Department Of Perinatology Research Articles

Pessary use for the treatment of cervical incompetence and prevention of preterm labour

Objective. To evaluate the efficacy and safety of polyvinyl chloride pessary in patients with cervical incompetence or at risk of preterm labour.Methods. Study was conducted on 56 pregnant women who were treated with pessary and delivered in the Department of Obstetrics and Perinatology in Lublin during a half-year period. Statistical evaluation included Spearman correlation analysis and Wilcoxon signed-rank test.Results. The mean gestational age at pessary insertion was 23 weeks gestation. Pessary was electively removed after 37 weeks gestation. The mean interval between pessary insertion and delivery was 13 weeks, the mean gestational age at delivery 38.3 weeks and birth weight was 3255 g. Two (3.6%) women delivered before 34 weeks. A total of 58 live infants was born. No significant complications that could be attributed to pessary use were observed.Conclusions. Pessary may be useful in women with cervical incompetence or at risk of preterm labour.

Intrafollicular concentration of adrenomedullin is associated with IVF outcome

Objective. To test the hypothesis that serum or intrafollicular concentrations of adrenomedullin (AM) would correlate with reproductive outcomes in in vitro fertilisation (IVF) cycles.Design. Serum and follicular fluid samples were collected during transvaginal oocyte retrieval. The follicular fluid was individually aspirated, and the presence of oocyte was recorded. AM concentrations were measured using an enzyme-linked immunosorbent assay.Setting. Department of Gynaecology, Perinatology and Child Health, ‘Sapienza’ University of Rome, Italy.Patients. Eighty women undergoing IVF for primary infertility aged 18–45 years.Main Outcome Measures. AM concentrations in plasma and follicular fluid were correlated to follicular fluid volume, presence of oocyte, oocyte maturation, embryo grading, fertilisation and pregnancy rates, live-birth rate and plasma estrogen concentration.Results. Monofollicular fluid AM concentrations did not differ between follicles containing oocyte and those without oocyte; however, AM concentrations were lower in follicles that resulted in pregnancy than in those that failed. Serum but not follicular fluid AM concentrations correlated with serum estrogen levels. Follicular fluid AM correlated with plasma AM levels.Conclusion. We conclude that higher level of AM in the follicular fluid appears to be associated with a negative outcome in IVF treatment.

Comparison of complications in second trimester amniocentesis performed with 20G, 21G and 22G needles

to compare short- and long-term complications of amniocentesis performed with 20G, 21G, and 22G needles. this observational study included 793 pregnant women who underwent amniocentesis in the Perinatology Department of Cerrahpasa Medical Faculty, Istanbul University, Turkey. The patients were divided into three groups according to the needle size used for the procedure: 20G (Group 1), 21G (Group 2), and 22G (Group 3). The incidences of early and late complications were compared among groups. fetal loss rates did not differ among groups (Group 1=1.57%, Group 2=1.47%, Group 3=1.61%). Rates of vaginal bleeding (1.57%, 1.10%, and 0.81%, respectively), bloody amniotic fluid (2.32%, 6.23%, and 2.67%, respectively) and amniotic fluid leakage (1.57%, 1.10%, and 1.61%, respectively) were also similar among the three groups. short- and long-term complications did not differ among amniocenteses performed with 20G, 21G, and 22G needles.

A Randomized Controlled Trial of Uterine Exteriorization and Nonexteriorization at Cesarean Section

Department of Obstetrics, Gynaecology and Perinatology, Obafemi Awolowo University, Ile-Ife, Nigeria

Maternal serum leptin levels in severe preeclamptic pregnant women in early postpartum stage

