Showing papers by "Roberto Romero published in 2001"
TL;DR: Intra-amniotic inflammation/infection complicates one third of the patients with preterm labor (32%; 65/206 women), and its presence is a risk factor for adverse outcome.
550 citations
379 citations
TL;DR: Preeclampsia is associated with phenotypic and metabolic changes in granulocytes and monocytes, and was associated with a significant increase in mean channel brightness for CD11b on granulocyte and monocyte but lower mean channel Brightness for CD62L ongranulocytes than those from women with normal pregnancy.
179 citations
TL;DR: Qualitative differences indicate that the innate limb of the immune response is not maximally activated during normal pregnancy, and pregnant women with acute infection had more marked phenotypic and metabolic changes of leukocytes than normal pregnant women.
176 citations
TL;DR: Elevated mid-trimester concentrations of amniotic fluid matrix metalloproteinase-8, and cytokines such as interleukin-6 and angiogenin can identify patients at risk for spontaneous preterm delivery in patients undergoing mid- Trimester amniocentesis.
141 citations
TL;DR: It is proposed that determination of amniotic fluid matrix metalloproteinase-8 concentrations may assist the assessment of the fetal inflammatory status, thereby eliminating the need for fetal blood sampling.
113 citations
TL;DR: Human parturition (preterm and term), rupture of fetal membranes (term and preterm) and intraamniotic infection are associated with a significant decrease in amniotic fluid TIMP-2 concentrations.
Abstract: Objective: Degradation of the extracellular matrix in fetal membranes has been implicated in the process of parturition and rupture of membranes. Matrix metalloproteinases (MMPs) are enzymes capable of degrading extracellular matrix including collagen. Tissue inhibitors of matrix metalloproteinases (TIMPs) inhibit the activity of MMPs by covalently binding to the enzymes. MMP-2 degrades Type IV collagen and TIMP-2 is its specific inhibitor. The objective of this study was to determine if human parturition, rupture of membranes (term and preterm) and microbial invasion of the amniotic cavity (MIAC) are associated with changes in the concentrations of MMP-2 and TIMP-2 in amniotic fluid. Study design: A cross-sectional study was conducted with women in the following categories: 1) term with intact membranes, in labor and not in labor; 2) preterm labor and intact membranes who delivered at term, who delivered preterm and preterm labor with MIAC; 3) preterm premature rupture of membranes (PROM) with and without infection; 4) term and preterm PROM not in labor; and 5) midtrimester. MMP-2 and TIMP-2 concentrations in amniotic fluid were determined using sensitive and specific immunoassays. Results: The concentration of TIMP-2 increased with advancing gestational age (r = 0.6, p < 0.001). No correlation was found between MMP-2 concentrations and gestational age. Human parturition and rupture of membranes (term and preterm) and in patients with intact membranes were not associated with changes in the amniotic fluid MMP-2 concentrations. In contrast, 1) patients with spontaneous labor (term and preterm) had significantly lower median concentrations of TIMP-2 compared to those not in labor (p < 0.05 for both); 2) MIAC in women with preterm labor and preterm PROM was associated with a significant decrease in amniotic fluid TIMP-2 concentrations (p < 0.04 for both comparisons); 3) Rupture of the membranes (term and preterm) was also associated with a significant decrease in the amniotic fluid TIMP-2 concentrations (p < 0.05 and p < 0.03, respectively). Conclusions: Human parturition (preterm and term), rupture of fetal membranes (term and preterm) and intraamniotic infection are associated with a significant decrease in amniotic fluid TIMP-2 concentrations.
107 citations
TL;DR: Preterm labor with intact membranes is associated with phenotypic and metabolic changes of maternal granulocytes and monocytes, and it is proposed that parturition requires fetomaternal cooperation and that inflammation is an integral part of the parturitional process.
97 citations
TL;DR: In this paper, the authors determined whether the placement of cervical cerclage on transvaginal ultrasonography reduces the rate of preterm delivery and increased the risk of premature rupture of membranes.
95 citations
TL;DR: In this article, the authors examined whether the pattern of inflammation of the umbilical cord correlates with a biochemical marker of systemic fetal inflammation, and an adverse neonatal outcome and found that infants whose placenta demonstrates umbilial arteritis have higher concentrations of cord plasma interleukin-6 and higher rates of adverse outcome than those without.
