Uncomplicated Pregnant Women Research Articles

Fetal Cardiodynamics by Echocardiography in Insulin Dependent Maternal Diabetes and Its Correlation with Pregnancy Outcome.

Maternal diabetes mellitus is associated with an increased risk of fetal and neonatal morbidity and mortality. Usual screening tests have not proved to be good prognostic indicators of fetal distress. Fetal cardiodynamics is potentially a useful screening tool. To determine if cardiodynamics of the fetus differ in pregnancy with diabetes requiring insulin than those without and to determine whether cardiodynamics predict fetal and neonatal outcomes. This prospective case control study was carried out in 40 pregnant women with diabetes who required insulin for blood sugar control. Twenty uncomplicated pregnant women were taken as controls. Systolic and diastolic cardiac functions along with interventricular septal thickness were assessed at 26-28 weeks and again at 34-36 weeks of gestation in fetuses by echocardiography. Fetal and neonatal adverse outcomes were evaluated in terms of major and minor morbidity. Among all parameters, E/A ratio across both mitral and tricuspid valves, myocardial performance index and cardiac output were significantly different in fetuses of diabetic mothers at both gestations. However, pulmonary vein pulsatility index and interventricular septal thickness were similar between the two groups. At 26-28 weeks of gestation myocardial performance index correlated with abnormal biophysical profile whereas cardiac output correlated with minor morbidity. At 34-36 weeks of gestation, cardiac output correlated with abnormal biophysical profile while both MPI and cardiac output correlated with minor morbidity. Echocardiographic parameters of fetuses of diabetic women significantly differed from those of uncomplicated non-diabetic women. However, only myocardial performance index and cardiac output correlated with adverse fetal and neonatal outcomes.

Association between decreased plasma levels of soluble human leukocyte antigen-G and severe pre-eclampsia.

The aim of this study was to investigate the levels of different isoforms of soluble human leukocyte antigen-G (sHLA-G) in maternal plasma during early and late pregnancy, and to investigate the expression of sHLA-G isoforms in women with early or late-onset severe preeclampsia. This prospective, nested, case-control study was performed in 24 early-onset severe preeclamptic, 34 late-onset severe preeclamptic, and 74 uncomplicated pregnant women. Plasma levels of sHLA-G1/5 were measured using ELISA. Plasma sHLA-G1 levels in women with late-onset severe preeclampsia were markedly lower compared with normal controls (median: 0 vs. 1.22 ng/mL) at the first trimester, and plasma sHLA-G1 levels in women with early-onset severe preeclampsia were markedly lower compared with normal controls at the second (median: 0 vs. 1.24 ng/mL) and third (median: 0 vs. 1.34 ng/mL) trimesters. There was no difference between the late-onset and early-onset groups at three trimesters. As for sHLA-G5, there was no difference in concentrations among the three groups at any time point. However, compared with controls, more women with early- or late-onset severe preeclampsia had undetectable sHLA-G5 levels in the first (71.4% and 76.2% vs. 14.1%), second (75.0% and 73.3% vs. 19.0%), and third (100.0% and 70.4% vs. 14.8%, respectively) trimester (all P<0.05). sHLA-G1 levels in the first (odds ratio [OR]=0.254, 95% confidence interval [CI]=0.109-0.591, P=0.010), second (OR=0.315, 95% CI=0.158-0.627, P=0.001), and third (OR=0.170, 95% CI=0.054-0.533, P=0.002) trimester was a risk factor for severe preeclampsia. Severe preeclampsia was associated with low/undetectable maternal plasma levels of sHLA-G. Low sHLA-G1 levels might be a risk marker for severe preeclampsia.

Circulating chromosome 19 miRNA cluster microRNAs in pregnant women with severe pre-eclampsia.