The aim of this study is to determine early postpartum maternal serum leptin levels in severe preeclamptic pregnant women. This study was planned as a prospective controlled trial. The patient and control groups in the study were composed in the period between January 2003 and January 2004. The study, performed in the Department of Perinatology of SSK Bakirkoy Maternal Hospital and Women and Child Diseases Education Hospital, consists of forty-four singleton pregnant women giving birth after hospitalized with diagnosis of severe preeclampsia and forty-four normotensive singleton pregnant women who were found to have healthy pregnancy on examination and analysis before given birth. The venous blood of all pregnants was taken from the antecubital region in early postpartum period while they were all hungry. We studied the relation between demographic data, biochemical data, baby weight at birth and the serum leptin levels. Comparing the preeclamptic pregnant women with control group in terms of leptin, although leptin levels in severe preeclamptic pregnant women were found to be higher than control group, statistically, no significant difference was determined (p: 0.069). In severe preeclamptic group, baby weight at birth was found to be significantly lower (p: 0.000). Evaluating all pregnant women, it was determined that there has been a positive significant relation between serum leptin levels and diastolic tension (p: 0.044), urea (p: 0.019), creatinine (p:0.000), uric acid (p: 0.000); and a negative significant relation between serum leptin levels and baby weight at birth (p: 0.038). No relation was found between the leptin level and the gender of infants. No significant difference of early postpartum maternal serum leptin levels between severe preeclamptic group and normotensive group was determined. Key words: Preeclampsia, early postpartum stage, serum leptin levels, severe preeclamptic pregnant women.

Discrepant findings in a monoamniotic twin pregnancy affected by infantile myofibromatosis

In 1876, Sir Francis Galton argued that twins are of value in studying heredity1. Monozygotic (MZ) twins are not always concordant despite deriving from one zygote. In the most comprehensive study2 12/315 monochorionic (MC) twin pregnancies were monoamniotic (MA), including four sets of conjoined twins and four sets with discrepant malformations, suggesting a rate of 50% concordance in MA non-conjoined twins. We report the case of a twin pregnancy diagnosed as being MCMA at 13 weeks' gestation. An echodense tumor was seen on the side of the head of one twin by two- and three-dimensional ultrasound examination. Amniocentesis revealed a normal karyotype (46,XX) and normal values of alpha-fetoprotein and acetylcholinesterase. Transabdominal ultrasound examination at 18 weeks, using a 3.5-MHz transducer and power Doppler imaging (Voluson 730 Expert, GE Medical Systems, Zipf, Austria), suggested vascularization of the tumor (Figure 1). Magnetic resonance imaging excluded connections to the ventricles or brain. At 30 weeks intestinal dilatation was diagnosed in the same twin. After Cesarean section at 32 weeks, the presence of a superficial head tumor was confirmed and laparotomy revealed that the intestine was compressed by a tumor mass, which was classified histologically as infantile myofibromatosis. The tumors were inoperable and the infant died from sepsis 12 days after birth. Cross-sections of the intestine and head tumor obtained at postmortem examination are shown in Figure 2. The co-twin developed uneventfully. Power Doppler ultrasound image at 18 weeks showing a head tumor with vascularization in only one of the monoamniotic twins. Congenital generalized fibromatosis was described in 19543, and later subclassified into a form limited to the skin, soft tissue or bone and a rare form with visceral involvement. Our case shows that both forms may occur sequentially. The term infantile myofibromatosis was recommended as the cells have features of fibroblasts and smooth muscle cells4. No case with infantile myofibromatosis has been diagnosed prenatally. Ten years ago, we observed one MC diamniotic twin with a mediastinal tumor leading to hydrops and postnatal death. Histology revealed infantile myofibromatosis with infiltrative growth into the lungs. The earliest that fatal infantile myofibromatosis has been diagnosed was in a 3-day-old neonate5 in whom, as in our case, histology showed proliferation of fibromatous spindle cells in the intestinal wall (Figure 2). Chemotherapy has been successfully performed postnatally in cases of infantile myofibromatosis6, and prenatal sampling or even chemotherapy might be an option in the future. Histological findings in the twin affected by infantile myofibromatosis. Cross-sections of the intestine: (a) the lumen is filled with tumor and infiltrative growth is seen within the tunica muscularis; the arrow indicates the remaining intestinal lumen with ulcerated surface; (b) detail of infiltrative growth within the tunica muscularis (arrowhead); and (c) immunohistochemical stain with antibodies against smooth muscle actin, the arrowhead indicating the tunica muscularis. In the skin biopsy of the head tumor (d), the same tumor-type as shown in the intestine is seen (lower half of image); (e) detail of the tumor found in the skin biopsy. Three families with a history of infantile myofibromatosis have been described, suggesting an autosomal dominant inheritance7 and an interstitial deletion of 6q has been detected in an infantile tumor8. Prenatal discordant malformations, and more specifically tumorigenesis, in MZ twins raises questions regarding the possible etiology, such as defects in the splitting process (with the ultimate example being conjoined twins), vascular compromise due to a shared placenta9 and de-novo mutations in one twin after splitting. Different activation of maternal and paternal genes and copy number variants have been highlighted as related to changes in gene expression, and any variation in the human genome that alters gene expression is now a candidate for being involved in a disease process10. B. Arabin [email protected]*, K. Hack*, L. Nooij*, P. Nikkels , * Department of Perinatology, Isala Clinics Zwolle, The Netherlands, Department for Pathology, University Medical Center Utrecht, The Netherlands

