Outcome In Uncomplicated Pregnancies Research Articles

Evaluation of two-dimensional ultrasound fetal thymus size in correlation to infection parameters in pregnancies complicated with preterm premature rupture of membranes

Background/aim The thymus is essential for developing the fetal immune system and may show involution upon exposure to acute stress. Early detection of intrauterine infection is urgently needed to avoid fetal affection and sepsis. The present study aims to correlate the fetal thymus size with the infection parameters in pregnancies complicated with preterm premature rupture of membranes (PPROM). Subjects and methods The present study recruited pregnant women who fulfilled the inclusion criteria in a ratio of 1 case to 4 controls according to the study design; Group 1 of twenty cases presenting in PPROM, and Group 2 of eighty cases of women without PPROM. The primary outcome of the study was to measure fetal thymus size by abdominal ultrasound and its correlation with maternal total leukocytic count (TLC) and its differential count, C-reactive protein (CRP), and maternal fever. The secondary outcomes involved the correlation of the fetal thymus size with fetal distress, the occurrence of neonatal infection, Apgar neonatal score, and histological examination of the placenta and membranes for evidence of chorioamnionitis. Results Group 1 had a significantly higher CRP level (P<0.001), higher TLC level (P=0.035), and higher Staff (P<0.001). On the contrary, group 2 had significantly higher AFI (P=0.022), greater Thymus perimeter (P<0.001), and greater thymus transverse diameter (P<0.001). In addition, the pathological examination of the placenta revealed positive signs of infection in group 1 in only 65% of cases. Group 1 had a positive correlation between Thymus perimeter and APGAR score of the neonates (r=0.658, P=0.002), Thymus perimeter and birth weight (r=0.741, P<0.001), Thymus transverse diameter and APGAR score of the neonates (r=0.741, P<0.001), and finally Thymus transverse diameter and birth weight (r=0.734, P<0.001). Group 2 showed a significant positive correlation between the Thymus perimeter and neonatal APGAR score (r=0.232, P=0.039) and Thymus transverse diameter and birth weight (r=0.320, P=0.004). In Group 1, Cases with placental signs of infection (n=13) had higher CRP levels (P=0.046), higher TLC levels (P=0.014), higher Staff (P<0.001), but lower AFI (P=0.032). Conclusion The assessment of the fetal thymus during the routine second- and/or third-trimester scan could be a predictive measure for intra-amniotic infection. However, there is no association between small fetal thymus and adverse perinatal outcomes in uncomplicated pregnancies. Further larger studies with different demographic, maternal characteristics, and different inflammatory processes with and without active management to summarize whether fetal thymus can be used in clinical practice to avoid infection-related fetal morbidities or not.

Cerebroplacental ratio for prediction of adverse intrapartum and neonatal outcomes in a term uncomplicated pregnancy

BackgroundFetal hypoxia is one of the major causes of high perinatal morbidity and mortality rates. Doppler ultrasound tests such as cerebroplacental ratio (CPR) evaluation are commonly used to assess blood flow disturbances in placento-umbilical and feto-cerebral circulations. A low cerebroplacental ratio has been shown to be associated with an increased risk of stillbirth regardless of the gestation or fetal weight. We conducted this study to assess the fetal cerebroplacental ratio in prediction of adverse intrapartum and neonatal outcomes in a term, uncomplicated pregnancy to reduce fetal and neonatal morbidity and mortality.ResultsIt was found that neonates with CPR ≤1.1 had significantly higher frequencies of cesarean delivery (CS) for intrapartum fetal compromise compared to those with CPR >1.1 (p=0.043). Neonates with CPR ≤1.1 had significantly lower Apgar score at 1 min and 5 min than those with CPR >1.1 (p=0.004) and (p=0.003), respectively. Neonates with CPR ≤1.1 had significantly higher rates of NICU admission than those with CPR <1.1 (p=0.004).ConclusionThe cerebroplacental ratio shows the highest sensitivity in the prediction of fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies at term. The cerebroplacental ratio index is useful in clinical practice in antenatal monitoring of these women in order to select those at high risk of intra- and postpartum complications.