To clarify the association between circulating chromosome 19 miRNA cluster (C19MC) microRNAs in maternal plasma and severe pre-eclampsia. Maternal blood samples (7 mL) at 27-34 weeks of gestation were obtained from 20 pregnant women with severe pre-eclampsia (sPE group) and from 20 uncomplicated pregnant women (NP group). Twenty cases of severe pre-eclampsia were classified into late onset (sPELO group; n = 14) and early onset (sPEEO group; n = 6). Plasma concentration of C19MC microRNAs (miR-518b, -1323, -516b, -516a-5p, -525-5p, -515-5p, -520 h, -520a-5p, -519d and -526b) was measured on quantitative real-time reverse transcription-polymerase chain reaction. The circulating levels of all 10 C19MC microRNAs in maternal plasma were significantly increased in the sPE group compared with the NP group. Plasma concentration of all 10 C19MC microRNAs tested was significantly increased in the sPEEO group compared with the NP group, while plasma concentration of nine miRNAs, except for miR-519d, was significantly increased in the sPELO group compared with the NP group. Of the 10 C19MC microRNAs measured, plasma concentration of eight miRNAs, except for miR-518b and miR-519d, was significantly increased in the sPEEO group compared with the sPELO group. Increased levels of C19MC microRNAs in maternal plasma are a characteristic phenomenon of established severe pre-eclampsia, and it has been shown for the first time that the upregulation of C19MC miRNAs occurred as a consequence of, not in advance of, the onset of pre-eclampsia.

Human amniotic epithelial cells: Proliferation and apoptosis during their hepatic differentiation

Human amniotic epithelial cells: Proliferation and apoptosis during their hepatic differentiation

90-OR

Objectives To identify potential biomarkers for early preeclampsia (PE) with placental lesions consistent with maternal vascular underperfusion (MVU) using a novel proteomic approach. Methods A longitudinal study included uncomplicated singleton pregnant women whose samples were collected between 24 and 42 weeks (controls: n = 50, total samples = 199). Cases were women with early PE (delivered n = 44) and the samples were collected at the time of diagnosis. Proteomic profiles were analyzed using aptamer-based multiplexed proteomic technology which measured 1129 proteins. Log transformed and normalized protein concentrations in uncomplicated pregnancies were modeled using locally weighted linear quantile regression to establish the 10th and 90th percentiles of their distribution as a function of gestational age. Sensitivity for each protein in the identification of early PE with MVU at fixed 90% specificity was computed. Confidence intervals (CI) for sensitivity estimates were obtained by using a bootstrap procedure. Results (1) Twenty-five proteins had a sensitivity of at least 80% (at 90% specificity) for the identification of early PE with MVU; (2) four proteins (soluble tyrosine-protein kinase receptor-1, PlGF, and two newly-identified biomarkers had more than 90% sensitivity to identify such disorder; (3) each of these 4 proteins had at least 91% with 95% CI between 73% and 100% when confirmed by bootstrap; and (4) the median coefficient of variation (CV) for 1129 proteins was 6.07% (IQR = 4.4–8.5%). Conclusions Four proteins each had at least 90% sensitivity and specificity in the identification of patients with PE. The panel included two novel markers. Protein expression profiles in maternal plasma in normal pregnancy and early PE with MVU (red dots). (For interpretation of the references to color in this figure legend, the reader is referred to the web version of this article.) Disclosures P. Chaemsaithong: None. R. Romero: None. A.L. Tarca: None. Z. Xu: None. A.I. Ahmed: None. S.S. Hassan: None. L. Yeo: None. T. Chaiworapongsa: None.

Prediction of Preeclampsia by First Trimester Combined Test and Simple Complete Blood Count Parameters.

Preeclampsia is a serious disease which may result in maternal and neonatal mortality and morbidity. Improving the outcome for preeclampsia necessitates early prediction of the disease to identify women at high risk. Measuring blood cell subtype ratios, such as the neutrophil to lymphocyte (NLR) and platelet to lymphocyte (PLR) ratios, might provide prognostic and diagnostic clues to diseases. To investigate hematological changes in early pregnancy, using simple complete blood count (CBC) and blood concentrations of beta-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) to determine whether these measures are of any value in the prediction and early diagnosis of preeclampsia. Six hundred fourteen consecutive pregnant women with preeclampsia (288 with mild disease and 326 with severe disease) and 320 uncomplicated pregnant women were included in the study. Blood samples for routine CBC and first trimester screen, which combines PAPP-A and free β-hCG blood concentrations, were analyzed. The NLR values were significantly higher in the severe preeclampsia group compared with the control group (p<0.001). We also confirmed that levels of PAPP-A were lower in patients who developed preeclampsia. Because measuring CBC parameters, particularly NLR, is fast and easily applicable, they may be used to predict preeclampsia.