The influence of Chlamydia trachomatis infection on spontaneous abortions

The aim of the study was to evaluate the frequency of Chlamydia trachomatis (C.t.) infection among women who experienced a miscarriage. Patients referred to the Centre for STD Research and Diagnostics in Bialystok from the Department of Perinatology and from gynaecological outpatient clinics, after spontaneous abortion were enrolled in the study. C.t. infection diagnostics were performed among 76 women with 1 miscarriage and 44 patients with > or =2 miscarriages in anamnesis. Forty-six patients in the 2nd and the 3rd trimester of normal pregnancy served as a comparative group. Endocervical swabs as well as blood serum were obtained. To detect chlamydial DNA, direct PCR method was performed (Roche, Molecular Systems, N.J., USA). To detect IgA and IgG specific anti-chlamydial antibodies we used immunoenzymatic assay (medac, Hamburg, Germany). In patients with 1 miscarriage (gr.1), C.t. infection by means of PCR was detected in 11.8% of women (p=0.029), in patients with > or =2 miscarriages (gr.2) in 9.1% (p=0.198) and in the comparative group (gr.0) in 2.2%. Specific anti-chlamydial antibodies IgA class were detected in: 7.9 (p=0.082) in group 1, 4.5% (p=0.236) in group 2 and in 0% in group 0, and IgG class in 21.1% (p=0.024), 36.4% (p=0.000) and in 4.4%, respectively. 1. C.t. infection is an important causative agent of miscarriages in women. 2. C.t. infection diagnostic procedures should be considered in screening tests during pregnancy.

The effects of betamethasone treatment on clinical and laboratory features of pregnant women with HELLP syndrome

The present study aims to investigate the effects of betamethasone treatment on clinical outcome and laboratory data of pregnant women diagnosed with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. A prospective, randomized and placebo-controlled clinical trial was undertaken in a total of 60 pregnant women with HELLP syndrome who were treated at the perinatology department of the study center between January 2005 and February 2008. Betamethasone treatment (intramuscular injection of 12 mg in every 24 h) was given to 30 subjects while remaining 30 subjects received placebo. The treatment and control groups were compared in the aspects of clinical outcome and laboratory data. The alterations in platelet counts, alanine aminotransferase, aspartate aminotransferase and lactate dehydrogenase levels of women treated with betamethasone were statistically similar to those of the placebo group. Although there was a significant decrease in diastolic blood pressure values of control group (P = 0.04), alterations in systolic blood pressure values were statistically indifferent in both study groups. Hematological and metabolic complications occurred significantly less in women treated with betamethasone (P < 0.05). Interestingly, the percentage of women who received platelet transfusion was significantly higher in the control group (P < 0.005). No case of maternal mortality occurred. The betamethasone treatment has ended up with insignificant alterations in clinical outcomes and laboratory data of women with HELLP syndrome except beneficial effects on metabolic complications and need for platelet transfusion. Further investigation is required to assess the efficiency of betamethasone in management of HELLP syndrome.

