Agkistin, a snake venom-derived glycoprotein Ib antagonist, disrupts von Willebrand factor-endothelial cell interaction and inhibits angiogenesis

Glycoprotein (GP) Ib, an adhesion receptor expressed on both platelets and endothelial cells, mediates the binding of von Willebrand factor (vWF). Platelet GPIb plays an important role in platelet adhesion and activation, whereas the interaction of vWF and endothelial GPIb is not fully understood. We report here that agkistin, a snake venom protein, selectively blocks the interaction of vWF with human endothelial GPIb and inhibits angiogenesis in vivo. Agkistin specifically blocked human umbilical vein endothelial cell (HUVEC) adhesion to immobilized vWF in a concentration-dependent manner. Fluorescein isothiocyanate (FITC)-conjugated agkistin bound to HUVECs in a saturable manner. AP1, a monoclonal antibody (mAb) raised against GPIb, specifically inhibited the binding of FITC-conjugated agkistin to HUVECs in a dose-dependent manner, but other anti-integrin mAbs raised against alpha(v)beta(3), alpha(2)beta(1), and alpha(5)beta(1) did not affect this binding reaction. However, neither agkistin (2 microgram/ml) nor AP1 (40 microgram/ml) apparently reduced HUVEC viability. Both agkistin and AP1 exhibited a profound anti-angiogenic effect in vivo when assayed by using the 10-day-old embryo chick chorioallantoic membrane model. These results suggest endothelial GPIb plays a role in spontaneous angiogenesis in vivo, and the anti-angiogenic effect of agkistin may be because of disruption of the interaction of endogenous vWF with endothelial GPIb.

Spleen laceration, a rare complication of laparoscopy

A 31-year-old woman had secondary infertility of 4 years' duration. Hysterosalpingography revealed bilateral distal tubal occlusion with bilateral hydrosalpinx-like appearance. At laparoscopy, both oviducts were occluded with marked hydropic change. Salpingoplasty was performed to correct bilateral hydrosalpinges and reform the fimbriated tubal ends. The procedure was performed uneventfully by an experienced surgeon in 45 minutes. Nine hours after the operation an emergency exploratory laparotomy was performed due to massive intraabdominal bleeding. The cause was a small tear, 3 cm long and 1 cm deep, with active bleeding in the inferior splenic tail. The laceration was repaired successfully with 1-0 chromic suture. The etiology of splenic laceration during laparoscopic surgery is uncertain. Many complications of laparoscopy are physiologic, and this one might have occurred while establishing pneumoperitoneum. Distortion and stretching of small vascular adhesions of the spleen with the abdominal wall also may have played a role. Gynecologists must be aware of the physiologic insult to patients during laparoscopy.

Second-trimester maternal urine human chorionic gonadotrophin beta-core fragment concentrations in Asian pregnancies with fetal chromosomal abnormalities

The aim of this study was to investigate the second trimester concentrations of maternal urine human chorionic gonadotrophin beta-core fragment (HCGbetacf) in Asian pregnanci2es with fetal chromosomal abnormalities. HCGbetacf concentrations were analysed from 34 urine samples in chromosomally abnormal pregnancies, including 28 cases of Down's syndrome, one case of trisomy 18, and five cases of other chromosomal abnormalities (one mosaic deletion and four translocations), and in a cohort of 268 normal pregnancies receiving second trimester amniocentesis. Results were normalized to urine creatinine (Cr) concentration and converted to the multiple of the median (MOM) concentration for the appropriate gestation. The median HCGbetacf MOM concentrations of Down's syndrome pregnancies (12.89) was significantly higher than that of normal pregnancies (1. 06) (P < 0.00001). Wide variations of HCGbetacf concentrations were observed in other chromosomally abnormal pregnancies. There were 18 of 28 (64%) Down's syndrome cases but one of five (20%) other chromosomally abnormal cases with HCGbetacf concentrations above the 95th centile of the control values (8.22 MOM cut-off). These findings suggest that HCGbetacf could be a potential marker in urine screening for fetal Down's syndrome in Asians.

Effect of a sonographically diffusely enlarged uterus without distinct uterine masses on the outcome of in vitro fertilization-embryo transfer

PURPOSE

Our objective was to study the effect of a sonographically diffusely enlarged uterus without distinct uterine masses on the outcome of in vitro fertilization-embryo transfer (IVF-ET).

METHODS

Nineteen primary infertility patients undergoing IVF-ET who had a sonographically diffusely enlarged uterus without distinct uterine masses were enrolled. An age-controlled group of 144 primary infertility patients undergoing IVF-ET with a normal uterus and no history of uterine surgery was included.

RESULTS

The age, day 3 follicle stimulating hormone, antral follicle count, ovarian response, endometrial thickness, number of retrieved and fertilized oocytes, number of transferred embryos, clinical pregnancy rate, and total delivery rate were not statistically different between the two groups (P < 0.05). Patients with a sonographically diffused enlarged uterus without distinct uterine masses had a higher spontaneous abortion rate (66.7%) than controls (P < 0.04; odds ratio = 7.5; 95% confidence interval, 1.16-48.56).

CONCLUSIONS

A high spontaneous abortion rate was found in patients with a sonographically diffusely enlarged uterus without distinct uterine masses undergoing IVF-ET. Enhanced luteal support was required.

Urine free beta-hCG and total estriol for Down syndrome screening during the second trimester in an Asian population

OBJECTIVE

To evaluate second-trimester free beta-hCG and total estriol (E3) in the maternal urine as markers for Down syndrome screening in an Asian population.

METHODS

Free beta-hCG and total E3 were measured in the urine samples of 28 Taiwanese Down syndrome pregnancies and 268 unaffected singleton pregnancies at 14-25 weeks. Results were normalized to urine creatinine concentrations and converted to multiples of the median (MoM) levels. Gestational ages were estimated by ultrasound measurements.

RESULTS

Median values of free beta-hCG, total E3, free beta-hCG to total E3 ratio, and the free beta-hCG to total E3 MoM ratio in Down syndrome pregnancies were 4.75 MoM, 0.66 MoM, 8.99 MoM, and 9.51, respectively. At a 5% false-positive rate, the observed detection rates were 36% (ten of 28) with total E3, 71% (20 of 28) with free beta-hCG, 68% (19 of 28) with free beta-hCG/total E3, and 71% (20 of 28) with free beta-hCG/total E3 MoM. When combined with maternal age, the expected detection rates were 65% with total E3, 71% with free beta-hCG, 76% with free beta-hCG/total E3, 80% with free beta-hCG/total E3 MoM, and 89% when combining free beta-hCG, total E3, and maternal age.

CONCLUSION

Urine free beta-hCG and total E3 are useful markers for Down syndrome screening during the second trimester in Taiwanese women.

