with a history of uterine perforation during hysteroscopy became pregnant after donor oocyte in vitro fertilization. To provide more insight into the possible risk factors for prelabor uterine rupture in primigravidae, a literature review was performed.

Peripartal Myocardial Infarction Caused by Placenta Embolus

A-32-year old second gravid woman without known cardiovascular risk factors underwent an elective cesarean delivery during the 33rd week of gestation because of intrauterine growth retardation secondary to placenta insufficiency. The latter was most likely related to a previously diagnosed symptomatic antiphospholipid syndrome. Twenty hours after an uncomplicated delivery, the patient reported a sudden onset of typical chest pain after a severe cough attack. Pulmonary embolism was ruled out by computed tomography. Chest pain had subsided 1 hour after onset following the initiation of medical therapy. The ECG showed transient, nonsignificant ST-segment changes (Figure 1) in the inferior leads, and cardiac enzymes were slightly elevated, reaching peak values 12 hours later. The diagnosis of subacute non–ST-elevation myocardial infarction (peak troponin I 2.240 μg/L [<0.010 μg/L], peak creatine kinase 1316 U/L [<170 U/L], and peak creatine kinase MB 87.9 μg/L [<4.0 μg/L ]) was established, and the patient was transferred to the coronary care unit. Transthoracic echocardiography showed a modest inferolateral hypokinesia with preserved global systolic left ventricular function (Movie I in the online-only Data Supplement). The patient underwent coronary …

Second trimester fetal nasal bone length in a low‐risk Turkish population

To define normal values of second trimester fetal nasal bone length (NBL) in a low-risk Turkish population. Prenatal records of singleton fetuses who underwent second trimester ultrasonographic examination in the 16 to 23 weeks of pregnancy were retrospectively analyzed for NBL and biometric measurements (BPD, FL and HL). The relationship among NBL and gestational age (GA), biparietal diameter (BPD), femur length (FL) and humerus length (HL) was determined. Additionally, percentile values of NBL for each gestational week were provided. A total of 1467 fetuses were included in this study. There was a significant linear association among NBL and GA (R(2) = 0.709), BPD (R(2) = 0.752), FL (R(2) = 0.742) and HL (R(2) = 0.747). Fifth percentile values of fetal NBL were 3.11 mm for 16th, 3.50 mm for 17th, 3.70 mm for 18th, 4.10 mm for 19th, 4.50 mm for 20th, 4.62 mm for 21st, 5.24 mm for 22nd and 5.37 mm for 23rd gestational weeks. The study provides normal ranges of NBL between 16 and 23 weeks of pregnancy in a low-risk Turkish population. Future studies with larger sample sizes including pregnancies carrying high risk for aneuploidy are needed to define cut-off values for NBL.

Enterectomy During Pregnancy for Mesenteric Vein Thrombosis Factor V Leiden Homozygosity

Background: Pregnant women carrying the factor V Leiden (FVL) mutation have a higher risk of venous thromboembolism. Case: A 39-year-old woman, homozygous for factor V Leiden mutation, presented with abdominal pain in the 33rd week of pregnancy. The patient suffered from mesenteric vein thrombosis. Results: Immediate cesarean birth was followed by a partial enterectomy. Conclusions: When signs of peritonitis are present, as in this case, successful treatment of mesenteric vein thrombosis mandates early resection of the infarcted bowel and mesentery to encompass the entire thrombotic process. In the presence of thrombophilia, the patient should also be given antepartum and postpartum low–molecular-weight heparin prophylaxis. (J GYNECOL SURG 27:111)

Expression of lumbosacral HOX genes, crucial in kidney organogenesis, is systematically deregulated in clear cell kidney cancers

