Showing papers in "Journal of Maternal-fetal & Neonatal Medicine in 2005"
TL;DR: In this article, the concentrations of sVEGFR-1 in plasma of pre-eclamptic patients change prior to the clinical manifestations of the disease and correlates with the severity of the diseases.
Abstract: Objective: Accumulating evidence suggests that the balance between vascular endothelial growth factor (VEGF), placental growth factor (PlGF), and their receptors is important for effective vasculogenesis, angiogenesis, and placental development. Recently, the soluble form of VEGFR-1 (sVEGFR-1), an antagonist to VEGF and PlGF, has been implicated in the pathophysiology of pre-eclampsia. Plasma sVEGFR-1 concentration is elevated in pre-eclampsia at the time of clinical diagnosis and correlates with the severity of the disease. The purpose of this study was to determine whether the concentrations of sVEGFR-1 in plasma of pre-eclamptic patients change prior to the clinical manifestations of the disease.Methods: A longitudinal case-control study was conducted in normal pregnant women (n = 44) and patients with pre-eclampsia (n = 44). Blood sampling was performed at six intervals: (1) 7–16 weeks; (2) 16–24 weeks; (3) 24–28 weeks; (4) 28–32 weeks; (5) 32–36 weeks; and (6) more than 37 weeks of gestation. To exam...
339 citations
TL;DR: Hypertensive disorder, failure to progress during the second stage of labor, oxytocin augmentation, vacuum extraction and LGA were found to be major risk factors for severe PPH.
Abstract: Objective. The study was aimed to identify obstetric risk factors for early postpartum hemorrhage (PPH) in singleton gestations and to evaluate pregnancy outcome.Study design. A comparison between ...
252 citations
TL;DR: It is proposed that physiologic activation of the complement system during pregnancy is a compensatory mechanism aimed at protecting the host against infection.
Abstract: Background. The complement system, a major component of innate immunity, has recently been implicated in the mechanisms of fetal loss and placental inflammation in the anti-phospholipid antibody syndrome. Inhibition of complement has been proposed as an absolute requirement for normal pregnancy. Yet, pregnancy is characterized by a generalized activation of the innate immune system. This study was conducted to determine whether or not normal pregnancy is associated with complement activation in the maternal circulation.Methods. Anaphylatoxins (C3a, C4a and C5a) were determined in the plasma of normal pregnant (20–42 wks; n = 134) and non-pregnant women (n = 40). These complement split products (C3a, C4a and C5a) were measured using specific immunoassays. Non-parametric statistics were used for analysis.Results. 1) The median plasma concentrations of C3a, C4a and C5a were significantly higher in normal pregnant women than in non-pregnant women (all p < 0.001); 2) the concentration of C3a, C4a and C5a did n...
157 citations
TL;DR: It is suggested that MCP-1 may play a role in preterm labor regardless of the presence of IAI, and a significant relationship existed between the amniotic fluid concentrations of immuno-reactive M CP-1 and the interval from amniocentesis to delivery.
Abstract: Objective. Pro-inflammatory chemokines have been associated with preterm parturition. Monocyte chemotactic protein-1 (MCP-1) is a chemokine capable of recruiting monocytes/macrophages into sites of...
144 citations
TL;DR: It is suggested that nulliparous women who are overweight or obese prior to pregnancy, and particularly those who are also short, have an increased risk of delivering their infants by cesarean section.
Abstract: Objective. To determine the extent to which, if at all, maternal pre-pregnancy adiposity and other anthropometric factors are related to risk of cesarean delivery.Methods. This hospital-based prospective cohort study included 738 nulliparous women who initiated prenatal care prior to 16 weeks gestation. Participants provided information about their pre-pregnancy weight and height and other sociodemographic and reproductive covariates. Labor and delivery characteristics were obtained from maternal and infant medical records. Risk ratios (RR) and 95% CI were estimated by fitting generalized linear models.Results. The proportion of cesarean deliveries in this population was 26%. Women who were overweight (BMI 25.00–29.99 kg/m2) were twice as likely to deliver their infants by cesarean section as lean women (BMI < 20.00 kg/m2) (RR = 2.09; 95% CI 1.27–3.42). Obese women (BMI ⩾ 30.00 kg/m2) experienced a three-fold increase in risk of cesarean delivery when compared with this referent group (RR = 3.05; 95% CI 1...