Correlation between Cerebroplacental ratio and umbilical artery Doppler with pregnancy outcome in postdates

Background: Postdate pregnancy is a real problem in modern obstetrics. Its incidence has been reported to be between 4-14% with an average of 10.5%. Postdate pregnancy is associated with increased risk of perinatal morbidity and mortality. Assessment of fetal wellbeing is a corner stone in the management of prolonged pregnancy.Aim: To assess the usefulness of cerebroplacental ratio (CPR) compared with umbilical artery Doppler alone in prediction of the intrapartum fetal hypoxia and the adverse perinatal outcome in uncomplicated pregnancies (low risk pregnancy) beyond 40 weeks. Patients and Methods: This study was carried out on 60 pregnant women with uncomplicated postdate pregnancies beyond 40 weeks gestation attending the antenatal clinics of Al-Zahraa University Hospital for antepartum assessment of CPR. Results:CPR had a high predictive value in postdate pregnancy with sensitivity, specificity, PPV and NPV (85.7%, 73.9%, 50%, and 94.4%), respectively, in comparison to other parameters, with cut off value (0.94).Conclusion:CPR had the highest sensitivity and NPV in prediction of neonatal outcome. Cerebroplacental ratio less than 0.94 were the best predictor of adverse perinatal outcome and neonatal ICU admission.

Predictive value of Cerebroplacental blood flow ratio for fetal heart rate disturbances and perinatal outcome

Background: Doppler ultrasound velocimetry foetal vessels have become established method of antenatal monitoring, allowing non-invasive assessment of foetal circulation. Aims: To determine the usefulness of Doppler velocimetry, based on cerebroplacental ratio (C/U) evaluation, in predicting intrapartum fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies from 36 to 40 weeks. Subjects and Methods: this is prospective study include 300 uncomplicated pregnant women, age ranged from 17 to 45 years, with gestational age 36 to 40 weeks. Results: there was significant relation between CPR and adverse neonatal outcome p-value <0.001 with sensitivity, specificity and PPV, NPPV of CPR in detecting neonatal adverse outcome 100%. Conclusion: better prediction of neonatal outcome can be done by C/U ratio

Predictive value of Cerebroplacental blood flow ratio for fetal heart rate disturbances and perinatal outcome

Background: Doppler ultrasound velocimetry foetal vessels have become established method of antenatal monitoring, allowing non-invasive assessment of foetal circulation. Aims: To determine the usefulness of Doppler velocimetry, based on cerebroplacental ratio (C/U) evaluation, in predicting intrapartum fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies from 36 to 40 weeks. Subjects and Methods: this is prospective study include 300 uncomplicated pregnant women, age ranged from 17 to 45 years, with gestational age 36 to 40 weeks. Results: there was significant relation between CPR and adverse neonatal outcome p-value <0.001 with sensitivity, specificity and PPV, NPPV of CPR in detecting neonatal adverse outcome 100%. Conclusion: better prediction of neonatal outcome can be done by C/U ratio

Implications of Early Pregnancy Obesity on Maternal, Fetal and Neonatal Health: Retrospective cohort study from Oman.

This study aimed to determine the prevalence of early pregnancy obesity among Omani women and to review maternal antenatal complications, intrapartum and postpartum events and neonatal complications among such women in comparison to women of normal weight. This retrospective cohort study included 2,652 pregnant Omani women who delivered at the Royal Hospital, Muscat, Oman, between November 2011 and April 2012. The patients' electronic medical records were reviewed for antenatal, intrapartum and postpartum data. Body mass index was measured during the first trimester (≤12 gestational weeks) and classified according to the World Health Organization categories. Maternal and neonatal complications were compared between obese women and those of normal weight. Obstetric outcomes in uncomplicated pregnancies were also compared. In the study cohort, there were 901 (34%) obese women and 912 (34.4%) women of normal weight; of these, 440 (48.8%) and 672 (73.7%) had uncomplicated pregnancies, respectively. Obese women had a significantly increased incidence of gestational diabetes (relative risk [RR]: 2.23; 95% confidence interval [CI]: 1.70-2.92; P <0.01), gestational hypertension (RR: 3.04; 95% CI: 1.63-5.65; P <0.01), Caesarean delivery (RR: 1.48; 95% CI: 1.08-2.03; P <0.01), postpartum haemorrhage (RR: 2.10; 95% CI: 1.11-4.10; P = 0.01) and fetal macrosomia (RR: 2.71; 95% CI: 1.21-6.09; P <0.01). Approximately one-third of the studied Omani women were obese. These women had a significantly increased risk of various maternal antenatal complications, intrapartum and postpartum events and neonatal complications.

