Volume 38, Issue 1

No abstract available

Aims: To assess pregnant women's opinions on and perceptions of oral health and their relationship to oral hygiene and dental care practices. Methods: Questionnaire survey on perceived oral health, oral hygiene and utilization of dental services among 649 nulliparae attending for antenatal care at all public antenatal clinics in Adelaide, South Australia. Results: Women rated their general health significantly better than their oral health (P<0.001) and attributed more importance to healthy teeth for their baby than for themselves (P<0.001). Only 35% had dental care during pregnancy; 35% had no dental visit for at least two years and 27% reported cost as a major deterrent. Eighteen percent had experienced gingival bleeding before pregnancy and 41% during pregnancy. Gingival bleeding outside pregnancy was clearly related to perceived oral health (P<0.001), but this was less so for bleeding during pregnancy. The latter was not related to age, level of education, employment, marital status, or smoking habits. Only 38% of women with gingival bleeding in pregnancy had a dental care visit in pregnancy and 28% considered their oral health as very good. Conclusions : Many pregnant women do not perceive gingival bleeding as indicating inflammatory disease and seek no professional help for it. Maternity care providers need to devote more attention to oral health in antenatal clinics and antenatal education.

Objective: An emerging theme in modern biology is that adipose tissue can respond to metabolic stress, and to inflammatory stimuli, by regulating the secretion of a complex network of soluble mediators, termed adipokines. Adiponectin, the most prevalent circulating adipokine in human, has profound insulin-sensitizing and anti-inflammatory properties. Indeed, the notion that adiponectin plays an important role in the interactions between the metabolic and the immune systems has been strongly suggested. Thus, the aim of this study was to determine if pyelonephritis during pregnancy is associated with changes in maternal serum adiponectin concentrations. Study design: This cross-sectional study included women in the following groups: 1) normal pregnant women (n=200); and 2) pregnant women with pyelonephritis (n=50). Maternal plasma adiponectin concentrations were determined by ELISA. Non-parametric statistics were used for analyses. Results: 1) The median maternal plasma adiponectin concentration was lower in patients with pyelonephritis than in those with a normal pregnancy (P<0.001); 2) among pregnant women with a normal weight, patients with pyelonephritis had a lower median plasma adiponectin concentration than those with a normal pregnancy (P<0.001); 3) similarly, among overweight/obese patients, those with pyelonephritis had a lower median plasma adiponectin concentration than those with a normal pregnancy (P<0.001); and 4) the presence of pyelonephritis was independently associated with maternal plasma adiponectin concentrations after adjustment for maternal age, smoking, gestational age at sampling, and pregestational body mass index (BMI). Conclusion: 1) The findings that acute pyelonephritis in pregnancy is characterized by low maternal plasma concentrations of adiponectin in both lean and overweight/obese patients are novel and concur with the antiinflammatory properties of adiponectin; and 2) the results of this study support the notion that adiponectin may play a role in the intricate interface between inflammation and metabolism during pregnancy.

Aims: A clinically useful website at the US National Institutes of Child Health and Human Development (NICHD) uses an algorithm based on a recent publication to estimate peri-viable neonatal outcomes. This algorithm uses gestational age, ultrasound estimated fetal weight (EFW), fetal sex, and the use of antenatal corticosteroids as the basis for estimation of outcomes and when used after birth is superior to such estimation by gestational age alone. Because one might be tempted to use this algorithm with obstetric patients, we tested its clinical applicability. Methods: We reviewed the literature using search terms relating to the above clinical factors. Next, we gathered data from the website. The range of outcomes for neonates was then estimated using the uncertainty derived for these clinical factors before birth from the literature review and the NICHD website algorithm. Results: We found increased uncertainty for estimating outcomes, as a function of the greater uncertainty in knowledge of the clinical factors in obstetrics as opposed to neonatology. Conclusions: The imprecision during the time before birth seriously restricts the obstetric use of the NICHD algorithm at this time. Refining the precision of the algorithm prior to birth is necessary.

Objective : To compare the success rate of external cephalic version (ECV) at term using ritodrine or atosiban as a tocolytic agent. Study design: Prospective cohort study with a sample of 236 pregnant women with a breech presentation at term, from November 2006 to March 2008. Data have been analyzed from the moment the cephalic version is performed until the time of delivery. Results : ECV success rate using ritodrine as a tocolytic agent was 56.8% compared to 31.4% with atosiban. Ritodrine increases the version success potential more significantly than atosiban (P<0.05). In both cases, the use of ECV reduced the rate of cesarean sections, although a higher number of versions are required with atosiban [numbers needed to treat (NNT)=9.08] to avoid a cesarean section compared to ritodrine (NNT=3.41). Conclusions : Ritodrine seems better than atosiban as tocolytic agent for ECVs.

