Enrico Picciolini

Maternal and Neonatal Plasma Cytokine Levels in Relation to Mode of Delivery

After birth, host defences must be recruited to manage the transition from an almost sterile to a normal environment. The present study was undertaken to evaluate the relationship between cytokine plasma levels and phagocyte burst in mothers and neonates during the peripartal period. Plasma levels of interleukin (IL)-1, IL-6, tumour necrosis factor (TNF)-alpha, interferon (IFN)-gamma, and granulocyte-macrophage colony-stimulating factor (GM-CSF) and whole blood superoxide anion (.O2-) generation were evaluated in 27 healthy mothers, 16 undergoing vaginal delivery (VD) and 11 elective caesarean section (ECS) and in their babies. Blood specimens were taken from the mothers at the beginning of labour, during labour, immediately after delivery and 4 days later in the VD group, and before anaesthesia, immediately after delivery and 4 days later in the ECS group; neonatal samples were taken at birth (cord blood) and 4 days later. After delivery by VD, these mothers had higher plasma levels of IL-1 beta, IL-6, IFN-gamma and higher .O2- generation than those delivered by ECS. IL-6 plasma levels and .O2- generation were higher in babies born by VD than in those born by ECS. A statistically significant correlation between IL-6 plasma levels and .O2- release was observed in cord blood of babies born by VD (r = 0.69; p < 0.006). The study demonstrates that labour plays an important role in modulating host defences in the newborn.

Superoxide Anion Release by Polymorphonuclear Leukocytes in Whole Blood of Newborns and Mothers during the Peripartal Period

ABSTRACT: Superoxide anion (·O2-) production was investigated in whole blood of mothers in the peripartal period and in neonates. Blood samples from 14 mothers undergoing vaginal delivery (VD) were tested at the beginning of labor, during labor, after delivery, and 4 d after delivery. Nine mothers undergoing elective cesarean section (ECS) were tested before anesthesia, after extraction of the fetus, and 4 d later. Seventy-two healthy, full-term newborn infants were examined at birth and on the fourth day of life. Red cell glutathione peroxidase, catalase, glutathione reductase, and superoxide dismutase activities were also measured at birth and on the fourth day of life in 26 of the 72 neonates. Higher ·O2- levels were detected in mothers undergoing VD compared with ECS (p < 0.05). A significant decrease was detected in zymosan-stimulated ·O2- production between cord and fourth-day blood samples in both VD- and ECS-delivered infants (p < 0.01). Zymosan-stimulated samples showed higher values after VD than ECS, both in cord blood (p < 0.004) and on the fourth day of life (p < 0.006). A positive correlation was found between ·O2- release in zymosan-stimulated cord blood and that found in the mothers at the beginning of labor (r 0.654; p < 0.01), during labor (r = 0.721; p = 0.008), and after delivery (r = 0.832; p = 0.0008). A positive correlation was also found between ·O2- release and glutathione peroxidase on the fourth day (r = 0.709, p = 0.014). The results of the present investigation demonstrate the role of peripartal events in modulating free radical release by polymorphonuclear leukocytes during the perinatal period.

Comparison of two-dimensional and three-dimensional ultrasound in the assessment of the cervix to predict preterm delivery

This study sought to determine whether 3-D transvaginal ultrasound (3D-TVS), compared with the 2-D transvaginal approach (2D-TVS), offers a better identification of some specific features of the uterine cervix that could be useful in the prediction of spontaneous preterm delivery (PTD). A total of 103 women with singleton pregnancies were prospectively evaluated with 2D-TVS and 3D-TVS in the second or third trimester of pregnancy. Statistical analysis was performed with Wilcoxon matched-pairs test, chi2 and Pearson test (p<0.05 was considered significant) and receiver operating characteristic (ROC) curve analysis. Significant differences between these approaches were found for cervical length (p<0.001). A significant correlation was identified between 3D-TVS cervical length and the interval between ultrasound examination and delivery as well as the gestational age at delivery (both p<0.001). ROC curve identified a threshold for 3D-TVS cervical length of 35 mm as an optimal predictor of PTD in the second trimester (sensitivity 100%, specificity 88%). 3D-TVS evaluation of the cervix in pregnancy seems to be an effective, noninvasive method for predicting PTD risk.

Prolactin-lowering effect of nomifensine in the rat.

Summary The effect of nomifensine (Nom), a new antidepressant agent which facilitates dopaminergic neurotransmission by blocking the reuptake of dopamine (DA) into nerve terminals and by promoting DA release, was studied on plasma prolactin (PRL) levels in the rat. Nom reduced baseline plasma PRL levels in untreated or reserpine-pretreated male rats and in ovariectomized, estrogen-primed female rats. Nom did not alter plasma PRL levels in reserpine-α-methyl-p-tyrosine-pretreated male rats and in hypophysectomized female rats bearing a pituitary transplant under the kidney capsule nor inhibited PRL release from in vitro-in-cubated pituitaries. The availability of drugs such as Nom, whose action rests on the integrity of dopaminergic transmission in the CNS, without involving direct stimulation of pituitary DA receptors, offers a valid means to investigate CNS function in hyperprolac-tinemic states.

