Brigida Carducci

Gadolinium periconceptional exposure: pregnancy and neonatal outcome

Background. Gadolinium derivatives are ionic paramagnetic contrast agents used to enhance magnetic resonance images, labeled as a pregnancy category C by the Food and Drug Administration because of a lack of epidemiological studies concerning first‐trimester exposure. Methods. Prospective cohort study to determine whether gadolinium derivatives exposure in periconceptional period is a risk factor for pregnancy or fetal development. Results. We report the outcome of 26 pregnant women exposed to gadolinium derivatives in the first trimester without adverse effect on pregnancy and neonatal outcome. Conclusions. Currently, this study represents the only prospective investigation of gadolinium derivatives in pregnancy, but more data are necessary to exclude a teratogenic risk.

Homocysteine Induces Trophoblast Cell Death with Apoptotic Features

Abstract Hyperhomocysteinemia has been suggested as a possible risk factor in women suffering from habitual abortions, placental abruption or infarcts, preeclampsia, and/or intrauterine growth retardation. However, little is known about the pathogenic mechanisms underlying the action of homocysteine. The present study investigated the in vitro ability of homocysteine to affect trophoblast gonadotropin secretion and to induce cell death. In primary human trophoblast cells, homocysteine treatment (20 μmol/L) resulted in cellular flattening and enlargement, extension of pseudopodia, and cellular vacuolization. Cellular detachment, apoptosis, and necrosis were favored. With in situ nick end labeling, we investigated DNA degradation, and we used M30 CytoDEATH to selectively stain the cytoplasm of apoptotic cells. Cytochrome c release from mitochondria to the cytosol and DNA cleavage in agarose gel have been investigated. Homocysteine, but not cysteine, induced trophoblast apoptosis and significantly reduced human chorionic gonadotropin secretion. These findings suggest that trophoblast cell death might represent a pathogenic mechanism by which homocysteine may cause pregnancy complications related to placental diseases.

Longitudinal changes of adiponectin, carbohydrate and lipid metabolism in pregnant women at high risk for gestational diabetes

To evaluate, in pregnant women at high risk for gestational diabetes (GDM), the longitudinal changes of adiponectin, carbohydrate and lipid metabolism, and to assess their independent value as risk factors for the development of GDM. Fifty women at beginning of pregnancy were studied. Adiponectin, insulin sensitivity (homeostasis model assessment, HOMA) and lipid panel were measured at 1st, 2nd and 3rd trimesters of pregnancy. Twelve patients developed GDM. In both groups, GDM and normal glucose tolerance (NGT), adiponectin decreased from 1st to 2nd and 3rd trimesters by about 5 and 20% (GDM, p < 0.05), and of about 17 and 25% in NGT (p < 0.05), respectively. Values observed in NGT were similar to those of GDM (F = 9.401; p = 0.238). The Cox regression model identified as the strongest independent risk factor for GDM HOMA over 1.24 (RR = 14.12) at 1st trimester, fasting glycaemia over 87 mg/dl (RR = 42.68) triglycerides over 158 mg/dl (RR = 5.87) and body mass index (BMI) over 27 kg/m2 (RR = 4.38) at 2nd trimester. Adiponectin in high-risk women is characterised by a constant reduction throughout gestation, irrespective of the development of GDM. HOMA, fasting glycaemia, triglycerides and BMI, but not adiponectin are independent predictors of GDM.

Poor Pregnancy Outcome and Anticardiolipin Antibodies

The present study reports for the first time on the presence of anticardiolipin antibodies (aCL) in a population of 259 women with a history of recurrent abortion, intrauterine death, and/or neonatal death associated with fetal growth restriction, preeclampsia and abruptio placentae. The overall incidence of aCL in this study group was 20.5%, a statistically significant increase in comparison with a control group. The highest positive rate was observed among women who presented both recurrent abortion and intrauterine death (33.3%), the lowest was observed among women with a history of neonatal death. Our findings confirm that aCL are strongly linked with fetal loss. Thus, before planning a subsequent pregnancy, the presence of aCL should be tested in all women with poor pregnancy outcome.

