A Enekwe

Serum concentrations of afamin are elevated in patients with polycystic ovary syndrome

Oxidative stress seems to be present in patients with polycystic ovary syndrome (PCOS). The aim of this study was to evaluate the correlation between characteristics of PCOS and serum concentrations of afamin, a novel binding protein for the antioxidant vitamin E. A total of 85 patients with PCOS and 76 control subjects were investigated in a pilot cross-sectional study design between 2009 and 2013 in the University Hospital of Essen, Germany. Patients with PCOS were diagnosed according to the Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group. Afamin and diagnostic parameters of PCOS were determined at early follicular phase. Afamin concentrations were significantly higher in patients with PCOS than in controls (odds ratio (OR) for a 10 mg/ml increase in afamin=1.3, 95% CI=1.08–1.58). This difference vanished in a model adjusting for age, BMI, free testosterone index (FTI), and sex hormone-binding globulin (SHBG) (OR=1.05, 95% CI=0.80–1.38). In patients with PCOS, afamin correlated significantly with homeostatic model assessment-insulin resistance (HOMA-IR), fasting glucose, BMI, FTI, and SHBG (P<0.001), but in a multivariate linear model, only HOMA-IR remained significantly associated with afamin (P=0.001). No correlation was observed between afamin and androgens, LH, FSH, LH/FSH ratio, antral follicle count, ovarian volume, or anti-Müllerian hormone. In conclusion, elevated afamin values may indicate a state of oxidative stress and inflammation, strongly associated with IR and offering an indicator of impaired glucose tolerance in patients with PCOS irrespective of obesity.

The Use of Plasma Exchange in a Very Early-onset and Life Threatening, Hemolysis, Elevated Liver Enzymes, and Low Platelet (HELLP) Syndrome: A Case Report

Background: HELLP syndrome is a life threatening pregnancy and early postpartum complication. Very early presentation (before the 21st pregnancy week) is rare and represents an extremely difficult situation for patients and physicians. Supportive therapy (magnesium sulfate, antihypertensive drugs and corticosteroids) may be useful to prolong pregnancy; till now the removing of placenta is the only effective therapeutic option. Plasmapheresis may represent a new and efficacious therapeutic option. Case description: The article reports on a case of very-early onset HELLP Syndrome at the 18th (17+5) week of gestation. It was a challenging clinical and therapeutic case. Since the fetus did not show any signs of growth retardation or pathological Doppler findings, indicating a good fetal prognosis, we used plasmapheresis as an ultima ratio to prolong pregnancy. With plasmapheresis, the pregnancy was prolonged for 20 days. Unfortunately the deterioration of the clinical situation required delivery in the 21st (20+4) gestational week. Conclusion: Plasmapheresis allows prolongation of pregnancy with early onset, life threatening HELLPSyndrome.

Follistatin during pregnancy and its potential role as an ovarian suppressing agent

OBJECTIVE Ovarian quiescence is a common condition during pregnancy. In vitro, follistatin, an antagonist of follicle-stimulating hormone, blocks follicular development at early stages, and its serum levels increase during pregnancy. A possible surrogate biomarker of ovarian arrest during pregnancy is a decrease in anti-mullerian hormone (AMH) levels followed by an increase in these levels on the second day after labor. The purpose of this study was to determine whether follistatin could act as an ovarian-suppressing agent during pregnancy. Follistatin levels and AMH levels were determined at various stages of pregnancy and postpartum. STUDY DESIGN The follistatin and AMH levels of 69 patients were retrospectively determined with the AMH Gen II ELISA and with the Human Follistatin Quantikine ELISA Kit. For 49 patients, samples were available from various trimesters for cross-sectional analysis; for the other 20, samples were available longitudinally from day one before labor and then daily on days 1 through 4 after labor. Statistical significance was determined with linear regression, the Friedman rank sum test and the Wilcoxon-Nemenyi-McDonald-Thompson post hoc test. RESULTS The behavior of follistatin levels was exactly opposite that of AMH levels: Follistatin levels increased significantly during pregnancy and on the first day after parturition but declined afterwards, whereas AMH levels decreased significantly during pregnancy and increased after labor. CONCLUSION Follistatin can induce ovarian arrest during pregnancy.

Change of anti-Mullerian-hormone levels during follicular phase in PCOS patients.