Objectives: To investigate whether a near infrared spectroscopy (NIRS) system is useful for evaluation of the placental function in cases of fetal growth restriction (FGR). Methods: Subjects included 282 delivered neonates of appropriate for gestational age (AGA) and 44 small for gestational age (SGA) babies. The measurement of the concentration of oxyhemoglobin (HbO 2 ) and deoxyhemoglobin (HHb) was conducted using transabdominal NIRS targeting the placenta at around 20 weeks, 30 weeks and after 36 weeks of gestation and calculated tissue oxygen indexes (TOI=HbO 2 /total Hb). We correlated between TOIs and causes of FGR. Results: TOIs measured immediately before delivery in the SGA group with severe pre-eclampsia (79.2±3.8 (%±standard deviation (SD); P=0.002)) and placental abnormalities (78.2±3.6; P=0.043) were higher than in the AGA group (74.0±4.5). TOIs in the SGA group with umbilical cord abnormalities were lower (69.7±7.7; P=0.024) than in the AGA group. Conclusion: NIRS might provide information about blood oxygen level of the intervillous space and thus explain the cause of FGR.

Aims: To examine the association between women's perception of onset and the duration of labor after hospital admission. Methods: Women whose labor started spontaneously at term, delivering at the Hannover Medical School Hospital, Germany, between 2001 and 2004 were asked when and how labor had started. Answers were analyzed using structured content analysis. Women's symptoms were grouped in eight predefined categories; inter-rater agreement was assessed (κ=0.93). Associations between women's symptoms and labor duration after admission were also analyzed. Results: Duration of labor after admission was longer in nulliparas (n=347) than in multiparas (n=304, P<0.001). Nulliparas experienced shorter labor in association with recurrent pain, advanced cervical dilatation at admission and spontaneous rupture of membranes. Oxytocin augmentation and epidural analgesia were associated with a longer duration. In multiparas, advanced cervical dilatation at admission, spontaneously ruptured membranes, blood-tinged mucus or emotional upheaval perceived by women were associated with a shorter interval from admission until birth. Conclusions: How women diagnose their onset of labor relates to some extent with labor duration after admission. Recognized symptoms and their association with labor duration differed between nulliparas and multiparas.

Objective: Previous studies reported that the clinical significance of intra-amniotic inflammation with a negative amniotic fluid (AF) culture is similar to that of intra-amniotic inflammation with microbiologically-proven AF infection. However, the magnitude of the fetal inflammatory response in these two conditions is different as gauged by umbilical cord C-reactive protein (CRP) concentrations. We undertook this study to determine if the frequency of oligohydramnios is different in these two conditions. Methods: The amniotic fluid index (AFI) was measured in 205 patients with preterm premature rupture of membranes (PROM) (≤35 weeks). AF was cultured for aerobic and anaerobic bacteria and genital mycoplasmas. Intra-amniotic inflammation was defined as an elevated AF matrix metalloproteinase-8 (MMP-8) concentration (>23 ng/mL). Patients were divided into three groups according to the results of AF culture and the presence or absence of intra-amniotic inflammation: 1) without intra-amniotic inflammation and a negative culture (n=109); 2) with intra-amniotic inflammation and a negative culture (n=44); and 3) a positive culture (n=52). Results: Patients with a positive culture had a higher frequency of oligohydramnios and a lower median AFI than those with a negative culture but with intra-amniotic inflammation (P<0.01). However, there was no significant difference in the median AFI or in the frequency of oligo-hydramnios according to the presence or absence of intra-amniotic inflammation among patients with a negative culture (P>0.1). Conclusion: Oligohydramnios was more frequent in patients with culture-proven AF infection than in those with intra-amniotic inflammation and a negative AF culture.

