Janet Brennand

Interleukin-8 production by the human cervix

OBJECTIVES Our purpose was (1) to determine whether the human cervix is capable of producing interleukin-8 in vitro and to examine the possibility of stimulating an increase in any such output and (2) to examine the concomitant production of prostaglandins. STUDY DESIGN Cervical tissue was obtained from 48 women, 29 pregnant women undergoing surgical termination of pregnancy (20 of whom were treated with the prostaglandin analog Cervagem), 14 nonpregnant, premenopausal women, and three postmenopausal women. Explants were cultured and the medium was assayed for interleukin-8 and prostaglandin E2. Analysis of variance and Newman-Keuls statistical tests were used. RESULTS Significant quantities of interleukin-8 were produced by the tissue, and the data indicate that cervical explants from pregnant and nonpregnant women behave in a similar way when challenged by phorbol myristate acetate but that the postmenopausal cervix loses its capacity for interleukin-8 production. CONCLUSIONS Human cervix is capable of producing large amounts of interleukin-8 in vitro, and it may be influenced by the steroid hormones. Thus interleukin-8 could be an excellent candidate for a prime role in neutrophil-mediated cervical ripening.

Short term outcomes following intrauterine transfusion in Scotland

Aim To describe neonatal outcomes following intrauterine transfusion (IUT) for severe Rhesus isoimmunisation from 1993 to 2004. Results 116 neonates who had undergone 457 IUTs (median 4, range 1–9) were identified. Three neonates died, all before 1995 (two because of hypoxic ischaemic multiorgan failure and one because of overwhelming Escherichia coli sepsis). 13 neonates (11%) were delivered by emergency Caesarean section following either IUT complication or spontaneous onset of preterm labour. They were more likely to require intubation (p<0.0001), on-going respiratory support (p=0.0007) and an exchange transfusion (p=0.007). 23 (20%) required an exchange transfusion and 63 (54%) at least one top-up transfusion. Conclusions Management of severe Rhesus disease is associated with encouraging neonatal outcomes and most infants can be managed with phototherapy and a few top-up transfusions. IUT complications are rare but significantly increase neonatal mortality and morbidity. Antenatal counselling should address the likely postnatal course for these infants.

The influence of amniotic fluid on prostaglandin synthesis and metabolism in human fetal membranes.

OBJECTIVE To investigate the effect of amniotic fluid on prostaglandin synthesis and metabolism in the fetal membranes. DESIGN A cell culture study of amnion and chorion obtained at elective cesarean section incubated with amniotic fluid collected following either spontaneous labor and delivery, or elective cesarean section. SUBJECTS Forty-eight pregnant women at 3742 weeks gestation: 24 in spontaneous labor and 24 delivered by elective cesarean section. RESULTS Significantly more PGE2 and PGF2alpha were produced by amnion and chorion treated with amniotic fluid from spontaneous labor compared with elective cesarean section. Spontaneous labor amniotic fluid favors PGE2 and PGFM production by amnion and chorion respectively; while elective section fluid stimulates PGE2 synthesis by both tissues (reflected as PGEM in chorion). Amniotic fluid, from either spontaneous labor or elective section, had no effect on the metabolism of exogenous PGE2 or PGF2alpha by chorion cells. CONCLUSION Spontaneous labor is associated with the presence of a substance in amniotic fluid which facilitates prostaglandin synthesis in the fetal membranes, but which is without effect on prostaglandin metabolism.

The observed to expected lung head ratio as a predictor of outcome in antenatal congenital diaphragmatic hernia

Introduction Congenital diaphragmatic hernia (CDH) has an incidence of 1 in 2500 and around 30% of babies with isolated CDH die from pulmonary hypoplasia. There have been several techniques describing prediction of postnatal outcome in antenatally diagnosed isolated CDH based on the estimation of residual lung capacity by US and MRI. Recently, the observed to expected lung head ratio (O/E LHR) has been validated as a reliable method of lung estimation by 2D ultrasound and is a marker of postnatal morbidity and mortality.1 The authors sought to determine if the O/E LHR predicts survival in our West of Scotland population. Methods The authors conducted a retrospective analysis of antenatally diagnosed isolated left-sided CDH cases referred to the Ian Donald Fetal Medicine unit, Queen Mothers Hospital, Glasgow from 2002 to 2009. Results 58 patients had an antenatal diagnosis of isolated fetal left-sided CDH, lung head ratios were available for 25 cases. The mortality was 29%, none of these patients underwent in utero fetal tracheal occlusion. There was no significant difference in conventional LHRs between the neonates that survived (n=18) and those that did not (n=7), p=0.11. Using the O/E LHRs however the neonates that survived had a significantly higher O/E ratio than those that did not (p=0.03). The liver position (being in the fetal chest or abdomen) did not affect the O/E ratios in the group of survivors (p=0.26) or non-survivors (p=0.44). Conclusion The authors have shown that the O/E LHR is a good predictor of mortality in our population of antenatally diagnosed CDH.