Maternal urine alpha-fetoprotein concentrations between 14 and 21 weeks of gestation

BACKGROUND

The aim of this study was to ascertain the normal range of the midtrimester maternal urine alpha-fetoprotein (AFP) concentrations in Taiwanese pregnancies.

METHODS

AFP was measured in the urine samples, obtained before genetic amniocentesis, from 268 women with normal singleton pregnancies between 14 and 21 weeks of gestation. Week-specific median values for urine AFP/creatinine (Cr) were calculated by weighted linear regression after log transformation and the data were converted to units in the multiple of the median (MoM). The gestational age in all cases was determined by ultrasound parameters.

RESULTS

The levels of urine AFP and AFP/Cr increased gradually with advancing gestational age. The AFP/Cr MoM values of singleton pregnancies after log transformation showed a normal distribution with a mean (standard deviation) of 0.0071 (0.3228). The median, 10th and 90th centiles of AFP/Cr were 0.98, 0.43 and 3.61 MoM, respectively. Of the pregnant Taiwanese women studied, 4.9% (13/268) and 16% (43/268) had urine AFP/Cr MoM levels less than 0.31 MoM and 0.5 MoM respectively.

CONCLUSION

The establishment of a reference range which allows for gestational differences in AFP/Cr levels is essential for further antenatal testing.

Tumor vascular pattern and blood flow impedance in the differential diagnosis of leiomyoma and adenomyosis by color Doppler sonography

PURPOSE

Our objective was to evaluate the differences between leiomyoma and adenomyosis by color Doppler sonography with new criteria.

METHODS

A total of 78 patients with symptomatic uterine nodularities who were sonographically suspected to have leiomyoma or adenomyosis without other coexisting pathologic conditions was enrolled in the study. All patients underwent transvaginal color Doppler sonography (7.0-MHz vaginal probe) or transabdominal color Doppler sonography (5.0 MHz) during the early follicular phase. The morphology, tumor vascular pattern, and blood flow impedance of the uterine tumors were measured. All of the patients underwent surgery and the pathologic reports were used as references.

RESULTS

The mean age was not statistically significant in patients with adenomyosis versus leiomyoma (P > 0.05). The morphologic criteria for adenomyosis and leiomyoma by sonography detected 79% of adenomyosis and 84% of leiomyoma. Adenomyosis had 87% randomly scattered vessels or intratumoral signals and 88% of leiomyomas showed peripheral scattered vessels or outer feeding vessels. Eighty-two percent of adenomyosis had a pulsitility index (PI) of arteries within or around uterine tumors > 1.17 and 84% of leiomyomas had a PI < or = 1.17. The reliability test of tumor vascular pattern and blood flow impedance were better than that of using morphological criteria alone.

CONCLUSIONS

With the aid of color Doppler sonography, tumor vascular pattern and blood flow impedance of the arteries within or around uterine tumors could more accurately diagnose adenomyosis and leiomyoma in addition to the morphologic criteria on transvaginal sonography.

Delivery of a severely anaemic fetus after partial molar pregnancy: clinical and ultrasonographic findings

The incidence of a normal live fetus and a partial molar placenta is extremely rare. Although triploidy is the most frequent association, a fetus with normal karyotype can survive in cases of partial molar pregnancy. We report a case of partial molar placenta in which a live female baby was delivered at 32 weeks gestation by a 30-year-old woman. At the 18th week, ultrasonographic examination revealed a normal fetus with a huge, multicystic placenta. Chromosomal evaluation by amniocentesis revealed a normal female karyotype (46,XX), and serial biometric measurement of the fetus showed normal growth during pregnancy. There were no obstetric complications until the 32nd gestational week when preterm rupture of the membranes occurred. The electronic fetal heart beat tracing showed a repeated sinusoid pattern and late deceleration after admission. The patient underwent emergency Caesarean section and delivered a 1551-g, anaemic female baby with an Apgar score of 1, 4 and 6 at 1, 5 and 10 min, respectively. The baby recovered within 2 weeks after respiratory support and transfusion of packed red blood cells. Although anaemia is one of the risk factors that jeopardize the fetus in the case of partial molar pregnancy, termination is not indicated when the fetus is normal and no complications have occurred.

Risk factors for placenta accreta

OBJECTIVE

To identify risk factors associated with placenta accreta in a large cohort study.

METHODS

Data for this study came from the Taiwan Down Syndrome Screening Group, an ongoing project on feasibility of serum screening in an Asian population. Women who had serum screening for Down syndrome at 14-22 weeks' gestation using alpha-fetoprotein (AFP) and free beta-hCG between January 1994 and June 1997, and delivered in the same institution, were included (n = 10,672). Those who had multiple gestations (n = 200), overt diabetes (n = 11), or fetal malformations (n = 101) were excluded. If a woman was involved more than once, one randomly selected pregnancy was included in the analysis (n = 9349). Twenty-eight pregnancies were complicated by placenta accreta, diagnosed by clinical presentation (n = 26) or histologic confirmation (n = 2). Multiple logistic regression with adjustment for potentially confounding variables was used to identify independent risk factors for placenta accreta.

RESULTS

Women who had placenta previa (odds ratio [OR] 54.2; 95% confidence interval [CI] 17.8, 165.5) and second-trimester serum levels of AFP and free beta-hCG greater than 2.5 multiples of the median (OR 8.3; 95% CI 1.8, 39.3 and OR 3.9; 95% CI 1.5, 9.9, respectively), and were 35 years and older (OR 3.2; 95% CI 1.1, 9.4) were at increased risk of having placenta accreta.

CONCLUSION

Risk factors for placenta accreta include placenta previa, abnormally elevated second-trimester AFP and free beta-hCG levels, and advanced maternal age.

Urine free beta-human chorionic gonadotropin levels between 14 and 21 weeks of gestation in Taiwanese pregnancies

BACKGROUND

The purpose of this study was to determine the reference range of maternal urine free beta-human chorionic gonadotropin (beta -hCG) concentrations between 14 and 21 weeks of gestation.

METHODS

We measured the concentrations of urine free beta -hCG from 268 healthy singleton Taiwanese pregnancies between 14 and 21 weeks of gestation. Results were corrected for creatinine (Cr) concentration and converted to the multiple of the median (MOM) level for the appropriate gestation. Gestational ages of all cases were determined using ultrasound dating.

RESULTS

The median levels of urine free beta -hCG and free beta-hCG/Cr had a downward trend in association with the increasing gestation age. The median, 5th, 10th, 90th and 95th centiles of free beta- hCG/Cr MOM values were 1.02, 0.20, 0.25, 2.32 and 3.38 MOM, respectively. Urine free beta- hCG/Cr MOM values showed a log Gaussian distribution with the mean and standard deviation (SD) distribution of -0.0657 and 0.3792, respectively.

