Microparticles hyperactivity in a case of intrauterine growth restriction

A case of a residual intrauterine fetal growth is described in a primiparous woman, aged 33 years, undergoing the 37th week of pregnancy. The patient was admitted to the outpatient department of the present clinic complaining of decreased fetal movement in the past few days. The cardiotocography (CTG) was non reactive, with reduced variability for a period of more than 30 minutes. The evaluation of the activity of microparticles (MPs) showed a value of 48.90 nM, which was 21.26 times higher than the mean of normal women of comparable pregnancy age (2.31 ± 1.95 nM) and 18.11 times higher than that of the average women who had intrauterine growth retardation (2.70 ± 2.63 nM). The reasons for this increase in the activity of the MPs are discussed in this case report.

Total infusion of low molecular weight iron-dextran for treating postpartum anemia

AIM

135 puerperal women with iron deficiency anemia participated in our prospective randomized controlled trial in order to investigate alternative treatments to blood transfusion for anemia.

MATERIALS AND METHODS

The criteria for the diagnosis of anemia were Hb < 8 g/dl and ferritine < 10 microg/dl. Women were randomly separated in two groups, A and B. Women of group A (n = 109 women) received a total amount of 1000 mg low molecular weight (LMW) iron-dextran intravenously in two doses. Group B (n = 26) was the control group. They received orally 800 mg daily for 30 days of iron protein-succinylate. Three weeks later women of both groups underwent a full blood count analysis.

RESULTS

Hemoglobin and ferritin levels increased significantly in group A compared to group B (p < 0.0001). No adverse side-effects due to the treatment were noted in either group.

CONCLUSION

It seems that total iron-dextran infusion is a safe and rapid therapy of iron-deficiency postpartum anemia increases the Hb level more rapidly than oral ferrous sulfate, and it also appears to replenish iron stores more rapidly.

Correlation between asymmetric dimethylarginine maternal plasma levels and preeclampsia

OBJECTIVE

To aim of our study is to support the correlation between blood pressure and asymmetric dimethyl argine (ADMA) concentrations as a possible marker for early diagnosis of the preeclampsia syndrome.

STUDY DESIGN

We attempted to calculate in 38 pregnant women with preeclampsia (group A) plasma levels of the main inhibitor to nitric oxide synthase (NOS), which is ADMA, and to compare our findings with the levels of ADMA in 36 non preeclamptic pregnant women (group C) and also with the levels in 29 pregnant women who had a history of preeclampsia in previous pregnancies (group B). Maternal venous EDTA plasma samples of 5 ml were collected and analyzed to measure the ADMA concentrations in each subject. Statistical analysis was performed using the Graph Pad Instat Mann-Whitney test, unpaired, non parametric test, two-tail p values.

RESULTS

There was no statistical difference between the three groups regarding maternal and gestational age (24-32 weeks). There was a significant statistical difference between the three groups regarding ADMA levels. The two-tailed p value between group A and group C (normal group) was < 0.001, between group A and group B < 0.002 and between group B and group C < 0.002.

CONCLUSION

In conclusion we have observed that ADMA probably fulfills many of the criteria to be characterized as a preeclamptic factor and an accurate cut-off point matched to each week of pregnancy should be determined.

D-dimer levels as a predicting factor for DIC following single twin death: a case report and review of the literature

BACKGROUND

Intrauterine death of one twin in the second or third trimester occurs in about 1% of all twin pregnancies. The retention in utero of the dead fetus may be associated with maternal disseminated intravascular coagulation.

CASE

We present the case of a diamniotic monochorionic pregnancy with intrauterine death of the first twin at 24 weeks. The pregnancy reached 33 weeks. In our case although all coagulation factors were within normal limits, D-dimer levels were significantly high, without any evidence though of any clotting problems to the mother.

CONCLUSION

The role of D-dimers is practically unknown in multiple pregnancies. It seems that the interpretation of elevated D-dimer levels is still of limited value for prediction or prognosis of thromboembolic complications of multiple pregnancies.

Pregnancy-associated breast cancer--a review analysis

The aim of the present review was to assess the relationship between pregnancy and/or lactation and breast cancer, the influence of pregnancy on mortality and prognosis of the disease, the consequences of breast cancer to the current pregnancy and also to discuss the future perspective for women's fertility.

MATERIALS AND METHODS

Articles were obtained from Medline (1988 present) using as keywords breast cancer, pregnancy, breastfeeding, lactation, carcinoma and pregnancy.

RESULTS

Unfortunately, delays in diagnosis and treatment are common during pregnancy and the prognosis is thus worsened. Nulliparity, early menarche and late age at first pregnancy are associated with increased risk for breast cancer. Breastfeeding confers a protective effect on risk of breast cancer, which appears to be related to the duration of breastfeeding. In cases of advanced metastatic disease during the first 14 to 15 weeks of pregnancy when chemotherapy is necessary for prompt treatment, termination of pregnancy may be proposed, particularly if the patient is ER-positive. Modified radical mastectomy is probably the procedure most frequently used today. In general chemotherapy should be delayed until after 14 to 15 weeks of gestation and radiation should be reserved until post delivery. Several authorities generally advise that future pregnancy should be delayed for at least two years after breast cancer treatment.