Abstract Anti-Mullerian-hormone (AMH) does not seem to fluctuate significantly during the menstrual cycle in healthy women. However, little is known about cycle fluctuations of AMH levels in patients with polycystic ovarian syndrome (PCOS). The purpose of this study was to examine AMH fluctuations during the follicular phase in PCOS patients receiving antiestrogens or recombinant follicle-stimulating hormone (FSH). About 40 PCOS patients diagnosed according to Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group 2003 and 19 controls were prospectively enrolled. PCOS patients received either antiestrogens or recombinant FSH for monoovulation induction and controls received antiestrogens. AMH levels were determined (1) between the 2nd and the 5th day of follicular phase and (2) when a single large dominant follicle ≥18 mm had appeared. Our study shows that AMH levels do not change during follicular development in controls as well as in PCOS patients with AMH levels < 5 ng/ml, irrespective of antiestrogen or FSH therapy. However, in PCOS patients with AMH levels ≥5 ng/ml, AMH declines significantly during follicular development (p < 0.01). We conclude that AMH levels should be determined in the early follicular phase in PCOS patients without the influence of antiestrogens or exogenous FSH, because these interventions may lower AMH values in patients with high levels. Chinese abstract 抗苗勒管激素（AMH）在健康妇女月经周期中似乎并没有明显波动。然而多囊卵巢综合征（PCOS）患者月经期AMH水平的变化却鲜为人知。本研究的目的是检测PCOS患者卵泡期接受抗雌激素或重组卵泡刺激素（FSH）治疗后AMH水平的波动。其中40名患者诊断为PCOS（根据2003年欧洲人类生殖与胚胎学会和美国生殖医学会发起的PCOS共识研讨会），19人纳入对照组。PCOS患者采用抗雌激素或重组FSH诱发单卵泡发育，对照组接受抗雌激素治疗。(1)月经第2天至第5天和（2）出现单个优势卵泡（卵泡直径≥18mm）时分别监测AMH水平。我们的研究表明无论是否接受抗雌激素或FSH治疗，对照组和AMH＜5ng/ml的PCOS组AMH水平在卵泡发育过程中并没有波动。而AMH＞5ng/ml的PCOS组，AMH在卵泡发育过程中则显著下降（P＜0.01）。我们得出结论PCOS患者AMH水平应在没有接受抗雌激素或外源FSH治疗的早卵泡期测定，因为对于高AMH水平的PCOS患者这些干预治疗可能会降低AMH水平。

Predictive value of sFlt-1, PlGF, sFlt-1/PlGF ratio and PAPP-A for late-onset preeclampsia and IUGR between 32 and 37 weeks of pregnancy

OBJECTIVES The aim of this study was to investigate, whether maternal serum levels of sFlt-1, PlGF and PAPP-A at third trimester of pregnancy are associated with late-onset PE and intrauterine growth retardation (IUGR) after 34 weeks of pregnancy. METHODS This was a prospective study measuring the maternal serum levels of soluble tyrosine kinase-1 (sFlt-1), placental growth factor (PlGF) and pregnancy-associated plasma protein-A (PAPP-A) at 32-37 weeks of pregnancy: 730 patients were enrolled and 676 had neither intrauterine growth restriction (IUGR) nor preeclampsia (PE) or pregnancy induced hypertension (PIH) throughout the pregnancy. 22 patients developed IUGR, 32 PE and 24 PIH. RESULTS Linear regression analyses after adjusting for maternal age, gestational age at the blood sampling and maternal BMI showed associations between PE and serum sFlt-1 levels (Exp(ß) = 3.29; 95% CI: 2.69-4.04), serum PlGF levels (Exp(ß) = 0.18; 95% CI: 0.13-0.24), sFlt-1/PlGF ratio (Exp(ß) = 15.59; 95% CI: 10.64-22.84) and serum PAPP-A (Exp(ß) = 1.48; 95% CI 1.15-1.89). sFlt-1, PlGF and sFlt-1/PlGF-Ratio showed comparable area under the curve (AUC) estimates with a predictive ability to discriminate pregnancies developing PE and IUGR from controls. The predictive ability of PAPP-A for PE was only slightly better than chance. CONCLUSIONS This study supported the ability of a single measurement of sFlt-1/PlGF ratio at third trimester to predict PE and IUGR occurring after 34 weeks of pregnancy. However, larger multicentre studies are needed to replicate our results.

Vascular biopsy of the placenta using VOCAL2 ultrasound software in the prediction of IUGR

Methods Placental vascular image biopsy was taken using VOCAL2 software, prospectively, during the scan, using a practical approach by optimised machine settings (21 cases with IUGR, 233 controls). This enabled the examiner to take the image in 5 seconds. The 3D power Doppler measurements such as placental vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI) were calculated using the machine software. To compare the placental function with the new measurements, the Doppler measurements of the uterine arteries, umbilical artery and middle cerebral artery were performed. The 5. percentile in birth weight was taken as cut-off to define the newborns with IUGR. Linear regression analysis was used to estimate the difference of each placental vascular index between IUGR and control pregnancies after adjusting for gestational age.

Geburtseinleitung: „anything new?“

ZusammenfassungDie Geburtseinleitung ist eine häufige geburtshilfliche Maßnahme, die bei angemessener Indikationsstellung Vorteile für Mutter und Kind erbringen kann. Zur Verfügung stehen sowohl medikamentöse als auch mechanische Methoden: PGE1/PGE2 in unterschiedlicher Verabreichungsform und Oxytocin sowie mechanische Instrumente wie der Zervixreifungsballon (CRB Cook®) und Foley-Katheter (Off-label-Use). Ein kombiniertes Einleitungsschema, das mechanische Methoden wie den Zervixreifungsballon impliziert, erscheint effektiv, sicher und für die Patientinnen sehr zufriedenstellend.AbstractInduction of labor is a common obstetric procedure, which, when based on appropriate indications, can be advantageous for mother and child. Drug-based and mechanical methods are available: prostaglandins (PGE1/PGE2) in various administration forms and oxytocin; as well as mechanical instruments such as the Foley catheter (off-label use) and the cervical ripening balloon (CRB Cook®; Cook Group, Bloomington, Indiana, USA) can be used. Combined induction implicating mechanical methods such as the CRB seems to be effective, safe, and comfortable for patients.