Objective: Intrauterine devices (IUDs) are used for contraception worldwide; however, the management of pregnancies with an IUD poses a clinical challenge. The purpose of this study was to determine the outcome of pregnancy in patients with an IUD. Study design: A retrospective cohort study (December 1997–June 2007) was conducted. The cohort consisted of 12,297 pregnancies, of which 196 had an IUD. Only singleton pregnancies were included. Logistic regression analysis was used to adjust for potential confounders between the groups. Results: 1) Pregnancies with an IUD were associated with a higher rate of late miscarriage, preterm delivery, vaginal bleeding, clinical chorioamnionitis, and placental abruption than those without an IUD; 2) among patients with available histologic examination of the placenta, the rate of histologic chorioamnionitis and/or funisitis was higher in patients with an IUD than in those without an IUD (54.2% vs. 14.7%; P<0.001). Similarly, among patients who underwent an amniocentesis, the prevalence of microbial invasion of the amniotic cavity (MIAC) was also higher in pregnant women with an IUD than in those without an IUD (45.9% vs. 8.8%; P<0.001); and 3) intra-amniotic infection caused by Candida species was more frequently present in pregnancies with an IUD than in those without an IUD (31.1% vs. 6.3%; P<0.001). Conclusion: Pregnant women with an IUD are at a very high risk for adverse pregnancy outcomes. This finding can be attributed, at least in part, to the high prevalence of intra-amniotic infection and placental inflammatory lesions observed in pregnancies with an IUD.

Takayasu's arteritis (TA) is a rare inflammatory disease of the arteries that affects women of childbearing age. The optimal management for pregnant patients with this disease has not yet been defined. The course of disease seems to be neither affected nor worsened by pregnancy. We could not find reported maternal deaths directly related to pregnancy. However, many authors report maternal as well as fetal unfavorable events in the course of pregnancy. We describe a 25-year-old primigravida of Turkish-Greek origin who presented at 30 weeks of pregnancy with active TA. In the 37 th week, intrauterine fetal death occurred. Our patient did not show high blood pressure or aortic inflammation. The course of her disease was stable. Whether a newly diagnosed TA during pregnancy should be regarded as an indication for premature delivery is discussed. An interdisciplinary collaboration of rheumatologists, nephrologists and obstetricians is necessary to improve maternal and fetal prognosis.

Aim: To investigate the role of four parental folate pathway single nucleotide polymorphisms (SNPs) i.e., methylene tetrahydrofolate reductase (MTHFR) 677C>T, MTHFR 1298A>C, methionine synthase reductase (MTRR) 66A>G and glutamate carboxypeptidase (GCP) II 1561C>T on susceptibility to neural tube defects (NTDs) in 50 couples with NTD offspring and 80 couples with normal pregnancy outcome. Results: Maternal MTHFR 677C→T (odds ratio (OR): 2.69, 95% confidence interval (CI): 1.35–5.34) and parental GCP II 1561C→T (maternal: OR: 1.89, 95% CI: 1.12–3.21 and paternal: OR: 3.23, 95% CI: 1.76–5.93) were found to be risk factors for a NTD. Both paternal and maternal GCP II T-variant alleles were found to interact with MTHFR 677T- and MTRR G-variant alleles in increasing the risk for NTD. Segregation of data based on type of defect revealed an association between maternal 677T-allele and meningomyelocele (OR: 9.00, 95% CI: 3.77–21.55, P<0.0001) and an association between parental GCP II 1561T-allele and anencephaly (maternal: OR: 2.25, 95% CI: 1.12–4.50, P<0.05 and paternal: OR: 4.26, 95% CI: 2.01–9.09, P<0.001). Conclusions: Maternal MTHFR C677T and parental GCP II C1561T polymorphisms are associated with increased risk for NTDs. Apart from individual genetic effects, epistatic interactions were also observed.

Aim: Cholinergic regulation is important in the control of cardiovascular and endocrine responses. The mechanisms behind cardiovascular responses induced by cholinergic activation are explored by studying hormonal systems, including renin-angiotensin and vasopressin (VP). Results: In chronically prepared fetal sheep, intravenous infusion of the cholinergic agonist carbachol increased fetal systolic, diastolic, and mean arterial pressure accompanied with bradycardia at near-term. Although intravenous administration of carbachol had no effect on plasma VP concentrations, this agonist increased angiotensin I and angiotensin II levels in fetal plasma. Fetal blood values, including sodium, osmolality, nitric oxide, hemoglobin, and hematocrit were unchanged by intravenous carbachol. Conclusion: Cholinergic activation by carbachol controls fetal blood pressure and heart rate in utero . An over-activated fetal renin-angiotensin-system (RAS) is associated with changes in vascular pressure following intravenous administration of carbachol, indicating that the cholinergic stimulation-mediated hormonal mechanism in the fetus might play a critical role in the regulation of cardiovascular homeostasis.