312: Maternal extracellular miRNAs as biomarkers for placental dysfunction between 17-28 weeks gestation

We used next-generation sequencing methods to identify miRNAs in the extracellular RNA in the serum of patients between 17-28 weeks gestation in patients who developed placental dysfunction (preeclampsia or intrauterine growth restriction) compared to those with uncomplicated pregnancy outcomes. Maternal serum was collected between 17-28 weeks gestation from the UC San Diego Placental Dysfunction Clinic. Subjects were referred to the clinic for abnormal analytes from first or second trimester serum aneuploidy screening or maternal co-morbidites that increased their risk for placental dysfunction. 19 cases and 29 controls were selected from this cohort. Extracellular RNA was isolated from the serum samples, and small RNA sequencing libraries were constructed. Differential rank conservation was used to identify extracellular miRNA biomarkers associated with placental dysfunction. The UCSD cohort was analyzed in two technical replicates. To avoid normalization artifacts, ratios of pairs of miRNAs were used as analytes. The performance of all possible pairs of detected miRNAs was determined separately for the two technical replicate datasets for this cohort. The 100 top performing miRNA pairs from the first technical replicate of the UCSD cohort were selected for further analysis. There was an enrichment of miRNAs encoded by two miRNA gene clusters on chromosomes 14 and 19, both of which have been reported to be expressed in the placenta in prior studies. The performance of all possible combinations of 5 pairs from these 100 top performing miRNA pairs were tested. The best combinations of 5 miRNA pairs yielded a sensitivity of 94.4% and specificity of 96% in the first technical replicate and a sensitivity of 93% and specificity of 89.5% in the second technical replicate. The performance of these combinations in a sample set including only normal versus severe preeclampsia cases only, and obtained a sensitivity and specificity of 100% for the top performing combinations in both the first and second technical replicates. By isolating and performing small RNA sequencing on extracellular RNA from maternal serum collected between 17-28 weeks gestation, we identified candidate biomarkers for placental dysfunction miRNAs in the maternal serum. Future work will include validation of these candidates in an independent cohort.

Neonatal effects after vasopressor during spinal anesthesia for cesarean section: a multicenter, randomized controlled trial

BackgroundPlacental transfer of ephedrine causes fetal effects when compared with phenylephrine. This study compared their drug effects on neonatal parameters after cesarean delivery under spinal anesthesia. MethodsThree-hundred-and-fifty-four women undergoing elective cesarean delivery who needed intravenous vasopressor following spinal anesthesia were randomized into two groups. Group E received boluses of ephedrine 6mg, and Group P phenylephrine 100µg, titrated to maintain systolic blood pressure near baseline values. Neonatal heart rates at 10 and 30–45min of age, oxygen saturation and capillary blood glucose at 30min, and capillary blood lactate and urine metamphetamine were recorded. ResultsNeonatal heart rate at 10min was significantly higher (mean difference 4.0, 95%CI 0.6 to 7.3, P=0.02) in Group E versus Group P, but this was not clinically relevant. There was a linear correlation between neonatal heart rate at 10min and ephedrine dose in Group E (r2=0.29, 95%CI 0.22, 0.74, p<0.01). The decremental changes in neonatal heart rate at 10 and 30min were significantly greater in Group E. Urine metamphetamine tests were positive in 19% of 44 neonatal urine samples. Neonatal heart rates at 30min, oxygen saturation, capillary blood glucose and the incidence of tachycardia, respiratory problems or abnormal glucose, were not significantly different. ConclusionsEphedrine, compared to phenylephrine as a vasopressor during cesarean delivery, was associated with higher neonatal heart rate in the early post-birth period, but without a significant difference in clinical outcomes in uncomplicated pregnancies.

