Devender Roberts

How strong is the association between maternal thrombophilia and adverse pregnancy outcome?: A systematic review

OBJECTIVE To determine whether inherited and acquired thrombophilias are associated with adverse obstetric complications. STUDY DESIGN A systematic review; studies where women with adverse obstetric complications were tested for one or more acquired and inherited thrombophilias were included. MAIN OUTCOME MEASURES Prevalence of thrombophilia in women with severe pre-eclampsia/eclampsia, severe placental abruption, intrauterine growth restriction or unexplained stillbirth. RESULTS Compared with controls, placental abruption was more often associated with homozygous and heterozygous factor V Leiden mutation, heterozygous G20210A prothrombin gene mutation, homocysteinaemia, activated protein C resistance or anticardiolipin IgG antibodies. Women with pre-eclampsia/eclampsia were more likely to have heterozygous factor V Leiden mutation, heterozygous G20210A prothrombin gene mutation, homozygous MTHFR C677T mutation, protein C deficiency, protein S deficiency or activated protein C resistance compared with controls. Unexplained stillbirth, when compared with controls, was more often associated with heterozygous factor V Leiden mutation, protein S deficiency, activated protein C resistance, anticardiolipin IgG antibodies or lupus anticoagulant. Women with intrauterine growth restriction had a higher prevalence of heterozygous G20210A prothrombin gene mutation, homozygous MTHFR C677T gene mutation, protein S deficiency or anticardiolipin IgG antibodies than controls. There was wide heterogeneity in the prevalence of thrombophilia between the studies. CONCLUSIONS Women with adverse pregnancy outcome are more likely to have a positive thrombophilia screen but studies published so far are too small to adequately assess the true size of this association. Screening for thrombophilia should not become standard practice until clear evidence emerges that thromboprophylaxis during pregnancy improves perinatal outcome. Further research into the link between the observed association, causality and heterogeneity is required.

Neuromuscular function in pesticide workers.

Jager, K. W., Roberts, D. V., and Wilson, Andrew (1970).Brit. J. industr. Med.,27, 273-278. Neuromuscular function in pesticide workers. Electromyography (EMG) provides a sensitive, objective, and speedy method of detecting impairment of nerve and muscle function in pesticide workers who are apparently in good health. Exposure to two organophosphorus compounds (both were dimethyl phosphate esters) was associated with a high incidence (about 50%) of EMG signs of impaired nerve and muscle function. In workers exposed only to organochlorine compounds there was a much lower incidence (about 4%) of abnormal EMG. Exposure to these organophosphorus compounds was not associated with depression of blood cholinesterase activity even in those workers with typical EMG signs. It is concluded that measurement of blood cholinesterase activity does not provide a sensitive index of functional impairment of nerve and muscle.

Computerised antenatal fetal heart rate recordings between 24 and 28 weeks of gestation

Objective To assess computerised fetal heart rate recordings between 24 and 28 weeks of gestation for gestation related differences.

The ‘Making it Happen’ programme in India and Bangladesh

Please cite this paper as: Raven J, Utz B, Roberts D, van den Broek N. The ‘Making it Happen’ programme in India and Bangladesh. BJOG 2011;118 (Suppl. 2):100–103.

Association between maternal sleep practices and late stillbirth – findings from a stillbirth case‐control study

To report maternal sleep practices in women who experienced a stillbirth compared with controls with ongoing live pregnancies at similar gestation.

The fetal outcome in pregnancies with isolated reduced amniotic fluid volume in the third trimester

Our aim was to assess the outcome of pregnancies where oligohydramnios, defined by a published gestational reference range for amniotic fluid index, was the only abnormal finding at third trimester scan, and all other ultrasound parameters including biometry were within normal limits at initial scan. A retrospective case-control study was performed at The Liverpool Maternity Hospital. 103 pregnancies with reduced amniotic fluid index in the third trimester and apparently normal fetal growth profile ultrasonographically were identified from ultrasound reports throughout 1993. Pregnancies in the third trimester with normal amniotic fluid index on index scan were also identified from these reports and 103 were matched for parity, gestational age at delivery, mode of onset of labour, presentation at labour and medical conditions. Exclusion criteria were ruptured membranes, fetal abnormalities, estimated fetal weight below the fifth centile at index scan and multiple pregnancies. The outcome criteria were birthweight, Apgar scores at delivery, induction and emergency delivery for fetal reasons and admission to Neonatal Intensive Care Unit. Statistical analysis was performed by Fishers exact test and Garts odds ratio. Compared with controls, pregnancies in the reduced liquor group had a higher number of babies below the 5th centile (odds ratio 5.2, 95% confidence interval 1.6 to 22), a higher risk of induction for fetal reasons (odds ratio 34.4, 95% confidence interval 5.35 to 1425.5) and admission to Neonatal Intensive Care Unit (odds ratio 9.77, 95% confidence interval 1.3 to 432). Any observed difference in the need for emergency delivery due to fetal reasons was not clinically significant (odds ratio 2.16, 95% confidence interval 0.77 to 6.6) The definition used for oligohydramnios used in this study appears to identify a group of babies with a fourfold risk of low birthweight and a high risk of admission to the Neonatal Intensive Care Unit and induction of labour for fetal reasons. This would suggest that pregnancies with isolated oligohydramnios require some form of fetal monitoring and further prospective studies are required to determine the most appropriate method.