CONCLUSION

To allow for differences in free beta -hCG/Cr median values at various ages of gestation, establishment of the reference range is essential for further development of maternal urine screening for Down syndrome.

Elevated second-trimester maternal urine free beta-human chorionic gonadotropin levels in Asian pregnancies with fetal chromosomal abnormalities

OBJECTIVES

To investigate the second trimester maternal urine free beta-human chorionic gonadotropin (hCG) levels of chromosomally abnormal pregnancies in Asians.

METHODS

Free beta-hCG levels were analyzed from the urine samples of 110 control and 17 chromosomally abnormal pregnancies, including 11 cases of Down syndrome, 1 case of trisomy 18, and other chromosomal abnormalities (one mosaic deletion and 4 translocations) from the second trimester of pregnancy. Results were normalized to urine creatinine (Cr) concentration and converted to the multiple of the median (MOM) level for the appropriate gestation. Gestational age of all cases was determined by ultrasound parameters.

RESULTS

The median free beta-hCG MOM levels of Down syndrome (4.02 MOM) and other chromosomally abnormal pregnancies (2.03 MOM) are significantly higher than that of normal pregnancies (0.99 MOM) (p = 0.002 and p = 0.024, respectively). Nine of 11 (81.8%) Down syndrome cases, one trisomy 18 case, and 2 of 5 (40%) other chromosomally abnormal cases would be expected to be above the 95th centile of the control values (2.95 MOM cut-off).

CONCLUSION

Urine free beta-hCG could be a potential and useful marker in the detection of fetal Down syndrome and other chromosomal abnormalities in Asians.

Prognostic factors for an unsatisfactory primary methotrexate treatment of cervical pregnancy: a quantitative review

To determine the risks when the primary methotrexate (MTX) treatment of cervical pregnancy has an unsatisfactory outcome, we conducted a Medline search on relevant literature published from January 1983 to June 1997. The search yielded 28 publications of 48 cases of cervical pregnancy. These and four new cases from our institutions were used in our study. A cervical pregnancy that presented with a serum beta-human chorionic gonadotrophin concentration of > or = 10,000 mIU/ml [odds ratio (OR) 10.82, 95% confidence interval (CI) 2.59, 45.14], gestational age at > or = 9 weeks (OR 6.44, 95% CI 1.46, 28.52), embryonic cardiac activity (OR 14.29, 95% CI 2.95, 76.92), and crown-rump length of >10 mm (OR 13.33, 95% CI 1.46, 120.48) was considered to be associated with a higher unsatisfactory rate of primary MTX treatment. A concomitant feticide was found to enhance the therapeutic effect of MTX treatment if embryonic cardiac activity was evident (OR 0.13, 95% CI 0.02, 0.68). Administration of a high dose of MTX did not seem to be more effective than a lower one. Our findings supported some previous observations and, more importantly, provided useful clinical information in selecting appropriate candidates for MTX treatment in cases of cervical pregnancy.

Midtrimester maternal serum free beta-human chorionic gonadotropin levels: normal reference values for Taiwanese women

BACKGROUND

The purpose of this study was to establish normative median values for maternal serum free beta-human chorionic gonadotropin (beta-hCG) during the second trimester of pregnant Taiwanese women.

MATERIALS AND METHODS

We collected the data of midtrimester serum free beta-hCG concentration levels from 15,132 normal Taiwanese singleton pregnancies between 14 and 22 weeks' gestation. The maternal age on the day of delivery and maternal weight at the time of sampling were recorded in all cases. The relationship between gestational days and multiple of the median (MoM) levels of serum markers was analyzed using nonlinear regression methods.

RESULTS

The median values of free beta-hCG in pregnant Taiwanese women were higher than those of pregnant white women. The log10 standard deviation distribution of free beta-hCG MoM values in the study population was 0.275 with a log10 mean of 0.0097. There were 1.81% of pregnancies with free beta-hCG levels less than 0.3 MoM and 11.33% with levels less than 0.5 MoM; 12.91% had serum levels greater than 2.0 MoM and 5.29% had serum levels greater than 3.0 MoM.

CONCLUSION

Because of differences in race and methodology, any laboratory intended to provide determination of free beta-hCG for Down syndrome screening should establish its own normal reference values.

Use of the antral follicle count to predict the outcome of assisted reproductive technologies

OBJECTIVE

To evaluate the predictive value of the antral follicle count in patients undergoing assisted reproductive technologies (ARTs).

DESIGN

Prospective study.

SETTING

Tertiary care institutional hospital.

PATIENT(S)

Consecutively seen patients undergoing ARTs such as IVF-ET, gamete intrafallopian transfer, and tubal embryo transfer (TET).

INTERVENTION(S)

The ovarian antral follicle number was determined by transvaginal ultrasonography on the first or second menstrual day, before the administration of gonadotropins, in patients undergoing ARTs.

MAIN OUTCOME MEASURE(S)

Ovulation induction was accomplished with the use of GnRH agonist down-regulation combined with FSH and menotropin stimulation. Gamete intrafallopian transfer or TET was performed in patients with patent fallopian tubes, and IVF-ET was undertaken in the remaining patients. Analysis of variance and Mantel-Haenszel monotonic test for trends were used for data analysis.

RESULT(S)

A total of 149 treatment cycles for 130 couples were performed during the study period. The procedures performed included 89 ETs, 26 gamete intrafallopian transfers, 13 TET cycles, and 21 incomplete cycles (9 poor responders, 6 failed retrievals, and 6 nonfertilization cycles). All treatment cycles were divided into three groups according to the number of antral follicles (i.e., < or = 3, 4-10, and > or = 11) to evaluate the influence of various factors. The antral follicle count correlated significantly with patient age, day 3 serum FSH level, use of gonadotropins, serum estradiol concentration, number of oocytes retrieved, and, later, number of oocytes or embryos transferred. The group of patients who had a lower antral follicle count also had a significantly higher rate of cycle cancellation compared with the other two groups (68.8% vs. 5.3% and 0, respectively). No pregnancies occurred in the low antral follicle count group, whereas there was a trend toward an increasing number of pregnancies per attempt as the number of antral follicles increased (0, 23.7%, and 36.8%, respectively).

CONCLUSION(S)

It is easy to determine the number of antral follicles with a diameter of 2-5 mm on the first or second day of menstruation, or just before the administration of exogenous gonadotropins. We were able to predict the ovarian response and pregnancy results of patients undergoing ARTs with the use of this simple procedure.

