Mycoplasma and Ureaplasma carriage in pregnant women: the prevalence of transmission from mother to newborn

Background

Mycoplasma and Ureaplasma have been extensively studied for their possible impact on pregnancy, and their involvement in newborn diseases. This work examined Mycoplasma and Ureaplasma carriage among gravidas women and newborns in Israel, as well as associations between carriage and demographic characteristics, risk factors, pregnancy outcomes, and newborn morbidity rates.

Methods

A total of 214 gravidas women were examined for vaginal pathogen carriage through standard culture and polymerase chain reaction assay. Pharyngeal swabs were collected from newborns of carrier mothers. Clinical and demographic data were collected and infected newborn mortality was monitored for 6 months.

Results

Nineteen mothers were carriers, with highest prevalence among younger women. Pathogen carriage rates were 2.32% for Mycoplasma genitalium (Mg), 4.19% for Ureaplasma parvum (Up) and 2.32% for Ureaplasma urealyticum (Uu). Arab ethnicity was a statistically significant risk factor (p = 0.002). A higher prevalence was seen among women residing in cities as compared to villages. Thirteen (68%) newborns born to carrier mothers were carriers as well, with a higher prevalence among newborns of women delivering for the first time, compared to women that had delivered before. Infection rates among newborns were 20% for Mg (p = 0.238), 100% for Up (p < 0.01), and 28.5% for Uu (p = 0.058), with more male than female newborns being infected. No association was found between maternal carriage and newborn morbidity.

Conclusions

Maternal Mycoplasma or Ureaplasma carriage may be associated with ethnicity and settlement type. Further studies will be needed to identify factors underlying these associations and their implications on delivery.

Perinatal Outcome of Twin Pregnancies Complicated by Rupture of Membranes at 13-20 Weeks: Is Selective Termination an Appropriate Management Option?

OBJECTIVE

 To evaluate the outcome of twin pregnancies that were complicated by rupture of membranes at 13-20 weeks of gestation and were managed by expectant management or by selective termination.

METHODS

 A retrospective cohort study of all bichorionic twin pregnancies that were referred to three fetal medicine units between 2001 and 2016, due to rupture of membranes of one sac at 13-20 weeks of gestation. Women without clinical signs of infection who opted for expectant management or selective termination were included.

RESULTS

 20 patients met the inclusion criteria. 7 of them were managed expectantly and 13 underwent selective termination. In the expectant management group there was one case of fetal demise and two cases of neonatal death, resulting in a survival rate of 79 %. The median gestational age at delivery was 30 weeks. 3 neonates suffered from prematurity-related complications and 2 suffered from oligohydramnios-related orthopedic complications. Following selective termination the survival rate was 50 % (all fetuses that were not reduced), the median gestational age at delivery was 39 weeks, and the neonatal outcome was favorable. The maternal outcome was favorable in both groups.

CONCLUSION

 Selective termination in twin pregnancies complicated by rupture of membranes at 13-20 weeks has a favorable outcome and should be offered.

Maternal and neonatal outcome of asymptomatic bacteriuria at term pregnancy

OBJECTIVES

Guidelines recommend antibiotic treatment for every episode of asymptomatic bacteriuria throughout pregnancy in order to reduce maternal and fetal complications. We evaluated intra- and post-partum, as well as puerperal maternal and neonatal outcomes of an untreated group of pregnant women with asymptomatic bacteriuria at term.

METHODS

This was a single center prospective cohort study. We enrolled women who came for labor or checkups, 37-42 weeks gestation, with singleton, vertex presentation. On admission, women gave a urine sample; we compared maternal, obstetric and neonatal data from the positive culture group to the negative culture.

RESULTS

Among 248 pregnant women recruited, 205 negative and 32 positive urine cultures were collected. None of the women that participated in this study developed pyelonephritis during hospitalization or during the puerperium. No significant differences were detected between the two groups in terms of age, nulliparity, gestational age at delivery, length of hospitalization, birth type, intra- or post-partum fever, antibiotic treatment during labor or post-partum.

CONCLUSIONS

No increased maternal or neonatal adverse effects were observed in women with untreated ASB detected at term.

Does the empty follicle syndrome occur in cases of low number of maturing follicles in assisted reproduction?