CONCLUSION

Breast cancer has an equivalent prognosis in pregnant and non pregnant patients when matched by age and stage at diagnosis. Women are invariably best treated by multidisciplinary teams.

Intravenous administration of iron sucrose for treating anemia in postpartum women

BACKGROUND

To compare the efficacy of oral and intravenous administration of iron supplements for treating postpartum anemia.

METHODS

One hundred and four anemic postpartum women were studied prospectively. The criteria for the diagnosis of anemia were Hb<8 gr/dl and ferritine<10 microg/dl. They were randomised into two groups. Group A consisted of 78 women who received i.v. a total amount of 300 mg iron sucrose in three days. Group B consisted of 26 women, who received orally 800 mg iron proteinsuccinylate daily for four weeks.

RESULTS

At the end of the study, in group A the increase of Hb mean level was 4.6 gr/dl and of ferritin mean level was 105 mg/L. In group B the increase in hemoglobin mean level was 2.3 gr/dl and ferritin mean level was 68 mg/L. There was significant difference in the increase of hemoglobin level (p=0.0001) and also in the increase in ferritin level (p=0.0004) between the two groups.

CONCLUSION

Intravenous administration of iron sucrose seems to be safe and it helps postpartum women to recover early from anemia.

Anorexia nervosa in pregnancy: a case report and review of the literature

Anorexia nervosa is a complex illness rarely encountered in pregnant women. It is a disorder characterized by markedly decreased food intake accompanied by a distorted body image, resulting in an inability to maintain the body weight within 85% of ideal body weight. We describe a case of a pregnant woman diagnosed with anorexia nervosa at 28 weeks of gestation. Her body mass index was 17 kg/m(2). A live male infant weighing 2,08 kg was delivered prematurely via vaginal delivery at 35 weeks of gestation. Pregnant women with anorexia nervosa may have a higher risk of hypertension, miscarriage, difficult labour, premature delivery and intrauterine growth restriction. Management of pregnancy complicated with anorexia nervosa requires involvement of a multidisciplinary team and hospitalization in severe cases.

A four-year retrospective study of amniocentesis: one centre experience

AIM

Monitor the performance of the amniocentesis procedure for prenatal diagnosis and particularly the acquisition of results (time to get, success in getting them).

MATERIALS AND METHODS

This is a retrospective review of case notes of all pregnant women undergone amniocentesis in our department during the period 2002-2005. Two main operators performed the procedure, using 22 gauze needle usually and 20 gauze should longer needle was needed. Sevendy three patients undergone amniocentesis. The reasons for having this procedure were: increased risk for Down syndrome in 68% (50/73), maternal request in 24% (18/73), suspicious ultrasound findings in 4% (3/73) and family history in 3% (2/73). Maternal age ranged from 20 to 45 years and the gestation time that amniocentesis was performed was 15 to 23 weeks. Fluorescence in situ hybridization (FISH) and culture were used in order to obtain karyotype results.

RESULTS

In 92% (67/73) of cases one needle pass was needed. FISH and culture were performed in 96% (70/73) of cases, FISH only in 3% (2/73) and culture only in 1% (1/73). The chromosome results were normal in 93% (68/73) of cases, Down's syndrome in 4% (3/73) and Edwards syndrome in 3% (2/73). The outcome of pregnancies was: live births in 89% (65/73), stillbirths at 32 weeks and 35 weeks in 3% (2/73), miscarriages in 1% (1/73 at 19 weeks, 3 weeks after the amniocentesis), terminations in 7% (5/73, due to chromosomal abnormalities). Sixty one women delivered at term (84%) and 6 women (8%) delivered preterm.

CONCLUSION

The post amniocentesis rate of miscarriage is calculated at 1% in our centre. FISH analysis can relieve stress of couples by reducing the waiting time for results.

Tension free vaginal tape underneath bladder base: does it prevent cystocele recurrence?

OBJECTIVE

The target of the current prospective study was to assess the effectiveness of the polypropylene tapes in preventing recurrence of cystocele formation when placed underneath the bladder base.

MATERIALS AND METHODS

Twenty-two Caucasian women, predominantly postmemopausal with marked descent of the anterior, middle and/or posterior pelvic segment, participated in the study. Vaginal reconstructive surgery including anterior colporrhaphy and Kelly placation, posterior colpoperineorrhaphy and/or hysterectomy, was undertaken in all subjects. The polypropylene tape was placed not under the midurethra, as often performed in stress urine incontinence (SUI) cases, but underneath the bladder base as an adjunct to the anterior colporrhaphy sutures. The postoperative follow up lasted 2 years and was carried out every 4 months. The assessment of the anatomic result included evaluation of the operated sites and the position of the tapes inserted on clinical grounds and after perineal sonography. Urodynamic assessment was performed in the presence of urinary incontinence.