107 citations
TL;DR: A cross-sectional study to determine whether there is a gradient in the plasma concentration of sVEGFR-1 and PlGF between the uterine vein and the antecubital vein in both patients with preeclampsia and normal pregnant women.
Abstract: Background. Preeclampsia has been considered an anti-angiogenic state. Two factors have been implicated in the genesis of this state: soluble vascular endothelial growth factor receptor-1 (sVEGFR-1) and placental growth factor (PlGF). Indeed, the concentrations of PlGF, an angiogenic factor, are lower in preeclampsia than in normal pregnancy, while the opposite is the case for the anti-angiogenic factor, sVEGFR-1. The source of the excess sVEGFR-1 has not yet been determined. Since the placenta could be a source of sVEGFR-1, we conducted a study to determine whether there is a gradient in the plasma concentration of sVEGFR-1 and PlGF between the uterine vein and the antecubital vein in both patients with preeclampsia and normal pregnant women.Methods. A cross-sectional study was performed to determine the plasma concentrations of sVEGFR-1 and PlGF in the uterine and antecubital vein of patients with preeclampsia (n = 9) and normal pregnant women at term (n = 9). Plasma samples were collected from antecubi...
107 citations
TL;DR: Women with preterm labor and intact membranes that delivered within 7 days had higher AF concentrations of pro-inflammatory cytokines than those who delivered after 7 days of the amniocentesis regardless of the AF culture results.
Abstract: Objective. To compare the amniotic fluid (AF) concentration of pro-inflammatory cytokines between women with preterm labor and intact membranes that delivered within 7 days, with those that deliver...
96 citations
TL;DR: Fetal size and cesarean section rate are associated with the degree of carbohydrate intolerance (screening results), and obesity remains the main contributor impacting fetal size.
Abstract: Objective: To evaluate the association between obesity, glucose challenge test (GCT) and pregnancy outcome.Methods: A prospective cohort study of 6854 consecutive gravid patients screened for gestational diabetes (GDM) using 50-gram GCT, at 24–28 weeks' gestation was performed. A screening value ⩾ 130 mg/dl was followed by 100 gr oral GTT. Patients who were diagnosed with GDM were excluded. For purpose of analysis patients were categorized by prepregnancy BMI and by different GCT thresholds. Maternal outcome was defined by rate of preeclampsia, gestational age at delivery, cesarean section (CS) rate and the need for labor induction. Neonatal outcome was defined by fetal size (macrosomia/LGA), arterial cord pH, respiratory complications and neonatal intensive care unit (NICU) admission.Results: Overall, a positive GCT result (GCT ⩾ 130 mg/dl) was identified in 2541/6854 (37%) women. GDM was further diagnosed in 464/6854 (6.8%) of subjects. In both groups of screening results ( > 130 mg/dl and < 130 mg/dl),...
89 citations
TL;DR: A review of the literature on cord coiling is presented in this paper, where the authors discuss the theories involving the cause of cord co-iling, and the consequences of the deg...
Abstract: Our aim was to review the literature on umbilical cord coiling. Relevant articles in English published between 1966 and 2003 were retrieved by a Medline search and cross-referencing. The normal umbilical cord coiling index (UCI) is 0.17 (?± 0.009) spirals completed per cm. Abnormal cord coiling, i.e. UCI ?90th centile (?>?0.30) is associated with adverse pregnancy outcome. Hypocoiling of the cord is associated with increased incidence of fetal demise, intrapartum fetal heart rate decelerations, operative delivery for fetal distress, anatomic-karyotypic abnormalities and chorio-amnionitis. Hypercoiling of the cord is associated with increased incidence of fetal growth restriction, intrapartum fetal heart rate decelerations, vascular thrombosis and cord stenosis. It is not clear whether abnormal coiling is actually a cause of pathology, or merely one of the sequelae, or both. We discuss the theories involving the cause of cord coiling, and the consequences of the deg...
87 citations
TL;DR: MIAC was detected in 14% of patients with ‘idiopathic’ vaginal bleeding and was associated with subsequent preterm PROM and early preterm delivery, and may be the only clinical manifestation of MIAC.