Differential expression of interleukin-1 beta and interleukin-6 in human fetal serum and meconium-stained amniotic fluid

The study was designed to investigate the expression of the inflammatory cytokines interleukin-1 beta and interleukin-6 in meconium-stained amniotic fluid and in fetal cord serum. Amniotic fluid and fetal cord serum specimens were collected from 10 and 9 women with meconium-stained and clear amniotic fluid, respectively, during Caesarean operation at labor The mean concentrations of interleukin-1 beta found in clear and meconium-stained amniotic fluid were 10.0 and 54.5 pg/ml, respectively, and the difference was not statistically significant. On the other hand, the concentrations of interleukin-6 in meconium-stained amniotic fluid (774 pg/ml) was significantly higher than that found in clear amniotic fluid (149 pg/ml) (P = 0.0036). The differences of levels of both interleukin-1 beta and interleukin-6 in fetal cord serum specimens were not significant between neonates born to mothers with either clear or meconium-stained amniotic fluid (P = 0.8702 and 0.2987, respectively). The results of this study suggest that the production of at least one of the inflammatory cytokines, interleukin-6, is associated with the meconium found in amniotic fluid.

The antral follicle count predicts the outcome of pregnancy in a controlled ovarian hyperstimulation/intrauterine insemination program

PURPOSE

Our purpose was to test whether age-related changes in antral follicle counts can predict the pregnancy outcome in the early follicular phase of a controlled ovarian hyperstimulation/intrauterine insemination (COH/IUI) program.

METHODS

A selected group of 107 women (36 healthy women requesting child sex preselection, 52 women with unexplained infertility, and 19 with minimal endometriosis) who underwent controlled ovarian hyperstimulation with clomiphene citrate (CC) plus human menopausal gonadotrophin (hMG) and subsequent intrauterine insemination were enrolled in the study. Transvaginal ultrasonography (7.0 MHz) was used to determine the total number of antral follicles (2-8 mm) in the right and left ovaries. The association among the antral follicle count, age, dominant follicle, and estradiol (E2) level on the day of human chorionic gonadotropin (hCG) was analyzed. The association of the pregnancy rate and OHSS with the antral follicle count, dominant follicle count, and age was also examined.

RESULTS

The total antral follicle number decreased with age (P < 0.0001). Dominant follicle number increased with total antral follicle number in women who received CC plus hMG/ IUI(P < 0.0001). The pregnant group had a higher number of antral follicle and dominant follicles in comparison with the nonpregnant group (P < 0.01 and P < 0.02, respectively). The E2 level on the day of hCG injection increased positively with the total number of antral follicles (P < 0.0001) and the total number of dominant follicles (P < 0.0001). In women aged younger than 35 years, the pregnancy rate and dominant follicle number rose as the number of antral follicles increased (P < 0.03 and P < 0.0001, respectively). The pregnancy rate was low (2/39) in women aged older than 35 years regardless of the number of antral follicles (P < 0.05) and the extent of hMG administration (P < 0.02). Women aged older than 35 also produced fewer dominant follicles (P < 0.001). No pregnancy was achieved in a patient with an antral follicle number of less than five (17 cases).

CONCLUSIONS

Age-related changes in antral follicle count significantly predicted the dominant follicle count and the pregnancy outcome. In women with antral follicle counts of less than five or who are older than 35 years, the application of COH/IUI may not be indicated.

Influence of maternal age and weight on second-trimester serum alpha-fetoprotein, total and free beta human chorionic gonadotropin levels

BACKGROUND

The purpose of this study was to assess the relation of maternal age and weight on the maternal serum alpha-fetoprotein (AFP), total human chorionic gonadotropin (hCG) and free beta-hCG levels during the second trimester.

METHODS

We collected 419 serum samples from normal singleton pregnancies to assay serum marker levels of AFP, total hCG and free beta-hCG between 14 and 21 weeks of gestation. Maternal age at the day of delivery and maternal weight at the time of sampling were recorded in all cases. The relationship between maternal weight and multiple of the median (MoM) levels of serum markers was analysed by regression models.

RESULTS

There was an inverse trend in median MoM levels of serum markers in relation to maternal weight. No significant association between maternal age and serum marker levels was found.

CONCLUSION

Because of its impact on serum marker levels, weight correction may be mandatory for further refinement in the maternal serum screening for Down's syndrome.

Comparison of Down's syndrome screening strategies in Asians combining serum free beta-hCG and alpha-fetoprotein with maternal age

High free beta human chorionic gonadotropin (beta-hCG) and low alpha-fetoprotein (AFP) levels were found in 47 Asian Down's syndrome pregnancies (median values 2.79 and 0.77 MOM, respectively). At a 5 per cent false-positive rate, free beta-hCG alone would identify 46.8 per cent of Down's syndrome pregnancies, age alone detected 34.5 per cent of affected cases, whilst AFP alone detected 17 per cent and free beta-hCG/AFP MOM ratios detected 48.9 per cent of Down's syndrome cases. When combined with maternal age-specific risk, free beta-hCG could achieve a 59.6 per cent detection rate, with AFP achieving 42.6 per cent, free beta-hCG/AFP MOM ratios 61.7 per cent, and combined free beta-hCG and AFP a detection rate of 63.8 per cent for a 5 per cent false-positive rate. Down's syndrome screening at an early gestational age (before 18 weeks) could achieve a 68 per cent detection rate with a 5 per cent false-positive rate, compared with a 59.1 per cent detection rate for a 5.2 per cent false-positive rate when screening at a late gestational age. The use of free beta-hCG in Down's syndrome screening programmes can yield an improved efficacy in the detection of Down's syndrome in an Asian population.

Prediction of adverse perinatal outcome by maternal serum screening for Down syndrome in an Asian population

OBJECTIVE

To investigate the association between adverse perinatal outcomes and abnormal elevations of serum marker levels (alpha-fetoprotein [AFP] and free beta-hCG) or a false-positive screen for Down syndrome.

METHODS

Pregnancy outcome information was available for 5885 Taiwanese women under 35 years of age who had second-trimester maternal serum screening for Down syndrome, using AFP and free beta-hCG, and delivered a chromosomally normal fetus. Those with AFP at least 2.0 multiples of the median (MoM), free beta-hCG at least 2.5 MoM, or a false-positive screen (risk ratio at least 1:270) were identified, and the risk for adverse perinatal outcome was assessed.

RESULTS

A serum AFP level at least 2.0 MoM (n = 176, 3.0%) was significantly associated with the occurrence of preterm delivery, low Apgar scores, small-for-gestational-age infants, low birth weight or very low birth weight, fetal death, premature rupture of membranes, oligohydramnios, and a higher incidence of perinatal mortality. A serum free beta-hCG level at least 2.5 MoM (n = 416, 7.1%) was significantly associated with low birth weight, an abnormally adherent placenta, and the occurrence of meconium-stained amniotic fluid. A higher incidence of fetal structural anomalies other than neural tube or abdominal wall defects, large-for-gestational-age infants, and postpartum hemorrhage was observed for a calculated risk of at least 1:270 (n = 311, 5.3%) independent of the other biochemical markers.