Homeobox-containing genes are involved in different stages of kidney organogenesis, from the early events in intermediate mesoderm to terminal differentiation of glomerular and tubular epithelia. The HOX genes show a unique genomic network organization and regulate normal development. The targeted disruption of paralogous group 11 HOX genes (HOX A11, HOX C11 and HOX D11) results in a complete loss of metanephric kidney induction. Despite a large amount of data are related to the early events in the kidney development, not much is known about HOX genes in advanced kidney organogenesis and carcinogenesis. Here, we compare the expression of the whole HOX gene network in late-stage human foetal kidney development with the same patterns detected in 25 pairs of normal clear cell renal carcinomas (RCCs) and 15 isolated RCC biopsy samples. In the majority of RCCs tested, HOX C11 is upregulated, whereas HOX D11, after an early involvement becomes active again at the 23rd week of the foetal kidney development, is always expressed in normal adult kidneys and is deregulated, together with HOX A11 and lumbosacral locus D HOX genes. Thus, through its function of regulating phenotype cell identity, the HOX network plays an important role in kidney carcinogenesis. Lumbosacral HOX genes are involved in the molecular alterations associated with clear cell kidney cancers and represent, through their deregulation, a molecular mark of tubular epithelial dedifferentiation occurring along tumour evolution, with the restoration of genetic programs associated with kidney organogenesis. The deregulation of lumbosacral HOX genes in RCCs supports (i) the consideration of the HOX gene transcriptome as the potential prognostic tool in kidney carcinogenesis and (ii) the possibility to foresee clinical trials with the purpose of targeting these genes to achieve a therapeutic effect in RCC patients.

Ehlers Danlos Syndrome Type IV and pregnancy

A case report is presented of a 23-year-old patient who was diagnosed with Ehlers Danlos syndrome (EDS) Type IV (vascular type) in the 23rd week of her second pregnancy. EDS Type IV has one of the highest mortality rates for pregnant women of any condition with significant morbidity if the mother survives. Current literature is presented and supports the necessity for close monitoring of mother and child in a specialist unit with involvement of a multi-disciplinary team. There is no agreed consensus on the mode or timing of delivery but recent literature is supportive of delivery by caesarean section at 32weeks. This case report demonstrates a successful outcome for both mother and child with a planned delivery at 34weeks by caesarean section and emphasises the importance of strategic planning for complicated deliveries and the effectiveness of good communication networks. Patients with EDS Type IV should be counselled about the potential risks for both themselves and the child to enable them to make informed decisions about their obstetric care.

Management of Multiple Myeloma in Pregnancy: Strategies for a Rare Challenge

Multiple myeloma is the second most commonly diagnosed hematologic malignancy. It is characterized by the accumulation of monoclonal plasma cells. It typically manifests in the sixth decade of life or later, whereas the incidence in patients who are younger than 40 years old is extremely rare. Here, we report the case of a 34-year-old prima gravida, diagnosed with a κ light-chain myeloma (Durie&Salmon stage IIIA, International Staging System I) in the 23rd week of pregnancy. Our multimodal therapeutic approach during pregnancy, the delivery of a healthy male, and initiation of intensive anti-myeloma treatment thereafter (induction with bortezomib, cyclophosphamide, and dexamethasone, followed by tandem autologous peripheral blood stem cell transplantation) are described. Furthermore, we provide a comprehensive review of all 18 cases published between 1965 and 2010 in which a multiple myeloma was diagnosed and treated following different regimes and approaches before, during, or shortly after pregnancy. All delivered newborns were healthy, whereas the mothers' outcomes varied strongly. In our specific case, complete remission was achieved after tandem autologous peripheral blood stem cell transplantation. Emerging from these literature data and our case, we conclude that while awaiting delivery, the application of prednisolone as a nontoxic, but active anti-myeloma therapy can be recommended. Intensified postpartum anti-myeloma therapy should be induced as soon as possible to efficiently reduce myeloma burden and avoid organ damage in these young females.

