Kazumasa Hashimoto

Protective Effect of N-acetylcysteine on Liver Damage During Chronic Intrauterine Hypoxia in Fetal Guinea Pig

Chronic exposure to hypoxia during pregnancy generates a stressed intrauterine environment that may lead to fetal organ damage. The objectives of the study are (1) to quantify the effect of chronic hypoxia in the generation of oxidative stress in fetal guinea pig liver and (2) to test the protective effect of antioxidant treatment in hypoxic fetal liver injury. Pregnant guinea pigs were exposed to either normoxia (NMX) or 10.5% O2 (HPX, 14 days) prior to term (65 days) and orally administered N-acetylcysteine ([NAC] 10 days). Near-term anesthetized fetuses were excised and livers examined by histology and assayed for malondialdehyde (MDA) and DNA fragmentation. Chronic HPX increased erythroid precursors, MDA (NMX vs HPX; 1.26 ± 0.07 vs 1.78 ± 0.07 nmol/mg protein; P < .001, mean ± standard error of the mean [SEM]) and DNA fragmentation levels in fetal livers (0.069 ± 0.01 vs 0.11 ± 0.005 OD/mg protein; P < .01). N-acetylcysteine inhibited erythroid aggregation and reduced (P < .05) both MDA and DNA fragmentation of fetal HPX livers. Thus, chronic intrauterine hypoxia generates cell and nuclear damage in the fetal guinea pig liver. Maternal NAC inhibited the adverse effects of fetal liver damage suggestive of oxidative stress. The suppressive effect of maternal NAC may implicate the protective role of antioxidants in the prevention of liver injury in the hypoxic fetus.

Isolated low-normal amniotic fluid volume in the early third trimester: association with adverse perinatal outcomes.

Abstract Aims: To test if an isolated finding of low-normal amniotic fluid index (AFI) in the early third trimester in low-risk patients is associated with adverse perinatal outcomes. Methods: Retrospective cohort study with uncomplicated singleton pregnancies that had ultrasound studies between 28.0 and 31.9 weeks’ gestation. Two cohorts with AFI 8.0–11.9 cm (low-normal, LN) and AFI 12.0–19.9 cm (mid-normal, MN) were compared. Results: Patients with LN-AFI (n=99) were more likely to have early (<34 weeks) and late (<37 weeks) preterm birth (PTB) (relative risk 4.2 and 2.4, respectively) and a small for gestational age (SGA) infant (relative risk 1.8) than MN-AFI (n=834), corresponding to a higher NICU admission rate (relative risk 2.5). The risk of “spontaneous” PTB (preterm labor and rupture of membranes) did not differ between the cohorts, whereas the risk of “indicated” PTB (maternal or fetal indications) was significantly increased in LN-AFI. The incidence of abnormal antepartum testing, stillbirth, preeclampsia, placental abruption, fetal intolerance to labor, emergency cesarean delivery, umbilical artery pH <7.0, Apgar scores <7 at 5 min, and neonatal death was not increased in patients with LN-AFI. Conclusion: Low-normal AFI in the early third trimester increases the risk for subsequent delivery of an SGA infant and indicated PTB.

OC30.03: Cerebrouterine Doppler ratio: a predictor of third trimester stillbirth

growth restriction with or without preeclampsia, twin-to-twin transfusion syndrome, or oligohydramnios. UA Doppler waveforms were obtained at intra-abdominal cord insertion site in order to distinguish one from the other. Doppler findings of one UA were expressed as present end-diastolic flow (EDF), absent enddiastolic flow (AEDF), or reversed end-diastolic flow (REDF). The findings were recorded at both UAs and into four patterns: EDF/AEDF, AEDF/AEDF, AEDF/REDF, and REDF/REDF. There was no EDF/REDF case. Results: A total of 155 observations were undertaken. Twenty-seven of 50 patients (54%) showed AEDF or REDF in at least one umbilical artery during surveillance period and were included for analysis. Of these 27, 11 patients (40.7%) revealed discrepancy in Doppler waveforms between two umbilical arteries. The proportion of patients according to UA Doppler patterns was 30% in EDF/AEDF (8/27), 37% in AEDF/AEDF (10/27), 11% in AEDF/REDF (3/27), 22% in REDF/REDF (6/27). (Table 1). Conclusions: Doppler waveforms have discrepancy between two umbilical arteries in more than one third of high-risk pregnancies beginning to show AEDF or REDF in at least one UA. When Doppler waveforms of an UA were revealed as AEDF or REDF, clinicians must be cautioned to examine the contralateral UA.

OC30.06: Integrated surveillance predicts deterioration in fetal gastroschisis

fetal growth, amniotic fluid volume gastrointestinal appearance and cardiotocography (CTG). Pregnancy outcome was noted. Results: 105 cases of gastroschisis were identified in a 12 years period. FHM was performed in 97 cases starting at a median gestational age of 30 weeks (range 28–35). In 24 cases an abnormal FHM was registered, 11 were confirmed by in-hospital CTG including 2 cases of fetal demise, 9 emergency Cesarean section were performed at a mean gestational age of 33.1 ± 1.2 weeks, other 4 women had emergency cesarean section within one week for abnormal FHR at inhospital CTG. In 73 cases of normal FHM there were 17 emergency cesarean sections for abnormal FHR at in-hospital CTG at a mean gestational age of 34.6 ± 2.0 weeks. Eight women had no FHM, 3 of them undergone emergency cesarean section for abnormal FHR at in-hospital CTG at a mean gestational age of 35.3 ± 0.57 weeks. USexaminations showed the presence of intra-abdominal bowel dilation in 6/11 patients with abnormal FHM confirmed by in-hospital CTG compared to 24/73 of those without FHM anomalies. Conclusions: FHR abnormalities are frequent in fetuses with gastroschisis. The practice of FHM leaded to 23.2% percent of emergency cesarean sections for FHR abnormality at earlier gestational age, but it failed to prevent 2 intrauterine fetal deaths. The policy of routine FHM should now be evaluated in a randomized control trial.

OC30.01: Perinatal outcome of mildly decreased amniotic fluid index (AFI) in the early third trimester

Objectives: Mesh reinforcement of anterior colporrhaphy (AC) for cystocele repair has become popular in recent years, with some evidence of reduced recurrence rates. In this case control series, we aim to compare the effect of mesh use on anatomical and functional outcomes, including imaging assessment of prolapse recurrence after AC with and without transobturator mesh augmentation. Methods: Outcomes of 183 patients after anterior vaginal prolapse repair between Jan 1998 and Oct 2008 were analysed. 83 patients had AC, 100 patients AC with transobturator mesh. Patients were assessed post-surgically with a standardised interview, ICS POP-Q clinical examination and 4D translabial ultrasound using GE Kretz Voluson 730 expert and Voluson I system. Results: Potential predictors of recurrence such as age, BMI, vaginal parity and recurrence of prolapse as defined as POPQ ≥ Stage 2 were tested. Only length of follow-up and avulsion injury were significant predictors. Consequently, to match both groups for these two parameters, 49 datasets were removed in a blinded fashion, leaving a total of 67 patients in each group for analysis. Recurrent cystocele ≥ Stage 2 was observed in 31% of mesh patients and 55% in the non-mesh group (OR 0.37 [CI 0.18–0.75] P = 0.005). The rate of recurrence was significantly higher amongst patients with levator avulsion, 36% in the mesh group compared to 78% in the non-mesh group (OR 0.16 [CI 0.04–0.59] P = 0.004). Conclusions: At 4 years follow-up, mesh augmentation was associated with less recurrence of cystocele. This effect was mainly due to reduced recurrence in women with levator avulsion.