Abstract: Objective. To determine the frequency and clinical significance of microbial invasion of the amniotic cavity (MIAC) in patients with vaginal bleeding in the absence of placenta previa, preterm labor or preterm premature rupture of membranes (PROM). Study design. This retrospective cohort study included patients who presented with vaginal bleeding between 18 and 35 weeks, and underwent an amniocentesis shortly after admission for the assessment of the microbiologic status of the amniotic cavity and/or fetal lung maturity. Amniotic fluid was cultured for aerobic and anaerobic bacteria, as well as genital mycoplasmas. Patients presenting with preterm labor, preterm PROM, placenta previa, overt placental abruption, and an intrauterine device in situ were excluded, as well as those with local cervical bleeding. MIAC was defined as a positive amniotic fluid culture. Analysis was conducted with non-parametric statistics. Results. One hundred and fourteen patients met the entry criteria. MIAC was detected in 14% of cases (16/114). Patients with vaginal bleeding and a gestational age 5 28 weeks at the time of amniocentesis had a significantly higher frequency of MIAC than those with a gestational age 5 28 weeks [25% (13/52) vs. 4.8% (3/62), respectively; p 5 0.01]. Ureaplasma urealyticum was the microorganism most frequently isolated from the amniotic fluid. Except for one case admitted at 33 weeks, all patients with MIAC had an early preterm delivery 4 32 weeks. Patients with vaginal bleeding and MIAC had a shorter procedure-to-delivery interval than those without MIAC [MIAC, median survival 19 days (95% CI 10–27 days) vs. no MIAC, median survival 50 days (95% CI 37–62 days); p 5 0.0001]. Patients with vaginal bleeding and MIAC had a significantly lower gestational age at delivery and lower birth weight than those with vaginal bleeding and negative amniotic fluid cultures (for gestational age, median 25 weeks, range 21–33 weeks vs. median 37 weeks, range 19–42 weeks, respectively; p 5 0.01, and for birth weight, median 750 grams, range 520–1820 grams vs. 2800 grams, range 520– 4880 grams, respectively; p 5 0.01), as well as a higher frequency of subsequent preterm PROM [81.3% (13/16) vs. 9.2% (9/ 98); p 5 0.01]. Conclusions. MIAC was detected in 14% of patients with ‘idiopathic’ vaginal bleeding and was associated with subsequent preterm PROM and early preterm delivery. Vaginal bleeding may be the only clinical manifestation of MIAC, and it predisposes to adverse outcome.
81 citations
TL;DR: Intra-amniotic infection and preterm parturition, but not term parturitions, are associated with a significant increase in amniotic fluid MIF concentrations.
Abstract: Objective. Macrophage migration inhibitory factor (MIF) has emerged as an important mediator of septic shock. The administration of MIF increases lethality during endotoxemia, whereas neutralization of this cytokine prevents endotoxic shock and death associated with bacterial infection. The objective of this study was to determine whether there is a change in the amniotic fluid concentration of MIF in intra-amniotic infection and human parturition.Study design. A cross-sectional study was conducted in women in the following categories: (1) mid-trimester (n = 84); (2) preterm labor and intact membranes who delivered at term (n = 33), who delivered preterm (n = 53) and preterm labor with intra-amniotic infection (n = 23); (3) preterm premature rupture of membranes (PROM) with (n = 25) and without intra-amniotic infection (n = 26); and (4) term with intact membranes, in labor (n = 52) and not in labor (n = 31). MIF concentrations in amniotic fluid were determined using a sensitive and specific immunoassay. M...
TL;DR: The risk of cesarean section overall was significantly associated with all the variables under consideration, i.e., pre-induction cervical length, parity, gestational age at induction, maternal age and body mass index, but not by maternal age or maternal age.
Abstract: Objective. To examine the effect of pre-induction cervical length, parity, gestational age at induction, maternal age and body mass index (BMI) on the possibility of successful delivery in women undergoing induction of labor.Methods. In 822 singleton pregnancies, induction of labor was carried out at 35 to 42 + 6 weeks of gestation. The cervical length was measured by transvaginal sonography before induction. The effect of cervical length, parity, gestational age, maternal age and BMI on the interval between induction and vaginal delivery within 24 hours was investigated using Cox's proportional hazard model. The likelihood of vaginal delivery within 24 hours and risk for cesarean section overall and for failure to progress was investigated using logistic regression analysis.Results. Successful vaginal delivery within 24 hours of induction occurred in 530 (64.5%) of the 822 women. Cesarean sections were performed in 161 (19.6%) cases, 70 for fetal distress and 91 for failure to progress. Cox's proportiona...