The pathophysiology of the genuine empty follicle syndrome (EFS) is still debated. Ovarian aging has been contested as a cause of this condition. Our aim was to investigate the occurrence of the genuine EFS in cases of a low number of mature follicles in a prospective manner. Ninety-five infertile women were recruited and evaluated following conventional controlled ovarian stimulation (COS) with ≤ six follicles of ≥14 mm diameter on the day of hCG administration. Enrolled women were 37.5 ± 5.2 years of age with basal FSH level of 9.1 ± 3.7 mIU/L, antral follicle count (AFC) of 6.9 ± 4.6, and number of ≥14 mm follicles (on the day of hCG) of 3.4 ± 1.5. Among the 95 women, four were complicated by the genuine EFS (4.2%) with features of the depleted ovarian reserve. Comparison between these four cases and the 91 controls revealed significant differences between age, AFC, number of ≥14 mm follicles, and serum E₂ level corresponding to 41.8 ± 1.7 versus 37.4 ± 5.2 years, 1.7 ± 0.6 versus 7.1 ± 4.5, 2.0 ± 0.8 versus 3.4 ± 1.5 follicles, and 356 ± 200 versus 975 ± 557 pg/mL, respectively. Post hoc analysis revealed that 56 among the 95 women fulfilled the Bologna criteria for poor ovarian response and all four cases matched the definition of the genuine EFS raising its incidence to 7.1% in this group. A logistic regression analysis showed that AFC was a significant factor in the development of the genuine EFS. We conclude that the genuine EFS complicates infertile women characterized by a low number of mature follicles. Our findings suggest that the mechanism behind this occurrence is associated with a more exhausted ovarian reserve.

A comparison of enriched culture and Xpert polymerase chain reaction assay of Group B streptococcus carrier status at 35-37-week gestation to labor onset: a prospective controlled study

OBJECTIVES

(1) To compare the accuracy of vagino-rectal enriched culture (EC) and a rapid polymerase chain reaction (PCR) test for the detection of Group B streptococcus (GBS) carrier status at 35-37-week gestation and at onset of labor. (2) To assess the conversion rate of GBS carrier status between 35-37 weeks to the onset of labor according to the EC/PCR tests. A prospective study was performed at a women's health clinic, referred to give birth at one medical center.

STUDY POPULATION

Low risk pregnant women at 35-37-week gestation who did not know their GBS carrier status.

METHODS

Participants were evaluated for GBS status both at 35-37 weeks and at labor onset. Correlation between tests was calculated by Spearman correlation.

RESULTS

One hundred and ten specimens were analyzed. Correlations: EC-PCR: 35-37 weeks - very high (r = 0.8), at labor - high (r = 0.5).

EC-EC

35-37 weeks and at labor - high (r = 0.39); PCR-PCR: 35-37 weeks and at labor- high (r = 0.7).

CONCLUSIONS

Both the EC and Xpert PCR tests are accurate for detecting GBS carrier, both at 35-37 weeks and at labor onset. We did not detect a significant conversion of the GBS status from negative at 35-37 weeks to positive at onset of labor.

The effect of rLH supplementation to the GnRH-antagonist protocol on endocrine dynamics in the advanced reproductive age

PURPOSE

To explore serum endocrine dynamics, specifically LH levels, following rLH supplementation to rFSH following GnRH-antagonist treatment in the advance reproductive age.

METHODS

Women were prospectively and similarly treated employing rFSH and the flexible GnRH-antagonist protocol, while rLH was supplemented only to the study group. Serum FSH, LH, E_2, and P were evaluated throughout the follicular phase. Three strategies were a priori planned to examine endocrine dynamics among women enrolled.

RESULTS

While serum LH drop were similar before GnRH-antagonist stimulation, it dropped more times in the control group compared to the study group. Among women receiving rFSH only, serum LH levels dropped ≤2, ≤1 and ≤0.5 mIU/mL in 71.4, 46.4, and 28.6% of cases, while this occurred only in 38.7% (P = 0.01), 6.5% (P = 0.0004) and 3.2% (P = 0.007) of women receiving combined rFSH and rLH treatment, respectively. The same trend was found when serum LH dropped in at least two occasions following the GnRH-antagonist administration. Conversely, serum LH diagrams throughout the follicular phase did not differ between the two groups. Furthermore, individual area under the curve values of LH, E_2, and P was similar between the two groups following GnRH-antagonist initiation.

CONCLUSIONS

Different strategies to explore LH dynamics following the GnRH-antagonist administration have resulted in diverse results, implying the need for a consensus definition of LH threshold for adequate folliculogenesis and steroidogenesis. Such action would pave the way for understanding which groups of patients may benefit from rLH supplementation.

The association between multinucleated blastomeres and poor ovarian response under the Bologna criteria

PURPOSE

To investigate the occurrence of multinucleated blastomeres (MNB) in poor ovarian response (POR) women defined under the Bologna criteria.

METHODS

This observational study was designed in a prospective controlled manner. Among 380 cases evaluated for eligibility, 102 women were found suitable and recruited; 51 with POR in accordance with the Bologna criteria defined as the study group and 51 with normal ovarian response defined as the control group.

RESULTS

Among the 51 women in each group, 8 and 2 did not achieve embryos in the study and control group, respectively (P < 0.05). The percentage of women that had at least one embryo with one MNB was significantly higher in the study as compared to the control group, corresponding to 49 and 29 %, respectively. The total number of embryos evaluated was 416; 167 in the study and 249 in the control groups. Among these embryos, the MNB rate was significantly higher in the study as compared to the control group, corresponding to 19 and 8 %, respectively.