Na+, K+-ATPase and Ca2+-ATPase activities in basal and microvillous syncytiotrophoblast membranes from preeclamptic human term placenta

Objective: The aim of this study is to evaluate the effect of preeclampsia on the level of lipid peroxidation, activity and expression of both plasma membrane Ca2+- and Na+, K+-ATPases in syncytiotrophoblast. Methods: The level of lipid peroxidation was estimated by measuring TBARS. ATPase activities were quantified by a colorimetric method measuring the amount of inorganic phosphate during the assay. Expression of Ca2+- and Na+, K+-ATPases in syncytiotrophoblast plasma membranes and term placenta tissue sections was investigated using Western blot and immunohistochemistry, respectively. Results: Our results show a higher level of lipid peroxidation of syncytiotrophoblast plasma membranes from preeclamptic, as compared to uncomplicated pregnant women. Preeclampsia also significantly reduced the activity of Ca2+- and Na+, K+-ATPases; however, expression of both ATPases was unaffected. Conclusion: Our findings suggest that the reduction of Ca2+- and Na+, K+-ATPase activities during preeclampsia could be at least partially due to an increased level of lipid peroxidation of the syncytiotrophoblast plasma membranes.

Intra-abdominal pressure measurements in term pregnancy and postpartum: an observational study.

ObjectiveTo determine intra-abdominal pressure (IAP) and to evaluate the reproducibility of IAP-measurements using the Foley Manometer Low Volume (FMLV) in term uncomplicated pregnancies before and after caesarean section (CS), relative to two different reference points and to non-pregnant values.DesignObservational cohort study.SettingSecondary level referral center for feto-maternal medicine.PopulationTerm uncomplicated pregnant women as the case-group and non-pregnant patients undergoing a laparoscopic assisted vaginal hysterectomy (LAVH) as control group.MethodsIAP was measured in 23 term pregnant patients, before and after CS and in 27 women immediately after and 1 day after LAVH. The midaxillary line was used as zero-reference (IAPMAL) in all patients and in 13 CS and 13 LAVH patients, the symphysis pubis (IAPSP) was evaluated as additional zero-reference. Intraobserver correlation (ICC) was calculated for each zero-reference. Paired student's t-tests were performed to compare IAP values and Pearson's correlation was used to assess correlations between IAP and gestational variables.Main outcome measuresICC before and after surgery, IAP before and after CS, IAP after CS and LAVH.ResultsThe ICC for IAPMAL before CS was lower than after (0.71 versus 0.87). Both mean IAPMAL and IAPSP were significantly higher before CS than after: 14.0±2.6 mmHg versus 9.8±3.0 mmHg (p<0.0001) and 8.2±2.5 mmHg versus 3.5±1.9 mmHg (p = 0.010), respectively. After CS, IAP was not different from values measured in the LAVH-group.ConclusionIAP-measurements using FMLV is reproducible in pregnant women. Before CS, IAP is increased in the range of intra-abdominal hypertension for non-pregnant individuals. IAP significantly decreases to normal values after delivery.

Marked changes in olfactory perception during early pregnancy: a prospective case-control study.

Pregnancy seems to be related with a significant change in olfaction. Here, we investigate this theory by testing the odor identification abilities of uncomplicated pregnant women and compare the results with non-pregnant controls. The study included 31 healthy pregnant women in the first trimester (Group 1), 30 in the second trimester (Group 2), 31 in the third trimester, and 30 non-pregnant healthy controls (Group 4). In order to measure odor identification abilities, each subject completed the 12-item Brief Smell Identification Test (BSIT). Next, the demographic characteristics and BSIT scores of the groups were compared. The total BSIT scores of the subjects in Group 1 were found to be significantly lower than those of the other groups (p < 0.001). This reduction in odor identification abilities was particularly noticeable for leather, pine, and soot. Pregnant women in the second and third trimesters had similar odor identification abilities to the healthy controls (p > 0.05). Early pregnancy might be related to significant changes in olfactory performance. The distortion of odor identification in the first trimester might be a causative factor for the development of pregnancy-specific conditions, such as morning sickness and hyperemesis gravidarum, which are both common complaints during the early phase of parturition.