Spontaneous uterine rupture in the 33rd week of IVF pregnancy after laparoscopically assisted enucleation of uterine adenomatoid tumor

Although a uterine leiomyomectomy or adenomyomectomy is an accepted procedure to treat symptoms such as dysmenorrhea or hypermenorrhea to enhance fertility, the risk of future uterine rupture is a major concern for patients who become pregnant following these surgery. Although uterine rupture very rarely occurs, this is the most feared complication in pregnancy and is associated with a high rate of maternal and fetal morbidity and mortality. A 37-year-old nulliparous woman had a 2-year history of infertility. A transvaginal ultrasound revealed multiple uterine tumors that resembled leiomyomas on the posterior and fundal walls of the uterine body. After the patient had three failed in vitro fertilization and embryo transfer treatments, the uterine tumor was enucleated, and pathologically diagnosed as an adenomatoid tumor. Five months after the operation, the patient became pregnant as a result of a fourth in vitro fertilization and embryo transfer. At the 33rd week of gestation, she complained of a sudden onset of abdominal pain. The patient was diagnosed with a ruptured uterus based on an ultrasound, and an emergency cesarean section was performed. The rupture occurred at the site of the operation scar on the posterior wall of the uterine body. The fetal legs extruded into the abdominal cavity from the uterine cavity but were enclosed within the unruptured chorioamniotic membrane. A male neonate (1956 g) was delivered without asphyxia and had Apgar scores of 8 and 9. The ruptured uterine wall could be repaired by suturing. To our knowledge, this is the first case report of uterine rupture during pregnancy after resection of an adenomatoid tumor in the uterine body.

The values of serum cytokines in chronic lung disease in newborn

Chronic lung disease in the newborn is a complication of mechanical ventilation. The diagnosis of chronic lung disease is made in children of over 36 post-conceptual weeks' age who still require additional oxygen and who have abnormal chest x-ray findings. This study was aimed at triaging newborns at risk of developing chronic lung disease. The operating study hypothesis was that the values of insulin-like growth factor I below 30 microg/L in the 33rd post-conceptual week were associated with the development of chronic lung disease. The above hypothesis was verified by a cohort, prospective study, which included preterm newborns of 33 gestational weeks' age or less who were hospitalised at the Department of Neonatology of the Clinical Centre of Montenegro from Aril 2008 to July 2009. The blood sample was taken in the 33rd post-conceptual week and the insulin-like growth factor value was determined by the method of enzyme immunoassay. Our study results confirmed the theory of statistically significant correlation of the length of pregnancy and birth body weight with insulin-like growth factor serum level. We did not find any statistically significant correlation between the insulin-like growth factor serum value and chronic lung disease in the newborn. It is possible that the insulin-like growth factor has a different role at various stages of pathogenesis of diseases of prematurity. We believe that by correcting the term for determining the levels we can get a significant correlation between low values of insulin-like growth factor -1 and chronic lung disease.

Multifoetal pregnancies complicated by reversed arterial perfusion: Report of four cases

Twin reversed arterial perfusion syndrome (TRAP) or acardiac anomaly presents a rare and severe complication affecting monochorionic multiple pregnancies occurring in 1 per 35,000 pregnancies or 1 per 100 of monozygotic twins. We report four cases of multiple pregnancies with TRAP diagnosed over the last 2 years, which were under check-up and treatment during the entire pregnancy course finalized by delivery. In two cases pregnancies were trigeminal, and other two geminal, with acardia of one foetus, by anceps type in three and acephalus in one. Expectant management was initially done in all cases. The relation of acardiac and donor abdominal circumference was below 50% and negative signs of the donor's cardiac failure were detected in two cases, so that expectative management was continued until delivery. Due to obstetric indications, a cesarean section was performed on the 33rd and 34th gestational week, and healthy newborns were delivered. Another two acardiac twins had abdominal circumference ratio between the acardiac fetus and the donor of over 50%, and signs of congestive heart failure in the donor, which indicated invasive therapeutic procedure with absolute alcohol chemisclerosis; it was done by alcohol injection into the acardiac abdominal aorta which interrupted the retrograde blood-flow into the acardiac umbilicus. In the first case a successful intervention was performed at 29th gestational week, but after 12 hours distress signs were registered. The delivery was finalized by a cesarean section, and a live donor was delivered. In the second case the intervention was successfully done at the 20th gestational week, and after 96 hours from the intervention lethal ending of the donor was registered. Bearing in mind that the occurrence of TRAP is rare, it is necessary to sum-up experiences from a larger number of centres to determine efficient therapeutic procedure.

