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Showing papers by "Roberto Romero published in 1989"


Journal ArticleDOI
TL;DR: Amniotic fluid retrieved by amniocentesis from 264 patients with preterm labor and intact membranes admitted to Yale-New Haven Hospital from Jan. 1, 1985, to July 31, 1988 had a higher incidence of respiratory distress syndrome and infectious complications than preterm neonates born after negative amniotics fluid cultures.

645 citations


Journal ArticleDOI
TL;DR: The hypothesis that interleukin-1 may play a role in the initiation of preterm labor associated with intraamniotic infection is supported.

594 citations


Journal ArticleDOI
TL;DR: The data support the concept that macrophage activation is involved in the onset of human parturition in the setting of infection, and it is proposed that the host (fetus and/or mother) signalsThe onset of parturitions through the secretion of inflammatory cytokines released in response to bacterial invasion.

418 citations


Journal Article
TL;DR: Clinical and epidemiologic evidence indicates a strong association between untreated asymptomatic bacteriuria and LBW/preterm delivery and that antibiotic treatment is effective in reducing the occurrence of LBW.

406 citations


Journal ArticleDOI
TL;DR: It is suggested that antiphospholipid antibodies are related to adverse pregnancy outcomes in a complex fashion and that therapy is not always required for acceptable outcomes in patients without other risk factors.

327 citations


Journal ArticleDOI
TL;DR: Indomethacin blocked the effect of IL-1 in prostaglandin biosynthesis by human amnion, and Interleukin-1, a fever mediator, could serve as a signal for the initiation of labor in cases of intrauterine or systemic infection.

309 citations


Journal Article
TL;DR: It is demonstrated that human decidua can produce interleukin-1 in response to bacterial endotoxin, as demonstrated by the blockade of this bioactivity with antibodies againstinterleuk in-1: interleukesin-i alpha and interleuko-1 beta.

228 citations


Journal ArticleDOI
TL;DR: A significant increase in the release of all PGs into the media occurred in response to LPS and TNF, indicating that bacterial and host secretory products could trigger the onset of labor, activating the decidua to produce PGs.
Abstract: The purpose of these studies was to determine the effect of bacterial endotoxin and tumor necrosis factor (TNF) on prostaglandin (PG) secretion by human decidua. Decidual explants were established from women undergoing elective cesarean sections before the onset of labor. Escherichia Coli endotoxin and purified human recombinant TNF (rhTNF) were incubated with decidual explants. PGF2α and PGF2 biosynthesis was measured by radioimmunoassay. A significant increase in the release of all PGs into the media occurred in response to LPS and TNF. In the setting of an extraamniotic infection, bacterial and host secretory products (TNF) could trigger the onset of labor, activating the decidua to produce PGs.

137 citations


Journal ArticleDOI
TL;DR: It is concluded that thrombocytopenia is an independent and important risk factor for the occurrence of maternal and perinatal complications in PIH.
Abstract: The purpose of this study was to establish the prevalence and clinical significance of thrombocytopenia in pregnancy-induced hypertension (PIH). Thrombocytopenia, defined as a platelet count less than 100,000/mm3 was found in 11.6% of all patients with PIH. Logistic regression analysis was used to assess the relative contribution of thrombocytopenia, proteinuria, and the degree of hypertension to maternal and perinatal outcome. Thrombocytopenia was the principal contributor to the occurrence of abdominal pain, liver dysfunction, the presence of schistocytes in the peripheral smear, proteinuria, fetal distress, and the requirement for blood transfusions. Thrombocytopenia was also associated with a higher incidence of preterm delivery and intrauterine growth retardation. The nadir platelet count occurred within 48 hours of delivery in 56.7% (21 of 37) of cases. The median number of days for recovery of the thrombocytopenia was 2.0 days (range, 0 to 8 days). In five patients thrombocytopenia preceded the clinical manifestations of PIH. We conclude that thrombocytopenia is an independent and important risk factor for the occurrence of maternal and perinatal complications in PIH.

83 citations


Journal ArticleDOI
TL;DR: It is concluded that some cases of sirenomelia can be detected on prenatal sonograms by demonstration of a single lower extremity, oligohydramnios, and bilateral renal agenesis, allowing for termination of pregnancy.
Abstract: Prenatal sonographic findings of sirenomelia (or mermaid fetus) were retrospectively reviewed in eleven proven cases. Sonography showed oligohydramnios in all the cases, five (45%) of which had severe oligohydramnios that limited prenatal diagnosis by poor visibility. In five cases (45%), sirenomelia was correctly diagnosed by ultrasound; in the remainder, only bilateral renal agenesis was identified. All eleven fetuses had other associated malformations: congenital heart defects (4), skeletal deformities (10), and abdominal wall defects (4). Death resulted from termination of pregnancy in six cases and stillbirth in three cases. Two newborns died at 24 and 36 hours of neonatal life, respectively. We concluded that some cases of sirenomelia can be detected on prenatal sonograms by demonstration of a single lower extremity, oligohydramnios, and bilateral renal agenesis. Sirenomelia is a lethal condition and can be detectable in the second trimester of pregnancy, allowing for termination of pregnancy.