88 citations
TL;DR: In this article, the value of amniotic fluid matrix metalloproteinase-8 determinations in patients with preterm labor and intact membranes was examined to identify patients at risk for intra-amniotic infection, impending preterm delivery, and adverse neonatal outcome.
TL;DR: Increased concentrations of neutrophil collagenase (matrix metalloproteinase-8) in amniotic fluid are associated with intra-amniotic infection, impending preterm delivery, and adverse neonatal outcome in patients with preterm premature rupture of the membranes.
TL;DR: Patients with preterm premature rupture of membranes and an amniotic fluid index of < or = 5 cm are at increased risk for a shorter interval to delivery.
TL;DR: A positive fetal fibronectin result in cervicovaginal fluid is a powerful predictor of preterm delivery and is considered a marker for upper genital tract infection (ie, intrauterine infection) and treatment with antimicrobial agents is being considered in patients with a positive fibronECTin test of cervico/vaginal fluid.
TL;DR: It is suggested that the occupied IL‐1 receptor‐generated signal in HMC is transmitted by multiple pathways, one is coupled to a PTX‐sensitive G‐protein upstream from the MAPK phosphorylation cascade, which may interact with another signaling pathway, the activation of NF‐κB, via the phosphorylated of the IκB kinase complex.
Abstract: PROBLEM The objective of this study was to evaluate the possible role of pertussis toxin (PTX)-sensitive G-protein(s) in interleukin-1beta (IL-1) signaling in human myometrial cells (HMC) METHOD Primary cultures of HMC were stimulated with human recombinant IL-1 alone or in combination with PTX Prostaglandin (PG) E2 in the medium was measured by radioimmunoassay, cyclooxygenase type 2 (Cox-2) and IkappaB by western analysis, and the activities of two members of the mitogen-activated protein kinase (MAPK) family of enzymes, ERK-2 and JNK, by the phosphorylation of appropriate substrates RESULTS IL-1 increased PGE2 output during an 18-hr long incubation by 217-fold (n = 5 experiments) This increase was inhibited by 57% after pretreatment overnight with PTX IL-1-induced expression of Cox-2 protein was also suppressed to a similar degree in PTX-treated HMC cultures Degradation of the nuclear factor kappa B (NF-kappaB)-inhibiting protein (IkappaB), a critical step in IL-1 signaling to the nucleus, was significantly inhibited by PTX, as was IL-1-induced activation of ERK-2 and JNK CONCLUSIONS It is suggested that the occupied IL-1 receptor-generated signal in HMC is transmitted by multiple pathways One is coupled to a PTX-sensitive G-protein upstream from the MAPK phosphorylation cascade This, in turn, may interact with another signaling pathway, the activation of NF-kappaB, via the phosphorylation of the IkappaB kinase complex
TL;DR: The inflammatory changes occurring in the lungs of infants at risk for bronchopulmonary dysplasia over the first 28 days of life are defined and an optimal strategy for steroids therapy in the prevention of BPD is defined.
Abstract: The aim of this study was to define the inflammatory changes occurring in the lungs of infants at risk for bronchopulmonary dysplasia (BPD) over the first 28 days of life, and to define an optimal strategy for steroids therapy in the prevention of BPD. We measured levels of interleukin-6 (IL-6) and interleukin-1 beta (IL-1beta) in tracheal aspirate (TA) samples and blood of premature infants with severe respiratory distress syndrome RDS (n = 45) on the first day of life prior to initiation of surfactant therapy and on days 5-7, 12-14, 19-21, and 26-28. Levels of IL-6 and IL-1beta were determined with a commercially available enzyme-linked immunoassay. Logistic regression analyses were performed in order to examine differences in trends in levels of IL-6 and IL-1beta between groups of infants. Infants were divided into group I (n = 30, FiO(2) 0.35 based on their likelihood of developing BPD at 36 weeks postconceptional age (PCA). The infants were comparable with respect to mean ( +/- SEM) birth weight (895 +/- 33 g vs. 900 +/- 40 g), gestational age (27 +/- 0.38 weeks vs. 27 +/- 0.54 weeks), and severity of respiratory illness at entry into the study (mean airway pressure: 12 +/- 1 cmH(2)O vs. 12 +/- 1 cmH(2)O, and oxygen index: 15 +/- 2 vs. 19 +/- 4) (group I vs. group II, respectively). Logistic regression analyses failed to reveal any significant differences in linear trends of levels of IL-6 and IL-1beta in TA samples between both groups of infants. No particular pattern of change in levels of IL-6 or IL-1beta could be identified among groups of infants. Levels of IL-6 and IL-1beta in TA samples on the first day of life failed to predict the need for FiO(2) > 0.35 at 28 days of age. We could not identify an increasing trend or a specific pattern of changes in postnatal levels of IL-6 or IL-1beta in TA samples of infants who were at greater risk of developing BPD at 36 weeks PCA compared to infants who were not.