Expression of metalloproteinases 2 and 9 and cyclooxygenase 2 in endometrial carcinoma

0020-7292/$ see front matter D 2006 International Federation of All rights reserved. doi:10.1016/j.ijgo.2005.12.028 * Corresponding author. Tel.: +39 055 4478138; fax: +39 055 4379868. E-mail address: mariarosaria.raspollini@unifi.it (M.R. Raspollini). and metastasis [1] while cyclo-oxygenase (COX)-2 expression has been related to immunomodulation [2] and neoangiogenesis [3]. The aim of this study was to investigate the roles of MMPs and their correlation with COX-2 expression in endometrial carcinoma. mRNA expression of the MMP-2, MMP-9, and COX-2 genes was assessed in paraffin-embedded samples of endometrial carcinoma from 30 consecutive patients and non-neoplastic endometrial tissue from 20 matched controls. Endometrial carcinoma tissue samples were obtained from the uteruses of patients who had undergone total abdominal hysterectomy and bilateral salpingooophorectomy at the Department of Gynecology, Perinatology and Reproductive Medicine of the University of Florence School of Medicine, Florence, Italy. The patients, aged from 50 to 82 years (median, 62.5 years; mean, 62.1 years), had complete records of their clinical history and follow-up. Amplification of mRNA was detected by reversetranscription polymerase chain reaction assay and measured quantitatively. mRNAwas successfully extracted from 15 (75%) of the 20 control samples and 18 (60%) of the 30 tumor International Journal of Gynecology and Obstetrics (2006) 93, 64—66

Physiology Should be Supported with Evidence in Progesterone Administration for Threatened Miscarriage – Authors’ Reply

American Journal of Reproductive ImmunologyVolume 54, Issue 6 p. 397-397 Physiology Should be Supported with Evidence in Progesterone Administration for Threatened Miscarriage – Authors’ Reply Jaroslaw Kalinka MD, PhD, Jaroslaw Kalinka MD, PhD Department of Perinatology, I Division of Gynecology and Obstetrics, Medical University of Lodz; ul. Wileñska 37, 94-029 Lodz, Poland. Tel.: +48 601251516; fax: +48 42 631 45 62; e-mail: [email protected]Search for more papers by this authorJulia Szekeres-Bartho MD, PhD, Julia Szekeres-Bartho MD, PhD Department of Perinatology, I Division of Gynecology and Obstetrics, Medical University of Lodz; ul. Wileñska 37, 94-029 Lodz, Poland. Tel.: +48 601251516; fax: +48 42 631 45 62; e-mail: [email protected]Search for more papers by this authorJarosaw Kalinka MD, PhD, Jarosaw Kalinka MD, PhD Department of Perinatology, I Division of Gynecology and Obstetrics, Medical University of Lodz; ul. Wileñska 37, 94-029 Lodz, Poland. Tel.: +48 601251516; fax: +48 42 631 45 62; e-mail: [email protected]Search for more papers by this author Jaroslaw Kalinka MD, PhD, Jaroslaw Kalinka MD, PhD Department of Perinatology, I Division of Gynecology and Obstetrics, Medical University of Lodz; ul. Wileñska 37, 94-029 Lodz, Poland. Tel.: +48 601251516; fax: +48 42 631 45 62; e-mail: [email protected]Search for more papers by this authorJulia Szekeres-Bartho MD, PhD, Julia Szekeres-Bartho MD, PhD Department of Perinatology, I Division of Gynecology and Obstetrics, Medical University of Lodz; ul. Wileñska 37, 94-029 Lodz, Poland. Tel.: +48 601251516; fax: +48 42 631 45 62; e-mail: [email protected]Search for more papers by this authorJarosaw Kalinka MD, PhD, Jarosaw Kalinka MD, PhD Department of Perinatology, I Division of Gynecology and Obstetrics, Medical University of Lodz; ul. Wileñska 37, 94-029 Lodz, Poland. Tel.: +48 601251516; fax: +48 42 631 45 62; e-mail: [email protected]Search for more papers by this author First published: 18 November 2005 https://doi.org/10.1111/j.1600-0897.2005.00325.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume54, Issue6December 2005Pages 397-397 RelatedInformation