CONCLUSIONS

Blastomere multinuclearity is significantly more common in women and embryos of POR cases, defined under the Bologna criteria. Future studies are warranted to substantiate our observation that has the potential to be clinically implemented in this sub-group of women undergoing assisted reproductive technologies (ART) treatment.

Glycemic control and clinic attendance of emerging adults with type 1 diabetes at a transition care clinic

BACKGROUND

Emerging adulthood is a challenging period for diabetes management. Our aim was to determine whether a dedicated transition clinic for emerging adults with type 1 diabetes can improve glycemic control and visit attendance.

METHODS

An observational study of 53 emerging adults (30 males) treated during 2010-2014 in a newly established transition clinic. The clinic was operated jointly by pediatric and adult endocrinologists and included a transition coordinator. Data collected included the source of referral, HbA1c levels, frequency of visit attendance, and acute complications. For 27 patients who had attended the pediatric clinic at the same medical center, data from up to 2 years preceding the transition were also collected. Patients filled the Diabetes Quality of Life-Youth questionnaire at the transition and 1 year later.

RESULTS

Mean ± SD age at the transfer to the transition clinic was 22.1 ± 2.7 years; mean disease duration was 8.4 ± 5.0 years. Follow-up duration at the transition clinic was 1.2 ± 1.1 years. Mean HbA1c levels decreased from 67 mmol/mol (95 % CI 63-72) [8.3 % (95 % CI 7.9-8.7)] at transfer to 57 mmol/mol (95 % CI 52-63) [7.4 % (95 % CI 6.9-7.9)] after 1 year (p < 0.001). Thirty-six patients (68 %) attended three or more visits during their first year in the transition clinic. The impact of diabetes on quality of life, disease-related worries, and life satisfaction did not change significantly during 1-year attendance in the transition clinic.

CONCLUSIONS

A dedicated transition clinic for emerging adults, with tailored support according to the developmental needs of emerging adulthood, showed improved glycemic control and visit attendance.

The effect of LH supplementation to the GnRH antagonist protocol in advanced reproductive ageing women: a prospective randomized controlled study

OBJECTIVE

Although the fundamental significance of both LH and FSH for adequate ovarian folliculogenesis and steroidogenesis has been extensively discussed, the clinical implication of recombinant (r) LH to rFSH for ovarian stimulation employing the GnRH antagonist protocol remains to be elucidated. The aim of this prospective randomized controlled study was to explore whether rLH supplementation to rFSH following GnRH antagonist has an added value to the late follicular ovarian steroidogenesis in the advanced reproductive aged women.

DESIGN AND SUBJECTS

Sixty-three consecutive infertile women above 35 years of age and/or with a previous low ovarian response admitted for IVF/ICSI treatment were prospectively randomized. Women in the study and control groups were similarly treated employing the rFSH 300 IU/day and the flexible GnRH antagonist 0·25 mg/day protocol. On the day of antagonist initiation, rLH 150 IU/day was added only to the study group and continued till the hCG day.

RESULTS

Serum E2 level on hCG day did not significantly differ between the study and control groups, corresponding to 1268 ± 1006 and 1113 ± 669 pg/mL, respectively (P = 0·9). In the study group, the duration of GnRH antagonist administration was significantly lower than the control group corresponding to 5·0 ± 1·5 to 4·0 ± 1·5 days, respectively (P < 0·05). The total dosage of rFSH administration did not differ between the two groups.

CONCLUSIONS

rLH supplementation to rFSH following GnRH antagonist administration employing the flexible protocol does not seem to significantly augment serum E2 level on the day of hCG administration in the advanced reproductive ageing women. This suggests that endogenous serum LH levels following GnRH antagonist initiation are sufficient for adequate late follicular ovarian steroidogenesis in this setting.

Teaching internal medicine in the community

BACKGROUND

Teaching Internal Medicine is mainly hospital-based. Chronic diseases are treated mostly in community-based ambulatory care. This study describes our experience during the first year of teaching Internal Medicine in the community, with a focus on chronic disease management.

METHODS

This was an observational study describing the content of clinical exposure and the feedback from students after a two-week clerkship in community health centers.

RESULTS

Over a period of three months, 54 students spent two weeks in health centers singly or in pairs. The disciplines covered were: Endocrinology, Gastroenterology, Pulmonology, Rheumatology and Geriatrics. In their feedback, the students most frequently noted knowledge acquired in the management of diabetes, infectious diseases and cardiology. The teaching content was determined by the case-mix of patients. The spectrum of conditions was wide. Students who were used to more structured hospital-based study found it difficult to cope with this mode of learning by discovery.

DISCUSSION

Future research should concentrate on the transition between the different modes of learning as students move from the hospital to the community setting.