TL;DR: This study confirms the importance of smoking as a major risk factor for pregnancies complicated by the birth of an SGA infant, and shows major protection being conveyed by having a regular job and being generally healthy.
Abstract: Background. Risk factors for pregnancies being complicated by the birth of a small-for-gestational age (SGA) infant were analysed in a socio-economically disadvantaged area, with separate analysis for population-based and customized-based birth weight percentiles.Methods. A retrospective case-controlled study of all singleton pregnancies resulting in the birth of an infant with a birth weight < 10 population-based centile, born in the Northern suburbs of metropolitan Adelaide, between 1998 and 2003. Significant risk factors in the univariate analysis were subsequently checked with multivariate analysis.Results. The analyses confirm marked differences between population-based and customized-birth weight centiles. Patterns of risk factors show clear differences in risk factors for these two different SGA groups. Univariate analyses of all (nulliparous and multiparous women) customized SGA infants shows us the following odds ratio's (OR); unemployment OR 2.06, 95% confidence interval (CI) 1.46–2.92, being a ...
TL;DR: The most important neurodevelopmental events, the basic technology of 4D ultrasound and its application in the assessment of functional development of fetal central nervous system will be the subject of this review.
Abstract: The investigation of fetal intrauterine activities has been enabled by the development of two-dimensional ultrasound. It has been shown that the earliest signs of fetal motor activity can be in the late embryonic period, and that the characteristics of fetal motor patterns change constantly throughout gestation. During the first trimester of pregnancy, the repertoire and frequency fetal movement patterns constantly expand, whereas the second and third trimesters are characterized by the progressive organization of fetal activities into complex and clearly distinct behavioral patterns. The comparison of real time ultrasonic studies of fetal behavior with the morphological studies of fetal brains has revealed that the appearance of new behavioral patterns or the transition of existing patterns directly reflect the complex neurodevelopment processes. It has been suggested that the assessment of fetal behavioral patterns could give us insight into the integrity of fetal central nervous system and enable the e...
TL;DR: A good transfer of allopurinol from mother to fetus is demonstrated and the possibility of intrauterine treatment to inhibit fetal brain damage resulting from increased oxygen free radicals is suggested.
Abstract: Objective To evaluate the transplacental effect of allopurinol, which acts as a xanthine oxidase inhibitor and free radical scavenger, on inhibiting the production of superoxides during intermittent partial umbilical cord occlusionMethods Using four chronically instrumented fetal lambs, ewes received 400 mg allopurinol over a period of two hours Concentrations of allopurinol and oxypurinol in blood samples from mothers and fetuses and fetal brain microdialysis perfusate were measured by HPLC In another three cases the production of superoxide during intermittent umbilical cord occlusion was studied by measurement of chemiluminescence in perfusate before and after administration of AllopurinolResults (i) Allopurinol concentration in mothers had reached equilibrium by 30 min after starting administration and maintained a concentration about 6 μg/ml Allopurinol concentration in fetuses increased gradually and reached 225 ± 054 μg/ml at 120 min; (ii) Oxypurinol concentration in both mothers and fetu
TL;DR: The factors that might influence the accuracy of sonographic estimated fetal weight were determined and if feasible the sonographic examination should be done by RDMS and within a week of delivery.
Abstract: Purpose. To determine the factors that might influence the accuracy of sonographic estimated fetal weight.Study design. A PubMed search (Jan 1975 to Jan 2003) of articles published in the English language was carried out and the inclusion criterion was that estimates were within 10% of birth weight. A Chi-square test for trend was used and odds ratio (OR) with 95% confidence intervals (CI) was calculated.Results. Over 28 years, 175 articles were identified but only 54 (31%) met the inclusion criterion. Overall 62% (8895/14 384) of the predictions were within 10% of the actual weight. The accuracy was significantly different in articles where 7 days were allowed to lapse between examination and delivery (OR 2.17, 95% CI 1.93, 2.45); where examinations were done by registered diagnostic medical sonographers (RDMS; 65%) versus physicians (59%) or residents (57%; p 1000 vs. <1000 cohorts (OR 1.62; 95% CI 1.51, 1...
