M. M. Anceschi

Effect of antenatal betamethasone therapy on maternal-fetal Doppler velocimetry

BACKGROUNDnThe effect of antenatal betamethasone on fetal parameters includes a transient reduction of FHR variation and of fetal body movements. An effect on maternal-fetal blood flow has also been shown, with non-univocal results.nnnAIMSnTo evaluate the effect of antenatal betamethasone in third trimester singleton high-risk pregnancies by Doppler technology.nnnSUBJECTS AND METHODSnThirty-six pregnant women who received a full course of betamethasone (12 mg i.m. two times, 24 h apart) were studied. The Doppler examination included the assessment of the pulsatility index (PI) of the umbilical artery (UA PI), the middle cerebral artery (MCA PI) and of resistance index of uterine arteries (Ut RI) before treatment, and 48 and 96 h after second dose of betamethasone.nnnRESULTSnNo significant variation was noted in UA PI through betamethasone therapy. MCA PI decreased significantly 48 h from the last injection of betamethasone (P=0.002), and returned to basal values at 96 h. No difference was found for the other Doppler parameters examined. When serial Doppler studies were analyzed according to the gestational age, in the group <32 weeks gestation, MCA PI decreased significantly after 48 h (P<0.006) and returned to pre-treatment values after 96 h from the last betamethasone dose. Conversely, no difference was found in Doppler serial measurements in any of the analyzed districts in the subgroup > or =32 weeks.nnnCONCLUSIONnBetamethasone treatment is associated with a significant, although transient, reduction of MCA PI, especially at gestational ages <32 weeks.

Association between maternal-fetal Doppler velocimetry and fetal lung maturity.

Abstract Aims: To correlate maternal-fetal Doppler velocimetry parameters to indices of fetal lung maturity (FLM). Methods: Fifty-five consecutive third trimester pregnancies in which a pulsed-wave Doppler study, including uterine resistance index (Ut RI), umbilical artery pulsatility index (UA PI), middle cerebral artery pulsatility index (MCA PI) and the UA/MCA ratio was performed within 24 hours before amniocentesis and within a week from birth. FLM was determined by amniotic fluid lamellar bodies count (LBs). Results: A positive correlation between MCA PI and LBs (p < 0.007, r = 0.44) was found. MCA PI showed a trend to lower values in fetuses that developed RDS at birth (1.3±0.5 vs. 1.7±0.4, NS). LBs significantly decreased as Ut RI increased (O.R.: 0.98, C.I. 0.97–0.99, p < 0.05). A mean Ut RI > 0.64 was correlated to delayed FLM (LBs < 20,000/μl; sensitivity: 90.9%, specificity: 90.3%; positive predictive value: 76.9%, negative predictive value: 96.6%). Comment: In third trimester pregnancies abnormal uterine artery waveforms may be associated to a delayed FLM, as expressed by decreased amniotic fluid LBs.

The effect of primary cytomegalovirus infection on fetal lung maturity indices

The aim of this study was to evaluate the impact of primary cytomegalovirus (CMV) infection on fetal pulmonary surfactant production as assessed by different tests for the diagnosis of fetal lung maturity (FLM) on amniotic fluid (AF). A cross-sectional cohort study. AF samples from 11 pregnant women with primary CMV infection were examined for FLM between the 26th and 37th week of gestation. Normal pregnancies (n = 11) were matched for gestational age at amniocentesis and at delivery, birth weight, Apgar score and gender sex. FLM was assessed by planimetric and stoichiometric lecithin to sphingomyelin ratio (L/S), phosphatidylglycerol (PG) presence and lamellar bodies count (LB). Maternal immunological parameters (T-cells, natural killer [NK] activity) were also considered. Mean planimetric L/S ratio (4.2+/-2.1 vs 2.3+/-0.7, P < 0.01) and LB count (42.6 x 10(3)+/-19.0 x 10(3) vs 16.8 x 10(3)+/-11.5 x 10(3), P < 0.004) were higher in controls when compared to CMV infected patients. Moreover, planimetric L/S ratio was higher in five CMV non-infected babies compared to six CMV-infected babies (3.1+/-1.3 vs 1.9+/-0.8, P < 0.05). When FLM was related to maternal immunological results, planimetric and stoichiometric L/S and LBs count were negatively correlated with CD8+ T-cells (r = -0.8, P < 0.05; r = -0.9, P < 0.05; r = -0.9, P < 0.01, respectively); LBs was also negatively correlated with CD14+ T-cells (r = -0.8, P < 0.03). In contrast, a positive correlation was found between stoichiometric L/S and NK activity (r = 0.9, P > 0.01). Maternal primary CMV infection impairs FLM indices as a possible result of reduced surfactant release and/or production. Significant correlations were found between immunity status of CMV-infected mothers and FLM tests.