Changes in aquaporin 1 expression affect amniotic fluid volume

STEPHANIE MANN, NATALIA DVORAK, ROBERT TAYLOR, Phoenix Integrated Residency in Ob/Gyn, Obstetrics and Gynecology, Phoenix, Arizona, University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, California OBJECTIVE: Recent work from our laboratory has demonstrated the presence of aquaporin (AQP) water channels in fetal membranes from pregnancies with normal amniotic fluid (AF) volume. The objective of this study was to investigate changes in AQP 1 mRNA expression from fetal membranes of pregnancies with polyhydramnios and oligohydramnios. STUDY DESIGN: Placentas from term pregnancies (37-40 wks) were collected from women who presented with intact membranes and one of the following: (1) idiopathic oligohydramnios (AFI !5.0 cm); (2) polyhydramnios (AFI >24.0 cm); and (3) normal amount AF (AFI >5.0 cm and!24.0 cm). The membranes (amnion and chorion) directly overlying the placenta and the free floating reflected membranes were sampled (total of four samples from each placenta). RNA was isolated from the amnion and chorion of each region. Quantitative RT-PCR was used to compare expression of AQP1 mRNA in the membranes collected from the above pregnancies. Statistical analysis was performed with a t test. P ! .05 was considered signficant. RESULTS: As shown in the figure, AQP1 mRNA expression is increased in the reflected amnion from pregnancies with idiopathic polyhydramnios and decreased in the reflected amnion and chorion from pregnancies with oligohydramnios. CONCLUSION: The expression of the water channel AQP1 is altered in the reflected fetal membranes. These results suggests that there is an adaptive response by the fetal membranes in situations of either decreased or increased AF volume to prevent excessive loss or accumulation of fluid, respectively. We speculate that therapies focused on regulating AQP1 expression may be useful for treating oligohydramnios and polyhydramnios. 458 PERINATAL GLUCOSE TOLERANCE AFTER INTRAUTERINE GROWTH RESTRICTION IN THE LATE-GESTATION OVINE FETUS PHILIPPE DERUELLE, IVA GUEORGUIEVA, BERENGERE SICOT DE JENLIS, SOPHIE JAILLARD, JACQUES WEILL, VERONIQUE DEBARGE, LAURENT STORME, CHRU de Lille, Lille, France, CHRU de Lille, Pediatric endocrinology unit, Lille, France, CHRU de Lille, Department of perinatology, Lille, France, CHRU de Lille, France, Department of perinatology, Lille, France OBJECTIVE: Newborns with Intrauterine-Growth Restriction (IUGR) are at increased risk to develop a metabolic syndrome later in life, namely obesity, cardiovascular disease, impaired glucose tolerance. Whereas these facts have been largely studied during childhood or adult life, little is known about the consequences of IUGR on glucose tolerance during the perinatal period. The purpose of this study was to determine whether chronic placental embolization in the late gestation ovine fetus induce insulin resistance during the perinatal period. STUDY DESIGN: IUGR was induced by umbilico-placental embolization during late gestation in chronically catheterized sheep. Umbilico-placental embolization was performed between 130 and 140 d of gestation (terme = 147 d) during which fetuses were hypoxemic relative to controls. Euglycemic, hyperinsulinemic glucose clamp experiments were performed in utero and during the first three weeks after birth in order to measure the effect of fetal insulin concentration on fetal glucose uptake at a constant glucose concentration. Fetal coricotropin, cortisol and catecholamines concentrations were measured daily. RESULTS: Chronic placental embolization produced asymmetrically IUGR fetuses and increased vascular resistance in umbilical artery (P ! .05). The exogenous glucose infusion rate necessary to maintain constant glycemia was significantly lower in IUGR relative to control fetuses at 140 d of gestation (IUGR vs. control, 2.5 G .5 mg/kg/min and 5.0 G 0.5 mg/kg/min, P ! .05) and 7 days after birth (IUGR vs. control, 3.5 G .7 mg/kg/min and 5.7 G 1.4 mg/kg/ min, P ! .05). Glucose clamps were similar between groups at 2 and 3 weeks after birth. Cortisol levels were similar between the two groups. In response to chronic fetal hypoxemia, there was a progressive increased in baseline fetal plasma epinephrine, norepinephrine and dopamine concentrations (P ! .01). CONCLUSION: We concluded that chronic fetal hypoxemia induces insulin resistance during the perinatal period. We speculate that this change could be related to an increase in fetal catecholamines levels.