Calponin levels in term laboring women

OBJECTIVE

Calponin, a specific smooth muscle contraction regulatory troponin-like protein, is present in large quantities in uterine smooth muscle. Serum troponin levels rise in acute myocardial infarction, and creatine phosphokinase levels rise at high physical activity, both due to destruction of cardiac and striated muscle fibers. We hypothesize that the active labor process may cause uterine smooth muscle cell damage, which may result in rising maternal serum calponin levels. This was a preliminary study, searching for a new biomarker for preterm labor.

METHODS

The study group included laboring term primiparous women with a singleton fetus. The control group included similar demographic and pregnancy characteristics pregnant women not in labor. Maternal serum levels of calponin basic isoform were measured evaluated and compared in both groups.

RESULTS

Study group included 100 pregnant women. Calponin serum levels were higher in the active labor (794 ± 974 ng/mL) than in the group not in labor (591 ± 587 ng/mL), although it did not reach statistical significance. Gender and neonatal weight were similar in the two study groups.

CONCLUSIONS

Calponin serum levels showed moderate elevation during active labor, compared to the levels in a cohort of pregnant comparable women at the same gestational weeks but not in labor.

The use of continuous glucose monitoring systems in a pediatric population with type 1 diabetes mellitus in real-life settings: the AWeSoMe Study Group experience

AIMS

The aim of the study was (a) to compare annual glycemic control in pediatric patients with type 1 diabetes mellitus (T1DM) who used a healthcare-funded continuous glucose monitoring system (RT-CGMS) to that of those who performed self-monitoring blood glucose (SMBG) only, in a real-life setting, and (b) to define parameters associated with compliance and glycemic control.

METHODS

A total of 149 youth with T1DM (52.3 % females), mean age 11.8 ± 3.6 years, and 83 in the CGMS group were followed prospectively for 12 months. Glycemic control parameters and compliance to RT-CGMS were assessed periodically.

RESULTS

Glycemic parameters did not differ significantly between the groups during follow-up periods. The time spent with RT-CGMS decreased and only 38 % used it for more than 75 % of the time during the 12 months (consistent users). Mean HbA1c decreased by 0.27 % in consistent users and increased by 0.21 % among intermittent users (used RT-CGMS less than 75 % of time), p = 0.013. Consistent users were younger 10. 6 ± 4.2 vs. 12.5 ± 3.6, p = 0.07, and had higher frequency of SMBG at baseline, 10.6 ± 4.9 vs. 6.3 ± 2.8, p = 0.011.

CONCLUSIONS

The adoption of RT-CGMS was low, even in a healthcare system that funds its use. Caregivers should consider patient characteristics when recommending RT-CGMS use.

Reduced protein C Global assay level in infertile women prior to IVF-ET treatment

PURPOSE

In the last few years more robust evidence is emerging to point out at an increased rate of prematurity and low birth weight in singleton pregnancies following ART. Whether this increased rate is related to ART practice or to infertility per se, is still an open question. Our aim in this study was to explore this question by evaluating Protein C (ProC) Global assay in infertile women before ART treatment.

METHODS

A cohort of 95 unselected and consecutive infertile women, eligible for ART, was prospectively recruited for the study. The control group included 77 matched healthy fertile women with a history of spontaneous conceptions. Pro C Global assay was evaluated in both groups. A full thrombophilic work-up was performed in the study group.

RESULTS

ProC Global assay level was found to be significantly lower in the study as compared to the control group, corresponding to 0.78 ± 0.16 and 0.88 ± 0.16, respectively (P < 0.01). As well, abnormal ProC Global assay level of ≤ 0.8 was significantly higher in the study as compared to control group corresponding to 53 % and 29 %, respectively. ProC Global assay level was significantly lower in women within the study group found to have APCR, factor V Leiden and high factor VIII level, any thrombophilia or combined thrombophilia when compared to women without these thrombophilic risk factors.

CONCLUSIONS

Reduced ProC Global assay level is encountered in infertile women prior to ART treatment. This finding may suggest a unique anticoagulation Protein C pathway in infertile as compared to fertile women. Further studies are encouraged to explore this finding.

Prospective evaluation of early follicular ovarian stromal blood flow in infertile women undergoing IVF-ET treatment

BACKGROUND

To evaluate the role of early follicular stromal flow studies in predicting ovarian response during IVF-ET treatment and to assess their correlation with ovarian reserve parameters and clinical pregnancy achievement.

MATERIALS & METHODS

One hundred and sixty-eight consecutive and unselected infertile women undergoing their first IVF-ET treatment were included in the study. Basal ovarian reserve and stromal Doppler flow studies were performed in a natural cycle before starting treatment. Four Doppler indices were measured; peak systolic velocity (PSV), pulsatility index (PI), resistance index (RI) and systole/diastole ratio (S/D). Following completion of IVF-ET treatment Pearson's correlation analysis was performed to examine the correlation between Doppler indices, ovarian response, basal ovarian reserve parameters and clinical pregnancy achievement.

