Mei-Leng Cheong

Pregnancy outcomes in unselected singleton pregnant women with an increased risk of first‐trimester Down's syndrome

Background.  The purpose of this study was to assess outcomes in pregnancies with a positive screen of first‐trimester combined test (nuchal translucency, pregnancy‐associated plasma protein‐A and free beta‐human chorionic gonadotropin).

First-trimester Down syndrome screening in women younger than 35 years old and cost-effectiveness analysis in Taiwan population

OBJECTIVES Outcome of the first-trimester Down syndrome screening in younger population was less reported before. We present the outcome of this screening in Taiwanese women younger than 35 years old. We also test whether or not the first-trimester Down syndrome screening of women <35 years of age and women >35 years old routinely receiving amniocentesis is cost-effective compared with all pregnant women screened with this test in the setting of increased maternal age. METHODS From 1999 to 2007, the first-trimester Down syndrome screening including nuchal thickness, pregnancy-associated plasma protein A and free beta-hCG are provided to 10 811 singleton women <35 years of age with the cut-off of 1/270. A cost-effectiveness analysis of young women receiving this screening and older women undergo amniocentesis versus all women undergo this screening was performed in Taiwan population from 1987 to 2006, in which advanced age pregnancies increased from 2.8% to 11.6% of total pregnancies. RESULTS Detection rates of trisomy 21, trisomy 18, Turner syndrome and other chromosome anormalies in women <35 years of age are 87.5% (14/16), 50% (2/4), 80% (8/10) and 63% (12/19), respectively, with a false-positive rate of 5.5% (590/10 811). As advanced age pregnancies reached 11.6%, the average cost per one case averted for all women screened ranged from

Low Maternal Serum Levels of Pregnancy-associated Plasma Protein-A During the First Trimester are Associated with Subsequent Preterm Delivery with Preterm Premature Rupture of Membranes

77 204 to

First-trimester ultrasound diagnosis of Meckel-Grüber syndrome

98 421, while the cost ranged from

EXPRESSION OF A HOECHST 33342 EFFLUX PHENOMENON AND COMMON CHARACTERISTICS OF PLURIPOTENT STEM CELLS IN A SIDE POPULATION OF AMNIOTIC FLUID CELLS

99 647 to

Can First-Trimester Maternal Serum Level Of Pregnancy-associated Plasma Protein-A Predict Subsequent Fetal Growth Restriction?

116 433 for only women <35 years of age receiving this screening. CONCLUSIONS In an aging population, the first-trimester Down syndrome screening should be implemented for all pregnant women when it is available.

Association between fetal nuchal translucency thickness in first trimester and subsequent gestational hypertension and preeclampsia

OBJECTIVE To assess the relationship between the first-trimester maternal serum pregnancy-associated plasma protein-A (PAPP-A) levels and pregnancies complicated by preterm delivery. MATERIALS AND METHODS The correlation between PAPP-A levels and gestational age at delivery was analyzed by linear regression. The probabilities of low PAPP-A multiples of the median (MoM) levels between preterm delivery and control population were analyzed by logit model. RESULTS A positive correlation was noted between the first-trimester PAPP-A MoM levels and gestational age at delivery between 34-38 weeks (p < 0.001). Lower PAPP-A MoM level had a significantly higher likelihood of preterm delivery (p < 0.05). When preterm premature rupture of membranes (PPROM) and preterm labor (PTL) were analyzed separately, there was an increasing likelihood of PPROM with decreasing PAPP-A MoM levels (p < 0.05), but not for PTL with intact membranes. CONCLUSION Low maternal serum PAPP-A levels during the first trimester may reflect a trophoblast invasion defect in the maternal-fetal interface, resulting in subsequent preterm delivery, particularly in those of PPROM.

First trimester combined test for Down syndrome screening in unselected pregnancies - a report of a 13-year experience.