Can the cerebroplacental ratio (CPR) predict intrapartum fetal compromise? A prospective observational study

Objective: To investigate the potential clinical use of serial fetal CPR measurements during the last month of pregnancy for the prediction of adverse perinatal outcome in unselected low-risk pregnancies. Methods: A multicenter prospective observational cohort study in 315 consecutively recruited low-risk pregnancies. All eligible pregnancies underwent serial sonographic evaluation of fetal weight and Doppler indices at two week intervals, from 36 weeks gestation until delivery. Data were converted into centiles correcting for gestational age. These data were not available for the obstetrical team and hence, could not influence management decisions. Primary outcomes were operative delivery for presumed fetal compromise and a composite neonatal outcome (arterial cord Ph 90th centile). Results: Three hundred fifteen women were recruited in this study. We ecxluded 32 pregnancies because of small for gestational age babies (SGA), leaving 293 women and 583 CPR values for data-analysis. There were 85 (27%) adverse neonatal outcomes and 29 patients (9%) underwent operative delivery for presumed fetal compromise. Both primary and secondary outcomes were not significant different between the different CPR groups. Furthermore, we examined if individual serial CPR measurements could predict adverse outcome and found no linear correlation between repeated measurements of CPR and adverse outcomes. Conclusion: Our study shows that routine serial screening by CPR measurements provides poor prediction for adverse perinatal outcome in uncomplicated pregnancies.

Cerebroplacental ratio in prediction of adverse perinatal outcome and fetal heart rate disturbances in uncomplicated pregnancy at 40 weeks and beyond.

IntroductionThe aim of the study was to determine the usefulness of Doppler velocimetry, based on cerebroplacental ratio (C/U) evaluation, in predicting intrapartum fetal heart rate abnormalities and adverse neonatal outcome in uncomplicated pregnancies at 40 weeks and beyond.Material and methodsOne hundred and forty-eight women in uncomplicated pregnancies, between 40 and 42 completed weeks, were divided into control and study groups: with the absence (n = 79) and with the presence of a fetal brain-sparing effect (n = 69), respectively. Pulsatility and resistance indices in the middle cerebral, the umbilical artery and the C/U ratio were evaluated daily by Doppler ultrasonography. C/U < 1.1 was reported as suggestive of a brain-sparing effect. Abnormal flow indices were analyzed and compared to adverse pregnancy and neonatal outcome determinants.ResultsIn the abnormal C/U group the abnormal CTG records were significantly more frequently observed (62.3%) than in normal C/U group (19.0%) (p = 0.0001). The comparison of selected Doppler indices revealed that C/U showed the highest sensitivity in prediction of both the intrapartum abnormal FHR (74.1%) and the adverse neonatal outcome (87.8%).ConclusionsThe C/U index shows the highest sensitivity in prediction of FHR abnormalities and adverse neonatal outcome in uncomplicated pregnancies at 40 weeks and beyond. The C/U index is useful in clinical practice in antenatal monitoring of these women in order to select those at high risk of intra- and postpartum complications.