RESULTS

A positive correlation was found between the number of ≥14 mm follicles on hCG day and PSV. The number of ≥14 mm follicles and retrieved oocytes had a significant negative correlation with RI and S/D ratio. As well, the number of fertilized oocytes had a significant negative correlation with S/D ratio. Absence of a Doppler signal in one or both ovaries was significantly higher in the women with poor response (31%) as compared to women with normal response (16%). In addition, RI correlated positively with basal FSH as well as FSH/LH ratio and negatively with AFC. The S/D ratio had a negative correlation with AFC (p = 0.027). A significant positive correlation between PSV, total ovarian volume (p = 0.011) and mean ovarian volume (p = 0.019) was detected. However, no correlation between all four Doppler indices and age was detected. Moreover, Doppler indices did not differ significantly between conception and non-conception cycles following IVF-ET treatment.

CONCLUSIONS

Early follicular stromal Doppler signals is correlated with ovarian response as well as basal ovarian reserve parameters, but have no correlation with age neither with clinical pregnancy achievement in infertile women undergoing IVF-ET treatment.

Outcome of Twin Pregnancies Complicated By Early Second Trimester Rupture of Membranes in One Sac

The aim of this study was to present the outcome of bichorionic twin pregnancies complicated by early second trimester rupture of membranes in one sac. Data regarding all cases of ruptured membranes at 13–20 weeks in bichorionic twin pregnancies were collected retrospectively from three fetal medicine units. Patients who have chosen to terminate the pregnancy were excluded from the study. Between January 2003 and July 2009, nine patients met inclusion criteria. Three out of nine couples decided on expectant management, and six preferred selective feticide. With expectant management one fetus died in utero and take home baby rate was 83% (5 of 6 fetuses), delivered at 27–32 weeks. When selective termination was performed, all non-reduced fetuses were born alive at 33–40 weeks. Two survivors of rupture of membranes had limb contractures, none had lung hypoplasia. One patient had clinical signs of amnionitis, which was ruled out later on pathological examination. Her post partum course was uncomplicated. Our data suggest that rupture of membranes in one sac of bichorionic twins at 13–20 weeks has favorable prognosis whether an intervention is preformed or not. Nonetheless, selective termination may have an advantage over expectant management, since gestational age at delivery was higher when selective termination was performed.

Sonographic evaluation of the fetal conus medullaris at 20 to 24 weeks' gestation

OBJECTIVE

To determine the normal level of the conus medullaris (CM) of the spinal cord of normal fetuses at 20 to 24 weeks' gestation using abdominal sonography.

METHODS

Using a 4 to 8 MHz ultrasound abdominal transducer, CM was imaged in the midsagittal plane with the fetal spine facing toward the transducer. The CM ending level was located by counting the vertebrae caudal starting at T12, which was identified by lowest fetal rib. The CM locations were defined according to their positions relative to the vertebrae.

RESULTS

One hundred and ten consecutive pregnant women were included in the study. The CM was clearly demonstrated in 78 (71%) of these cases. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2-3 inter-space and L3 (73/78, 93%). The L1-2, L2, L2-3, and L3 vertebral groups did not differ in mean gestational weeks, maternal age, or fetal gender.

CONCLUSION

The level of the CM can be determined at 20 to 24 weeks' gestation in about 70% of fetuses. Most of the scanned fetuses had the CM ending height adjacent to vertebrae L2, L2-3 vertebral space, and L3 (73/78, 93%). When detected lower than the third lumbar vertebra it should prompt prenatal and postnatal surveillance.

Successful monozygotic twin pregnancy fathered by a male 46,XY true hermaphrodite

This report presents an unusual case of absolute non-obstructive azoospermia revealed to be a male 46,XY true hermaphrodite who was successfully treated to father healthy monozygotic twins. A 27-year-old infertile male with non-obstructive azoospermia previously underwent an unsuccessful testicular sperm extraction procedure and refused donor sperm insemination.Revising the patient’s old records revealed that he was born with ambiguous genitalia. He had a 46,XY karyotype and was raised as a male. During childhood he underwent ambiguous genitalia reconstruction, right orchiopexy and left salpingo-oophorectomy that revealed a gonadoblastoma. A new treatment was employed performing testicular fine needle aspiration leading successfully to a monozygotic twin pregnancy. As far as is known, this is the first reported case of healthy twins fathered by a male 46,XY true hermaphrodite.

Does first polar body morphology predict oocyte performance during ICSI treatment?

PURPOSE

To gain insight into the morphology of the first polar body (1 PB) in ICSI patients and to explore whether it could predict mature oocyte viability and performance in this setting.

METHODS

Seventy two consecutive women planned to perform ICSI treatment were prospectively recruited for this study. All oocytes retrieved underwent evaluation for nuclear maturity and accurate assessment of 1 PB morphology. MII oocytes were cultured in separate groups in each woman in accordance with two different categories of 1 PB morphology. Category A included normal intact round or ovoid 1 PB and category B included abnormal fragmented 1 PB. Each oocyte was followed throughout fertilization, embryo cleavage and embryo transfer. Cycles that reached embryo transfer, were divided into three groups in accordance with 1 PB morphology. Group I included only category A 1 PB embryos, group II included categories A and B 1 PB embryos, whereas group III included only category B 1 PB embryos.