CONCLUSION

Asian women with unexplained elevations of serum AFP or free beta-hCG, or a false-positive screen for Down syndrome are at increased risk for various adverse perinatal outcomes. Careful fetal ultrasound examination and thoughtful strategy for perinatal management are warranted for these patients.

Effects of glucose on placental hormones in the human term placenta in vitro

Glucose intake during pregnancy results in a decrease in endogenous insulin-like growth factor binding protein-1 (IGFBP-1). However, the exact role of glucose on placental secretion of IGFBP-1 is unclear. This study was designed to investigate the direct effects of glucose on the production of IGFBP-1 and other placental hormones, using an isolated placental preparation. Using the dual recirculating perfusion system for an isolated human placenta lobule, a total of 43 experiments were performed over a duration of 6 hours. Twenty placentae were perfused with a medium containing 141 +/- 10 mg/dL (7.83 +/- 0.56 mmol/L) glucose (group I) and 23 placentae with 242 +/- 12 mg/dL (13.43 +/- 0.67 mmol/L) glucose (group II). Levels of insulin, glucose, lactate, insulin-like growth factor (IGF-I), IGFBP-1, human placental lactogen (hPL) and beta-human chorionic gonadotropin (beta-hCG) were measured at 30 minute intervals during perfusion. Insulin and IGF-I were barely detectable in the perfusates and their levels were not modulated by glucose. IGFBP-1 was predominantly detected in the maternal rather than the fetal compartment of the placental circulation. Glucose increased the levels of IGFBP-1 in the maternal circulation in groups I and II during the first two hours of perfusion (188 +/- 58% and 193 +/- 31%, respectively). However, during the subsequent 4 hour period, the increase in IGFBP-1 concentration was significantly higher in group II (926 +/- 427%) than in group I (428 +/- 216%) (p < 0.05). There was no difference in the levels of hPL or beta-hCG between the two groups in the maternal circulation. Thus, glucose stimulates the production of IGFBP-1 in the maternal circulation of a placenta in vitro. This increase in IGFBP-1 by glucose in vitro, as opposed to the decrease of IGFBP-1 in vivo, may be due to a lack of circulatory maternal insulin in the isolated placental preparation. These results also suggest that there may be a functional barrier within the placenta that prevents an increase in the level of IGFBP-1 in the fetal circulation.

The influence of endometriosis on the success of gamete intrafallopian transfer (GIFT)

PURPOSE

Our purpose was to evaluate the outcomes of gamete intrafallopian transfer (GIFT) therapy in patients with endometriosis.

METHODS

One hundred eight GIFT cycles performed under the indication of endometriosis were compared to 156 GIFT cycles with indications of other disease entities. A maximum of seven oocytes was transferred into one or both fimbriate ends with prepared spermatozoa. Clinical pregnancy rates and outcomes were evaluated according to Mantel-Haenszel's chi-square test. Multiple logistic regression analysis was performed to determine factors influencing the success on pregnancy in the total treatment cycles.

RESULTS

The anthropological variables, such as age of patients, duration of infertility, and semen grading, were comparable in both groups. The responses to controlled ovarian hyperstimulation (COH) were progressively decreased while increasing the severity of endometriosis conditions such as nonendometriosis, mild-form endometriosis, and advanced-form endometriosis patients. However, there were no significant differences in the clinical pregnancy rates (40.4, 36.7, and 41.7%, respectively), multiple pregnancy rates (34.9, 27.3, and 45.0%, respectively), and early pregnancy loss rates (27.0, 18.2, and 30.0%, respectively). Multivariate statistics of pregnancy rates that adjusted the effects of patients' age, tubal health, presence of active endometriosis and/or endometriomas, number of oocytes transferred, and quality of sperm exhibited no statistical significance between endometriosis and nonendometriosis groups.

CONCLUSIONS

Our data show that patients with records of endometriosis have both a decreased ovarian response to gonadotropin stimulation and a decreased number of retrieved oocytes. Since the number of oocytes needed for the GIFT procedure is limited, pregnancy results for patients in the study group were comparable with those for patients in the control group.

2-hydroxyethyl methacrylate-terminated polyurethane/polyurethane interpenetrating polymer networks

The interpenetrating polymer networks (INPs) of polyurethane (PU) and 2-hydroxyethyl methacrylate (MEHA)-terminated polyurethane (HPU) were prepared by solution polymerization. PU prepolymer was synthesized from 4,4-diphenyl methane diisocyanate (MDI) and poly(propylene oxide) glycol (PPG). HPU prepolymer was synthesized from MDI, poly(tetramethylene oxide) glycol and HEMA. Dynamic mechanical analysis showed that the resultant IPN membranes have good compatibility between their constituents. As the HPU content increased, the tensile strength of the IPNs first increased and then decreased. For the highest tensile strength, the optimum HPU content was about 25 wt %. The value of surface tension of IPNs varied from 44.4 to 50.5 dyne/cm, and polarity ranged from 0.59 to 0.91. The relative index of platelet adhesion (RIPA) of the IPN membranes was measured by the dynamic thrombosis test at constant shaking speed and temperature. By the criteria of this test, the IPN membranes with HPU content of about 25 wt% to the minimum platelet adhesion. When measured by the angular dependent ESCA technique on the surface of IPN samples, the variation in the RIPA correlated to the change in the surface soft segment to hard segment ratio. Higher HPU content resulted in more migration of soft segments toward the surface. The platelet adhesion was observed to be minimized when the surface O/N ratio was around 12.

Down syndrome screening in an Asian population using alpha-fetoprotein and free beta-hCG: a report of the Taiwan Down Syndrome Screening Group

OBJECTIVE

To evaluate whether the strategy of maternal serum screening for Down syndrome, using alpha-fetoprotein (AFP) and free beta-hCG in combination with maternal age, a technique developed in western countries, is applicable to an Asian population.

METHODS

Alpha-fetoprotein and beta-hCG were measured in serum samples from 23 Down syndrome pregnancies and 1748 unaffected singleton Taiwanese (ethnically Chinese) pregnancies at 14-22 weeks' gestation. Gestational age-specific medians and a maternal weight correction formula were established for our own population. Likelihood ratio for Down syndrome pregnancies in relation to multiples of the median (MoM) levels of these analytes were derived from the overlapping gaussian frequency distribution curves for Down syndrome and unaffected pregnancies.