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Objectives In singleton pregnancies, sFlt-1, PlGF and the sFlt-1/PlGF-ratio have shown utility as a diagnostic test for preeclampsia (PE). Previous case control studies have determined cut-off values for singleton pregnancies. The objective of this study was to characterize angiogenic factor levels of sFlt-1, PlGF and sFlt-1/PlGF-ratio in normal and preeclamptic multifetal gestations. Methods In a European multicentre case-control study, 52 women with multifetal gestation were recruited. A total of 34 patients with uneventful pregnancy outcome and 18 with PE were enrolled in the third trimester. sFlt-1 and PlGF were measured and ROC analysis was performed. The results of the median sFlt-1, PlGF maternal serum concentration and sFlt-1/PlGF-ratio were then compared to a gestational age- matched singleton cohort with PE (n = 54) and with uncomplicated pregnancy outcome (n = 238). Results In multiple pregnancies with PE, sFlt-1 and the sFlt-1/PlGF ratio were increased and PlGF was decreased as compared to multiple gestations with uneventful pregnancy outcome. In multiple pregnancies with PE, sFlt-1/PlGF-Ratio was significantly decreased as compared to controls due to higher median PlGF levels. In multiple pregnancies with uneventful pregnancy outcome, sFlt-1 and sFlt-1/PlGF-ratio were increased, but no differences in PlGF concentration were found when compared to singleton controls. ROC analysis determined 53 as an optimal cut-off for the sFlt-1/PlGF-ratio, yielding a sensitivity of 94.4% and a specificity of 73.5%. The cut-off values for singleton pregnancies of 33 and 85 lead to a sensitivity of 100% (83.3%) and a specificity 64.7% (79.4%). Conclusions Significant differences in the marker levels in singleton-versus multiple gestations were detected. Established reference ranges for singleton pregnancies are therefore not transferable to multiple pregnancies. Disclosures L. Droge: None. I. Herraiz: Research Support Recipient; Commercial Interest: Roche Diagnostics. H. Zeisler: Consultant, Research Support Recipient, Commercial Interest: Roche Diagnostics; D. Schlembach: Research Support Recipient; Commercial Interest: Roche Diagnostics. H. Stepan: Consultant, Research Support Recipient, Commercial Interest: Roche Diagnostics.W. Henrich: None. A. Galindo: Research Support Recipient; Commercial Interest: Roche Diagnostics. S. Verlohren: Consultant, Research Support Recipient, Commercial Interest: Roche Diagnostics, ThermoFisher, Novartis.

Plasma Clusterin Increased Prior to Small for Gestational Age (SGA) Associated With Preeclampsia and Decreased Prior to SGA in Normotensive Pregnancies

In our search for early biomarkers for the pregnancy complicationssmall for gestational age (SGA) and preeclampsia (PE) we analysed plasma from 19-21 weeks gestation in women recruited into the SCOPE study, a prospective cohort of nulliparous women, by differential in gel electrophoresis (DIGE). DIGE revealed the differential expression of clusterin levels and its isoforms in top6-depleted plasma of women who delivered an SGA infant but remained normotensive (SGA-NT; N = 8) compared to healthy women with an uncomplicated pregnancy outcome (Controls, N = 8). Immunosorbent enzyme-linked assay (ELISA) showed that compared to plasma clusterin levels from healthy controls [71.1 (SD 12.4) µg/mL, n = 39], clusterin was decreased in SGA-NT [58.3 (SD 11.7), N = 20, P < 0.0001], increased in women with SGA and PE [81.5 (SD 14.8), N = 20, P < 0.01], but similar in PE alone [71.2 (SD 9.4)g/ml, P = 1.0]. Screening for clusterin levels and/or its different isoformsmay be useful in mid-pregnancy to identify women who subsequently develop SGA but remain normotensive or who develop preeclampsia with SGA.

391: Maternal and fetal Doppler pulsatility indices predict adverse pregnancy outcome in uncomplicated pregnancies with borderline-low amniotic fluid index in the early third trimester