RESULTS

A total of 687 oocytes were aspirated and 553 MII oocytes underwent ICSI leading to 410 zygotes showing normal fertilization on day one. Three hundred ninety seven embryos cleaved on day two and a total of 176 embryos were replaced into the uterus. Clinical implantation and pregnancy rates were significantly correlated with the morphology of the 1 PB corresponding to 31%, 9% and 2% and 61%, 24% and 5%, in groups I, II and III respectively.

CONCLUSIONS

Our findings demonstrate that 1 PB morphology is related to mature oocyte viability and it has the potential to predict oocyte performance and pregnancy achievement in infertile women undergoing ICSI treatment.

[Correlation of maternal serum and amniotic fluid leptin and insulin levels with neonatal birth weight]

BACKGROUND

Numerous studies correlated maternal serum and fetal cord Leptin Levels in pregnancy with new born weight (NBW) and maternal body mass index (BMI). However, there are only a few published studies concerning amniotic fluid leptin and its possible relationship to fetal growth and NBW.

OBJECTIVES

To correlate leptin and insulin in amniotic fluid and maternal serum collected at 16-20 gestational weeks to NBW.

METHODS

This was an observational study in which maternal serum Leptin, insulin, and amniotic fluid Leptin and insulin, studied from 70 healthy pregnant women undergoing amniocentesis for karyotyping, at 16-20 weeks gestation. NBW was correlated with maternal BMI and leptin and insulin Levels in maternal serum and amniotic fluid.

RESULTS

Maternal serum leptin was detected as the best predictor of NBW. Squared correlation coefficient, r2 = 0.09, was statistically significant (P < 0.01). Maternal BMI correlated significantly with serum Levels of insulin and leptin r2 = 0.16 and 0.27 respectively, P < 0.01.

CONCLUSION

In normal pregnancies, amniotic fluid Leptin correlates partially with NBW. Maternal serum leptin correlates significantly with NBW.

[The genetic sonogram]

Mid-trimester soft sonographic markers have been linked with aneuploidies. This article describes the individual sonographic markers used in the genetic sonograms, and reviews the current relevant Literature. The significant soft markers are: nuchal thickness, echogenic bowel, shortened limbs and absence of nasal bone. The soft markers which are not significant as an isolated finding in young patients but are significant in combination with the biochemical markers, or in older age are: intracardiac echogenic focus, choroid pLexus cyst, pyelectasis and single umbilical artery. There are several other reported findings which might be linked to chromosomal abnormalities including hypoplasia of the middle phalanx of the fifth digit, sandal gap, ear size, brachycephaly, cervical cyst, iliac angle and others. These findings shouLd not be considered as soft markers since they were reported only in small series or case reports. The aneuploidy risk should be calcuLated on the basis of age, nuchal translucency, biochemical screening and anomaly scan. If the calculated risk for aneupLoidy exceeds 1:380, an invasive karyotyping procedure should be recommended. Adoption of this approach will reduce the unnecessary invasive tests, reduce abortion rate and will increase the detection rate of aneuploidy.

A simple multivariate score could predict ovarian reserve, as well as pregnancy rate, in infertile women

OBJECTIVE

To find a simple multivariate score that has the potential to predict ovarian reserve, as well as pregnancy rate, in infertile women.

DESIGN

A prospective study.

SETTING

A university-affiliated reproductive medicine unit.

PATIENT(S)

One hundred sixty-eight consecutive women undergoing their first IVF-ET treatment at our unit.

INTERVENTION(S)

Basal ovarian reserve studies, endocrine and sonographic, were performed before starting therapy. After completion of treatment, a logistic regression analysis was performed to examine which parameters significantly determined low ovarian reserve. These parameters were incorporated thereafter in a multivariate score to predict ovarian reserve, as well as clinical pregnancy rate.

MAIN OUTCOME MEASURE(S)

Low ovarian reserve defined as <or=3 oocytes on retrieval day and clinical implantation and pregnancy rates.

RESULT(S)

Logistic regression analysis revealed that age, antral follicle count, basal FSH, FSH/LH ratio, mean ovarian volume, infertility duration, number of previous cycle cancellations, and body mass index were all, in decreasing significance, independent factors that determine low ovarian reserve. The multivariate score was shown to have a distinctive prediction of ovarian reserve. A cumulative score of >14 was shown to be more accurate in predicting low ovarian reserve than age, day 3 FSH, or antral follicle count separately. Moreover, a score of >14 was shown to have a sensitivity of 88% and a specificity of 69% in predicting low ovarian reserve. More important, women with a score of >14 had significantly lower clinical implantation and pregnancy rates relative to women with a score of <or=14, corresponding to 6.7% versus 22.4%, and 11.3% versus 38.6%, respectively.