RESULTS

The serum AFP and free beta-hCG median MoM values of Down syndrome pregnancies were significantly abnormal in Asian subjects (0.77 and 2.91, respectively), and similar to those of affected pregnancies in white women. The median value of free beta-hCG:AFP MoM ratio (2.97) in Down syndrome pregnancies was significantly higher than that of unaffected pregnancies (1.09). The mean maternal weight during the second trimester in pregnant Asian women (55.2 kg) was markedly lighter than that of white women. At a 5.8% false-positive rate, free beta-hCG identified 47.8% of Down syndrome pregnancies (likelihood ratio 8.2), AFP detected only 13% of the cases (likelihood ratio 2.2), and free beta-hCG:AFP MoM ratio detected 43.5% of the cases (likelihood ratio 7.4). By using a multivariate risk algorithm involving the combination of AFP, free beta-hCG, and maternal age, 56.5% of Down syndrome cases could be detected with a 5.3% false-positive rate (likelihood ratio 10.7).

CONCLUSION

Maternal serum screening strategy using AFP and free beta-hCG in combination with maternal age is feasible in the detection of fetal Down syndrome among Asian women.

Metastatic choriocarcinoma with spontaneous splenic rupture following term pregnancy: a case report

Choriocarcinoma is a rare neoplasm which often spreads extensively. The metastases sometimes appear in the abdominal cavity where they can cause dramatic symptoms. We here describe a patient who had received a cesarean section twelve days before and intraperitoneal hemorrhage was diagnosed when she visited Chang Gung Memorial Hospital's emergency department. At laparotomy, ruptured spleen with active bleeding was found and splenectomy was performed. The histopathologic study revealed a metastatic choriocarcinoma. Multiagent chemotherapy was administrated and the patient responded well. To our knowledge, this is the fourth reported case that metastatic choriocarcinoma resulted in spleen rupture presenting as the principal sign of acute hemoperitoneum. Metastatic choriocarcinoma with rupture should be considered a cause of intraperitoneal hemorrhage in women of child-bearing age.

High maternal serum free beta-hCG levels in Down syndrome pregnancies: a preliminary report

To investigate the serum free beta-human chorionic gonadotropin (beta-hCG) value in women carrying Down syndrome fetus, we have retrospectively studied 11 Down syndrome pregnancies and 200 singleton unaffected pregnancies between 15 and 22 weeks' gestation. Each affected pregnancy was assigned at least 15 control cases matched with maternal age and gestational age. The median value of free beta-hCG in Down syndrome pregnancies and unaffected pregnancies was 2.56 multiples of the median (MoM) and 1.06 MoM, respectively. The mean free beta-hCG value after log transformation in Down syndrome pregnancies was 2.01 MoM that was significantly different from that of unaffected pregnancies (1.05 MoM, P = 0.024). There were 54.6% (6/11) of Down syndrome pregnancies and 5% (10/200) of unaffected pregnancies with free beta-hCG levels greater than 2.5 MoM. It is suggested that free beta-hCG may be a potentially useful and superior marker in the detection of Down syndrome pregnancies in our population.

Hyperglycemia induced activation of type-1 protein phosphatase activator (kinase FA) in perfused human placenta

We report the identification of type-1 protein phosphatase activating factor (kinase FA), a unique biologic mediator for both insulin and epidermal growth factors in the human placenta. The activity of kinase F, was found to be extremely labile in the unperfused placenta. Fresh term placentas lost more than 50% of the total kinase FA activity within 6 hours when exposed to air of incubated in medium but not perfused. In contrast, the activity of kinase FA was stable when the human term placenta was dually perfused. This indicates that placental dual perfusion is a useful method for studying protein phosphorylation-dephosphorylation involved in signal transduction. When fresh placentas were perfused with media containing glucose at 141 +/- 10, 242 +/- 12 and 436 +/- 20 mg/dL, kinase FA activity was stimulated several-fold in a glucose concentration-dependent manner when compared with control levels at delivery. The results suggest that hyperglycemia-mediated activation may represent a previously unknown control mechanisms for the regulation of protein kinase FA. The results also suggest that human placental perfusion is a good in vitro system for studying signal transduction mechanisms involved in hormonal actions and metabolic regulation.

Prenatal diagnosis of major congenital cardiovascular malformations

This prospective study was designed to determine whether there would be a higher incidence of congenital cardiovascular malformation (CCVM) in pregnant women with certain risk factors. Fetal echocardiography, from second trimester of term, was performed in 1,659 pregnant women with risk factors for CCVMs and 826 pregnant women without risk factors from March 1990 to April 1995. Two-dimensional imaging, fetal M mode measurements, Doppler waveform velocity and Doppler color flow mapping were used for fetal heart examination. During this period, 70 fetuses with major cardiovascular malformations were found. The prenatal detection rate was determined as 2.8% (70/2,485) in our study. The rate in the high-risk group, however, was 3.7% (61/1,659). Of all indications, fetal risk factors had the highest rate (9.3%, 46/494) of detected CCVMs. Maternal and familial indications could be excluded from the high-risk group as they did not show any increased incidence over the low-risk group. We suggest that fetal echocardiography is mandatory in the high-risk group, especially in cases with fetal and placental risk factors. Fetal cardiac screening in the hands of first-line sonographers has a major role in prenatal diagnosis of CCVMs in the low-risk group.

Allelic deletion mapping of putative tumor suppressor genes on 17q in sporadic ovarian cancer

OBJECTIVES

1) To study whether the same or different chromosome 17q genes may be involved in the oncogenesis of familial and sporadic ovarian malignancies. 2) To localize the candidate gene in the sporadic ovarian cancers.

METHODS (STUDY DESIGN)

Using DNA extracted from ovarian tumors and corresponding peripheral leukocyte, we examined the status of loss of heterozygosity (LOH) at 12 loci spanning chromosome 17q12-q25 by Southern hybridization and polymerase chain reaction.

RESULTS

Comparison of the extent of LOH among 25 epithelial ovarian tumors showing allele loss at one or more loci on 17q, the smallest overlapping region of allelic deletion is between D17S579 and GIP, with a genetic distance of approximate 2 cM.

CONCLUSIONS

From our allelic deletion analysis of chromosome 17q loci, it indicates that there are more than one ovarian cancer candidate genes on chromosome 17q.

Prenatal diagnosis of tetralogy of fallot by Doppler color flow mapping

The prenatal diagnosis of tetralogy of Fallot (TOF) can be difficult, as the routine sonographic four-chamber view may be normal before birth. Unlike the normal fetus, in which blood flows adjacent to the left side of the interventricular septum, on color Doppler mapping a fetus with TOF also demonstrates antegrade flow along the right side of the interventricular septum. This Y-shaped ventricular outflow passing through the dilated aortic tract is confluent at the level of the ventricular septal defect during the systolic phase. In the past 3 years, three cases of TOF have been diagnosed prenatally at the Chang Gung Memorial Hospital. In each case, the above picture was demonstrated. 2-Dimensional Doppler color flow mapping may be helpful in the prenatal diagnosis of TOF.