Intraamniotic surfactant for prevention of neonatal respiratory distress syndrome (IRDS): rationale and personal experience

OBJECTIVEnTo evaluate the efficacy of intramniotic instillation of supplementary surfactant for the prophylaxis of neonatal IRDS in an emergency obstetric setting.nnnSTUDY DESIGNnSupplementary natural surfactant (SS) was administered intra-amniotically (80 mg in 1 ml) under ultrasound guidance in the proximity of the fetal nostrils and mouth in six pregnant women at 24-32 weeks gestation, with immature amniotic fluid indices of fetal lung maturity, and whose delivery was imminent because of severe fetal distress, deteriorating maternal conditions, or refractory vaginal bleeding. The administration of SS was preceded by IV aminophylline to the mother (a bolus of 240 mg over 10 min, and a maintenance dose of 0.02-0.1 mg kg-1 min-1) in order to elicit sustained fetal breathing movements.nnnRESULTSnThe clinical conditions of the six newborn infants were good with no respiratory problems in four cases, and with mild IRDS in the remaining two, which, however, resolved uneventfully.nnnCONCLUSIONSnIt is suggested that this prophylactic approach has a great potential for becoming a reliable option for the antenatal prevention of IRDS.

The cholesterol to phospholipids ratio (C/PL) of the erythrocyte membrane in normotensive, hypertensive pregnant and in cord blood as assessed by a simple enzymatic method

The study described was conducted to evaluate a simple enzymatic method for the study of the cholesterol/phospholipids ratio in erythrocyte membrane (C/PL) in a group of normal pregnant, of hypertensive pregnant, in non-pregnant controls and in cord blood. Subjects consisted of 28 normotensive pregnant women (NT), 14 women with pregnancy induced hypertension (PIH), 10 non-pregnant normotensive women (Non-Preg) and 14 samples obtained from umbilical cord (C) at delivery from normotensive pregnant. Red blood cells were isolated from heparinated blood samples. Lipids were extracted from erythrocytes by isopropanol/chloroform, without preparation of cell ghosts. Cholesterol content was evaluated by cholesterol oxidase and phospholipids were estimated as organic phosphorus in the total lipid extract. We found a significant difference of C/PL between the PIH group and the NT group (1.01, SD 0.11 vs. 0.76, SD 0.10, 95% CI 0.74-0.78; p < 0.001) and the Non-Preg group (0.83, SD 0.11, 95% CI 0.80-0.86; p < 0.001). Cord blood C/PL was significantly elevated with respect to NT (1.25, SD 0.13 vs. 0.76, SD 0.10; p < 0.001). The method was proven to be fast, reliable and of value for the study of the pathophysiology of the alteration of the lipid composition, i.e., the increased cholesterol content, of the red cell membrane found in hypertensive pregnant patients.

Computerized FHR traces in post-term pregnancies.

Acc 15saccelerations of 15 bpm above the baseline for at least 15 s, HVsepisode of high variation measured in milliseconds, STVsshort-term variation measured in milliseconds and defined as variation of FHR in 1/16 min (3.75 s) epochs. AFIsamniotic fluid index, UA PIsumbilical artery pulsatility index, MCA PIsmiddle cerebral artery pulsatility index. Data are median (inter-quartile range). Juan J. Piazze*, A. Cerekja, M. Buccheri, S. Martiello and M.M. Anceschi

Differences in erythrocyte membrane cholesterol to phospholipids ratio in postmenopausal women with and without hormone replacement

OBJECTIVESnTo investigate the changes in the cholesterol:phospholipids (C/PL) ratio of erythrocyte membrane in post-menopausal women with and without hormone replacement therapy (HRT).nnnSTUDY DESIGNnA cross-sectional study including 83 patients divided into three groups according to HRT (group 1, no HRT (n = 52); group 2, combined HRT (n = 16); and group 3, estrogen-only therapy (n = 15)).nnnRESULTSnThe C/PL ratio was lower in group 2 with respect to group 1 and group 3 (P = 0.03). No difference was found in erythrocyte membrane cholesterol between the three groups; however, the phospholipid concentration was higher in group 2 with respect to the other groups (P < 0.05). In the control group, C/PL values correlated positively with plasma LDL levels (P < 0.005) and negatively with HDL levels (P < 0.005).nnnCONCLUSIONSnFrom our data the addition of progestogens in HRT appears to decrease the C/PL of the erythrocyte membrane possibly resulting in a beneficial effect on rheological properties of erythrocyte membrane. The results of our study thus suggest additional benefits from supplementation of progestogens in HRT, in addition to prevention of estrogen dependent endometrial hyperplasia and adenocarcinoma.