Avaliação do comprimento e área do corpo caloso fetal por meio da ultrassonografia tridimensional

to establish reference values for the length and area of the fetal corpus callosum between the 20th and 33rd weeks of gestation using three-dimensional ultrasound (3DUS). this cross-sectional study involved 70 normal pregnancies with gestational age between 20 and 33 weeks. An Accuvix XQ instrument with a convex volumetric transducer (3 to 5 MHz) was used. To assess the corpus callosum, a transfrontal plane was obtained using the metopic suture as an acoustic window. Length was obtained by measuring the distance between the proximal and distal extremities of the corpus callosum. Area was obtained by manual tracing of the external corpus callosum surface. The means, medians, standard deviations, and maximum and minimum values were calculated for the corpus callosum length and area. Scatter graphs were created to analyze the correlation between corpus callosum length and area and gestational age and biparietal diameter, the quality adjustments was verified according to the determination coefficient (R²). The intraclass correlation coefficient (ICC) was used to assess the intraobserver variability. mean corpus callosum length increased from 21.7 (18.6 - 25.2 mm) to 38.7 mm (32.6 - 43.3 mm) between 20 and 33 weeks of pregnancy, respectively. Mean corpus callosum area increased from 55.2 (41.0 - 80.0 mm²) to 142.2 mm² (114.0 - 160.0 mm²), between 20 to 33 weeks of pregnancy, respectively. There was a strong correlation between corpus callosum length and area and gestational age (R² = 0.7 and 0.7, respectively) and biparietal diameter (R² = 0.7 and 0.6, respectively). Intraobserver variability was appropriate, with an ICC of 0.9 and 0.9 for length and area, respectively. reference values for corpus callosum length and area were established for fetuses between 20 and 33 weeks gestation. Intraobserver variability was appropriate.

Influenza surveillance results during 2008 - 2009 season in Turkey

National influenza surveillance was performed by two institutions in Turkey, Refik Saydam National Public Health Agency (RSNPHA) and Istanbul Faculty of Medicine (IFM), which both are National Influenza Reference Laboratories. RSNPHA received samples from 9 sentinel Provinces and IFM received samples from 5 sentinel Provinces. We report the 2008 to 2009 surveillance results from October 2008 - May 2009. As many as 1,980 clinical specimens received from 14 sentinel and non-sentinel Provinces of which 257 nasal-nasopharyngeal samples were positive for influenza viruses. The predominant virus type was influenza B (67.5% of total detections), and the dominant sub-type among Influenza A viruses was H3 (98.8%). Influenza-like illness (ILI) activity started around the 42nd week, decreased around the 23rd week and the laboratory confirmed seasonal Influenza activity started around 48th week and ended around 22nd week. The 2008 - 2009 influenza seasons in Turkey was characterized by moderate clinical activity and a dominance of influenza B. In Hemagglutination inhibition (HI) test, the majority of influenza A/H3 viruses were closely related to the vaccine virus strain of the 2008 to 2009 season, Influenza A Brisbane/10/2007 (H3N2) like virus. However, Influenza B viruses were antigenically different from the vaccine strain and more closely related to Influenza B Malaysia/2560/2004 (Victoria lineage). It is concluded that knowledge about the influenza activity in Turkey, which is at the crossroads of Europe and Asia, contributed to monitoring the movement of influenza virus epidemiology. Key words: Influenza, surveillance, Turkey.

Clinical management of paroxysmal nocturnal haemoglobinuria in pregnancy: three case reports.