Association Between Obesity During Pregnancy and the Use of Prenatal Services

INTRODUCTION: Approximately 25% of women in the United States are obese (body mass index greater than 30 kg/m2). Obese women are at risk for poor perinatal outcomes, and studies imply that inadequate, late onset, or both of prenatal care are contributing factors in this population. We previously demonstrated that maternal obesity is actually associated with improved adequacy of prenatal care as measured by the Kotelchuck index and now further examine the use of specific prenatal services by otherwise uncomplicated obese women. METHODS: Retrospective cohort study of medically uncomplicated women who initiated prenatal care and delivered at our institution from January 2009 to December 2011. Maternal history and delivery information were obtained through chart abstraction. Use of specific prenatal care services including diabetic screening, ultrasound examinations, and hospitalization was compared between nonobese and obese women. RESULTS: A total of 320 women were evaluated, of whom 38% were obese. Mean (±standard error) length of hospital stay for combined intrapartum and postpartum care was 3.0±0.1 days in obese women compared with 2.9±0.1 days in nonobese women (P=.4). Both populations had similar diabetic screening compliance of 86.4% for nonobese and 86.8% for obese women (P=.9). However, obesity was significantly associated with more obstetrical ultrasonographic examinations with 48% obese women having five or more ultrasound scans compared with only 25% of nonobese women (P<.05). CONCLUSION: In our population, obesity in otherwise uncomplicated pregnant women is associated with increased use of obstetric ultrasound services, but there were no differences in use of other prenatal services.

Hypoproteinemia in the second trimester among patients with preeclampsia prior to the onset of clinical symptoms

Objective: To find a risk factor for “uncomplicated” preeclampsia (PE) comparing blood biochemical parameters between women with uncomplicated PE and healthy pregnant women in each trimester of pregnancy. Methods: A retrospective study was performed on 83 cases of uncomplicated PE, selected from 434 patients with PE, disregarding subjects with other complications relevant to hypertension during pregnancy. The study was limited to women with PE occurring in the third trimester, and records of blood biochemical parameters were evaluated. Controls were recruited from 108 healthy volunteers with normal singleton pregnancies. Results: A significant decrease in total protein was observed in the uncomplicated PE group in the second trimester prior to the onset of clinical symptoms. Conclusion: Hypoproteinemia during pregnancy may be a risk factor for this pathophysiology, and the maintenance of sufficient protein in early pregnancy could contribute to prophylaxis for women with uncomplicated PE.

Oxidative stress in the fetus of preeclamptic women with fetal growth restriction

Aim: The aim of this study was to determine whether oxidative stress occurring in the maternal body also affects the fetus in preeclamptic women with fetal growth restriction (FGR). Methods: We recruited 14 preeclamptic women with FGR, 13 preeclamptic women without FGR, and 10 uncomplicated pregnant women. We measured concentrations of derivatives of reactive oxygen metabolites (d-ROMs) as a marker of oxygen free radicals and biological antioxidant potential (BAP) in a umbilical artery and vein. Results: Umbilical artery and vein d-ROM levels were elevated in preeclamptic women with FGR compared to the control group. Umbilical artery d-ROM levels were significantly higher than in the vein in preeclamptic women with FGR, but not in those without FGR. Umbilical artery BAP levels did not change significantly in all three groups. Umbilical arterial blood pH was significantly lower and the partial pressure of carbon dioxide (PaCO 2) was significantly higher in preeclamptic women with FGR. Umbilical arterial blood partial pressure of oxygen (PaO 2) tended to be lower in preeclamptic women with FGR. Conclusions: These results indicate that oxidative stress occurring in the maternal body also affects the fetus in preeclamptic women with FGR.