indices predict adverse pregnancy outcome in uncomplicated pregnancies with borderline-low amniotic fluid index in the early third trimester Kazumasa Hashimoto, Tania Kasdaglis, Sheveta Jain, Ozhan Turan, Kristin Atkins, Jerome Kopelman, Chris Harman, Ahmet Baschat University of Maryland School of Medicine, Obstetrics, Gynecology and Reproductive Sciences, Baltimore, MD, University of Maryland School of Medicine, Obstetrics & Gynecology and Reproductive Sciences, Baltimore, MD OBJECTIVE: We have reported borderline-low (BL) amniotic fluid index (AFI) in the early third trimester in uncomplicated pregnancy associated with adverse outcome. The aim of this study is to test if maternal and/or fetal Doppler indices can stratify risks of adverse perinatal outcome. STUDY DESIGN: Nested case-control study in cohort of uncomplicated pregnancy with BL-AFI (8.0-11.9) at 28.0-31.9 weeks gestation (20062010, N 173). Frequency of abnormal uterine artery Doppler pulsatility index (UtA PI), umbilical artery (UA PI) and middle cerebral artery (MCA PI) were compared between controls and those with adverse outcome, defined in categories: Antepartum (abnormal antepartum testing, stillbirth, placental abruption, preeclampsia, N 9), Delivery (emergency and/or fetal-indicated Cesarean delivery, preterm birth, N 52), Neonatal (birth weight 1.645 (90th centile) for UA PI and UtA PI, and Z-score 1.645 (10th centile) for MCA PI, defined abnormal values. RESULTS: Abnormal UtA, UA, and MCA-PI were significantly more common in all categories of adverse outcome, compared to controls. When any Doppler index is abnormal, prediction of adverse outcome had the following characteristics: Antepartum sensitivity (SN 0.88), specificity (SP 0.80), positive predictive value (PPV 0.26) and negative predictive value (NPV 0.99); Delivery (SN 0.43, SP 0.84, PPV 0.56, NPV 0.76); Neonatal (SN 0.43, SP 0.84, PPV 0.56, NPV 0.76); Composite (SN 0.39, SP 0.85, PPV 0.63, NPV 0.67). While individual Doppler indices had clinically-low predictive ability, combining UtA, UA, and MCA PI increases SN and NPV. CONCLUSION: Using these parameters, maternal and fetal Dopplers can identify cases at high-risk for adverse outcome in uncomplicated patients with borderline AFI. Measurement of all three Doppler indices helps triage such pregnancies.

The signification of antiphospholipid antibodies in pregnancy-associated pathologies and venous thromboembolism

Women with antiphospholipid antibodies are at high risk of pregnancy complications. Three hundred and two women with pregnancy complications matched with 100 women having a past history of uncomplicated pregnancy outcome were screened for the presence of antiphospholipid antibodies such as lupus anticoagulant and immunoglobulin G (IgG)/M antibodies for cardiolipin. Among the overall positivity for any one of the antiphospholipid antibodies studied, significant associations were found with recurrent pregnancy loss (OR 16.87; 95% CI, 5.5–51.63, p < 10−3), intrauterine growth retardation (OR 3.9; 95% CI, 1.08–14.05, p = 0.04) and preeclampsia (OR 4.54; 95% CI, 1.25–16.42, p = 0.035). IgG was considered a risk factor for recurrent pregnancy loss (OR 15.31; 95% CI, 3.37–69.7, p < 10−3) and intrauterine growth retardation (OR 6.7; 95% CI, 1.3–34.4, p = 0.017). The lupus anticoagulant was associated only with recurrent pregnancy loss (OR 12.4; 95% CI, 1.48–103.1, p = 0.006).

Prevalence and significance of antiphospholipid antibodies in selected at-risk obstetrics cases: A comparative prospective study

SummaryIn a prospective comparative study we screened 112 women with a past history either of pre-eclampsia, eclampsia, recurrent abortion, IUGR, IUFD or abruptio placentae, with no apparent aetiology and a demographically matched cohort of 106 women having a past history of uncomplicated pregnancy outcome for the presence of antiphospholipid antibodies (aPL) and their significance. In the former group, the prevalence of aPL ranged from 10–46.87% compared with 8.49% in the later group. In women with the presence of aPL, the incidence of pre-eclampsia, early onset pre-eclampsia and abruptio placentae were 25%, 14.58% and 18.75%, respectively. In the same group, the abortion rate was 25% and live-birth rate was 64.58% with IUFD rate of 10.42%. Fetal morbidity rates were also higher in the mothers with aPL positivity, the incidence of IUGR was 27.08% and oligohydramnios was 33.33% in them. All these complications were statistically significant when compared with those of aPL negative mothers.

