Márta Katona

Increased nuchal translucency and congenital heart defects in euploid fetuses: The Szeged experience

OBJECTIVE To determine the utility of the first-trimester fetal nuchal translucency (NT) thickness in the prediction of fetal cardiac malformations. DESIGN Retrospective study. SETTING Department of Obstetrics and Gynecology and Medical Genetics, University of Szeged. METHODS The pre- and postnatal course and outcome, and the relationship between the first-trimester fetal NT thickness and fetal congenital heart defects (CHDs) in 4309 pregnancies ended up with birth or therapeutic abortion between January 1998 and June 2000 were registered. Prenatal care included first- and second-trimester fetal sonography at weeks 10-13 and 18-20, respectively. RESULTS 4251 births and 58 first- and second-trimester therapeutic abortions due to lethal congenital malformations or chromosomal abnormalities were recorded. Altogether 209 (4.9%) congenital malformations were detected, 39 (18.7%) of which were heart defects with normal karyotype. At birth, 151 congenital malformations were diagnosed, 34 of them were known prenatally. The prevalence of CHDs was 9 per 1000 pregnancies. The measurement of fetal NT thickness was available in 35 of the 39 fetuses with heart defects: it was > or = 3 mm in 18 (51.4%) and <3 mm in 17 (48.6%). A sensitivity of 51.4% was found at a cutoff of 3mm. CONCLUSIONS An increased NT thickness in chromosomally normal fetuses was found to be highly associated with CHDs and identified in more than half of the affected cases. Furthermore, an increased NT of > or = 3 mm can be regarded a selection criterion for early second-trimester targeted fetal echocardiography and for increased fetal and neonatal surveillance.

Obstetric and neonatal risk of pregnancies after assisted reproductive technology: a matched control study

Background.  The aim of the study was to evaluate the obstetric and neonatal outcome of pregnancies after assisted reproduction technology (ART) in comparison with matched controls from spontaneous pregnancies.

THE INCIDENCE OF MAJOR BIRTH DEFECTS FOLLOWING IN VITRO FERTILIZATION

AbstractPurpose: To evaluate the risk of congenital malformations in newborns delivered after IVF-ET in comparison with matched controls from spontaneous pregnancies. Methods: A total of 12,920 deliveries were subjected to retrospective analysis. A total of 301 neonates were evaluated. The incidence of major birth defects was compared with controls matched with regard to age, gravidity, parity, and previous obstetric outcome after spontaneous pregnancies. Results: The incidence of major congenital abnormalities was not significantly higher (p > 0.05

Selective sensory denervation by capsaicin aggravates adriamycin-induced cardiomyopathy in rats

) among the cases (1.90%) than among the controls (1.15%). Conclusions: The risk of major birth defects following IVF-ET is comparable with that of spontaneously conceived, matched pregnancies.

Risk factors for cesarean section of primiparous women aged over 35 years

Capsaicin-sensitive sensory nerves that contain calcitonin gene-related peptide (CGRP) contribute significantly to cardioprotective mechanisms. In this study, the possible role of capsaicin-sensitive afferent nerves in the development of congestive heart failure was examined in an established model of adriamycin-induced experimental cardiomyopathy in rats. Systemic treatment with capsaicin was utilized to deplete sensory neuropeptides from cardiac afferent nerves. Echocardiography was applied to assess the cardiac function in adriamycin-treated rats pretreated with capsaicin or its vehicle. In control rats, adriamycin treatment produced a reduction in the fractional shortening of the left ventricle and an increase in the ratio of the left atrial diameter and the aortic diameter, indicative of a decreased myocardial contractility and heart failure only at 3–4 weeks post-treatment. In contrast, in capsaicin-pretreated rats, a deterioration of the cardiac function was already evident 1 week after the cessation of adriamycin administration, while the clinical signs associated with cardiomyopathy were more severe and displayed a significantly more rapid progression. Immunohistochemistry revealed a complete depletion of calcitonin gene-related peptide from cardiac sensory nerves after systemic capsaicin treatment. This study has demonstrated that elimination of capsaicin-sensitive afferent nerves promotes the development and progression of adriamycin-induced myocardial dysfunction. The results suggest that interfering with capsaicin/vanilloid receptor function and/or perturbation of the myocardial CGRP metabolism may open up new perspectives concerning prevention and/or alleviation of the pathological changes that follow adriamycin treatment.