Midtrimester human chorionic gonadotropin levels: normal reference values in Chinese pregnant women

In order to establish normative median values of maternal serum total human chorionic gonadotropin (hCG) at our own laboratory, 2711 normal sera were collected from uncomplicated, singleton Chinese pregnant women, including 1705 samples measured by radioimmunoassay (RIA) between 13 and 24 weeks' gestation and 1006 samples measured by enzyme immunoassay (EIA) between 14 and 20 weeks' gestation. The hCG secretion pattern throughout midtrimester measured by RIA is similar to that of measured by both RIA and EIA have a steep drop initially and then steadily decline from 17 weeks of gestation. The total (hCG levels measured by RIA and EIA showed different normative median values and distribution. If it was measured by RIA between 14 and 20 week's gestation, there were 3.7% and 17.8% of pregnancies with serum total hCG levels less than 0.25 multiple of the median (MoM) and 0.5 MoM, retrospectively, and 11.6% and 5.5% among them with serum levels above 2.0 MoM and 2.5 MoM, respectively. When it was measured by EIA, there were 0.7% and 9.2% of pregnancies with serum total hCG levels less than 0.25 MoM and 0.5 MoM, respectively, and 8.9% and 3.7% among them with serum levels above 2.0 MoM and 2.5 MoM, respectively. Accurate and satisfactory interpretation of maternal serum screening for Down syndrome depends on establishment of a well-developed normative median value for each week of gestation. Any laboratory intends to provide hCG for maternal serum screening should have its own reference data by its own immunoassay method.

Congenital malformation in newborns. Analysis of 501 cases

Over a 14-year period in Chang Gung Memorial Hospital, 510 out of 44, 362 newborns were found to have birth defects. Maternal age, gestational age, parity, infant sex and birth weight were analyzed for each anomaly and compared to normal newborns. The average maternal age and parity for newborns with congenital anomalies were not significantly different from normal newborns. Mothers giving birth to babies with chromosomal aberrations, however, had a significantly older maternal age than the normal population. The gestational age at delivery was significantly shorter for all except craniofacial anomaly. In addition, there was a high percentage of intrauterine growth retardation in congenital anomalies. The central nervous system, the musculoskeletal system and craniofacial systems were the most commonly involved. The leading anomalies included cleft lip, cleft palate, anencephaly, polydactyly, hydrops fetalis, trisomy 21 and cystic hygroma. With improved ultrasound equipment and other prenatal diagnostic procedures, many defects of the fetus can now be identified. If the fetus is diagnosed with a surgically correctable lesion like cleft lip, it can be kept to term, delivered, then managed postnatally. If life-incompatible malformations have been detected before the 24th week, physicians are in a good position to counsel the parents. After the 24th week termination is proscribed by law. Therefore, physicians must take special care to detect fetal abnormalities early.

Hepatocellular carcinoma in a pregnant woman detected by routine screening of maternal alpha-fetoprotein

A 26-year-old pregnant woman was diagnosed as having hepatocellular carcinoma at 16 weeks of gestation when extremely high levels of alpha-fetoprotein were found on a routine screening examination. The pregnancy was terminated, and a right hepatectomy was performed. Although such cases are rare, this one suggests that early measurement of maternal serum alpha-fetoprotein in a pregnant woman with hepatitis B surface antigenemia may allow the timely detection of a hepatocellular carcinoma.

Presence of cells of fetal origin in maternal circulation of pregnant women

Fetal cells can be identified by using the polymerase chain reaction to test for the presence of human Y-chromosome-specific ZFY and SRY gene DNA sequences in maternal peripheral blood of women who bear a male fetus. Thirty-one pregnant women were studied in the first trimester to determine when fetal cells become detectable in the maternal circulation. Among the 19 women whose peripheral blood samples were positive for Y-chromosome-specific DNA sequences, the presence of fetal cells was quite case-variable from the 6th to 12th gestational weeks. Twenty-eight women who had given birth to their first male babies were studied postpartum to determine when fetal cells disappear from the maternal circulation. Fetal cells can still be detected in maternal blood 10 months postpartum in some cases. These results suggest that identification of fetal cells in the maternal circulation is possible. Nevertheless, interpretation of fetal cells in maternal circulation should be handled very carefully with respect to when these fetal cells first became detectable and potential interference from previous pregnancies.

Growth discordancy, birth weight, and neonatal adverse events in third trimester twin gestations

In order to understand the effects of intrauterine growth discordancy (15% or more birth weight difference), birth weight, and gestational age on the neonatal adverse events (including 1- or 5-min Apgar scores < 7, neonatal death, ICU admission, respiratory distress, hypoglycemia, hypocalcemia, perinatal infection, blood transfusion, and hyperbilirubinemia) in third trimester twin gestations, 279 consecutive twin pairs delivered from January 1986 to December 1991 were studied. Univariate analyses showed discordant twins were smaller than concordant twins in gestational age by 1.4 weeks (35.74 and 37.14 weeks respectively). When birth weight was compared, that of smaller (one with lower birth weight in a pair) discordant twins (1,951 g) was significantly lower than that of smaller concordant twins (2,423 g), while larger (one with higher birth weight in a pair) discordant twins (2,556 g) and concordant twins (2,594 g) showed no significant difference. Univariate analysis indicated there was a tendency for adverse events to occur in discordant twins, especially in the smaller twin. Through logistic regression analysis, it was found that birth weight and gestational age, but not discordancy, are the predictors of the occurrence of adverse events. A smaller twin weighing no more than 2,000 g has a 10 times greater risk to develop an adverse event as compared to a twin with a birth weight over 2,000 g and a similar gestational age; while a twin with a gestational age of less than 34 weeks has a 5 times greater risk than one 34 weeks or over with a similar birth weight.

Detection of beta-thalassemia carrier by direct analysis of beta-globin gene lesions

DNA was prepared from peripheral blood mononuclear cells of 114 Chinese with low erythrocyte mean corpuscular volume and analyzed by allele-specific DNA amplification for the presence of mutant alleles in the beta-globin gene that account for about 90% of beta-thalassemia in Chinese. A total of 9 mutations of the five most frequent mutant alleles were detected in 8 individuals. All mutant sequences were confirmed later by DNA sequencing. However, no mutation of these mutant alleles was detected in the remaining 106 individuals with low erythrocyte mean corpuscular volume including 22 who also had Hb A2 content of 6.0% or more. Our results seem to suggest that the presence of beta-thalassemia allele does not correlate very well with red blood cell indices and that direct DNA analysis by allele-specific DNA amplification is an accurate method to identify beta-thalassemia heterozygotes.