Cervical ripening and induction of labor by prostaglandin E2: a comparison between intracervical gel and vaginal pessary

Objective: To compare the effectiveness and safety of two formulations of prostaglandin (PG) E2 (gel and pessary) for induction of labor. Primary outcomes were cervical ripening, initiation/ duration of labor, and type of delivery. Study design: A total of 115 women with singleton gestations were consecutively enrolled and assigned to receive intracervical PGE2 (dinoprostone 0.5 mg) by gel (n = 66) or PGE2 (dinoprostone 10 mg) by intravaginal pessary (n = 49). Results: Independently from parity, the vaginal pessary induced successful cervical ripening with a slightly higher but not statistically significant occurrence of vaginal delivery with respect to gel induction. The mean time interval from induction to vaginal delivery did not differ between groups, despite being shorter for the pessary group in inducation-delivery intervals > 12 h. No significant differences were found between the groups with respect to patients who required a second course of PGE2 (9% vs. 2%), as well as oxytocin (11% vs. 13%) induction. No significant difference was found in the incidence of uterine hyperstimulation and other adverse reactions in nulliparas, or in fetal and neonatal outcome. Conclusion: Independently from parity, both PGE2 administration routes appeared to be effective in achieving cervical ripening, initiation of labor and optimal type of delivery, and showed the same incidence of side-effects.

Inflammatory and infectious risk factors are associated with the response to tocolysis in patients with preterm labor

Objective. Inflammation/infection is the most frequent conditions leading to preterm delivery (PTD). A few studies have assessed the clinical efficacy of long-term tocolysis with ritodrine hydrochloride. In this study, the relationship among inflammatory/infective risk factors of PTD, the response to long-term tocolysis, and timing of delivery were evaluated in women with preterm labor. Methods. On the basis of different responses to long-term tocolysis, defined as ≥ 7 days tocolysis, the cohort were classified as: (i) patients delivering at term (Group A) and (ii) patients delivering preterm (group B). Group B was subclassified as: (i) delivery before 48 h (group B1); (ii) delivery between 48 h and 7 days (Group B2), and (iii) delivery after 7 days (Group B3). Group B is divided in early preterm (<32 weeks) (Group B early) and late PTD (32–36 weeks) (Group B late). Results. Group A delivered at term and Group B preterm. Group B showed significantly higher (p < 0.0001) rate of CRP, bacterial vaginosis, and chorioamnionitis at placental histological examination than Group A. The same parameters were statistically higher (p < 0.0001) in group B1 than in B3. CRP, chorioamnionitis at placental histological examination was statistically higher (p < 0.0001) in Group B early than in Group B late. Conclusions. This retrospective study suggested that in women affected by preterm labor, the long-term tocolysis with intravenous ritodrine is able to prolong gestation beyond 7 days, in absence of inflammatory/infective risk factors of PTD.

38 CYTOKINE SERUM LEVELS AND WHOLE BLOOD SUPEROXIDE ANION GENERATION IN MOTHERS AND NEWBORNS DURING PERIPARTUM

The present study was undertaken in order to evaluate the relationship between cytokine plasma levels and leucocyte burst in mothers and neonates during peripartum. Serum levels of IL-1ß, IL-6, TNF-α, IFN-γ and GM-CSF, and whole blood superoxide anion generation (SAg) were evaluated in 27 healthy mothers, 16 undergoing spontaneous delivery (SD) and 11 elective cesarean section (ECS), and in their babies. Blood specimens were taken from the mothers at the beginning of labour (BL), during labour (DL), immediately after delivery (AD) and 4 days after delivery (4DAD) in the SD group, and before the operation, AD and 4DAD in ECS group, from the cord and from the babies 4DAD. The cytokines (IU/ml) were measured by enzyme-linked immunoassay. The SAg assay was performed spectrophotometrically by the method of superoxide dismutase inhibitable reduction of ferricytochrome C, with opsonized zymosan stimulation of PMN in whole blood. Statistical analysis was performed by two-tailed “t” test and by linear correlation. After delivery, SD mothers had higher levels of IL-Iß, IL-6 and IFN-γ than ECS (IL-1ß: 55.6 ± 49 vs 38.4 ± 23 p < 0.05; IL-6: 74.8 ± 68 vs 12.8 ± 6.7, p < 0.005; IFN-γ: 1.05 ± 1.02 vs 0.55 ± 0.38 p < 0.05; mean ± SD). IL-6 was higher in SD cord than ECS (20.6 ± 13 vs 12.6 ± 2.5, p < 0.05). No differences were found between the SD and ECS groups for TNF-α and GM-CSF. SAg in mothers was significantly correlated with SAg in the cord blood of their babies (BL: r = 0.64, p <0.01; DL: r = 0.71, p< 0.001). IL-6 values in mothers BL significantly correlated with SAg in mothers AD (r = 0.62, p <0.04) and SAg in cord blood of their babies (r= 0.54; p <0.05). In conclusion, labour appears to be associated with increased IL-Iß, IL-6 and IFN-γ and more active phagocyte function.