Differences in the Association between Maternal Serum Homocysteine and ADMA Levels in Women with Pregnancies Complicated by Preeclampsia and/or Intrauterine Growth Restriction

Objective. The aim of our study was to investigate the association between homocysteine and asymmetric dimethylarginine in preeclamptic women with and without intrauterine growth restriction compared with normal healthy uncomplicated pregnancies and normotensive pregnancies complicated by idiopathic isolated intrauterine fetal growth restriction. Methods. The maternal serum homocysteine and asymmetric dimethylarginine concentrations were determined using a sandwich enzyme-linked immunosorbent assays. Results. A statistically significant positive correlation of maternal serum homocysteine levels with the serum asymmetric dimethylarginine levels was observed in healthy normotensive uncomplicated pregnant women from the control group and in preeclamptic patients with appropriate-for-gestational-age fetuses (R = 0.380079, p-value = 0.002311* and R = 0.455797, p-value = 0.004030* for the control and the P groups, respectively). However, this correlation was not significant in women with pregnancy complicated by intrauterine growth restriction, both isolated and in the course of severe preeclampsia. Conclusion. These findings provide support for the hypothesis that elevated levels of asymmetric dimethylarginine in pregnancy complicated by preeclampsia are associated with elevated homocysteine levels. But our results also demonstrate that in pregnancies complicated by intrauterine growth restriction, this mechanism is important, although not the only one.

Comparison of thyroid function tests results determined by two kinds of immunoassay in uncomplicated pregnant women

Objective To compare thyroid function test (TFT) results and reference range of normal pregnant women in different gestational stages between two kinds of automation chemiluminescence immunoassay kit commonly used.Methods Serum of 693 normal pregnant women attended antenatal clinics in the International Peace Maternity & Child Health Hospital Affiliated to the Medical School of Shanghai Jiaotong University from Feb.17th to June 9th,2011 was collected,and were divided into five groups according to their gestational age,9-13,16-20,24-28,32-34 and 37-40 weeks.Thyroid stimulating hormone (TSH),free thyroxine (FT4) and free triiodothyronine (FT3) levels were determined by 2 kinds of detection reagents:Abbott Architect I2000 and Roche Cobas Eleesys 600.According to National Academy of Clinical Biochemistry (NACB),the reference range of the TFT indexes was calculated.The results were analyzed by one-way ANOVA,t-test and Spearman relation analysis.Results During pregnancy,TSH level at different stage of pregnancy detected by the two reagents showed linear correlation and the changing pattern was also consistent (r =0.833-0.973,P =0.000).In 9-13 gestational weeks group,TSH level were significantly lower than that of other groups; and in 37-40 gestational week group,it was higher than that of other groups (FAbbott =18.830,FRoche =21.012,all P=0.000).And TSH levels and its reference range determined by Roche detection reagent in each group were higher than those by Abbott detection reagent (|t| =3.002,4.948,6.353,4.636 and 4.391,P＜0.01,respectively).In 9-13 gestational weekgroup,FT4 level was higher than that of other groups (F A b bott =17.230,FRoche =14.439,P=0.000).In 9-13 week group,FT4 level determined by Roche reagent was higher than that detected by Abbott reagent (|t| =4.964,P=0.000).While in 24-28 and 37-40 weeks group,they were lower (|t| =4.183,P=0.000; |t| =2.417,P=0.016).In 9-13 and 16-20 gestational weeks group,FT:3 levels,determined by both Abbott and Roche reagents,were higher than those of other groups (FAbbott =46.142,FRoche=68.149,P=0.000).The FT3 level in each group detected by Roche reagent were higher than that detected by Abbott reagent (|t| =31.762,26.411,28.877,22.710 and 22.736,P=0.000).Only in 9-13 weeks group,the TSH level was related to FT4 and FT3 level determined byboth reagents (Abbott:r=-0.319 and -0.361,P=0.000; Roche:r=-0.352 and -0.329,P=0.000).Conclusions TSH serum level is the most accurate indicator of thyroid function.The upper limit of the empirical TSH reference range during pregnancy recommended by America Thyroid Association might not be appropriate for Chinese.Different reference range for pregnant women should be established according to different reagents applied. Key words: Pregnancy; Thyrotropin; Thyronines; Reagent kits, diagnostic; Reference values

