Moshe Mazor

Cord leptin level and fetal macrosomia.

Objective To determine the relationships among serum leptin, insulin-like growth factor-I, and insulin levels in large for gestational age (LGA) infants. Methods Serum samples were collected from maternal veins and umbilical arteries of 52 consecutive, term, LGA neonates of nondiabetic mothers. Maternal and neonatal serum samples were analyzed for levels of leptin, insulin-like growth factor-I, and insulin by specific radioimmunoassays. Multiple regression analysis was used to determine independent risk factors for fetal macrosomia. Results The independent risk factor significantly associated with fetal macrosomia was umbilical cord leptin concentration (P < .01, β = 0.59). There was a statistically significant correlation between umbilical cord leptin and insulin-like growth factor-I levels and birth weight (r = 0.51, P < .01; r = 0.37, P < .01; respectively). The correlation between umbilical cord insulin levels and birth weight was not statistically significant (r = 0.06, P = .63), nor was that between maternal body mass index and birth weight (r = 0.09, P = .50). Conclusion Our data showed that umbilical cord leptin concentration was an independent risk factor for fetal macrosomia.

The Role of the Coagulation System in Preterm Parturition

Term and preterm parturition have a common pathway that includes irregular uterine contractions, cervical effacement and dilatation, along with decidual activation and rupturing of the chorioamniotic membrane. This pathway is observed in the physiologic labor at term as well as in the pathological processes leading to premature delivery. Indeed, the clinical presentation of preterm parturition involves all components of this common pathway: 1. Preterm contractions in women with spontaneous preterm labor with intact membranes; 2.cervical effacement and dilatation in women with cervical insufficiency; and/or 3.decidual activation and rupture of membranes in those with preterm PROM.

Vaginal Bleeding and Preterm Delivery

Vaginal bleeding during gestation is an ominous sign indicating an adverse pregnancy outcome. Bleeding can occur during all stages of gestation. It complicates up to 20% of pregnancies during the first trimester and is regarded as a sign of threatened abortion. During the second and third trimesters, vaginal bleeding was found to be a risk factor for adverse maternal and neonatal outcomes including preterm labor (PTL), preterm prelabor rupture of membranes (PROM), placental abruption, placenta previa, and stillbirth.