Volume 30, Issue 6

Aim: To discuss the role of oxidant stress in preterm, premature rupture of the membranes (PPROM). Results: There is evidence to suggest that preterm, premature rupture of the membranes occurs secondary to focal collagen damage in the fetal membranes. Conclusion: Oxidant stress caused by increased ROS formation and/or antioxidant depletion may disrupt collagen and cause premature membrane rupture. We propose that supplementation with vitamins C and E may synergistically protect the fetal membranes, and decrease the risks of PPROM.

Objective: To assess the relationship between the absence of vaginal lactobacilli and preterm birth at < 33 weeks of gestation. Methods: A prospective study of the vaginal flora in the second trimester was undertaken in 1958 women with singleton pregnancies. The contribution of various microorganisms to preterm delivery was analyzed using a multivariate-logistic regression model. Results: Lactobacillus species were not cultured from 28% of 118 women who delivered at < 33 weeks, 10% of 224 women who delivered between 33 and 36 weeks, and 5% of 1616 women who delivered at > 37 weeks of gestation. Lactobacilli (odds ratio and 95% confidence interval: 0.15 [0.09 to 0.24]), Mycoplasma hominis (2.3 [1.0 to 5.4]), and glucose non-fermentative gram-negative rods (2.1 [1.0 to 4.2]) were identified as independent risk factors for preterm delivery at < 33 weeks of gestation. Absence of lactobacilli (sensitivity and positive predictive value: 28% and 25%) was a better predictor of preterm delivery at < 33 weeks of gestation than the presence of Mycoplasma hominis (7% and 13%, respectively) or glucose non-fermentative rods (9% and 11%). Conclusions: Although this was not a cohort study, results suggest that tests for determining the presence of vaginal lactobacilli may be clinically useful tools for identifying women at an increased risk of preterm delivery at < 33weeks of gestation.

The main aim of this prospective study was to determine the socioeconomic, demographic and environmental factors that may be associated with the occurrence of bacterial vaginosis at early pregnancy in an indigent population from Central Poland. A group of 196 pregnant women was selected randomly from the patients of 10 district maternity units in the Lodz region, Central Poland. Only singleton pregnancies between 8 and 16 week of gestation were qualified for inclusion in the survey. A standard questionnaire covering medical, socioeconomic, demographic, constitutional and environmental items was administered to every subject and was verified with medical records. Cervico-vaginal swabs were collected from the women under study and tested for bacterial vaginosis (BV) according to Spiegels criteria. Based on the results of Gram stain, BV was diagnosed in 51 women (28,5%), grade I microflora among 66 (36,9%) and grade II among 62 women (34,6%). In the univariate analysis, only single marital status proved to be an important risk factor associated with BV during pregnancy, this was confirmed in the multivariate analysis. Pregnant women who present risk factors for abnormal cervicovaginal microflora should be covered by comprehensive prenatal surveillance, which enables early detection and treatment of this pathology. Research that identifies the causal pathways and mechanisms through which social disadvantage leads to a higher risk of preterm birth may help to reduce current socioeconomic and demographic disparities and improve pregnancy outcome.

Objective: This study was performed to evaluate serum creatine kinase (CK) levels during tocolytic therapy. Methods: A retrospective study was performed in 27 patients who were treated with intravenous tocolytic agents for more than one week. The first-line tocolytic agent was ritodrine hydrochloride, followed by concomitant magnesium sulfate (MgSO 4 ). The serum CK level was measured on admission and every week thereafter. The patients were divided into the normal CK (group 1) and abnormal CK (> 150 IU/L) (group 2) groups. Results: Seventeen patients received both ritodrine hydrochloride and MgSO 4 . The CK levels in all patients rose significantly from 58.4 ± 30.8 IU/L on admission 116.0 ± 68.7 IU/L on day 7 (p = 0.002). Abnormal elevation of CK occurred in 7 (25.9%) of the 27 patients. Significant differences were found between groups 1 and 2 in the total doses of ritodrine and MgSO 4 (p = 0.046 and 0.0028, respectively). All patients in group 2 received ritodrine in combination with MgSO 4 (p = 0.018). Conclusion: When tocolytic therapy continued for more than 1 week, nearly one-fourth of patients showed an increase in CK level above the normal range.