TL;DR: Pregnant women with asthma are at an increased risk for adverse maternal outcome and this association persists after controlling for variables considered to co-exist with maternal asthma, however, perinatal outcome is favorable.
Abstract: Objective. To investigate pregnancy outcome of asthmatic patients.Methods. A retrospective population-based study comparing all singleton pregnancies in women with and without asthma was conducted. Patients lacking prenatal care (less than three visits in prenatal care facilities) were excluded from the study. Deliveries occurred during the years 1988–2002. Stratified analysis, using a multiple logistic regression model was performed to control for confounders.Results. During the study period 139 168 singleton deliveries occurred, of which 1.4% in asthmatic patients (n = 963). Using a multivariate analysis, with backward elimination, the following complications were significantly associated with maternal asthma: diabetes mellitus (OR = 1.8, 95%CI 1.5–2.0, p < 0.001), fertility treatments (OR = 1.6, 95%CI 1.3–2.1, p < 0.001), intrauterine growth restriction (IUGR) (OR = 1.5, 95%CI 1.1–1.9, p = 0.004), hypertensive disorders (OR = 1.5, 95%CI 1.2–1.7, p < 0.001) and premature rupture of membranes (OR = 1.2, ...
TL;DR: In women with favorable Bishop scores, elective induction of labor resulted in no increase in cesarean delivery compared to expectant management in a randomized clinical trial involving women according to strict dating criteria.
Abstract: Objective. To determine if elective induction (IND) increases the risk of cesarean delivery compared to expectant management (EM).Methods. A randomized clinical trial involving women ⩾39 weeks' gestation, according to strict dating criteria, with a Bishop score of 5 or more in nulliparous patients and 4 or more in multiparous patients. The control group was expectantly managed and delivered for obstetric indications, but not later than 42 weeks' gestation. The study had 80% power to detect a three-fold increase in cesarean delivery.Results. One-hundred-and-sixteen patients (45 nulliparous) were randomized to IND and 110 (58 nulliparous) to EM. Demographic characteristics were no different between the groups. The cesarean delivery rate in the IND group was 6.9% (8/116) compared to 7.3% (8/110) in the EM group (p = NS). Rates of cesarean delivery for nulliparous patients randomized to IND compared to EM were also not significantly different: 13.3% (6/45) versus 10.3% (6/58) respectively (p = NS). Neonates d...
TL;DR: A comparison of fetal behavior between a fetus with anencephaly and a normal fetus at 19 weeks of pregnancy is described.
Abstract: Diagnosis of anencephaly during early pregnancy by ultrasound which is based on the demonstration of absent cranial vault and cerebral hemispheres, has been known for more than 25 years. Morphological records of abnormal and normal brain structure in anencephalic fetuses have been clearly understood. Nevertheless, there are still unknown facts about fetal behavior affected by anencephaly. Although abnormal motor behavior in anencephalic fetuses has been reported, detailed quantitative and qualitative study of the fetal behavior assessed by direct four-dimensional (4D) ultrasound does not exist. In the present case, we describe a comparison of fetal behavior between a fetus with anencephaly and a normal fetus at 19 weeks of pregnancy.
TL;DR: Only large pragmatic trials based on such strategies will reveal whether the benefits of aggressive enteral nutrition can outweigh the risks of a potentially devastating illness like NEC, and of prolonged parenteral nutrition in preterm neonates.
Abstract: Postnatal growth restriction and failure to thrive have been recently identified as a major issue in preterm, especially extremely-low-birth-weight neonates. An increased length of time to reach fu...
TL;DR: Mothers who use Iqmik and their neonates have higher cotinine concentrations compared to mothers who use cigarettes and/or other forms of tobacco during pregnancy.
Abstract: Objective. To determine the concentration of nicotine and cotinine in maternal blood and neonatal cord blood among pregnant Alaska Native women and to assess the neonates for neurobehavioral effects.Methods. In a nonrandomized, clinical observational pilot trial, 60 pregnant Alaska Native women were enrolled for assessment of Iqmik (a mixture of leaf tobacco and ash) and other tobacco use during pregnancy and at delivery. Neonatal cord blood, nicotine and cotinine concentrations were obtained, and neonatal neurobehavioral effects were assessed using the Lipsitz scale.Results. At delivery, there were 22 subjects who reported using only Iqmik, and 10 who used other tobacco products. Subjects who reported using only Iqmik prior to delivery had higher concentrations of cotinine (167 ± 116 vs. 81 ± 100) in maternal blood (rank sum test, p = 0.036) and higher concentrations of nicotine (8.4 ± 7.3 vs. 4.4 ± 5.1, p = 0.048) and cotinine (153 ± 115 vs. 70 ± 95, p = 0.048) in cord blood compared to subjects who rep...