Uterine prolapse in pregnancy

We present a case of a patient developing uterine prolapse during pregnancy. The cervix reached the introitus at 10 weeks gestation and subsequentely protruted progressively as the pregnancy advanced. The patient was conservatively treated with bed rest and the main maternal and fetal risks are avoided. At 4 months postpartum follow-up there was no evidence of uterine prolapse.

Sexuality, pre-conception counseling and urological management of pregnancy for young women with spina bifida

A great number of newborns with spina bifida now survive with a growing life expectancy. Support with regard to sexual issues is essential in the management of adolescents with spina bifida, who require specific knowledge of sexual problems related to their disability. Women with spina bifida are usually fertile and need pre-conception counseling. Furthermore, compared to healthy women they have a higher chance of conceiving a child with spina bifida, so they are treated with periconceptional folic acid supplements. In addition pregnancies in women with spina bifida require adequate management of secondary conditions, mainly urological issues, which are exacerbated during pregnancy. This article gives an overview of sexual education, sex functioning and sexual activity among adolescents with spina bifida. Moreover, we aim to support young women with spina bifida, providing pre-conception counseling and practical guidelines essential for the urological management of their pregnancy.

Factor V deficiency in pregnancy complicated by Rh immunization and placenta previa : A case report and review of the literature

Polyhydramnios is a symptom of a continuity of conditions. As suggested above, traditionally the underlying conditions are divided into maternal, fetal, and placental causes. Nevertheless, approximately 60% of cases of polyhydramnios arc idiopathic in origin ( I ) . The most common known causes of polyhydramnios are matcrnal diabetes (1.3-36.1Y0) (1, 4). twin and triplet pregnancies, gastroentestinal obstructions, CNS-rnalformations, and fetal chromosomal disorders (1, 2, 4). Rarer conditions leading to polyhydramnios are placental tumors, fetal tumors, and rare fetal disorders including fetal infection ( 1 ) . Because of these conditions and the fact that polyhydramnios increases the risk of preterm delivery (up to 30% of these pregnancies end up in early delivery (4)) as well as the risk of intrapartum complications, especially amniotic cord complication and abruptio placentae ( I ) , the perinatal morbidity and mortality are high. Incidences of neonatal mortality between 16% and 69% are reported in different materials ( 1 ), just one reason why pregnancies complicated with polyhydramnios must be taken very seriously. Traditionally a volume of amniotic fluid of 2000 ml has been the lower limit of polyhydramnios. However, the exact volume of amniotic fluid is impossible to measure without using invasive procedures, which are today considered contraindicated. Two new methods of estimating amniotic fluid volume both based on the ultrasound examination have been developed: The traditional one-pocket measurement (the vertical depth of the largest fluid pocket measuring more than 8 cm=polyhydramnios), and the more recently developed four-quadrant technique, in which the largest pockets of the four abdominal quadrants are measured, added, and expressed as the amniotic fluid index (AFI), an AFI of more than 24 indicating polyhydramnios (5). In a study by Phelan et al. (5 ) , in which both the onepocket technique and the AFI were used in a material of 112 non-diabetic pregnancies, it was shown that AFI was significantly better correlated to pregnancy outcome than the onepocket technique. In our case two different clinicians have used different methods of diagnosing polyhydramnios. However, there is no doubt that the patient suffered from severe polyhydramnios. The treatment of choice in most cases of polyhydramnios is controlled removal of amniotic fluid by sterile amniocentesis ( I ) . An alternative is close observation without active treatment. The recently introduced pharmacological treatment by the NSAID indomethasin would in this case not seem rational, as its effect is mainly on the kidneys of the fetus not removing the already produced amniotic fluid between the separated membranes. A number of different authors have in the past described the features of amnion rupture, mostly in association with the amniotic band syndrome (the amputation or malformation of a limb because of amniotic band@) (3). There are few reports of amniotic rupture without the amniotic band syndrome, whether this is because of the rareness of the condition or because it is seldom recognized. To our knowledge no cases of amniotic rupture with severe intermembraneous polyhydramnios but without amniotic band syndrome have been reported in the literature in the recent past. This might be because of the extreme rareness of the condition, or the condition might ‘hide’ among the numerous less severe idiopathic cases only to be revealed during a cesarean section but not to be recognized during vaginal delivery.