Circadian Variation of Blood Pressure Is Impaired in Normotensive Pregnant Women with Gestational Diabetes Mellitus

Data about circadian blood pressure (BP) in normotensive patients with gestational diabetes mellitus (GDM) are lacking. Thus, we sought to compare dipper and nondipper circadian variation of BP profile between normotensive women complicated with GDM and normal pregnant women. Forty-two women with GDM and 33 normal uncomplicated pregnant women who met the entry criteria for the study were enrolled in the study. Twenty-four-hour noninvasive ambulatory blood pressure monitoring and echocardiography to measure the left ventricle mass index and diastolic parameters were performed. Nocturnal blood pressure dipping was calculated as follows: (awake BP – sleep BP) × 100/awake BP. Patients with a nocturnal reduction in average daytime systolic BP and diastolic BP of less than 10% were classified as nondippers. Left ventricle mass index was higher in normotensive pregnant women with GDM group than in normal pregnant subjects (101.98 ± 24 g/m2 vs. 90.67 ± 15 g/m2, P < .018). Significant nocturnal systolic and diastolic nondippings were observed in GDM groups compared with normal subjects. From diastolic variables, the mitral E velocity and isovolumetric relaxation time were compatible with diastolic dysfunction relaxation abnormalities (P = .003 and P = .015, respectively) in nondipper group. From all confounding factors, only E velocity (P = .002) and diagnosis of GDM (P < .001) were predictive of nondipper circadian variation. This study shows that (i) circadian BP is impaired in normotensive pregnant subjects with GDM, (ii) the left ventricle mass index is higher in pregnant subjects with GDM than in normal pregnant subjects who despite a 24-hour BP are within normal limits, and (iii) in nocturnal nondipper group, the tendency to having diastolic relaxation abnormalities is noted.

The Risk of Cesarean Delivery in Short Saudi Women

Objectives: To evaluate the relationship between maternal height of 37 weeks), uncomplicated singleton nulliparous pregnant women were enrolled on admission to labour room. The patients were divided into two groups based on maternal height, >155 cm (247 cases) as control and < 155 cm (158 cases) as study group. The medical records of these women were reviewed. Various baseline clinical characteristics were collected. Maternal characteristics and maternal and neonatal outcomes were recorded. Results: Caesarean section rate for all indications was higher among study group than control group (26.6% and 19.4% respec-tively, p = 0.023). Significant difference was observed in the rate of caesarean delivery due to failure to progress (7.3% and 12% in control and study group respectively, p-value 0.038). The rate of caesarean delivery due to failure to progress was highest among those with height 150 - 155 cm (p-value 0.022). Mean birth weight was significantly higher among control group than study group (3137 ± 403 g and 3030 ± 408 respectively, p-value 0.010). Conclusion: Term singleton nulliparous Saudi pregnant women with maternal height 151 - 154 cm were associated with a greater likelih-ood of caesarean section for failure to progress. Women with height <150 cm did not have increased cesarean section rate. However, mean birth weight was significantly lower in this group.

Variability of total thiol compounds, oxidative and nitrosative stress in uncomplicated pregnant women and nonpregnant women

The objective of this study was to determine the changes in total plasma thiols (homocysteine, cysteine and cysteinylglycine), lipid peroxidation and nitric oxide concentrations during normal pregnancy. These variables were measured in 28 uncomplicated pregnant women at first, second and third trimesters and in 19 nonpregnant women. The mean concentrations of homocysteine, cysteine and cysteinylglycine were significantly lower in all trimesters of pregnancy compared with nonpregnant controls. There was significant elevation in serum lipid peroxidation levels of pregnant women within first and third trimesters compared with nonpregnant women. In spite of increase in mean nitric oxide levels in pregnant women, this increase did not reach statistically significant levels. This study provides information about the changes in plasma levels of many variables having important role in pregnancy complication during all trimesters in uncomplicated pregnancy compared with nonpregnant women.