First described in 1928, paroxysmal nocturnal haemoglobinuria (PNH) is a rare disease resulting from an acquired defect of one or more lineages of haematopoietic stem cells. The prevalence is estimated to be approximately 1–10 cases per million people, with the disease mainly affecting young adults, including women of childbearing age1. PNH is characterised by paroxysmal intravascular haemolysis with anaemia, neutropenia, thrombocytopenia, bone marrow disorders, a thrombotic tendency and increased susceptibility to infections2,3. Until 2007, the treatment of this condition was mainly supportive, including transfusions of red blood cells and platelets, folic acid and iron replacement, glucocorticoids and anticoagulation therapy. Bone marrow transplantation appears to be the only potentially curative option, but it carries a 10–20% risk of early mortality3. Eculizumab, a humanised monoclonal antibody, has recently revolutionised the treatment of PNH. The use of this antibody for the treatment of PNH was approved by the United States Food and Drug Administration in March 2007 and subsequently by the European Medicines Agency in June 20073,4. We describe the clinical evolution during pregnancy and post-partum period of three women diagnosed with PNH and referred to the obstetric outpatient clinic of our tertiary care level hospital (Table I). The diagnosis of PNH was confirmed by laboratory studies in all three cases. Venous blood samples were collected in EDTA K3 and a Redquant® kit from Biocytex was used. The samples were treated according to standard protocols and submitted to flow cytometry in a FACS Calibur® (Becton-Dickinson, Enzifarma Portugal) using the Cell Quest program. The data were analysed with Paint-a Gate PRO software. Three cell lineages were studied after appropriate labelling: red blood cells (CD55-FITC and CD59-FITC), monocytes (CD48-FITC/CD87-PE/CD14-PerCP/CD4-APC), and granulocytes (CD24-FITC/CD87-PE/CD16-PerCP). Diagnostic criteria were the existence of at least two positive markers in a cell line, with at least two cell lines affected. Table I Description of cases. Case reports Case 1 A 29-year-old primipara of African descent was referred to our outpatient clinic in the 9th week of gestation for monitoring of her pregnancy. She had been diagnosed with PNH 5 years previously, following investigations for persistent fatigue and haemolytic anaemia (haemoglobin [Hb]=8.2 g/dL, lactate dehydrogenase=2,384 U/L). After oral iron replacement, she had remained asymptomatic without needing regular transfusion therapy. She had no prior history of thrombosis but she is heterozygous for the MTHFR mutation with a normal homocysteine level. At the time of referral she was taking aspirin (100 mg/day), advised by her general practitioner, and we decided not to discontinue this until the 35th week of pregnancy. At the first appointment, she had moderate haemolytic anaemia (Hb=9.4 g/dL) but, during pregnancy, she needed to be transfused with a total of 7 units of red blood cells (in weeks 14, 21, 29 and 35), in order to maintain her Hb level around 10 g/dL. Pregnancy was uncomplicated until the 33rd week, when she began to complain of a strong frontal headache and was given prophylactic subcutaneous Low Molecular Weight Heparin (LMWH), (enoxaparin 4,000 UI anti-Xa, daily). Despite this, 2 weeks later, the patient was admitted to hospital because of persistent headache; she was treated with intravenous analgesia and was discharged home after clinical improvement and cerebral magnetic resonance imaging, which showed no abnormalities. At the beginning of the 37th week she was readmitted to our hospital because of worsening symptoms and computed tomography of the brain showed a longitudinal sinus thrombosis. Anticoagulation therapy was started with unfractionated intravenous heparin and, in order to avoid the stress of vaginal delivery, we performed an elective caesarean section. The woman's baby, a female, weighed 2,300 g, had an Apgar score of 9 at the 1st minute and 10 at the 5th minute and did not require neonatal intensive care. The puerperium was uneventful and the patient began anticoagulation with warfarin, before being discharged home on the 16th day after delivery. Cerebral magnetic resonance imaging performed 1 month later showed complete resolution of the thrombosis. Contraception with a levonorgestrel-releasing intrauterine device (IUD) was instituted 3 months after delivery.