Aim: Few studies address decidual function in abnormal pregnancies, due obviously to shortage of appropriate markers. Glycodelin is produced by epithelial cells of pregnancy decidua. We investigated whether serum glycodelin concentrations are altered in premature rupture of membranes (PROM). Methods: Serum glycodelin concentrations were measured in 32 women with PROM and in 27 gestational age-matched healthy women. Serum C-reactive protein (CRP) concentrations were measured to indicate infection. Results: Glycodelin concentrations were similar in PROM patients and control subjects. No difference was found in glycodelin concentrations between the 17 PROM patients with CRP > 12 mg/l and controls, or between the 15 PROM patients with CRP ≤ 12 mg/l and controls. There was no correlation between the highest antepartum glycodelin level and the interval from PROM to delivery. A negative correlation between the last glycodelin concentration and the birth weight of the newborns was found in the PROM patients (r s = -0.369, p = 0.038). Conclusions: Decidual epithelial cell function does not seem to be compromised in PROM. The inverse correlation between serum glycodelin and the birth weight of the newborns in PROM may be explained by the normally occurring decline of serum glycodelin with advancing pregnancy in the third trimester.

Objective: The maternal-perinatal outcome and the significance of biophysical parameters in HELPP syndrome patients were evaluated. Methods: Sixty cases of HELLP syndrome were determined by retrospective analysis. Medical history, correlation of clinical, laboratory findings, records of fetomaternal Doppler studies, Nonstress test and maternal-perinatal outcome data were evaluated. Chi-square test was used for statistical analysis, and p < 0.05 was accepted as the significance level. Results: The incidence of HELLP syndrome in our institution was 1.03%. Mean gestational age at birth was 33.2 weeks, mean birth weight was 1861 ± 710 g and mean umbilical pH was 7.25 ± 0.13. Neonatal thrombocytopenia was demonstrable in 38% of neonates. Patients with low antepartal platelets (< 60 000/μl) had a significantly higher incidence of intrauterine growth retarded fetuses than patients with higher platelet counts (p = 0,002). Doppler flow measurements were performed in 33 patients (55%). In 16 (48.4%) a pathological Doppler flow was documented. Doppler findings demonstrated very high sensitivity (83%) and specificity (80%) in predicting adverse outcome in growth retarded fetuses. In 17 patients (27%) fetal heart rate monitoring had an obvious pathologic pattern. Respiratory distress syndrome (74.4%) was the main indication for NICU admission. Perinatal mortality rate was 8.3% and neonatal mortality rate was 11.6%. Maternal morbidity rate was 30%. The most commonly observed maternal complications were abruptio placentae (n = 8), disseminated intravascular coagulation (n = 3) and severe postpartal bleeding (n = 3). Conclusions: In HELLP syndrome patients it is very important to closely follow maternal vital signs and fluid intake and output, and to perform fetal status assessment tests.Of the biophysical parameters,Doppler flow measurement is an especially helpful predictor of poor perinatal outcome in growth retarded fetuses in HELLP patients. Patients with very low platelets have a significantly higher risk of intrauterine growth retarded fetuses.

The aim of this prospective cross-sectional study was to establish new Doppler reference curves for peak blood flow velocities (V max , V mean , V min ) and impedance indices (PI, RI) of the middle cerebral artery at 18–42 weeks of gestation by an automatic wave form analysis integrated into the ultrasound device. In 962 low-risk pregnancies, blood flow velocities were derived from the middle cerebral artery with pulsed color Doppler ultrasonography. Reference curves were constructed for the individual parameters based on a growth function from a fourparameter class of monotonic continuous functions according to the smallest square principle for maximum blood flow velocities, as well as on a polynomial function for resistance indices. Further assessed was intra-observer reliability. The results obtained for maximum blood flow velocities demonstrate a continuous increase (V max = 26.8 cm/s to 59.1 cm/s, V mean = 11.2 cm/s to 29.7 cm/s and V min = 4.9 to 15.8 cm/s) over the period from 18 to 42 weeks of gestation. In contrast, reference curves for the pulsatility and the resistance index are characterized by a parabolic pattern (18 weeks: 1.5; 28 weeks: 1.9; 42 weeks: 1.1 and 18 weeks: 0.68; 28 weeks 0.8; 42 weeks: 0.61). Intraobserver reliability for PI, RI, V max , V mean , and V max were 87%, 83%, 80%, 83% and 93%, respectively. At constant measurement conditions, the reference ranges for blood flow velocities and impedance indices in the middle cerebral artery established by this study were found to be a useful non-invasive tool in risk assessment for fetal anemia, as well as in the Doppler ultrasound observation of the course in fetuses with intrauterine growth restriction.