Objective: An evolving challenge for obstetrician is to better define normal and abnormal fetal neurological function in utero in order to better predict antenatally which fetuses are at risk for adverse neurological outcome. Patients and methods: Prenatal neurological assessment in high-risk fetuses using four-dimensional ultrasound applying the recently developed Kurjak antenatal neurodevelopmental test (KANET). Postnatal neurological assessment was performed using Amiel Tison's neurological assessment at term (ATNAT) for all live-borns and general movement (GM) assessment for those with borderline and abnormal ATNAT. Results: Inclusion criteria were met by 288 pregnant women in four centers of whom 266 gave birth to a live-born baby. It was revealed that 234 fetuses were neurologically normal, 7 abnormal and 25 borderline. Out of 7 abnormal fetuses ATNAT was borderline in 5 and abnormal in 2, whereas GM assessment was abnormal in 5 and definitely abnormal in 2. Out of 25 KANET borderline fetuses, ATNAT was normal in 7, borderline in 17 and abnormal in 1, whereas the GM assessment was as follows: normal optimal in 4, normal suboptimal in 20, and abnormal in 1. In summary, out of 32 borderline and abnormal fetuses ATNAT was normal in 7, borderline in 22 and abnormal in 3; GM assessment was normal optimal in 4, normal suboptimal in 20, abnormal in 6 and definitely abnormal in 2. Conclusion: The sonographic test requires further studies before being recommended for wider clinical practice.

Aims: To determine the predictive value of fetal pulse oximetry (FPO) for the development of fetal acidosis in cases of non-reassuring fetal heart rate (FHR). Methods: In a prospective observational study, pulse oximetry monitoring was examined in cases of non-reassuring FHR during singleton cephalic delivery at 36–42 weeks' gestation. The study examined whether fetal arterial oxygen saturation (FSpO 2 ) values <30% for at least 10 min during the last 60 min before delivery increase the risk of fetal acidosis. The predictive reliability of this algorithm and the correlation to fetal acidosis [umbilical artery pH (UApH) <7.15] were analyzed. Results: We included 101 patients with non-reassuring FHR during delivery. The incidence of fetal acidosis was significantly higher when FSpO 2 values <30% were recorded for at least 10 min (P=0.0). An UApH <7.15 was reliably excluded with a negative predictive value of 98.7% and detected with a sensitivity of 92.9%. Conclusions: A low pulse oximetry oxygen saturation <30% for at least 10 min correlates highly with fetal acidosis in cases of non-reassuring FHR. FPO reliably excludes moderate to advanced acidosis and can reduce the frequency of fetal blood analysis (FBA) in cases of non-reassuring cardiotocography (CTG).

Aims: This study examines predictors of neonatal and postneonatal mortality among infants born to black, white, and Hispanic women. Methods: Linked birth/infant death records from North Carolina for the period 1999–2007 were the source of data. Logistic regression models were constructed to estimate the effect of maternal and infant characteristics on neonatal (<28 days) and postneonatal (28–364 days) mortality. Results: Analyses revealed no racial/ethnic differences in neonatal mortality, but increased risk among black infants for postneonatal death. Inadequate prenatal care was associated with an increased risk for neonatal mortality across all three racial/ethnic groups. Younger maternal age and lower educational levels were associated with postneonatal deaths for black and white women, but not Hispanic. A previous child loss, being unmarried and labor/delivery complications increased the risk for postneonatal mortality only among white women. Black infants had higher rates of death attributed to sudden infant death syndrome (SIDS), infections, low birth weight (LBW)/prematurity, respiratory conditions, and injuries. Conclusions: Early initiation of prenatal care, access to risk-appropriate obstetric and neonatal services, and participation in intervention programs that support parenting of LBW/preterm infants throughout the first year of life are likely to yield the greatest impact in reducing infant mortality.

Bronchopulmonary dysplasia (BPD) and very low birth weight (VLBW) are associated with increased incidences of asthma and pulmonary dysfunction in childhood. However, no studies exist which examine asthma risk factors in children who were VLBW infants and did not have BPD. To address this issue, we assessed the asthma incidence and risk factors for asthma in 117 children (approximate mean age of 5 years) who were VLBW [<1500 g, mean gestational age (GA): 30 weeks] infants without BPD. The risk factors were both perinatal (such as steroid treatment, mechanical ventilation, surfactant treatment) and environmental (parental smoking, pet adoption, etc). The asthma incidence was 18.8%. Following multivariate analysis, it was determined that a family history of atopy was a strong risk factor for childhood asthma. Maternal antenatal steroid treatment was associated with a significantly reduced risk for asthma. GA and birth weight were not predictive of childhood asthma. These findings indicate that a history of familial atopy and antenatal steroid treatment are positively and negatively associated (independent of BPD) with childhood asthma in VLBW infants. The finding regarding antenatal steroid treatment warrants more extensive investigations.

No Abstract available

No Abstract available