Effect of anesthesiological strategies on neonatal bilirubin levels during cesarean section: a prospective and randomized trial

Neonatal jaundice, a frequent problem in neonatology, can be influenced by many factors. Here, we sought to clarify the role of anesthesia and to compare the effects of various anesthesiological strategies on neonatal bilirubin levels during cesarean section. We prospectively enrolled 167 ASA I-II status uncomplicated pregnant women who delivered by cesarean section as the study group. The patients were randomized based on anesthesiological strategy: inhalation (IA), spinal (SA), total intravenous (TIVA), and epidural anesthesia (EA) groups. Neonatal total (TB) and direct bilirubin (DB) levels at the 24th hour and 5th day of life and the need for phototherapy were compared between the groups. Direct bilirubin levels at 24th hour of SA group and EA group were higher compared to IA group (p = 0.008). When DB levels at fifth day were compared, levels in group TIVA were significantly higher than group SA (p = 0.019). TB levels at fifth day in group TIVA were higher than SA and EA groups (p = 0.05). The percentage of newborns needing phototherapy did not differ significantly among groups, but was highest in the TIVA group (25%), followed by the IA (15%), EA (10%) and SA (7%) groups (p = 0.08). EA and SA at cesarean section seem to be better among the four anesthesia techniques considering neonatal hyperbilirubinemia. Our findings are consistent with the idea that anesthesia may be a risk factor for hyperbilirubinemia. Although anesthesia may not significantly increase the need for interventions such as phototherapy, it may increase the burden of time, labor and cost.

Plasma level of soluble c-Met is tightly associated with the clinical risk of preeclampsia

The objective of the study was to examine the relevance of the soluble form c-Met (sMet) with the clinical risk for severe preeclampsia. This prospective case-control study was performed by using plasma derived from 44 preeclamptic and 51 uncomplicated pregnant women. Plasma concentration of sMet was measured with specific enzyme-linked immunosorbent assay, and the predictive values were determined based on the receiver-operating characteristic (ROC) curves analysis. Plasma s-Met level in normal pregnant women changed in a gestation-dependent manner, peaking at weeks 19-24. In women with severe preeclampsia, the circulating sMet level was significantly lower than that in the gestational stage-matched controls during gestational weeks 15-30. The ROC curve analysis revealed a significant correlation between plasma sMet level and the risk of developing severe preeclampsia. Plasma sMet could serve as a potential biomarker for predicting severe preeclampia at early second trimester of pregnancy.

Evaluation of a rapid ELISA technique for detection of circulating antigens of Toxoplasma gondii

To evaluate a modified rapid ELISA method for detecting CAg during Toxoplasma gondii infection, we analyzed the specificity and sensitivity of the ELISA method by using experimental Toxoplasma infection in rabbits and also tested this method in human samples including 5428 serum, 548 cerebrospinal fluid and two breast milk samples. We prepared PcAb, and used it for rapid one-step sandwich ELISA testing in which an incubation time in the regular ELISA procedure was omitted. This method detected CAg at the concentration of 31.2 ng/mL, and no cross-reaction was found with antigens of protozoa (Cryptosporidium parvum, Plasmodium falciparum), trematode (Schistosoma japonicum, Paragonimus sp.) and nematode (Brugia malayi, Ancylostoma duodenale, Ascaris lumbricoides and Trichinella spiralis). CAg was detected in rabbit serum 3 days after infection, and optical density values reached a peak 9-13 days after infection, then declined gradually. Among human serum samples, the positive rate of CAg was 2.11% in cerebral paralysis patients, whereas it was 0.22% or 0.71% in patients without neurological symptoms or in uncomplicated pregnant women. The difference among these three groups was statistically significant (P < 0.05). The positive rate of cerebrospinal fluid samples from cerebral paralysis patients was 10.58%. There is a statistically significant difference between the positive rates of meat-packing workers and blood donors (P < 0.01). In the retrospective analysis, CAg was detected in accordance with the onset of clinical symptoms, suggesting that CAg could reflect the clinical course in humans. Together with these results, CAg detected in the modified rapid sandwich ELISA could be a sensitive marker for acute and active infection of T. gondii.