Ian Greer

International consensus report on the investigation and management of primary immune thrombocytopenia

Previously published guidelines for the diagnosis and management of primary immune thrombocytopenia (ITP) require updating largely due to the introduction of new classes of therapeutic agents, and a greater understanding of the disease pathophysiology. However, treatment-related decisions still remain principally dependent on clinical expertise or patient preference rather than high-quality clinical trial evidence. This consensus document aims to report on new data and provide consensus-based recommendations relating to diagnosis and treatment of ITP in adults, in children, and during pregnancy. The inclusion of summary tables within this document, supported by information tables in the online appendices, is intended to aid in clinical decision making.

Term labor is associated with a core inflammatory response in human fetal membranes, myometrium, and cervix

OBJECTIVEnIdentify overlap of the transcriptome of myometrium and cervix in association with human labor.nnnSTUDY DESIGNnThe transcriptional profile of myometrial and cervical biopsies obtained from women in spontaneous labor at term (n = 9) and not in labor (n = 9) were characterized by Affymetrix v2 U133 plus 2 arrays. Common canonical pathways and functional groups were identified by Ingenuity Pathway Analysis.nnnRESULTSnOne hundred ten genes (false discovery rate < 1%) were commonly up-regulated by myometrium and cervix in association with labor and 29 genes (false discovery rate < 1%) down-regulated. Fold change in expression of up-regulated genes was strongly correlated; myometrium vs cervix (r = 0.51; P < .001), with no relationship in down-regulated genes (r = 0.26; P = .16). Canonical pathway analysis established up-regulation of inflammatory pathway signaling, with greatest increases in cellular movement and immune response gene ontology groups.nnnCONCLUSIONnGestational tissues exhibit a core inflammatory response in association with human parturition, with pathways regulating cellular trafficking dominating.

Vascular dysfunction and alteration of novel and classic cardiovascular risk factors in mothers of growth restricted offspring

OBJECTIVEnOffspring and maternal birthweight are inversely associated with maternal cardiovascular disease. However, whether established or putative novel cardiovascular risk factors including vascular and metabolic function are disrupted in women who delivered small for gestational age (SGA) offspring is unknown.nnnMETHODSnCase control study with analysis of inflammatory, lipid, metabolic and haemostatic markers and microvascular function as assessed by laser Doppler iontophoresis 4 years after the index pregnancy in 28 mothers who delivered SGA offspring at term and 29 matched controls.nnnRESULTSnDelivery of a SGA infant was associated with altered lipids [triglyceride median (IQR) mmol/l; control 0.64 (0.49-0.84); SGA 0.95 (0.67-0.95), p=0.012] [cholesterol:HDL ratio: control 2.64 (2.10-3.10); SGA 3.06 (2.65-3.89), p=0.013], systolic blood pressure [control mmHg: 110 (108-118); SGA 120 (110-130), p=0.031], subclinical inflammation [CRP mg/l: control 0.7 (0.3-2.1); SGA 2.2 (1.2-4.0), p=0.002] [IL-6 pg/ml: control 1.2 (0.8-1.4); SGA 1.5 (1.1-2.2), p=0.009] and endothelial activation [ICAM-1 ng/ml: control 237.7 (210.0-279.4); SGA 283.1 (240.5-366.3), p=0.013], with differences robust to confounder adjustment. Endothelium dependent (p=0.003) and independent microvascular function (p<0.001) were also impaired in mothers of SGA offspring.nnnCONCLUSIONSnMothers of term SGA offspring exhibit perturbation of metabolic and vascular function, which may underlie a lifelong trajectory of impaired health incorporating adverse perinatal and cardiovascular events.

Preterm Labour: Preterm Labour

1. Epidemiology of preterm delivery Peter Daniellian and Marion Hall 2. Biology of labour Andrew Thomson and Jane Norman 3. Transcriptional regulation of labour associated genes Philip Bennett, Tamsin Lindstrom and Jennifer Louden 4. Fetal outcome following preterm delivery M. Levene and Lawrence Miall 5. Prediction of preterm delivery Philip Owen and Fiona Mackenzie 6. Prevention of preterm labour J. Morrison and Nandi Ravikumar 7. Management of preterm premature ruptured membranes Donald Peebles 8. Management of threatened preterm labour Steve Thornton, Manu Vatish, Katie Groom and Philip Bennett 9. Management of preterm labour with specific complications Mark Kilby, David Somerset 10. Anaesthetic issues in preterm labour and intensive care management of the sick parturient Anne May and Chris Elton 11. Management of the preterm neonate Michael Weindling and Richa Gupta 12. Organisation of high risk obstetric and neonatal services Karl Murphy and Sara Twaddle 13. Legal issues in the management of pregnancy and labour S. M. McLean and Sara Elliston 14. Treating the preterm infant - the legal context Sara Elliston.

Preterm Labour: Contributors

1. Epidemiology of preterm delivery Peter Daniellian and Marion Hall 2. Biology of labour Andrew Thomson and Jane Norman 3. Transcriptional regulation of labour associated genes Philip Bennett, Tamsin Lindstrom and Jennifer Louden 4. Fetal outcome following preterm delivery M. Levene and Lawrence Miall 5. Prediction of preterm delivery Philip Owen and Fiona Mackenzie 6. Prevention of preterm labour J. Morrison and Nandi Ravikumar 7. Management of preterm premature ruptured membranes Donald Peebles 8. Management of threatened preterm labour Steve Thornton, Manu Vatish, Katie Groom and Philip Bennett 9. Management of preterm labour with specific complications Mark Kilby, David Somerset 10. Anaesthetic issues in preterm labour and intensive care management of the sick parturient Anne May and Chris Elton 11. Management of the preterm neonate Michael Weindling and Richa Gupta 12. Organisation of high risk obstetric and neonatal services Karl Murphy and Sara Twaddle 13. Legal issues in the management of pregnancy and labour S. M. McLean and Sara Elliston 14. Treating the preterm infant - the legal context Sara Elliston.

Preterm Labour: Index

1. Epidemiology of preterm delivery Peter Daniellian and Marion Hall 2. Biology of labour Andrew Thomson and Jane Norman 3. Transcriptional regulation of labour associated genes Philip Bennett, Tamsin Lindstrom and Jennifer Louden 4. Fetal outcome following preterm delivery M. Levene and Lawrence Miall 5. Prediction of preterm delivery Philip Owen and Fiona Mackenzie 6. Prevention of preterm labour J. Morrison and Nandi Ravikumar 7. Management of preterm premature ruptured membranes Donald Peebles 8. Management of threatened preterm labour Steve Thornton, Manu Vatish, Katie Groom and Philip Bennett 9. Management of preterm labour with specific complications Mark Kilby, David Somerset 10. Anaesthetic issues in preterm labour and intensive care management of the sick parturient Anne May and Chris Elton 11. Management of the preterm neonate Michael Weindling and Richa Gupta 12. Organisation of high risk obstetric and neonatal services Karl Murphy and Sara Twaddle 13. Legal issues in the management of pregnancy and labour S. M. McLean and Sara Elliston 14. Treating the preterm infant - the legal context Sara Elliston.