TL;DR: Whether genetic sonography of fetuses considered to be at moderate risk after maternal triple‐marker screening increases the detection for trisomy 21, is cost‐effective, and reduces the number of amniocenteses required to detect a single fetus with trisome 21 is determined.
Abstract: OBJECTIVE The current standard of practice is to screen women younger than 35 years for trisomy 21 with maternal triple-marker screening, followed by amniocentesis in high-risk (1:10-1:190) patients. Non-high-risk patients are not offered further diagnostic testing. This study was conducted to determine whether genetic sonography of fetuses considered to be at moderate risk (1:190-1:1000) after maternal triple-marker screening increases the detection for trisomy 21, is cost-effective, and reduces the number of amniocenteses required to detect a single fetus with trisomy 21. METHODS After triple-marker screening, mathematical modeling was used to classify 500,000 theoretical fetuses as high, moderate, or low risk (>1:1001-1:10,000) for trisomy 21. The sensitivity for genetic sonography varied between 60% and 90%, and false-positive rates varied between 5% and 25%. Two programs (I and II) were compared with the control program. The control program included patients with high-risk fetuses (1:10-1:190) who had amniocentesis. Program I consisted of patients in the moderate-risk group (1:191-1:1000) who had genetic sonography followed by amniocentesis only when an abnormal sonographic finding was present. Program II used an approach in which genetic sonography was done for both high- and moderate-risk fetuses, and amniocentesis was performed only when an abnormal sonographic finding was present. RESULTS When added to the control program, genetic sonography significantly increased the detection rate of Down syndrome (range, 68.1%-77.8% versus 49%), reduced the cost of detection, and resulted in a ratio of fetuses with Down syndrome detected to normal fetuses lost because of amniocentesis of greater than 1 (range, 2.1-4.2). Compared with the control program, program II significantly increased the detection of fetuses with trisomy 21 (range, 56%-72%) when the sensitivity of genetic sonography was >70%, reduced the cost of detection, and had ratios of trisomy 21 detection to normal fetuses lost because of amniocentesis of between 2.38 and 17.88. CONCLUSION Women younger than 35 years and classified as having moderate risk after triple-marker screening could undergo genetic sonography under 1 of 2 approaches, either of which would result in an increased detection rate of trisomy 21 and be cost-effective without increasing the loss rate of normal fetuses after genetic amniocentesis.
TL;DR: To determine the technical reliability of fetal iliac angle measurements by three‐dimensional sonography as a prenatal marker for Down syndrome, a large number of studies have found it to be reliable.
Abstract: Objective
To determine the technical reliability of fetal iliac angle measurements by three-dimensional sonography as a prenatal marker for Down syndrome.
Methods
Three-dimensional multiplanar views of the fetal pelvis were used to standardize iliac angle measurements from 35 normal second-trimester pregnancies. Measurement reliability for a single examiner and between two different examiners were analyzed by intraclass correlation. Normal iliac angle measurements were compared to those obtained from 16 fetuses with trisomy 21.
Results
The mean axial angle for normal fetuses was 79 ± 5.5 °, which was significantly less than that observed in fetuses with trisomy 21 (87.7 ± 4.9 °) (P < 0.001). Iliac angles did not correlate with gestational age. Axial angles were reproducible between two examiners who measured the same multiplanar view of the pelvis. Inter- and intraobserver reliability were also acceptable after a standardized multiplanar view was independently obtained by each examiner (intraclass correlation = 0.91 for both). Coronal angles were unreliable because of difficulties with finding a reproducible measurement plane. For a false-positive rate of 5%, an axial angle threshold of 87 ° correctly identified 56% of fetuses with trisomy 21.
Conclusion
Axial iliac angle measurements are reliable by standardized three-dimensional multiplanar views of the pelvis and can be used to identify some fetuses at increased risk for trisomy 21. Copyright © 2001 International Society of Ultrasound in Obstetrics and Gynecology
TL;DR: Choi et al. as mentioned in this paper found that normal pregnancy is associated with a selectin profile consistent with evidence of intravascular leukocyte activation and cytokine-induced endothelial cell activation.