Maternal and fetal single nucleotide polymorphisms in the epoxide hydrolase and gluthatione S-transferase P1 genes are not associated with pre-eclampsia in the Coloured population of the Western Cape, South Africa

Oxidative stress is thought to play an important role in the pathophysiology of pre-eclampsia. A defect in certain enzymes responsible for detoxification may cause prolonged exposure to reactive by-products and contribute to maternal endothelial as well as placental damage. Two polymorphisms affecting the function of the biotransformation enzymes epoxide hydrolase and glutathione S-transferase P1 were shown previously to be associated with pre-eclampsia in a Dutch population. The aim of this study was to determine if these two polymorphisms (maternal or fetal) contribute to pre-eclampsia in an anthropologically distinct population (the Western Cape region of South Africa) with a high incidence of the disease. Genomic DNA of mother - infant pairs with severe pre-eclampsia (n = 144), a population control group (n = 156) and control mother - infant pairs with uncomplicated pregnancy outcome (n = 45) were analysed for the EPHX and GSTP1 polymorphisms by polymerase chain reaction amplification and restriction enzyme digestion. Each polymorphism had a similar distribution in case and control subjects (mother and infant). The Val105/Val105 genotype of GSTP1 occurred at a higher frequency than reported for other populations. Neither maternal nor fetal EPHX Tyr113His and GSTP1 Ile105Val polymorphisms appear to contribute significantly to the pathophysiology of pre-eclampsia in the Coloured population of the Western Cape region of South Africa.

Perinatal outcome associated with oligohydramnios in uncomplicated term pregnancies.

In high-risk pregnancies, oligohydramnios is frequently used to identify fetuses at risk of an adverse outcome. The purpose of this study was to evaluate the effect of oligohydramnios on perinatal outcome in uncomplicated pregnancies between 40.0 and 41.6 weeks. From January 1997 to December 2000 all uncomplicated pregnancies reaching 40.0 weeks' gestation with a singleton non-malformed fetus and reliable dating underwent monitoring with serial determination of amniotic fluid index (AFI) and biophysical profile. Labor was induced for AFI <or=5 cm, biophysical profile score of 6 or less, rise in maternal blood pressure >140/90 mm Hg, or gestational age of 42.0 weeks. Perinatal outcome was compared between cases with AFI <or=5 cm and those with AFI >5 cm using Chi-square or Fisher's exact test for categorical variables, Student's t-test for continuous variables, and logistic regression analysis. A two-tailed p value <0.05 or an odds ratio (OR) with 95% confidence interval (CI) not inclusive of the unity was considered significant. RESULTS. Three thousand and forty-nine women met the inclusion criteria, 341 of which (11%) had an AFI <or=5 cm. Gestational age at delivery, rates of nulliparity and induction of labor were significantly different between cases with oligohydramnios and those with normal AFI (all p<0.001). Rates of cesarean delivery for non-reassuring fetal testing (8.2% vs. 3.9%, p<0.001) and of neonates with birth weight <10th percentile (13.2% vs. 5.5%, p<0.001) were significantly higher in the AFI <or=5 cm group compared with the AFI >5 cm. No significant differences were identified between the two groups in rates of meconium-stained amniotic fluid, 5-min Apgar score <7, or umbilical artery pH <7. Logistic regression analysis demonstrated that the association between oligohydramnios and rate of cesarean delivery for non-reassuring fetal testing lost significance after controlling for gestational age at delivery, nulliparity and induction of labor, whereas the association between AFI <or=5 cm and low birth weight centiles remained statistically significant (OR=2.2, 95% CI 1.5, 3.2). In conclusion, in uncomplicated pregnancies at 40.0 to 41.6 weeks, oligohydramnios is independently associated with a higher risk of low birth weight centile.

