Margaret Dziadosz

Human amniotic fluid: a source of stem cells for possible therapeutic use

Stem cells are undifferentiated cells with the capacity for differentiation. Amniotic fluid cells have emerged only recently as a possible source of stem cells for clinical purposes. There are no ethical or sampling constraints for the use of amniocentesis as a standard clinical procedure for obtaining an abundant supply of amniotic fluid cells. Amniotic fluid cells of human origin proliferate rapidly and are multipotent with the potential for expansion in vitro to multiple cell lines. Tissue engineering technologies that use amniotic fluid cells are being explored. Amniotic fluid cells may be of clinical benefit for fetal therapies, degenerative disease, and regenerative medicine applications. We present a comprehensive review of the evolution of human amniotic fluid cells as a possible modality for therapeutic use.

Use of hemoglobin A1c as an early predictor of gestational diabetes mellitus

Use of hemoglobin A1c as an early predictor of gestational diabetes mellitusLaxmi V. Baxi, Margaret DziadoszPII: S0002-9378(15)00202-1DOI: 10.1016/j.ajog.2015.03.008Reference: YMOB 10295To appear in: American Journal of Obstetrics and GynecologyReceived Date: 26 December 2014Accepted Date: 3 March 2015Please cite this article as: Baxi LV, Dziadosz M, Use of hemoglobin A1c as an early predictor ofgestational diabetes mellitus, American Journal of Obstetrics and Gynecology (2015), doi: 10.1016/j.ajog.2015.03.008.This is a PDF file of an unedited manuscript that has been accepted for publication. As a service toour customers we are providing this early version of the manuscript. The manuscript will undergocopyediting, typesetting, and review of the resulting proof before it is published in its final form. Pleasenote that during the production process errors may be discovered which could affect the content, and alllegal disclaimers that apply to the journal pertain.

Global prevalence of prothrombin gene mutation G20210A and implications in women's health: a systematic review.

Distribution of hereditary thrombophilic gene mutations differs globally. Prothrombin gene mutation G20210A is a common prothrombotic single-nucleotide polymorphism. In this systematic review, we provide a comprehensive report of the prevalence of prothrombin G20210A across the globe. Databases [Pubmed, Web of Science, Embase] were interrogated from their inception through December 2015 for articles reporting prothrombin G20210A prevalence rates and ethnicity. Prevalence rates were organized by continent and ethnoracial ancestry. A total of 113 articles were included with a total 61 876 participants tested for prothrombin G20210A. Reported prevalence rates varied from 0 to 15.9% among ethnic groups, with higher rates seen in the thromboembolism affected cohort compared with the unaffected cohort. Carrier rate distribution is supported by known historical migration patterns of global populations. This review of prothrombin G20210A prevalence may guide resourceful screening for identification of hereditary thrombophilia in female populations of interest with hypercoagulable states.

New Data on Largest Reported Group of “High” Cerclage in Patients With Mid-Trimester Sonographically Short Cervix [1L]

INTRODUCTION: There is operator variation in cerclage technique impacting effectiveness in improving pregnancy outcome. Previously we reported high success rate of cerclage on mid-trimester short cervix (Cx). We aim to find if addition of 23 patients (pts) to previously reported 54 changes the results. METHODS: We studied 77 consecutive pts with ultrasound (US) Cx <25 mm, at 16–24 6/7 weeks (wks) with a high MacDonald cerclage performed or supervised by a single operator (FB) between 2007–2015. High cerclage was defined; cerclage placement 5 cm above external os, intracervical-Foley (balloon filled above internal os) and amnioreduction in pts with short Cx (0–2 cm). Patients received pre-op antibiotics, pre, post-op indomethacin and regional anesthesia. Cx US images obtained immediately and 2 wks post-op to evaluate Cx length and cerclage quality. RESULTS: 64/77 pts had amnioreduction. Pre and post-op Cx were: Preop Cx: 23 pts (30%) >15 mm, 54 (70%) <15 mm, 29 (38%) <10 mm, 18 (23%) <5 mm (mean 11, median 11, range 0–25 mm). Post-op Cx: 39 pts (51%) 40–50 mm and 38 (44%) 30–40 mm (mean 41, median 41, range 30–55 mm). Outcome: 4 pts (5.3%) delivered at <24 wks, 4 (5.3%) at 24–25, 2 (2.6%) at 26–28, 8 (10.5%) at 28–32, 7 (9.2%) at 33–34, 10 (13%) at 35–36, and 41 pts (54%) at ≥37 wks. 67% and 76% delivered at >34 and >32 wks, respectively. CONCLUSION: Under appropriate conditions, an optimally placed high cervical cerclage by an experienced operator, in pts with short Cx is safe and associated with excellent pregnancy outcomes.

