Jindrich Tosner

Intraamniotic inflammatory response to bacteria: analysis of multiple amniotic fluid proteins in women with preterm prelabor rupture of membranes.

Objective: To analyse whether intraamniotic inflammation in response to bacteria is different below and above gestational age 32 weeks in pregnancies complicated by preterm prelabor rupture of membranes (PPROM). Methods: A prospective study was performed, and 115 women with singleton pregnancies complicated by PPROM at gestational ages between 240/7 and 366/7 weeks were included in the study. Transabdominal amniocenteses were performed. Amniotic fluid was analysed using polymerase chain reactions for genital mycoplasmas and cultured for aerobic and anaerobic bacteria. The concentrations of 26 proteins in the amniotic fluid were determined simultaneously using multiplex technology. Results: Bacteria were found in the amniotic fluid of 43% (49/115) of the women. The women were stratified into two subgroups according to gestational age 32 weeks. The amniotic fluid levels of four (interleukin-6, interleukin-10, CC chemokine ligands 2, and 3) and one specific (CC chemokine ligands 2) proteins were higher in women with the presence of bacteria in the amniotic fluid below and above 32 gestational weeks, respectively. Conclusions: An intraamniotic inflammatory response to bacteria in pregnancies complicated by PPROM seems to be different below and above 32 weeks of gestation.

Soluble Toll-like receptor 1 family members in the amniotic fluid of women with preterm prelabor rupture of the membranes

Objective: To determine soluble Toll-like receptor (sTLR) 1, sTLR2 and sTLR6 concentrations in amniotic fluid (AF) of women with preterm prelabor rupture of membranes (PPROM) and if there is an association with microbial invasion of the amniotic cavity and histological chorioamnionitis (HCA). Methods: Cross-sectional study was performed. Forty-two women with singleton PPROM pregnancies at a gestational age between 24 + 0 and 36 + 6 weeks were included in the study (twenty-two women with presence of both microbial invasion of the amniotic cavity and HCA, and 20 women without microbial invasion of the amniotic cavity and HCA). Amniocenteses were performed, and the concentrations of sTLRs were determined by sandwich enzyme-linked immunosorbent assays. Results: Women with microbial invasions of the amniotic cavity and HCA (n = 22) had significantly higher median sTLR1, sTLR2 and sTLR6 levels than those without (n = 20). (20.4 ng/mL vs. 0.44 ng/mL; p < 0.0001, 577.6 ng/mL vs. 60.7 ng/mL; p < 0.0001 and 0.44 ng/mL vs. 0.26 ng/mL; p = 0.02, respectively). Conclusions: Women with microbial invasion of the amniotic cavity and HCA had higher AF sTLR1, 2 and 6 levels.

Pentraxin 3 in amniotic fluid as a marker of intra-amniotic inflammation in women with preterm premature rupture of membranes

To determine whether amniotic fluid levels of pentraxin 3 (PTX3) are of value in the prenatal diagnosis of acute histological chorioamnionitis in preterm premature rupture of membranes (PPROM).

Umbilical cord blood concentration of soluble scavenger receptor for hemoglobin, but not pentraxin 3, is of value for the early postpartum identification of the presence of histological chorioamnionitis.

Objective: To determine whether umbilical cord blood concentrations of soluble scavenger receptor for hemoglobin (sCD163) and pentraxin 3 (PTX3) are of value in the early postpartum diagnosis of histological chorioamnionitis in preterm prelabor rupture of membranes (PPROM). Methods: Eighty-three women with pregnancies complicated by PPROM between 24 and 36 weeks of gestation with (n = 38) and without (n = 45) the presence of histological chorioamnionitis were included in the study. We compared umbilical cord blood sCD163 and PTX3 levels in preterm neonates from PPROM pregnancies with versus without the presence of histological chorioamnionitis using nonparametric test (Mann–Whitney U test). Results: The presence of histological chorioamnionitis was associated with a higher median umbilical cord blood sCD163, but not PTX3 concentration, to compare with the absence of histological chorioamnionitis [sCD163: median 1466 ng/mL, interquartile range (IQR) 1187–1828 vs. 1168 ng/mL, IQR 887–1595; p = 0.01; PTX3: median 3.96 ng/mL, IQR 2.24–6.77 vs. 2.95 ng/mL, IQR 1.74–6.93; p = 0.49]. Conclusions: HCA is associated with an increase of umbilical cord blood sCD163, but not PTX3 concentration. Umbilical cord blood sCD163 seems to be a postpartum marker of the presence of histological chorioamnionitis.

Amniotic fluid concentrations of soluble scavenger receptor for hemoglobin (sCD163) in pregnancy complicated by preterm premature rupture of the membranes and histologic chorioamnionitis.

Objective. To determine changes in the amniotic fluid, soluble form of scavenger receptor for hemoglobin (sCD163) concentrations during advancing gestation, and in patients with preterm premature rupture of membranes (PPROM) complicated by histological chorioamnionitis were studied. Methods. One hundred and fifty-two women with singleton pregnancies were enrolled. The concentration of sCD163 in amniotic fluid was determined using sandwich enzyme immunoassay technique. Results. Women in the midtrimester had a significantly higher median amniotic fluid sCD163 concentration than those at term not in labor (308 ng/ml vs. 217 ng/ml; p = 0.04). Patients with PPROM and histological chorioamnionitis had a higher median amniotic fluid sCD163 level than those with PPROM without histological chorioamnionitis (885 ng/ml vs. 288 ng/ml; p < 0.0001). Conclusions. Amniotic fluid sCD163 concentrations decrease with advancing gestation. Amniotic fluid sCD163 concentrations are significantly higher in women with PPROM between 24 and 36 gestational weeks with histological chorioamnionitis than those without histological signs of inflammation.

Prenatal diagnosis of an intertwin membrane hematoma

We report a case of a 26‐year‐old woman, gravida 2, para 1, with a dichorionic diamniotic twin pregnancy at 33 weeks of gestation with a 1‐day history of mild vaginal bleeding and irregular uterine activity. Ultrasonography showed 18 × 15 × 3‐cm‐sized complex hypoechoic mass located in the dividing intertwin membrane. Based on this finding, the diagnosis of an intertwin membrane hematoma was made. This unusual sonographic diagnosis was confirmed during the cesarean section. In the case of dichorionic twin pregnancy, partial placental abruption can lead to a subclinical intertwin membrane hematoma.

OP13.10: An ultrasound transverse diameter of fetal thymus as a marker of the histological chorioamnionitis

previous preterm labor admission according to a 25 mm cervical length cut-off. The area under the curve for a birth weight below 10th percentile was 0.55 (IC 95% 0.39–0.70) and for the requirement of intervention due to fetal distress 0.49 (IC 95% 0.34–0.64). Conclusions: Term born fetuses with cervical length at preterm labor admission over 25 mm present an increased risk of birth weight below the 10th percentile as well as increased requirement of intervention during labor due to fetal distress.

Hemangiopericytoma of the uterus: an unusual cause of the postmenopausal Metrorrhagia

Hemangiopericytoma is an uncommon vascular tumor firstly described by Stout and Murray in 1944 and originates from contractile perivascular cells known as pericytes which were described by Zimmermann in 1923. It may come anywhere in the body, but predominantly in the head, neck and extremities. A uterine origin is particularly rare (1, 2). We present a case of hemangiopericytoma of the uterus and review the literature.