Early first-trimester Sibutramine exposure. Pregnancy outcome and neonatal follow-up.

AbstractBackground: Sibutramine is a drug that is used in the treatment of obesity. There are currently no epidemiological studies relating to sibutramine exposure in pregnancy. The objective of our study was to determine whether sibutramine exposure during pregnancy constitutes a risk factor to the mother and developing fetus. Methods: Fifty-two pregnant women who were exposed to sibutramine in the first trimester of pregnancy, when they were unaware of being pregnant, contacted our Teratology Information Service. We recorded the prospective outcomes of this case series between May 2001 and September 2004 with a complete neonatal follow-up up to 1 month after delivery. Results: Seven cases of hypertensive complications were observed during pregnancies. No cases of congenital anomalies in neonates were observed. Conclusion: Although many more cases are necessary to demonstrate that sibutramine is not teratogenic in pregnancy, our experience improves the counseling of pregnancies occurring involuntarily during sibutramine therapy.

Predictive value of uterine artery velocimetry at midgestation in low- and high-risk populations: a new perspective

Objective: The aim of this study was to assess the value of uterine artery Doppler velocimetry performed at 18–20 and 22–24 weeks of gestation in predicting preeclampsia and adverse pregnancy outcome in low- and high-risk patients. Methods: 865 pregnant women were evaluated: 335 and 530 pregnant women represented the high- and low-risk groups, respectively. Doppler ultrasound examination of the uterine arteries was performed at 18–20 weeks of gestation in 385 patients and at 22–24 weeks of gestation in 659 patients. Pregnancy outcome was evaluated in terms of: onset of preeclampsia; birth weight <2,500 g; birth weight <1,750 g; delivery before 36 weeks, and delivery before 32 weeks. Results: At 18–20 weeks of gestation the sensitivity for the prediction of preeclampsia was 100 and 94% in low- and high-risk groups, respectively. Excellent negative predictive values towards birth weight <1,750 g (97% in low-risk and 93% in high-risk groups) and delivery prior to 32 weeks of gestation (99% in low-risk and 95% in high-risk groups) were obtained. At 22–24 weeks of gestation the sensitivity for the prediction of preeclampsia was 100 and 97% in low- and high-risk groups, respectively. Negative predictive values towards birth weight <1,750 g were 97% in low-risk and 94% in high-risk groups, whereas towards delivery prior to 32 weeks of gestation they were 98% in low-risk and 94% in high-risk groups. Conclusion: Doppler evaluation of the uterine artery at 18–20 and 22–24 weeks of gestation represents a useful predictive test in high-risk pregnancy and can also be used in prenatal surveillance of a low-risk population.

Drug-induced congenital defects: strategies to reduce the incidence.

Approximately 1% of congenital anomalies relate to pharmacological exposure and are, in theory, preventable. Prevention consists of controlled administration of drugs known to have teratogenic properties (e.g. retinoids, thalidomide). When possible, prevention could take the form of the use of alternative pharmacological therapies during the pre-conception period for certain specific pathologies, selecting the most appropriate agent for use during pregnancy [e.g. haloperidol or a tricyclic antidepressant instead of lithium; anticonvulsant drug monotherapy in place of multitherapy; propylthiouracil instead of thiamazole (methimazole)], and substitution with The most suitable therapy during pregnancy (e.g. insulin in place of oral antidiabetics; heparin in place of oral anticoagulants; α-methyldopa instead of ACE inhibitors). Another strategy is the administration of drugs during pregnancy taking into account the pharmacological effects in relation to the gestation period (e.g. avoidance of chemotherapy during the first trimester, avoidance of nonsteroidal anti-inflammatory drugs in the third trimester, and avoidance of high doses of benzodiazepines in the period imminent to prepartum).