Drug-induced neonatal myasthenia.

THE occurrence of myasthenia in the newborn infant is relatively rare and during the past 25 years about 40 cases have been reported (Osserman, 1958; Stern et al., 1964). Apart from its potential gravity neonatal myasthenia has aroused much interest from the point of view of its aetiology. The transient nature of the disorder has understandably focused attention on the possible transfer from the myasthenic mother during intrauterine life of some factor, whose adverse influence on the well-being of the infant has seldom persisted beyond about six weeks. The passive transfer of maternal antibodies such as have been detected in the serum of myasthenic adult patients (Strauss et al., 1960; Beutner e ta l . , 1962 ; van der Geld et al., 1963) or of antinuclear factor (White and Marshall, 1962) are attractive possibilities which so far have not been cleaIly shown to be involved in neonatal myasthenia. It has also been suggested that neonatal myasthenia is a result of placental transmission of a neuromuscular blocking substance, the origin of which may be the thymus gland (Keynes, 1949; Wilson et al., 1953; Goldstein, 1968). This explanation has been countered by reports of neonatal myasthenia in cases in which the mother had previously undergone thymectomy (Schlezinger,

Prenatal reflex DNA screening for trisomies 21, 18, and 13

PurposeThe purpose of the study was to determine the screening performance of prenatal reflex DNA screening for trisomies 21 (T21), 18 (T18), and 13 (T13) as part of a routine service at five hospitals.MethodsWomen who accepted screening had a first-trimester combined test (pregnancy-associated plasma protein A, free β-human chorionic gonadotropin, nuchal translucency interpreted with maternal age). Those with a risk of having an affected pregnancy ≥1 in 800 were reflexed to a DNA sequencing test using stored plasma from the original blood sample, thereby avoiding the need to recall them.ResultsOf 22,812 women screened (including 106 with affected pregnancies), 2,480 (10.9%) were reflexed to DNA testing; 101/106 were detected (69/73 T21, 24/25 T18, and 8/8 T13), a 95% detection rate (95% confidence interval 89–98%) with four false positives (0.02%, 95% confidence interval 0.00–0.05%). The odds of being affected given a positive result were 25:1. Of the 105 screen-positive pregnancies, 91 (87%) had an invasive diagnostic test. Reflex DNA screening avoided up to 530 invasive diagnostic tests compared with using the combined test.ConclusionReflex DNA screening was successfully implemented in routine care, achieving a high detection rate, low false-positive rate, and, consequently, greater safety with fewer invasive diagnostic tests than other methods of screening.

Amnioinfusion in very early preterm prelabor rupture of membranes (AMIPROM): pregnancy, neonatal and maternal outcomes in a randomized controlled pilot study

To assess short‐ and long‐term outcomes of pregnant women with very early rupture of membranes randomized to serial amnioinfusion or expectant management, and to collect data to inform a larger, more definitive clinical trial.

OP08.06: AMIPROM: a pilot RCT on serial transabdominal amnioinfusion versus expectant management in very early PROM

matched controls. Additionally, the second purpose was to determine the relationship between the placental pathologies and uterine artery (UtA) Doppler findings. Methods: 172 patients with singleton pregnancies between 24 and 35 weeks who presented with signs of preterm labor and 169 healthy pregnant women with correlative properties who admitted for routine pregnancy visits were recruited for the study. UtA blood flows were evaluated with Doppler ultrasonography during uterine inertia for both patients having preterm labor signs and for the control group. Each patient followed until the birth and delivery in 48 hours/7 days/14 days were recorded. The placental pathologies were interpreted (Redline 2007) and the relationship between the Doppler findings and placental pathologies were investigated. Results: Placental pathologies were found to be higher in the study group compared to their controls (P = 0.002). According to placental pathology patterns; the study group had significantly higher subclinical chorioamnionitis (P = 0.014), maternal vascular maldevelopment (P = 0.000) and maternal vascular loss of integrity (P = 0.021) than the control group. In the study group, the patients’ who delivered in 48 hours/7 days/14 days, presence of abnormal placental pathologies were also found to be higher (P = 0.001/P = 0.000/P = 0.000) than the patients who did not deliver. The study group with abnormal placental pathologies had substantially higher UtA PI (0.98 ± 0.39) than the patients without placental pathologies (0.74 ± 0.21) (P = 0.001). Conclusions: An underlying abnormal placental pathology was found to be higher in patients showing preterm labor symptoms and in the patients particularly who deliver in early time periods. With this study, it’s shown for the first time that the placental lesions prosecuted for preterm delivery were associated with antenatal UtA blood flows.