Dilemma of Increased Obstetric Risk in Pregnancies Following IVF-ET

Background.  To determine the perinatal outcome of pregnancy in primiparous women over 35 years of age and to evaluate determinants predicting cesarean delivery in these women.

Prostaglandin E1 treatment in patent ductus arteriosus dependent congenital heart defects.

AbstractPurpose: To determine the rates of pregnancy complications following in vitro fertilization in comparison with those in a matched control group. Methods: A total of 13,543 deliveries at the Department of Obstetrics and Gynecology, University of Szeged, between January 1, 1995 and February 28, 2002 were subjected to retrospective analysis. The 230 (1.7%) pregnancies following IVF-ET were evaluated and matched with spontaneous pregnancies concerning age, parity, gravidity, and previous obstetric outcome. Demographic and selected maternal characteristics, pregnancy and labor complications, and neonatal outcome were compared in the two groups. Results: The pregnancy complication rate was partly significantly higher among the singleton IVF-ET pregnancies. The obstetric risk was elevated, though not significantly concerning twin pregnancies. Conclusions: IVF-ET presents an additional obstetric risk. The neonatal outcome displays a significant difference only concerning an increased premature birth rate of singleton pregnancies. Triplet IVF-ET pregnancies involve a much higher risk of both pregnancy complications and neonatal outcome.

The perinatal outcome of pregnancy without prenatal care: A retrospective study in Szeged, Hungary

Abstract Prostaglandin E1 (PGE1) treatment can be life saving in patients suffering from ductus dependent congenital heart defect. We analyzed the indications and side-effects of PGE1 therapy over a five-year period. The purpose of the study was also to examine whether a change in serum electrolyte levels could be detected. Forty-nine patients were treated with PGE1 during this period. PGE1 treatment was indicated by ductus dependent systemic circulation in 16 cases, ductus dependent pulmonary circulation in 17 cases, transposition of the great arteries in 13 cases and pulmonary hypertension (persistent fetal circulation) in three cases. As early side-effects of the treatment, fever occurred in 27/49 cases while apnoea was observed in 15 patients. In a one-week-old neonate with coarctation of the aorta grade III intraventricular hemorrhage developed. A mild decrease of sodium, potassium and chloride levels and a slight shift of pH levels toward metabolic alkalosis could be detected after one day and one week of PGE1 treatment. Because of these side-effects of PGE1 patients should be monitored in an intensive care unit. According to our observations electrolyte levels may exhibit a slight decrease; however, in the case of a short-term therapy extra salt supplementation is not necessary.

Leiden mutation, bed rest and infection: Simultaneous triggers for maternal deep-vein thrombosis and neonatal intracranial hemorrhage?

OBJECTIVE The aim of this study was to examine the social conditions of women who never attended prenatal care and to evaluate the perinatal outcome of their newborns. STUDY DESIGN A retrospective analysis of uncared pregnancies of women who delivered at the Department of Obstetrics and Gynaecology, University of Szeged, Hungary between 1 January 1996 and 31 December 1998. There were 5262 deliveries during this period, of which 54 (1%) had no prenatal care. Matched controls (108 cases) were selected on the basis of maternal age, educational level, the number of gravidity and parity, and marital status. RESULTS The mean age of women with out-of-care pregnancies was 27 years+/-3.9; 5 women were under 18, 23 (43%) were unmarried, 5 (9.3%) did not finish elementary school and 35 (65%) had only elementary school education. Compared to the controls there were more in preterm labors (33 versus 14% (OR 3.1, 95% CI 1.4-6.8)), lower birth weight (P<0.001) and more given up for adoption (17 versus 0.9% (OR 21.4, 95% CI 2.63-173.9)). CONCLUSION These data underline the importance of regular prenatal care in the prevention of preterm delivery.

Side-effects of long-term prostaglandin E1 treatment in neonates

The possible etiologic roles of infection and bed rest are discussed in connection with a case of maternal homozygous Leiden mutation leading to prematurity, maternal deep-vein thrombosis and neonatal intracranial hemorrhage in a heterozygous premature baby. Maternal bacterial infection and bed rest may trigger deep-vein femoral thrombosis in women with a homozygous Leiden mutation on tocolytic therapy for the treatment of premature labor. The neonate carrying at least one mutated allele of factor V Leiden might be at risk for the development of intracranial hemorrhage.