66 citations


Journal ArticleDOI
TL;DR: Amniotic fluid concentrations of PGFM and PGEM-ll were significantly greater in women with preterm labor and intra-amniotic infection than in women without infection.

Journal Article
TL;DR: It is concluded that the weight of the evidence does not support an association between genital colonization with mycoplasma species and prematurity/LBW.

Journal ArticleDOI
TL;DR: Results indicate that the arachidonate lipoxygenase pathway is activated during the course of preterm labor.
Abstract: This study was conducted to determine if preterm labor with intact membranes is associated with changes in the amniotic fluid concentrations of arachidonate lipoxygenase metabolites. Amniotic fluid was obtained by transabdominal amniocentesis from 68 women with preterm labor. The patients were classified into three groups according to their response to tocolysis and their amniotic fluid culture results: Group 1 — women with a negative amniotic fluid culture who responded to tocolysis (n = 32); Group 2 — women with a negative culture, but who failed to respond to tocolysis (n = 22); and Group 3 — women with intraamniotic infection (n = 14). The following arachidonate lipoxygenase products were measured by radioimmunoassay: leukotriene B 4 (LTB 4 ); leukotriene C 4 (LTC 4 ); 12-hydroxyeicosatetraenoic acid (12-HETE); and 15-hydroxyeicosatetraenoic acid (15-HETE). The median concentrations of LTB 4 were significantly different among the three study groups (26 pg/ml, 67 pg/ml and 885 pg/ml, respectively, p > 0.05). Amniotic fluid concentrations of 12-HETE and LTC 4 did not vary among the three study groups. On the other hand, a significant difference in the distribution of amniotic fluid concentrations of 15-HETE was noted only between women with intraamniotic infection (Group 3) and women responding to tocolysis (Group 1). These results indicate that the arachidonate lipoxygenase pathway is activated during the course of preterm labor. Selective changes in the concentrations of the assayed metabolites were noted. Amniotic fluid LTB 4 concentrations may be a marker for the patient with preterm labor who is unresponsive to tocolysis.

Journal ArticleDOI
TL;DR: There may be a role for EGF in the mechanism of human parturition, as measured in amniotic fluid by radioreceptor assay and an increased release of prostaglandin E2 into the media was found.


Journal Article
TL;DR: It is concluded that the weight of the available evidence does not support an association between prematurity and GBS colonization of the genital tract in the absence of asymptomatic bacteriuria.
Abstract: The purpose of this study was to determine whether there is a relationship between colonization of the genitourinary tract with group B Streptococcus (GBS) and prematurity A search of the literature was conducted to identify articles addressing this issue Ten studies provided enough data for a critical review; seven studies focused on genital colonization and three on asymptomatic bacteriuria An association between cervicovaginal colonization with GBS and prematurity could not be demonstrated in six of the seven studies However, women with asymptomatic bacteriuria caused by GBS had a higher rate of prematurity than did women without asymptomatic bacteriuria We conclude that the weight of the available evidence does not support an association between prematurity and GBS colonization of the genital tract in the absence of asymptomatic bacteriuria

Journal ArticleDOI
TL;DR: A twin pregnancy in which a single fetal death was diagnosed in the first trimester is described and continued growth of the nonviable twin suggested the occurrence of the twin reversed arterial perfusion syndrome.