Substanzabusus in der Schwangerschaft

ZusammenfassungDer Konsum legaler oder illegaler Substanzen kann zu Schäden der Mutter-Plazenta-Kind-Einheit führen. Am bekanntesten ist das fetale Alkoholsyndrom, es spiegelt die Teratogenität von Alkohol wider. Auch für andere Substanzen wie Nikotin, Amphetamine, Kokain und Cannabis wurden in Studien nicht nur unmittelbar postnatal Auffälligkeiten des Neugeborenen beschrieben. Vermutlich kommt es durch fetale Programmierung und Störung des neuroendokrinen Systems pränatal zu Auffälligkeiten, die bis ins Jugendalter nachweisbar sind. Für die Betreuung der substanzabhängigen Schwangeren und deren Kindern ist eine interinstitutionelle Vernetzung zwischen medizinischen Fachgebieten und Ämtern nötig.AbstractThe use of legal or illicit drugs can cause damage to the mother–placenta–fetus entity. Best known is fetal alcohol syndrome, which reflects the teratogenicity of alcohol. For other drugs such as nicotine, amphetamine, cocaine, and cannabis, studies have also demonstrated abnormal symptoms that are not limited to the postnatal period. Fetal programming and prenatal disturbance of the neuroendocrine system are presumably responsible for symptoms and disorders which can be observed into adolescence. In order to care for the substance-dependent pregnant woman and her child, it is necessary to work within an interinstitutional network of medical departments and public institutions.

Substanzabusus in der Schwangerschaft: Auswirkungen auf die Schwangere und den Feten

ZusammenfassungDer Konsum legaler oder illegaler Substanzen kann zu Schäden der Mutter-Plazenta-Kind-Einheit führen. Am bekanntesten ist das fetale Alkoholsyndrom, es spiegelt die Teratogenität von Alkohol wider. Auch für andere Substanzen wie Nikotin, Amphetamine, Kokain und Cannabis wurden in Studien nicht nur unmittelbar postnatal Auffälligkeiten des Neugeborenen beschrieben. Vermutlich kommt es durch fetale Programmierung und Störung des neuroendokrinen Systems pränatal zu Auffälligkeiten, die bis ins Jugendalter nachweisbar sind. Für die Betreuung der substanzabhängigen Schwangeren und deren Kindern ist eine interinstitutionelle Vernetzung zwischen medizinischen Fachgebieten und Ämtern nötig.AbstractThe use of legal or illicit drugs can cause damage to the mother–placenta–fetus entity. Best known is fetal alcohol syndrome, which reflects the teratogenicity of alcohol. For other drugs such as nicotine, amphetamine, cocaine, and cannabis, studies have also demonstrated abnormal symptoms that are not limited to the postnatal period. Fetal programming and prenatal disturbance of the neuroendocrine system are presumably responsible for symptoms and disorders which can be observed into adolescence. In order to care for the substance-dependent pregnant woman and her child, it is necessary to work within an interinstitutional network of medical departments and public institutions.

Substanzabusus in der Schwangerschaft@@@Substance abuse during pregnancy: Auswirkungen auf die Schwangere und den Feten@@@Effects on the expectant mother and fetus

ZusammenfassungDer Konsum legaler oder illegaler Substanzen kann zu Schäden der Mutter-Plazenta-Kind-Einheit führen. Am bekanntesten ist das fetale Alkoholsyndrom, es spiegelt die Teratogenität von Alkohol wider. Auch für andere Substanzen wie Nikotin, Amphetamine, Kokain und Cannabis wurden in Studien nicht nur unmittelbar postnatal Auffälligkeiten des Neugeborenen beschrieben. Vermutlich kommt es durch fetale Programmierung und Störung des neuroendokrinen Systems pränatal zu Auffälligkeiten, die bis ins Jugendalter nachweisbar sind. Für die Betreuung der substanzabhängigen Schwangeren und deren Kindern ist eine interinstitutionelle Vernetzung zwischen medizinischen Fachgebieten und Ämtern nötig.AbstractThe use of legal or illicit drugs can cause damage to the mother–placenta–fetus entity. Best known is fetal alcohol syndrome, which reflects the teratogenicity of alcohol. For other drugs such as nicotine, amphetamine, cocaine, and cannabis, studies have also demonstrated abnormal symptoms that are not limited to the postnatal period. Fetal programming and prenatal disturbance of the neuroendocrine system are presumably responsible for symptoms and disorders which can be observed into adolescence. In order to care for the substance-dependent pregnant woman and her child, it is necessary to work within an interinstitutional network of medical departments and public institutions.