Avaliação da evolução da área das valvas mitral e tricúspide fetal com ultrassonografia tridimensional

to evaluate the areas of the atrioventricular valves (tricuspid and mitral) of normal fetuses by the use of three-dimensional ultrasound (3DUS) and the spatiotemporal image correlation (STIC) method.a cross-sectional study was conducted on 141 women between the 18th and the 33rd week of pregnancy. Cardiac volumes were measured with a volumetric transabdominal transducer attached to the Voluson 730 Expert equipment. The four chamber plane was used as reference, with the region of interest (ROI) positioned from the ventricles, and the area of the valves was obtained manually. To determine the correlation of the areas with gestational age, scatter plots were constructed and the Pearson correlation coefficient (r) was calculated. Means, medians, standard deviations (SD) and maximum and minimum values were calculated. The simple linear regression model was used to determine reference ranges of valve areas according to the gestational age by the Altman method, with the level of significance set at p<0.05. To calculate the intraobserver reproducibility, we used the intraclass correlation coefficient (ICC) and the Bland-Altman graph.the mitral and tricuspid valve areas were correlated to the gestational age (r=0.80 for the tricuspid and r=0.79 for the mitral valve) and the mean value of the tricuspid and mitral valves increased from 0.22 ± 0.10 cm² and 0.23 ± 0.10 cm² on the 18th week to 0.92 ± 0.29 cm² and 1.08 ± 0.41 cm² on the 33rd of pregnancy, respectively. The intraobserver reproducibility resulted in an ICC=0.993 (95%CI 0.987; 0.996) and the mean difference was 0.01 cm² (SD ± 0.2 cm² and CI95% ± 0.4 cm²).reference intervals for the areas of the mitral and tricuspid valve between the 18th and the 33rd week of gestation were determined and proved to be highly reproducible.

Molecular detection of adeno-associated virus in cases of spontaneous and intentional human abortion

Pregnancy failure is a common event and often of unknown cause. Some viruses are thought to cause abortions including the adeno-associated viruses (AAV), viruses which are regarded as being without any definitive association to any human disease. This study investigated AAV infection in 81 human abortions, both spontaneous and intentional that occurred up to the 23rd week of gestation. Nucleic acid of AAV-2, 3, and 5 types from 118 decidual and chorionic tissues, collected from the patients in this study, was amplified by nested-PCR. In situ hybridization (ISH) was developed with a digoxigenin-labeled AAV probe in paraffin embedded tissues from the AAV positive cases. AAV was observed in 28.4% (23/81) of the cases, of which, 78.3% (18/23) were in the decidua and 21.7% (5/23) in the extravillous trophoblast, the chorionic plate, or chorionic villi fragments. AAV-2, the only type detected, occurred in 32.3% (22/68) and in 7.7% (1/13) of the spontaneous and intentional abortions, respectively. ISH revealed AAV in the decidua, chorionic tissue or chorionic plate and extravillous trophoblast. The detection of only AAV-2 type indicates that it is the most frequent in the population studied and/or shows tissue tropism. The presence of AAV in decidual or trophoblastic cells in cases of abortion, as observed by ISH, implies that the virus could jeopardize the pregnancy. The significant predominance in spontaneous cases suggests possibly a causal association between AAV and abortion.

Long-term amnioinfusion through a subcutaneously implanted amniotic fluid replacement port system for treatment of PPROM in humans

Objectives To introduce a novel method for the treatment of PPROM (preterm premature rupture of membranes) using continuous amnioinfusion via a subcutaneously implanted port system. Study design After development and testing since 2001 in a fetal sheep model, the port system has been successfully implanted in two humans with PPROM. In the first case, the subcutaneous port system was implanted during the 23rd week of gestation in a 39-year-old 5th-gravida with PPROM since the 18th week of gestation; in the second case, the port system was implanted during the 24th week of gestation in a 27-year-old 3rd gravida with PPROM since the 21st week of gestation. After port implantation, 100 ml/h saline solution was infused intermittently into the amniotic cavity. The whole course of treatment was supported by tocolysis. Results In the cases presented, gestation was terminated by cesarean section, in one case in the 29th week of gestation, and in the other case in the 30th week. The newborns showed no signs of lung hypoplasia and were successfully extubated on the 1st or 2nd day after delivery. Six months later the children did not exhibit any deviation from the normal development. Conclusion Long-term amnioinfusion via a subcutaneously implanted port system could be used in humans with PPROM for prolongation of pregnancy and to avoid lung hypoplasia. Prospective randomized studies are ongoing.