CONCLUSION(S)

A novel and simple multivariate score using clinical and basal endocrine and sonographic parameters has a distinctive prediction of low ovarian reserve in infertile women undergoing assisted reproductive technology treatment. Moreover, it has the potential to predict clinical implantation and pregnancy rates in women with low and good ovarian reserve.

Prenatal diagnosis of fetal cardiac right ventricular diverticulum disappearing at three months of age. A case report and literature review

Congenital cardiac diverticula are transmural localized protrusions within the free wall of the ventricles. Right ventricular diverticula are rarely diagnosed during the fetal period, and due to their rarity, their natural history remains unclear. We present a case of prenatal diagnosis of right ventricular diverticulum at 22 weeks' gestation. No other pathological findings were detected, the pregnancy and delivery were uneventful, and the diverticulum disappeared before the age of 3 months. Echocardiography of the infant at 1 year of age revealed no cardiac diverticulum or any cardiac anomaly and showed normal heart function. Literature review of all cases published to date reveal good outcome of right ventricular diverticula. We suggest reassuring our patients about the good prognosis of this cardiac anomaly.

Abdominal compartment syndrome after laparoscopic salpingectomy for ectopic pregnancy

Abdominal compartment syndrome is a consequence of increased intraabdominal pressure. It can be triggered by inflammation, hemorrhage, chemical peritonitis, or prolonged insufflations during laparoscopy. It is a well-known phenomenon for intensive care specialists, but gynecologists are relatively unfamiliar with its occurrence. A woman with heterotopic pregnancy underwent urgent laparoscopy because of abdominal hemorrhage. The postoperative course was complicated by abdominal pain, ascites, bowel dysfunction, and renal failure, which resolved rapidly after catheterization and paracentesis. In this case, abdominal compartment syndrome developed after unremarkable laparoscopy, and appeared to be triggered by change of progesterone formulation. Decompression by paracentesis was lifesaving, and led to rapid resolution of the symptoms.

Nonconventional approach to twin pregnancies complicated by extremely preterm premature rupture of membranes of one twin

The common management in most centers in cases of multiple pregnancies with preterm premature rupture of membranes (PPROM) before 22 weeks of gestation is termination of the pregnancy or the expectant approach. Expectant management of previable PPROM in twin pregnancies results in an increased rate of fetal and neonatal morbidity and mortality of both twins. Selective fetocide of the twin with early midtrimester rupture of membranes may improve the unfavorable pregnancy outcome of the remaining fetus. We report two successful cases of twin pregnancies complicated by extremely PPROM managed by selective fetocide of the affected twin, with an uneventful single pregnancy course and delivery of healthy newborns at 36 weeks of gestation.

Undetectable basal ovarian stromal blood flow in infertile women is related to low ovarian reserve

To gain insight into the physiological significance of basal ovarian stromal blood flow and to assess whether its detection ability is related to ovarian reserve in infertility patients undergoing in vitro fertilization (IVF) - embryo transfer (ET) treatment. Thirty two consecutive infertile women scheduled for IVF-ET treatment were prospectively evaluated. Basal ovarian hormonal, ovarian volume and stromal blood flow studies were performed on day 3 of a natural cycle before treatment. The performer of the ultrasound studies was blinded to the clinical data. Women in the study were divided into two groups in accordance with estradiol level on the day of administration of human chorionic gonadotropin. Day-3 follicle-stimulating hormone and ovarian volume were significantly poorer in the women with low (group A) as compared with good (group B) ovarian reserve. Likewise, the numbers of follicles > or =14 mm in diameter, oocytes retrieved and embryos achieved were significantly lower in group A than group B. Six clinical pregnancies were obtained in group B, whereas no pregnancy was obtained in group A. Nine out of the 15 (60%) women in group A had undetectable basal stromal blood flow in at least one of the ovaries, whereas only one of the 17 (6%) women in group B had undetectable flow (p < 0.002). Basal stromal peak systolic blood flow velocity, pulsatility index and resistance index mean values did not differ significantly between the two groups. We conclude that undetectable basal ovarian stromal blood flow in at least one ovary is related to low ovarian reserve in infertile women undergoing IVF-ET. It seems that undetectable basal stromal blood flow is not solely a technical issue, but rather linked to the pathophysiology of ovarian aging.

Poor oocyte retrieval is a manifestation of low ovarian reserve

Women with complete absence of oocytes during retrieval, as well as those with less than the 10th percentile of the expected number of oocytes retrieved, have clear manifestations of low ovarian reserve. It seems that this occurrence is a gradual biological phenomenon related to the basic pathophysiology of ovarian aging.

Evaluation of fetal cardiac contractility by two-dimensional ultrasonography

OBJECTIVE

Evaluation of fetal cardiac contractility by two-dimensional ultrasonography and construction of nomograms of area shortening fraction, end-diastolic area and end-systolic area of fetal cardiac ventricles during uncomplicated pregnancy.