Does antenatal glucocorticoid improve pulmonary circulatory adaptation at birth?

ADAPTATION AT BIRTH? PHILIPPE DERUELLE, VERONIQUE DEBARGE, ERIC MAGNENANT, SOPHIE JAILLARD, THAMEUR RAKZAH, FRANCIS PUECH, LAURENT STORME, CHRU de Lille, France, Department of perinatology, Lille, France, CHU de Lille, Dept. Ob/Gyn, Lille, France OBJECTIVE: Adaptation to extra-uterine life requires dramatic modifications of pulmonary vascular resistances (PVR). Mechanisms that induce pulmonary vasodilatation at birth are incompletely understood but may include alveolar ventilation, increase of partial oxygen pressures, modifications of the shear stress and synthesis of vasoactive mediators. We hypothesized that antenatal glucocorticoids increase pulmonary vasodilatation to birth-related stimuli. To test this hypothesis, we studied pulmonary hemodynamic response at birth to ventilation in chronically prepared late-gestation fetal lamb after antenatal maternal GC injection (130-132 d of gestation). STUDY DESIGN: Catheters were inserted in the main pulmonary artery (PAP), aorta, left atrium and amniotic cavity to measure pressure. Pulmonary artery flow was measured in the left lung with an ultrasonic flow transducer. Lambs were randomized in 2 groups: ‘‘GC’’ group (dexamethasone 0.5 mg/kg) and ‘‘control’’ group (saline). 72 hours after injection, fetuses were delivered by Csection and a tracheotomy was performed. Animals were placed on a time– cycled pressure limited neonatal ventilator with a FIO2 !0.10 then a FIO2 of 1.0. Finally, the umbilical cord was ligated. PaCO2 was controlled between 35 and 45 Torr. RESULTS: Basal PVR was similar between groups. PaCO2, PaO2 and Ph were not different between groups during the study period. During ventilation with Fi02 !0.1, PVR were lower in the ‘‘GC’’ group than in ‘‘control’’ (0.18 G 0.02 vs. 0.25 G 0.01 mm Hg/mL.min, P ! .01 GC vs. control). During ventilation with 100% O2, PVR were similar between groups (0.14 G 0.02 vs. 0.15 G 0.01 mm Hg/mL.min, GC vs. control). We did not observed further decrease of the PVR after ligation between the two groups. Mean PAo and PAP did not changed during the study in both groups. CONCLUSION: Antenatal GC enhance pulmonary vasodilatation induced by alveolar ventilation but don’t modulate oxygen response. We speculate that this effect could be included to mechanisms for neo-natal hemodynamic adaptation after antenatal GC. 510 SUSPECTED FETAL MACROSOMIA: GUIDELINES VS. REALITY RONNY SHACHAR, ASNAT WALFISCH, ILANA SHOHAM-VARDI, HILLEL VARDI, MORDECHAI HALLAK, Soroka University Medical Center, Beer-Sheva, Israel OBJECTIVE: Suspected macrosomia is a common obstetric condition, which is still considered challenging. We aimed to evaluate the effect of our management policy in a suspected macrosomic fetus on pregnancy outcome. Furthermore, our prediction ability of excessive fetal weights using clinical and ultrasonographic estimations was evaluated. STUDY DESIGN: In this prospective observational study we followed the management of 145 term women who were admitted with a documented diagnosis of suspected fetal macrosomia, as well as women with fetal weight estimation of >4000 g. The diagnosis was made by an obstetrician, based on his clinical judgment and/or ultrasound results. The comparison group (n = 5943) consisted of all other women who gave birth during the data collection period. These data was received from our computerized perinatal database. RESULTS: Induction of labor and cesarean delivery rates in the macrosomic pregnancies (birth weight >4000 g) of the study group were significantly higher when compared with the macrosomic pregnancies of the comparison group (42.1% vs. 13.6%, P ! .001 and 57.1% vs. 16.7%, respectively). When comparing the non macrosomic (birth weight !4000 g) to the macrosomic pregnancies of the study group no significant difference was demonstrated regarding maternal or infant complications. The sensitivity, specificity and positive predictive value of the methods used for detecting macrosomia were 21.6%, 98.6% and 43.5% respectively. CONCLUSION: Our active management of suspected macrosomic pregnancies increased induction of labor and cesarean delivery rates without improving maternal or fetal outcome. Our ability to predict macrosomia is poor.