Journal ArticleDOI
TL;DR: The acridine orange (AO) stain offered no significant advantage over the Gram's stain examination of amniotic fluid in the detection of intra-amniotic infection, however, the AO stain was able to identify mycoplasma infections that escaped detection by the gram's stain.
Abstract: The rapid diagnosis of intra-amniotic infection in patients with premature rupture of the membranes (PROM) and preterm labor is of utmost importance. The Gram's stain examination of amniotic fluid can only detect half of these infections. The acridine orange (AO) stain has been claimed to be superior to the Gram's stain in the detection of bacteria in biologic fluids. Therefore, we undertook the present study to examine the value of AO in the detection of bacteria in amniotic fluid. One hundred and thirty-eight patients with a culture-documented prevalence of intra-amniotic infection of 23.2% were studied. The diagnostic indices of the AO were: sensitivity, 43.8%, specificity, 97.2%, positive predictive value, 82.8%, and negative predictive value, 85.1%; the diagnostic indices for the Gram's stain were: sensitivity, 46.8%, specificity, 98.1%, positive predictive value, 88.2%, and negative predictive value, 85.9%. There was no difference in the diagnostic values of the tests. The agreement between the two techniques was substantial, as indicated by a kappa index of 0.72 (SE = 0.17, p less than 0.001). The AO offered no significant advantage over the Gram's stain examination of amniotic fluid in the detection of intra-amniotic infection. However, the AO stain was able to identify mycoplasma infections that escaped detection by the Gram's stain. Therefore, the AO is presently the only microscopic technique capable of detecting mycoplasma in amniotic fluid.

Journal ArticleDOI
TL;DR: It is concluded that liver dysfunction is a frequent complication of PIH and that it is an independent risk factor for maternal and perinatal complications.
Abstract: Hepatic dysfunction is one of the frequent manifestations of multisystemic involvement in preeclampsia. This study was conducted to establish the impact of liver dysfunction on maternal and neonatal outcome in women with pregnancy-induced hypertension (PIH). The prevalence of liver dysfunction as determined by an elevated serum glutamic oxalacetic transaminase (SGOT) concentration was 21% in a population of 355 patients with PIH. Liver dysfunction was associated with the presence of severe hypertension, proteinuria, a lower platelet count, and renal compromise (elevated blood urea nitrogen, creatinine, and uric acid serum concentrations). Abdominal pain was also associated with an SGOT elevation. Liver dysfunction was associated with intrauterine growth retardation and prematurity. Furthermore, the association with these neonatal complications was independent from the severity of the hypertension and the presence of proteinuria. Thus, we conclude that liver dysfunction is a frequent complication of PIH and that it is an independent risk factor for maternal and perinatal complications.

Journal ArticleDOI
TL;DR: A false positive diagnosis of spina bifida occurred in a fetus affected with ventriculomegaly, omphalocele, severe kyphosis and scoliosis, and the specificity of sonography in the prenatal diagnosis of neural tube defects was 98.3%.
Abstract: This study was undertaken to determine the accuracy of sonographic examination in the prenatal diagnosis of neural tube defects. The study population consisted of 237 patients divided into three groups according to the indication for the sonographic examination. The overall sensitivity of sonography in the diagnosis of neural tube defects was 94.7%, and the specificity was 98.3%. A false positive diagnosis of spina bifida occurred in a fetus affected with ventriculomegaly, omphalocele, severe kyphosis and scoliosis. There were three false negative diagnoses of spina bifida.

Journal ArticleDOI
TL;DR: The median amniotic fluid concentration of 5-HETE of women in labor was significantly greater than that of women not in labor, which is consistent with activation of the lipoxygenase pathway of arachidonic acid metabolism during spontaneous human parturition at term.
Abstract: 5-hydroxyeicosatetraenoic acid (5-HETE) is an arachidonate lipoxygenase product capable of stimulating uterine contractility in a dose-dependent manner in vitro. The purpose of this study was to determine if spontaneous human labor at term is associated with changes in the concentration of this metabolite in amniotic fluid. Fluid was retrieved from 36 women not in labor and from 30 women in active labor at term. 5-HETE was determined by radioimmunoassay. The median amniotic fluid concentration of 5-HETE of women in labor was significantly greater than that of women not in labor (3538 pg/ml vs. 1977 pg/ml, respectively; p = 0.05). This observation is consistent with activation of the lipoxygenase pathway of arachidonic acid metabolism during spontaneous human parturition at term.

Journal ArticleDOI
TL;DR: A patient with vaginal bleeding in the first trimester of pregnancy had a serum human chorionic gonadotropin (hCG) titer of 495,132 mlU/ml and an abdominal ultrasound examination revealed an intrauterine gestational sac without a fetal pole, and Histopathologic examination showed hydropic villi and chromosomal studies were consistent with triploidy.
Abstract: A patient with vaginal bleeding in the first trimester of pregnancy had a serum human chorionic gonadotropin (hCG) titer of 495,132 mlU/ml and an abdominal ultrasound examination revealed an intrauterine gestational sac without a fetal pole. Two and a half weeks later the hCG titer was 385,000 mlU/ml and a fetal pole was visualized. Transabdominal villous sampling was performed because of the suspicion of a partial mole. Histopathologic examination showed hydropic villi and chromosomal studies were consistent with triploidy. The diagnosis of partial mole in the first trimester of pregnancy was made and the pregnancy terminated.