TL;DR: The findings are consistent with reports from six of eight previous studies on the topic, but prospective cohort studies are needed to further evaluate the extent to which migraines and/or its treatments are associated with preeclampsia risk.
Abstract: Objective. We examined the relationship between migraines and preeclampsia risk.Study design. Cases were 244 women with preeclampsia and controls were 470 normotensive women. Women were asked if a physician had ever told them that they had migraines. Odds ratios (OR) and 95% confidence intervals (CI) were calculated.Results. A history of migraines was associated with a 1.8-fold increased risk of preeclampsia (95% CI 1.1–2.7). Women who were 30+ years old when diagnosed with migraines had the highest risk (OR 2.8, 95% CI 0.8–9.0). The migraine–preeclampsia association appeared to be modified by pre-pregnancy overweight status (p = 0.06). Overweight migrainous women, compared with lean nonmigrainous women, had a 12-fold increased preeclampsia risk (95% CI 5.9–25.7).Conclusion. Our findings are consistent with reports from six of eight previous studies on the topic. Nevertheless, prospective cohort studies are needed to further evaluate the extent to which migraines and/or its treatments are associated with ...
TL;DR: Outcome was favorable in 85% of IVM cases, decreasing to 79% when cases were followed to at least 20 months of age, and prospective cohort studies with new diagnostic modalities are recommended to better identify the underlying conditions relating to moderate/severe impairments in the remaining cases.
Abstract: Objective. To establish the perinatal and neurodevelopmental outcomes of fetuses diagnosed with isolated ventriculomegaly (IVM).Methods. A systematic review of cohort, case/control studies, case series and case reports of IVM (unilateral or bilateral enlargement of the lateral ventricle, ⩾10 mm, with no additional diagnosis at the time of the initial ultrasound), identified by searching, without language restrictions, The Cochrane Library, MEDLINE and Embase databases in June 2004.Results. No cohort study was retrieved but 577 cases were identified in one case/control study and 29 case series/case reports. Of 207 cases with follow-up and known gestational age at diagnosis, normal developmental outcomes were found in 82%, mild impairments in 9% and moderate/severe impairments in 10%. Prenatal diagnosis could possibly have reduced the risk of moderate/severe impairments to 7%. In 137 cases followed to at least 20 months of age, 79% had normal neurodevelopment, 10% were mildly delayed and 11% had moderate/se...
TL;DR: Women with treated hypothyroid disease are not at higher risk than the general population for adverse neonatal outcomes, but may be at increased risk for pre-eclampsia.
Abstract: Objective: We sought to determine whether women with treated hypothyroid disease were more likely than women without thyroid disease to suffer adverse obstetric or neonatal outcomes or to deliver a child with a congenital anomaly.Methods: Using an institutional database, we identified women with treated hypothyroid disease (n = 482) who delivered a baby at our institution during a 33-month period. We compared the occurrence of adverse obstetric or neonatal outcomes among these women to the occurrence among women without thyroid disease (n = 19,487).Results: Women with treated hypothyroid disease were not at increased risk for delivering a baby with low birth- weight, fetal demise, or congenital anomaly compared to the control group. Women with treated hypothyroid disease were more likely to have chronic hypertension (2.3% vs. 1.2%, p = 0.03) and had an increased risk of pre-eclampsia (4.3% vs. 2.6%, p = 0.03) compared to women without thyroid disease.Conclusion: Women with treated hypothyroid disease are ...
TL;DR: Thrombin treatment selectively increased the concentration of MMP-9 in culture media of amniochorionic membranes, providing a potential mechanism through which alterations in hemostasis promote PPROM through thrombin-dependent stimulation of M MP-9.