1. Frantzel O. Angeborener Defect der Rechten Lungenarterie. Virchows Arch Pathol Anat. 1868;/42:/420. 2. Harkel AT, Blom NA, Ottenkamp J. Isolated unilateral absenceof a pulmonary artery. Chest. 2002;/122:/1471 7. 3. Bouros D, Pare P, Panagou P, Tsintiris K, Siafakas N. The varied manifestation of pulmonary artery agenesis inadulthood. Chest. 1995;/108:/670 6. 4. Pool PE, Vogel JHK, Blount SG Jr. Congenital unilateral absence of a pulmonary artery: the importance of flow inpulmonary hypertension. Am J Cardiol. 1962;/10:/706 32. 5. Stiller RJ, Soberman S, Turetsky A, Lockwood C, Haddad R. Agenesis of the pulmonary artery: an unusual cause of dyspnea in pregnancy. Am J Obstet Gynecol. 1988;/158:/ 172 3. 6. Ferrari M, Karrazi R, Lampronti G, Biasin C, Zuccali V, Olivieri M, et al. Effect of changing position on arterial oxygenation in a patient with agenesis of the left pulmonary artery. Respiration. 1997;/64:/371 4. 7. Ko T, Gatz MG, Reisz GR. Congenital unilateral absence of a pulmonary artery: a report of two adult cases. Am Rev Respir Dis. 1990;/141:/795 8. 8. Weiss BM, Zemp L, Seifert B, Hess OM. Outcome of pulmonary vascular disease in pregnancy: a systematic overview from 1978 through 1996. J Am Coll Cardiol. 1998;/31:/ 1650 7.

Frequency of postnatal hydronephrosis in infants with a renal anterior-posterior pelvic diameter > 4 mm on midtrimester ultrasound.

OBJECTIVE The aim of this study was to verify the existence of a side population (SP) of cells in second-trimester amniotic fluid. MATERIALS AND METHODS Amniotic fluid samples (n = 35) were obtained, and the number and size of viable amniotic fluid cells (AFCs) were analyzed. Small AFCs (SAFCs) and large AFCs (LAFCs) were isolated using a sterile 10-microm pore size strainer. Hoechst 33342 dye exclusion assay, flow cytometry analysis, reverse transcriptase polymerase chain reaction and immunocytochemistry were used to analyze the characteristics of SAFCs and LAFCs. RESULTS The mean concentration of viable AFCs from 16 to 21 weeks of gestation was 0.3 x 10(5), 0.8 x 10(5), 1.1 x 10(5), 1.3 x 10(5), 1.0 x 10(5) and 1.0 x 10(5) cells/mL respectively. The mean percentage of SAFCs from 16 to 21 weeks of gestation was 27.3%, 40.5%, 49.7%, 60.2%, 41.0% and 58.2%, respectively. The Hoechst 33342 efflux phenomenon was obvious among SAFCs but was rare in the LAFC population. Flow cytometry analyses showed that cell surface antigen expression on LAFCs and SAFCs were positive for CD29, CD44, CD73, CD90, CD166 and HLA-I, but negative for CD31, CD34, CD45, CD117 and HLA-II. Importantly, Nanog, Oct-4, ABCG2 and SOX2 expression in cells was easily detectable among the SAFC population. Expression of Nanog and ABCG2 was not observed among LAFCs. CONCLUSION Amniotic fluid contains a SP that was found mostly among the SAFCs. Enriched SP cells isolated by the efflux of Hoechst 33342 could be a novel and promising source of pluripotent-like amniotic derived stem cells for cellular therapy in the near future.

Corrigendum to “First trimester combined test for Down syndrome screening in unselected pregnancies — A report of a 13-year experience” [Taiwan J Obstet Gynecol 52 (4) (2013) 523–526]

Summary Objective To evaluate whether the maternal serum level of pregnancy-associated plasma protein-A (PAPP-A) in the first trimester can predict pregnancy complicated by low birth weight (LBW) and fetal growth restriction (FGR). Materials and Methods This retrospective analysis enrolled 3,089 women with singleton pregnancy who underwent screening for Down syndrome in the first trimester of pregnancy and who delivered at Cathay General Hospital. They were divided into five groups according to the birth weight of their infants: three FGR groups of birth weight less than the 10 th , 5 th , and 3 rd centiles, a LBW group of birth weight less than 2,500 g, and a control group of all other women. Results The mean multiples of median (MoM) values of PAPP-A were significantly lower in the LBW group (0.98) and the three FGR groups ( th centile, 1.03; th centile, 0.96; and rd centile, 0.99) than in the control group (1.15). Women with PAPP-A less than 0.3 MoM, 0.5 MoM or in the 5 th centile (0.32 MoM) also had a significantly higher relative risk of pregnancy complicated by LBW and FGR, but the sensitivity of detection was low. The highest sensitivity using a cut-off at 0.5 MoM was 22.5%. Conclusion Our study demonstrated that a low maternal serum PAPP-A level in the first trimester is associated with pregnancy complicated by LBW and FGR, but the sensitivity was low. As a single marker, PAPP-A is not sufficient to predict LBW and FGR.