RESULTS

In all patients the postoperative correction of the anterior vaginal wall was sufficient, 14 subjects did not present genitourinary symptoms and therefore were considered as cured; three patients were designated as improved because despite sufficient anatomic correction of the anterior vaginal segment they reported urinary incontinence symptoms. Retropubic haematoma occurred in 1 patient, transient urge incontinence in 1, transient stress incontinence in 1, and persistent stress incontinence also in 1. There was no erosion of the tape noticed. Mean residual urine was 30 ml, mean bladder base distance to the inferior edge of the symphysis pubis was 1.2 cm and the mean total vaginal length was 7 cm.

CONCLUSION

Despite the relative short follow up period and the limited number of patients enrolled, we conclude from our study that the use of polypropylene tapes as an adjunct for fortification of the anterior pelvic segment could provide an option in preventing recurrence of cystocele formation.

Cholestasis and Pregnancy

Obstetric cholestasis is an intrahepatic multifactorial disease, unique to pregnancy which presents with intense pruritis and abnormal liver function tests (LFTs). It commonly presents in the third trimester and becomes more severe with advanced gestation. The prevalence of obstetric cholestasis is influenced by genetic and environmental aspects and varies in different populations. The pathogenesis appears to relate to a predisposition to the cholestatic effect of increased circulating oestrogens and progestogens. Also genetic mutations have been reported in a sub-group of women with elevated γ-GT. There can be significant maternal morbidity due to intense pruritis and consequent sleep deprivation. There may be malabsorption with steatorrhea resulting in vitamin K deficiency, prolongation of clotting times and increased risk of postpartum haemorrhage (PPH). Caesarian section rate is much higher for women with obstetric cholestasis. The potential fetal risks include preterm labour and prematurity and unexplained intrauterine death. The aim of the management of obstetric cholestasis is to avoid fetal complications and to relieve maternal symptoms. A variety of drug therapies have been used to reduce maternal pruritis. Policies of active management and induction of labor before 38 weeks may improve pregnancy outcome. Obstetric cholestasis is a diagnosis of exclusion, and other causes of pruritis should be excluded.

A prospective two years study of first trimester screening for Down syndrome

INTRODUCTION

Nowadays maternal age of pregnant women has increased in most developed countries. The rate of women above 35 years old constitutes about 15% of pregnancies.

AIM

The aim of our study is to prove that by first trimester screening, the number of women who have indication for invasive prenatal diagnostic procedure is significantly reduced.

MATERIALS AND METHODS

This prospective study lasted two years from 02/2005 to 02/2007. The participants to our study were 531 pregnant women with a mean maternal age of 30 years (19-42). We used the first trimester screening test for Down's syndrome. The biochemical blood test of free b-hCG (beta human chorionic gonadotropin) and PAPP-A (pregnancy associated plasma protein A) and the measurement of nuchal translucency were performed between 11-13 weeks +6 days (mean gestational age 12 weeks +2 days).

RESULTS

In our study group, 69 women (12%) were 35 years old or more. The risk estimate for Down syndrome was 1 in 300 or more in 14 (2%) cases. In all these 14 cases we offered CVS (chorionic villus sampling) or amniocentesis.

CONCLUSION

It is a fact that although the risk of any individual 36 years old is higher, most abnormalities (approximately 70%) occur in the low risk population. With the first trimester screening the sensitivity of detecting DOWN syndrome reaches 90%. Our study confirms that by first trimester screening, the number of women who have indication for invasive prenatal diagnostic procedure is significantly reduced. As a result the cost for prenatal diagnosis of the population and also the risk of iatrogenic missed miscarriages is also reduced. Finally, this screening method gives the advantage of early diagnosis.

Fine needle aspiration cytology of the ovary: is it reliable?

PURPOSE OF INVESTIGATION

The purpose of this study was to evaluate the cytologic findings from the fluid of ovarian cysts in comparison with the histologic diagnosis.

METHODS

Over a four-year period all women with single ovarian cysts and no evidence of malignancy from ultrasound examination and tumour marker levels were included in the study. Prior to removal of the cyst, fluid was aspirated from the cyst and prepared for cytologic examination. Subsequently the ovarian cyst wall and biopsy from the ovary were sent for histologic examination. The cytologic findings were compared to the histologic diagnosis.

RESULTS

The material of the study was 120 ovarian specimens from 107 women. Twenty-four (20%) of the specimens submitted for cytology were non diagnostic and a comparison between cytologic and histologic findings was possible in 96 cases. The sensitivity and the specificity of fine needle aspiration (FNA) cytology of the ovary was 25% and 97%, respectively.

CONCLUSIONS

FNA cytology of the ovary is an accurate method for predicting benign ovarian histologic findings in carefully selected populations.