Abstract: Objective. Amniochorion matrix metalloproteinase (MMP)-9 levels increase during labor, reaching a maximum in patients with preterm premature rupture of membranes (PPROM). Bleeding is a major risk factor for PPROM. Since such hemorrhage into the tissue factor-enriched decidua induces intense thrombin formation, we determined whether thrombin stimulates MMP levels in amniochorionic membranes.Study design. Fetal membrane (amniochorion) cultures were maintained in media with and without thrombin, lipopolysaccharide (LPS), thrombin receptor agonist peptide (TRAP)-14, and the anti-inflammatory steroid, dexamethasone (DEX). Concentrations of MMP-9, MMP-1, and tissue inhibitor of metalloproteinase (TIMP)-1 in culture media were measured by ELISA and normalized to total cell protein.Results. The presence of thrombin induced MMP-9 levels. TRAP-14, a thrombin receptor agonist, also significantly increased MMP-9 levels, suggesting that thrombin-induced changes in MMP-9 expression were mediated through the thrombin re...
TL;DR: STIC can be reproducibly used to evaluate fetal cardiac outflow tracts by independent examiners and slightly better image quality rating scores during the intraobserver variability trial suggests the presence of a learning curve for the manipulation and analysis of volume data obtained by STIC.
Abstract: Objective. To test the agreement between observers and reproducibility of a technique to display standard cardiac views of the left and right ventricular outflow tracts from four-dimensional volume datasets acquired with Spatiotemporal Image Correlation (STIC).Methods. A technique was developed to obtain dynamic multiplanar images of the left ventricular outflow tract (LVOT) and right ventricular outflow tract (RVOT) from volume datasets acquired with STIC. Volume datasets were acquired from fetuses with normal cardiac anatomy. Twenty volume datasets of satisfactory quality were pre-selected by one investigator. The data was randomly assigned for a blinded review by two independent observers with previous experience in fetal echocardiography. Only one volume dataset was used for each fetus. After a training session, the observers obtained standardized cardiac views of the LVOT and RVOT, which were scored on a scale of 1 to 5, based on diagnostic value and image quality (1 = unacceptable, 2 = marginal, 3 =...
TL;DR: Real time three-dimensional (3D) ultrasound imaging has been the dream of sonographers and engineers for many years, but only recently has it become a reality and its potential impact on prenatal diagnosis of congenital heart disease is discussed.
Abstract: Real time three-dimensional (3D) ultrasound imaging has been the dream of sonographers and engineers for many years, but only recently has it become a reality. In this editorial I would like to discuss briefly this development specifically in relation to its potential impact on prenatal diagnosis of congenital heart disease. The importance of prenatal recognition of congenital cardiac anomalies is well recognized. Cardiac malformations are the most frequent developmental defects affecting a single organ. Approximately 35,000 babies are born annually with congenital heart disease (CHD). The estimated cumulative survivors of CHD to the year 2000 in the United States approached almost 800,000 [1]. With early recognition and improvements in medical and surgical management of these defects, there has been a substantial decline in infant mortality and morbidity and most infants with simple CHD now survive into adulthood. It has been shown that prenatal diagnosis significantly improves the prognosis. Patients diagnosed postnatally have worse surgical outcome and are more likely to be sick at presentation with increased incidence of preoperative acidosis, cardiac dysfunction, and the need for medical resuscitation. Perioperative mortality is higher in infants when the diagnosis is postnatal [2]. Prenatal diagnosis of CHD also offers other significant benefits which include preparing the parents with informed counseling on the prognosis, the available choices of management, appropriate genetic and pediatric cardiology consultations, and individualized perinatal care. Advances in ultrasound technology with the introduction of two-dimensional (2D), M-mode, spectral Doppler, and color Doppler fetal echocardiography have allowed prenatal evaluation of fetal cardiac anatomy and physiology. Sonographic imaging of the fetal heart, however, is often technically challenging mostly because of the complexities of the fetal cardiac structure and unfavorable fetal position. Two-dimensional imaging has limited ability in providing clear anatomical and spatial perspectives of the fetal heart. Many of these limitations may be obviated by the current advances in true real-time 3D ultrasonography. This progress, however, has not been achieved easily as attempts to capture live 3D views of the heart have had to surmount substantial technological hurdles. The early 3D methods did not possess the capability of imaging the fetal heart in real time with acceptable temporal and spatial resolution. Despite these limitations, several investigators have reported the use of various technical solutions for creating 3D echocardiographic images in the fetus [3, 4]. These approaches were mostly based on postimaging reconstruction of the fetal cardiac anatomy out of stored scanned volume data acquired by automatic or freehand scanning, and interpretation was challenging because of inadequate image quality and artifacts related to fetal cardiac and body motions despite innovative gating techniques. Invention of two-dimensional phased array technology has made true real time three-dimensional ultrasound imaging a reality. The pioneering credit goes to Olaf von Ramm and his team at Duke University [5]. The idea of developing a twodimensional phased array transducer for threedimensional imaging was apparently first conceived for potential use in a sonar camera for underwater rescue. Because of its tremendous potential for medical imaging, subsequent innovations led to the development of medical imaging transducers with sparse phased array technology where one set of the elements of the array transmitted and the rest of the elements received the echoes. The massive computing needs were addressed by parallel processing and the system was able to generate 3D pyramidal volume in real time. Commercial development followed under the brand name of Volumetrics Ultrasound. The image resolution was however not adequate and the device as produced commercially was not widely available. The Journal of Maternal-Fetal and Neonatal Medicine, January 2005; 17(1): 1–2
TL;DR: Water birth appears to be associated with a significantly shorter first stage of labor, lower episiotomy rate and reduced analgesic requirements when compared with other delivery positions, and if women are selected appropriately and hygiene rules are respected, water birth seems to be safe for both the mother and neonate.