Aims: To quantify hemoglobin concentration and oxygen saturation in the human fetal brain using intensity modulated optical spectroscopy during labor. Methods: A specially designed probe was applied to the fetal scalp in 20 women during uncomplicated labor at term. Optical fibres transmitted near infrared light to and from an intensity modulated optical spectrometer (IMOS), which detected changes in the optical parameters of the infra-red light source.Using novel offline analytic techniques, these changes were converted into absolute measurements of oxyhemoglobin (HbO 2 ) and deoxyhemoglobin (Hb). Summing Hb and HbO 2 gives total hemoglobin concentration (HbT) and HbO 2 /HbT×100% provided measurements of cerebral saturation (SmcO 2 ). Results: Of 20 fetuses studied, data from 10 fetuses were suitable for analysis. Over three consecutive uterine contractions, the mean (± SD) absolute cerebral concentrations of Hb and HbO 2 were 30+/-18 and 46+/-21 μmol/l, respectively. This gave a mean cerebral HbT of 77+/-29 μmol/l and a mean SmcO2 of 59+/-12%. In the other ten fetuses insufficient light was detected to allow chromophore quantification. Conclusion: These are the first absolute measurements of cerebral Hb and HbO 2 in human fetuses during labor. The values of total hemoglobin are similar to those obtained in neonates with hypoxia-ischemia and the measurements of fetal cerebral oxygen saturation are similar to previously published values. Keywords: Cerebral blood volume, fetal, intrapartum, saturation.

There is an ongoing controversy whether the presence of a male twin affects the birth weight of its female co-twin, and if affected, whether birth weights of females are lower or higher in the presence of a male co-twin. The purpose of this study was to study this controversy in a large population of 12,639 twin pairs born in Israel between 1993–1998. Comparison of 7566 females in same-sex (FF) pairs with 4900 females in unlike-sex (FM) pairs, adjusted for the lighter and heavier twin in the pair, showed significantly higher birth weights of females in FM pairs. The same trend was found when concordant pairs and discordant pairs (birth weight difference > 25%) were compared separately. No significant difference was found when 7912 males in same-sex (MM) pairs were compared with 4900 males in FM pairs, adjusted for the lighter and heavier sib. Our study supports a definite intrauterine effect of the male twin on birth weight of its female co-twin. This consequence may potentially be associated with fetal programming of adult disease.

A patient with twin gestation was hospitalized because of preterm labor and treated with intravenous ritodrine hydrochloride and magnesium sulfate. After more than 5 weeks of therapy, the patient developed muscle pain, which was diagnosed as rhabdomyolysis.

We report a term infant with Pompe disease presenting in the immediate newborn period. The infant was born at 40 weeks gestation, weighing 3600 g to a 32 year-old black female. Infant presented at delivery with massive hypertrophic cardiomyopathy and pulmonary hypertension. Diagnosis was confirmed by low α-glucosidase activity. The histopathology and electron microscopic findings were consistent with Pompe disease. This is the second reported case of Pompe disease presenting at delivery.

The incidence of nonimmunological fetal hydrops is between 1 in 1500 and 1 in 4000. Overall mortality for this condition is about 80%. This report describes a case of prenatally diagnosed hydrops fetalis with severe generalized edema, ascites and pleural effusion of unknown origin at 19 weeks of gestation. No symptoms were found of infections or anemia, no variabilities were observed in fetal blood analysis or in karyotyping. All signs of hydrops resolved completely after 6 weeks without treatment. The pregnancy continued with normal fetal development; labor was induced at 41 weeks of gestation. After vaginal delivery with vacuum extraction the child was completely healthy and demonstrated no signs of remaining hydrops fetalis or any other pathological parameters except an uncritical atrial septal defect type II which healed without any complications within 3 months post delivery.

A case of epiphyseal separation of the distal humerus is presented, emphasizing the clinical and radiological features of this rare birth trauma. Conservative treatment resulted in complete recovery.