The Use of Intravenous Methotrexate in the Treatment of Ectopic Pregnancy

Between January 1996 and December 2001, at the Department of Gynecology, Perinatology and Human Reproduction of the University of Florence, 49 ectopic pregnancies were submitted to medical treatment. The treatment schedule consisted of the administration of 100 mg of intravenous methotrexate (MTX). The patients included in this study fulfilled the following requisites: gestational period <8 weeks; diameter of the ectopic gestational sac <4 cm; serum level of human chorionic beta-gonadotropin (β-hCG)<5000 IU/ml; absence of clinical and ultrasound signs of tube rupture with initial hemoperitoneum; hematochemical tests compatible with chemotherapic treatment.All patients were followed with a dosage of serum β-hCG repeated every 2-3 days after chemotherapy and with an ultrasound every 3-4 days. In case of docu-mented success of treatment the patient was hospitalized for no more than 3 days after administration of the drug. In 1 case therapy took place in a day-hospital reg-imen.Medical treatment was effective in 35 patients out of 49 (71.4%) and led to negative ?-hCG in a median time of 11 days, with a range between 2 and 48 days. In the 14 non-responsive cases (28.6%), after a mean time of 6 days we proceeded to a traditional surgical approach or laparoscopy. In none of the cases did we find significant pharmacological toxicity, while in 9 patients (18.3%), severe painful symptoms appeared immediately after treatment, but resolved within 24 hours.Our results are interesting and in agreement with other experiences found in the literature. In our opinion, the advisability of a second administration in case of slow response, the comparison with an analogous intramuscular treatment, a more pre-cise definition of the eligibility criteria, long-term follow-up of the patients, espe-cially in case of subsequent pregnancies should all be further considered.

Amniotic fluid inflammatory proteins and digestive compounds profile in fetuses with gastroschisis undergoing amnioexchange.

In gastroschisis, an inflammatory process related to the presence of digestive compounds may be involved in intestinal damage. We measured the amniotic fluid concentrations of total protein, ferritin and amylase, lipase, gamma-glutamyl transferase and bile acids before each amnioexchange performed in women whose infants had gastroschisis. We estimated the correlation among total proteins, ferritin and digestive compounds and postnatal outcome. All women whose infants had gastroschisis in our fetal medicine unit are offered repeated amnioexchange during the third trimester of pregnancy to improve the quality of the exteriorised bowel at birth. Amniotic fluid was sampled at the beginning of each amnioexchange and total proteins, ferritin and digestive compounds were assayed. This study was conducted in the Department of Perinatology of the University Hospital Robert Debré in Paris. Thirty pregnant women with a gastroschisis affected fetus diagnosed antenatally. The biological results were expressed as multiples of the median with respect to a control population. Gestational age at delivery and the outcome of the infants were recorded and correlated with amniotic fluid total proteins, ferritin and digestive compounds. There was a positive correlation (P < 0.01) between digestive compounds (except amylase at the final amnioexchange) and ferritin on the one hand, and all digestive compounds and total proteins concentration at the final amnioexchange on the other. In addition, among total proteins amylase and lipase, lipase concentrations were related with parameters of short term outcome (P < 0.05). Amniotic total proteins and ferritin are elevated in fetuses presenting with gastroschisis as a consequence of an inflammatory process. Inflammation may be induced by the presence of digestive compounds in the amniotic fluid. The concentrations of which may constitute a marker of short term outcome of the newborn infant.