Abstract: Objectives. We reviewed 1600 water births at a single institution over an 8-year period.Methods. We compared 737 primiparae deliveries in water with 407 primiparae deliveries in bed, and 142 primiparae on the delivery stool. We also evaluated the duration of labor, perineal trauma, arterial cord blood pH, postpartum maternal hemoglobin levels, and rates of neonatal infection. In 250 water deliveries we performed bacterial cultures of water samples obtained from the bath after filling and after delivery.Results. The duration of the first stage of labor was significantly shorter with a water birth than with a land delivery (380 vs. 468 minutes, P < 0.01). The episiotomy rate in all water births was lower with a water birth than with a delivery in bed or a delivery on the birthing stool (0.38%, 23%, and 8.4%, respectively). The rate of perineal tears was similar (23%, respectively). There were no differences in the duration of the second stage (34 vs. 37 minutes), arterial cord blood pH, or postpartum matern...
TL;DR: Maternal plasma sTNF-rI levels were higher in preeclampsia with fetal involvement, suggesting that increased TNF-α production in preeClampsia is related to impaired placentation rather than to the maternal syndrome.
Abstract: Objective. Tumor necrosis factor-alpha (TNF-α) is thought to play a role in immune activation in preeclampsia. The objective of this study was to establish if soluble TNF-receptor I (sTNF-rI) levels relate to the onset and severity of preeclampsia.Methods. Maternal plasma sTNF-rI levels were studied throughout pregnancy in 68 women with a history of severe preeclampsia or intra-uterine growth restriction (IUGR), and primigravidas with chronic hypertension. Data are presented as mean (SD) in ng/ml.Results. In the second trimester there was a significant difference in sTNF-rI levels between preeclamptic pregnancies with and without IUGR (means 1.33 (0.20) and 1.11 (0.15) respectively, p < 0.005). In severe preeclampsia with delivery before 34 weeks of gestation, sTNF-rI levels were higher than in mild preeclampsia in the second and third trimesters (means 1.40 (0.16) vs. 1.16 (0.19), p < 0.02 and 1.82 (0.47) vs. 1.42 (0.22), p < 0.05, respectively).Conclusion. sTNF-rI levels were higher in preeclampsia with...
TL;DR: An association of occupational standing with preterm labor and preterm birth is suggested in a large prospective study of a low-risk healthy population of working women cared for by a single group of health providers.
Abstract: Objective. The effects of standing, lifting and noise in low-risk, healthy pregnant women are uncertain. In the past, the heterogeneity of the populations studied, the limitations of the designs of the retrospective and case control studies, and a failure of some of the larger investigations to evaluate all the potential confounding variables has hampered many studies. The purpose of this investigation was to evaluate, throughout pregnancy, the effects of standing, repetitive lifting, and noise in the workplace compared with no standing, lifting or noise exposure, on maternal and perinatal outcomes in a large prospective study of a low-risk healthy population of working women cared for by a single group of health providers.Methods. This prospective observational study used an extensive questionnaire to collect antepartum, intrapartum, and postpartum information. Information was collected on the initial visit, each subsequent visit, and immediately after delivery. The participating women were divided into ...