Detection of aflatoxin B1-DNA adducts in human placenta and cord blood

Human placenta and cord blood are readily available specimens that respond to maternal environmental insult and are being used to investigate metabolism, bioactivation, and transplacental transfer of procarcinogens. Enzyme-linked immunosorbent assay was used to quantitate 120 placentas and 56 cord bloods from term, uncomplicated pregnancies at Taipei Chang Gung Memorial Hospital, Taiwan, for the presence of the imidazole ring-opened form of aflatoxin B1-DNA (AFB1-DNA) adducts. Of the 120 samples of placentas, 69 (57.5%) contained AFB1-DNA adducts in levels from 0.6 to 6.3 mumol/mol DNA. Of the 56 samples of cord bloods, 5 (8.9%) contained AFB1-DNA adducts in levels from 1.4 to 2.7 mumol/mol DNA. A higher positive rate was found in samples collected in the summer than in the winter. These results indicate that a significant number of individuals in an area of high liver cancer risk have been exposed to AFB1, and it is possible to transfer AFB1 and its metabolites to the progeny through the transplacental unit. Thus, monitoring adduct levels in human specimens may provide information not only on carcinogen exposure but also on the relationship among infection with hepatitis B/C virus, dietary exposure to AFB1, and liver cancer.

Maternal renal artery Doppler flow-velocity waveform in preeclampsia. A preliminary report

By use of duplex Doppler ultrasonography, we preliminarily studied 30 normal pregnancies (control group) and 30 patients with preeclampsia (study group) before treatment. The peak systolic flow height to end diastolic flow height (S/D) ratio of the maternal right and left renal arteries of both groups were compared and analyzed. The results showed that there were no significant differences between the right and left renal arteries in either group, but unexpectedly the S/D ratio of the renal artery on both sides in preeclamptic patients was significantly lower than in normal pregnant women (mean +/- SD, 2.07 +/- .12 vs. 2.41 +/- .12, respectively, P < .001). The lower S/D ratio of the renal artery may reflect a decrease in renovascular resistance and an increase in renal perfusion. These findings were the reverse of what might be expected from an elevated vascular resistance and hypoperfusion model.

Possible non-sexual transmission of genital human papillomavirus infections in young women

Human papillomaviruses were detected by an in vitro enzymatic DNA amplification method in cells obtained from vulvar swabs of 9 of 61 (14.8%) young women without prior experience of sexual intercourse and in 7 of 57 (12.3%) young women with prior experience. The prevalence of human papillomavirus DNA in these two groups of women was not significantly different (x2 = 0.16, p > 0.5; 95% confidence interval -0.165 to 0.215). These results suggest that genital human papillomavirus is not sexually transmitted in all cases and that it may be acquired by modes other than sexual contact.

Outcome of pregnancy in patients with organic heart disease in Taiwan

A total of 122 pregnancies in 101 women with organic heart disease were reviewed. The incidence of organic heart disease in pregnant women was 0.25%. The ratio of rheumatic to congenital heart disease was 1.0 to 1.5. In the congenital heart disease group, IUGR was more frequent in the cyanotic group as were preterm births. Patients with cyanotic lesions had a significantly higher maternal mortality rate than those with acyanotic lesions. The cyanotic group without surgical correction had a significantly higher maternal mortality rate and more IUGR than those with correction. Congestive heart failure was the most common maternal complication, with a rate of 38.1%. The patients with good cardiac status control during pregnancy developed less IUGR, had fewer preterm births, less maternal morbidity and less maternal mortality than those in poor condition. Patients in functional classes I and II before pregnancy carried less risk of maternal morbidity than those in classes III and IV.

Pregnancy outcome of preterm premature rupture of the membranes before 28 weeks

From January 1987 to December 1990 at Chang Gung Memorial Hospital, the fetal membrane ruptured in 47 singleton pregnancies at the 20th to the 28th gestational weeks. Sixty-six percent of the patients delivered within three days and 91.5% within one week. Only six (12.8%) patients carried their pregnancies over the 28th week. Of the 47 patients, 16 (34.0%) developed clinical evidence of chorioamnionitis during the latent period. The development of chorioamnionitis was not related to any of clinical factors [gestational age at rupture of the membranes, duration of rupture of the membranes before admission, positive endocervical culture, tocolysis, latent period or the presence of oligohydramnios (p > 0.05)]. The neonatal survival rate was 12.7% (six out of 47). Neonatal death was mainly attributable to prematurity. Gestational age beyond the 28th week and body weight greater than 1000 gm are two factors contributing to fetal survival. When fetal lung maturity has not occurred expectant management in the absence of infection is an alternative treatment.

Neonatal status in cesarean section under epidural anesthesia with supplementary oxygen

Simple O2 mask has been used in patient under regional anesthesia for increasing the FiO2, especially in the aged and the pregnant. The relationships between maternal FiO2 and umbilical arterial (UA) and venous (UV) PO2, PCO2, pH, and neonatal Apgar score were studied in 45 patients receiving Cesarean section under epidural anesthesia. 2% xylocaine 18-20 ml with adrenaline 1:200,000 was used to attain the sensory level of T-4. Patients were allocated randomly into three groups. Group I, acting as a control group, breath only room air during the course of anesthesia. Group II was breathing through a simple face mask with an oxygen inflow of 6L/min. Group III was breathing oxygen with a flow rate of 10L/min through a simple face mask. UA and UV blood samples were collected separately at the time of delivery for blood gas analysis. The 1-min, and 5-min Apgar scores were recorded also. Mean values of the UA blood samples for the 3 groups (Gp. I, Gp. II and Gp. III respectively) were: PO2--16.50 mmHg, 20.20 mmHg and 19.50 mmHg; PCO2--49.20 mmHg, 48.10 mmHg and 50.3 mmHg; pH--7.31, 7.30 and 7.30. Mean values of the UV blood samples for the 3 groups (Gp. I, Gp. II and Gp. III respectively) were: PO2--28.6 mmHg, 36.9 mmHg and 36.5 mmHg; PCO2--38.20 mmHg, 38.80 mmHg and 40.40 mmHg; pH--7.36, 7.36 and 7.34. There was a significant increase in UA and UV PO2 when using a simple O2 mask (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis C virus in peripheral blood mononuclear cells

RNA extracted from plasma and peripheral blood mononuclear cells of patients with chronic hepatitis C were used as the template for reverse transcription followed by double in vitro enzymatic amplification with nested primers. Hepatitis C virus was detected in 14 of 15 (93.3%) plasma specimens and in 8 of 15 (53.3%) peripheral blood mononuclear cell specimens obtained from patients with chronic hepatitis C and abnormal liver functions. The results suggest that hepatitis C virus could be found frequently in peripheral blood mononuclear cells of patients with chronic hepatitis C. Whether the presence of hepatitis C virus in peripheral blood mononuclear cells plays any role in the pathogenesis of diseases associated with hepatitis C virus infection remains to be determined.