Distribution of Components of the Glutathione Detoxification System Across the Human Placenta after Uncomplicated Vaginal Deliveries

The function of the glutathione-related detoxification system plays an important role to ensure an uncomplicated pregnancy outcome. This study was performed to investigate whether the components of the glutathione-related detoxification system are equally distributed among the different cotelydons in the human placenta. We measured glutathione, cysteine, glutathione S-transferase (GST) isoenzyme levels (GSTA1+A2, GSTP1, GSTM1 and GSTT1), enzyme activities of glutathione S-transferase and glutathione peroxidases, protein carbonyl levels, and antioxidant capacities at twelve different standardized positions in six placentae from healthy women after uncomplicated pregnancy and vaginal delivery. Data were statistically evaluated with a Friedman two-way ANOVA with Bonferroni correction. ‘Foetal’-side values were not significantly different from those at the ‘maternal’-side. Except for GSTA1+A2, no significant differences were found between different sampling sites indicating that the distribution of all parameters measured was homogenous throughout the placenta. Since levels of GSTA1+A2 were minor compared to those of GSTP1 and GSTT1, the clinical relevance of this heterogeneity may be limited. These results implicate that the location of sampling is not important as long as biopsies are taken from physiological cotelydons.

Pregnancy outcome and infant follow-up of fetuses with abnormally increased first trimester nuchal translucency.

The numbers of fetuses with an abnormal increased first trimester nuchal translucency (NT) but a confirmed normal anatomy and karyotyping is relatively small and therefore a challenge for prenatal counselling. The aim of the current study was to assess the long-term pregnancy outcome and infancy prognosis of 78 fetuses with NT > 95th centile of the normal range for crown-rump length (CRL). The most common abnormalities in this group were aneuploidy, which affected 32 of the fetuses followed by four and three cases which were miscarried or had cardiac defects respectively. The remaining euploid fetuses with normal detailed scans were followed throughout their infancy (mean 24 months; range 12-36 months). Post-natally, except for a correctable case of ventricular septal defect and a case of posterior urethral valve, no other abnormalities were detected. After excluding all aneuploid cases and using the maternal age as a second variable, an uncomplicated pregnancy outcome could be anticipated in 17 cases (100%) when the maternal age was <30 years and NT between 95th centile and 5 mm. However, the chance of a normal outcome dropped to 50% in four cases with maternal age > or =30 years and NT > or =5 mm (Fisher's exact test; P: = 0.02). These findings suggest that the long-term prognosis of the euploid fetuses with large NT (<5 mm) is reassuring in younger women.

Ultrasonographic Identification of Polyhydramnios

Polyhydramnios is a condition where there is more amniotic fluid than is normal for gestational age, and it is associated with various maternal and fetal abnormalities. Ultrasonography is the primary means of assessing the amount of amniotic fluid. To date, an association between polyhydramnios and aneuploidy has not been firmly established. Therefore, a retrospective analysis was conducted of 766 patients who were referred to a high-risk referral center between January 1, 1986 and January 1, 1990 for ultrasound examination and genetic amniocentesis, to investigate the relationship between polyhydramnios and aneuploidy. During the course of the complete ultrasound examination, the amniotic fluid was quantified using standard methods and patients were categorically placed into one of two groups. Group 1 included all patients with normal or decreased amounts of amniotic fluid, and group 2 included all patients with polyhydramnios. The results of the fetal cytogenetic analysis were obtained for each fetus. A total of 726 patients met the criteria to be included in the study. The rate of aneuploidy was 3% (19 cases in 690 patients) in group 1 and 17% (6 cases in 36 patients) in group 2. A statistically significant difference between the two groups in the incidence of aneuploidy was observed (P = 0.0001). This study also showed that only 28% (10 out of 36) of nondiabetic and nonsensitized patients had an uncomplicated pregnancy outcome. It is therefore concluded that within a high-risk population pregnancies complicated by polyhydramnios are at significant risk for aneuploidy; prenatal cytogenetic analysis may be offered to patients with polyhydramnios, regardless of concomitant ultrasonographic findings; and pregnancies complicated by polyhydramnios are at risk for peripartum complications and poor pregnancy outcome.