Human chorionic gonadotropin assay in cervical secretions for accurate diagnosis of preterm labor

Objectives: We planned to determine whether the concentration of human chorionic gonadotropin (hCG) in cervical secretions could be a useful marker for accurate diagnosis of preterm labor, and whether the use of cervical hCG assay in combination with the Bishop score would improve the prediction of delivery within 7 days, and to determine the cut-off values for hCG in prediction of delivery within 100 h, 7 and 14 days, as well as before 35 and 37 weeks of gestation in a group of women at high risk for preterm delivery. Methods: The study was conducted in the perinatology department of Zeynep Kamil Women and Children Diseases Education and Research Hospital between February 2002 and February 2003. One hundered and two subjects with a diagnosis of threatened preterm labor with intact membranes were included in the study. For hCG measurements, a cotton swab was rolled intracervically for 10 s to absorb fluid. Bishop scores were assessed. The correlation test was employed for the variables influencing hCG values. The ROC curve analysis was used to establish an optimal cut-off concentration for cervical hCG and an optimal cut-off level for Bishop score. The continous variables were analyzed by the unpaired, independent, two-tailed t-test and categorical data were analyzed by the chi-square test. Results: A significant positive correlation was present between the cervical hCG concentrations and Bishop scores ( r=0.72, P<0.0001), and a highly negative correlation between the cervical hCG concentrations and the time interval from sampling time until delivery ( r=−0.80, P<0.0001) was detected. The cut-off value for cervical hCG concentration and its sensitivity, specificity, positive and negative predictive values, accuracy, relative risk and likelihood ratio for accurate determination of delivery within 100 h were ≥32 mIU/ml, 98%, 55%, 70%, 96%, 77%, 19.68 and 2.18, respectively. However, these values were ≥32 mIU/ml, 97%, 84%, 89%, 95%, 92%, 17.37 and 6.06, respectively, for prediction of delivery within 7 days; ≥30 mIU/ml, 97%, 79%, 87%, 94%, 89%, 15.15 and 4.62, respectively, for prediction of delivery within 14 days; ≥33 mIU/ml, 89%, 92%, 94%, 83%, 90%, 5.83 and, 11.55, respectively, for prediction of delivery before 35 weeks; and finally ≥27 mIU/ml, 76%, 50%, 85%, 37%, 71%, 1.34 and 1.52, respectively, for prediction of delivery before 37 weeks. Conclusions: Cervical hCG expression seems to be rewarding in accurate diagnosis of preterm labor. This test has the advantage of low cost and wide availability.

Suppression of pelvic pain during hysteroscopy with a transcutaneous electrical nerve stimulation device

Objective To evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) as a pain control method during office hysteroscopy. Design A prospective, randomized study. Setting Centre for Minimally Invasive Surgery, Department of Gynecological Science and Perinatology, “La Sapienza” University, Rome, Italy. Patient(s) One hundred forty-two patients undergoing office hysteroscopy. Intervention(s) Application of a TENS device on the patient’s abdomen before and during office hysteroscopy. Main outcome measure(s) The level of pain experienced by the patients was assessed using a 10 cm visual analog scale; the side effects and changes in the hemodynamic parameters were evaluated. Result(s) The patients treated with TENS during hysteroscopy (group A, n = 71) were compared with a control group (group B, n = 71) on whom the TENS device was not used. The women in the TENS group experienced a significantly lower level of pain during hysteroscopy. No differences in side effects were observed between both group. Conclusion(s) TENS is a simple, efficient, and safe method of relieve pain during office hysteroscopy.

Pregnancy in Women with Epilepsy

The aim of this study was to analyze the outcome of pregnancy and delivery in epileptic women. A retrospective review of the 41 pregnant women with epilepsy who delivered in the Department of Obstetrics and Perinatology of the University School of Medicine in Lublin over 7 years (1993–1999) was carried out. Women with epilepsy had more pregnancy complications including premature labor, anemia, hypertension, vaginal bleeding, urinary tract infection, nausea and vomiting. An increased risk of congenital malformations and intrauterine fetal growth retardation was observed. Women with epilepsy require more extensive pregnancy planning including neurologic and preconceptional care.

Immunocytochemical study of glycinergic neurons in rat brain: Reiji Semba, Eiko Aoki, and Sigeo Kashiwamata, Department of Perinatology, Institute for Developmental Research, Aichi-ken Colony, Kasugai, Aichi 480-03, Japan

Immunocytochemical study of glycinergic neurons in rat brain: Reiji Semba, Eiko Aoki, and Sigeo Kashiwamata, Department of Perinatology, Institute for Developmental Research, Aichi-ken Colony, Kasugai, Aichi 480-03, Japan