MATERIALS AND METHODS

Fetal echocardiography was performed on 160 pregnant women between 14 and 28 weeks' gestation. Measurements were taken on the four-chamber view. The area of each ventricle was measured by tracing the endocardium at the end of systole and at the end of diastole. Area shortening fraction was calculated by the following formula: SF = (Ad - As)/Ad (SF--area shortening fraction, Ad--end-diastolic ventricular area, As--end-systolic ventricular area).

RESULTS

A statistically significant increase in normal fetal area shortening fraction, end-diastolic area and end-systolic area of both ventricles with advancing gestational age was established. There were no significant differences in the area shortening fraction between right and left ventricles.

CONCLUSIONS

Area shortening fraction shows good correlation with gestational age. Nomogram of area shortening fraction, end-diastolic area and end-systolic area of both ventricles can be used as the reference for evaluation of ventricle size and cardiac contractility in normal and pathological cases.

Pregnancy outcome after laparoscopy or laparotomy in pregnancy

STUDY OBJECTIVE

To assess obstetric performance and fetal outcomes after laparoscopy or laparotomy performed during pregnancy.

DESIGN

Nationwide, multicenter, retrospective chart review (Canadian Task Force classification II-2).

SETTING

Seventeen hospitals throughout Israel: 12 university or university-affiliated hospitals and 5 general hospitals.

PATIENTS

Three hundred eighty-nine pregnant women.

INTERVENTION

Laparoscopy or laparotomy for various indications.

MEASUREMENTS AND MAIN RESULTS

Of 192 laparoscopies performed, 141 were during the first, 46 during the second, and 5 during the third trimester; respective figures for 197 laparotomies were 63, 110, and 24. No intraoperative complications were reported for either procedure. Six and 25 women had complications after laparoscopy and laparotomy, respectively. There was no significant difference in abortion rates between groups. Mean gestational age at delivery and mean birthweight were comparable between groups. No significant difference was found in frequency of fetal anomalies between groups or when compared with the Israel register of anomalies.

CONCLUSION

Operative laparoscopy seems to be as safe as laparotomy in pregnancy.

In-utero development of the fetal colon and rectum: sonographic evaluation

OBJECTIVE

To construct a normal range for the internal diameter of the fetal descending colon and rectum during gestation.

SUBJECTS AND METHODS

This was a prospective, cross-sectional study including 379 healthy pregnant women with normal singleton pregnancies at 19-40 weeks of gestation. Measurements of the fetal descending colon (maximum internal diameter) and the fetal rectum (at the level of the bladder, measuring the anteroposterior diameter), were performed by high-resolution transabdominal sonography.

RESULTS

Adequate bowel measurements were obtained in all 379 fetuses. The diameter of the descending colon and rectum plotted as a function of gestational age had a sigmoid curve; the curve estimation was expressed by a cubic regression equation with R(2) of 0.848 and 0.831, respectively (P < 0.0001). The normal mean and the 95% prediction limits were defined.

CONCLUSION

The present data provide a normal range of fetal bowel (descending colon and rectum) diameters from the early second trimester of pregnancy onwards. They may allow intrauterine assessment of the development of the fetal colon and may serve as reference values in the detection of anomalies of the fetal bowel.

Effects of soy protein on endothelium-dependent vasodilatation and lipid profile in postmenopausal women with mild hypercholesterolemia

BACKGROUND

Estrogens appear to improve endothelium-dependent systemic and coronary vasodilator function, perhaps by increasing nitric oxide levels and the subsequent effect of nitric oxide on endothelial function and smooth-muscle relaxation. Because soybean foods contain phytoestrogens, we evaluated the effect of orally administered soy proteins on vascular responsiveness.

METHODS

This double-blind, placebo-controlled crossover study involved 24 postmenopausal women (mean age 55 yr) who were hypercholesterolemic, who were not taking hormone replacement therapy and had not taken antioxidants or lipid-lowering agents in the preceding 2 months. The patients were randomized to receive a 25-g soy protein supplement or a mild protein placebo for 6 weeks, separated by a washout period of 4 weeks. To evaluate nitric oxide bioactivity we used ultrasonography to measure endothelium-dependent dilator responses in the brachial artery to hyperemia. We induced hyperemia by inflating a blood pressure cuff on the forearm to 250 mm Hg for 5 minutes. We also determined the effect of the supplements on various lipids.

RESULTS

The mean (+/- standard deviation) brachial artery diameter was similar in both groups (3.94 [0.79] mm in the placebo group and 4.13 [0.74] mm in the soy protein group). In both placebo and protein groups, the serum triglyceride levels increased, and total cholesterol and low-density lipoprotein cholesterol levels fell significantly (p < 0.05). High-density lipoprotein cholesterol levels were little changed.

INTERPRETATION

Consumption of a supplement of 25 g of soy protein daily for 6 weeks had no measurable effect on arterial diameter or vasodilatation in response to hyperemia.