More Data Supporting That Intra-Amniotic “Sludge” Does Not Affect Pregnancy Outcome in Patients With Short Cervix [4K]

INTRODUCTION: Previously we showed that finding of intra-amniotic “sludge” (IAS), an ultrasound (US) finding of hyperechoic matter in the amniotic fluid (AF) close to cervical internal os, did not change pregnancy outcome in asymptomatic patients (pts) undergoing high cerclage for sonographically short cervix (Cx). We aim to find if addition of 22 pts to previously reported 46 changes the result. METHODS: Records of 68 consecutive pts, who underwent high MacDonald cerclage between 16–24 6/7 weeks (wks) for a sonographically short Cx (<25 mm) between 2007–2015 were evaluated. Transvaginal US images were evaluated for cervical length, funneling and presence of IAS. Baseline morphological characteristics and pregnancy outcomes were compared between those with and without IAS. RESULTS: Of 68 pts, 36 had IAS present and 32 did not. Pts with IAS had shorter Cx at time of cerclage 9.9±7 vs 13.7±6.7 mm (P=.025) and more cervical funneling (P=.022). Other baseline characteristics were largely similar. Pregnancy outcomes were similar for delivery rates at gestational age (GA) with mean; 36 1/7±4 wks for IAS, 36 4/7±4 2/7 wks for no IAS (P=.719), and neonatal weight; 2745 (808) grams vs. 2938 (827) grams (P=.356). CONCLUSION: Despite associated differences in Cx funneling and shorter Cx, presence of IAS did not affect pregnancy outcome in GA at delivery or neonatal birth weight. These results suggest that presence of IAS does not contraindicate use of optimally placed cerclage in asymptomatic pts who are candidates for cerclage.

Presence of “Sludge” Does Not Justify the Need for Amniocentesis to Rule Out Infection in Patients With a Short Cervix [27I]

INTRODUCTION: Previously we found that biomarkers for infection at the time of cervical cerclage were similar between patients (pts) with Intra-amniotic “sludge” (IAS), an ultrasound (US) finding of hyperechoic matter in amniotic fluid (AF) close to the internal os, and without IAS. We aim to find if addition of 23 pts to previously reported 41 pts changes the result. METHODS: Record of 64 consecutive pts who underwent a high MacDonald cerclage between 16–24 6/7 weeks (wks) for a sonographically short Cx (<25 mm) from 2007–2015, performed or supervised by a single operator (FB) were evaluated. Transvaginal US images prior to cerclage evaluated for Cx length and presence or absence of IAS. AF collected at the time of cerclage (transabdominal amniocentesis) evaluated for presence of infection by culture, Gram stain (GS), glucose (Glu), red (RBC), and white blood cell (WBC) count. RESULTS: 36 of 64 pts (56%) had IAS, 28 (43%) did not. All culture and GS were negative. No differences between groups were detected with regards to Glu, (P=.48), RBC (P=.44) or WBC (P=.85). Pregnancy outcomes were similar in terms of gestational age (GA) at delivery. Baseline Cx lengths were similar between groups. Cerclage occurred at slightly earlier GA and patients were slightly older for the IAS Group. CONCLUSION: IAS does not indicate the presence of infection. The presence of IAS in asymptomatic pts with sonographically short Cx at mid-trimester does not constitute an indication for an amniocentesis to rule out IA infection or increased risk for premature birth.

Revision of Failed Cerclage Is Associated With Higher Risk of Premature Birth Compared to Primary Cerclage [24N]

INTRODUCTION: Little is known about the outcome of revising failed cerclage, previously placed for sonographically short mid-trimester cervix. Our previous data reported higher risk of premature delivery in patients (pts) with revision compared to single cerclage. We aim to find if addition of 23 pts to previously reported 54 changes the results. METHODS: This is a cohort of 77 pts with ultrasound cervical length (CL) of <25 mm at 16–24 6/7 weeks (wks) who underwent high MacDonald cerclage. Nine pts required revision to correct a failed cerclage (performed by other operators). Failed cerclage was defined as presence of prolapsed membrane beyond cerclage or CL distal to cerclage of <1 cm. All surgeries were performed or supervised by one operator (FB). Gestational age (GA) at delivery, and other obstetrical outcomes, were compared between 2 groups. RESULTS: 68/77 pts had primary cerclages, 9/77 pts had revision cerclages. 4 pregnancy losses noted (2 in primary, 2 in revision). Pts with revision had shorter delivery GA; mean of 27 3/7 (±6.7) vs 36 2/7 (±4.1) wks (P=.003). Birth weight was lower in revision group; mean 1345 (±1056) vs 2830 grams (±816) (P=.005). More babies in revision group had NICU admissions 5/7 (71.4%) vs 14/64 (22%) pts (P=.008). CONCLUSION: Patients with revision cerclages have higher premature delivery compared to successful primary cerclages. Revised cerclages were associated with a high take-home baby (7/9 or 78%) but also with high preterm delivery rate (8/9 or 89%), which should be considered when counseling pts with failed cerclages and candidates for revision cerclage.