N. Papantoniou

Placental pathology in women with gestational diabetes

Background. The aim of this study was to investigate pathologic differences of the placenta in pregnancies complicated by gestational diabetes compared to non‐diabetic pregnancies. Methods. Forty singleton pregnancies complicated by gestational diabetes were recruited and compared to 40 consecutive normal pregnancies. A pathologist, blinded to all clinical data, reviewed all histological samples of the placentas. The histological assessment was carried out with regard to the following aspects: fetal vessel thrombosis, villous immaturity, chorangiosis, presence of nucleated fetal red blood cells (NFRBCs), ischemia, infarction, presence of hydropic or avascular villi, lymphohistiocytic villitis and villous fibrinoid necrosis. Results. The presence of degenerative lesions such as fibrinoid necrosis and vascular lesions like chorangiosis was apparent, mainly in the diabetes group. Villous immaturity and the presence of NFRBC as an indication of chronic fetal hypoxia were significantly increased in the placentas of women with diabetes compared with the control group. Fetal/placental weight ratio was significantly lower in the diabetic group. Conclusion. Histological abnormalities were observed more frequently in the diabetic placentas compared to the controls. These findings support the hypothesis that impaired placental function is one of the main reasons for the increased frequency of fetal complications in diabetic pregnancies.

Amniotic fluid interleukin-6 and tumor necrosis factor-α at mid-trimester genetic amniocentesis: Relationship to intra-amniotic microbial invasion and preterm delivery

OBJECTIVE To determine the value of amniotic fluid interleukin-6 (AF IL-6) and tumor necrosis factor-alpha (AF TNF-alpha) in the diagnosis of microbial invasion of the amniotic cavity and in the prediction of preterm delivery (PTD). STUDY DESIGN Following amniocentesis, a sample of amniotic fluid was sent for aerobic and anaerobic bacterial cultures along with Ureaplasma urealyticum culture and it was also assessed for IL-6 and TNF-alpha. RESULTS Forty-eight women who delivered preterm (<37 weeks) were matched with 96 controls. The AF IL-6 and TNF-alpha concentrations of women with spontaneous PTD were significantly higher than those who delivered at term (IL-6: 176.3 pg/ml [130.6-208.6] vs. 52.3 pg/ml [37.2-92.3]; TNF-alpha: 8.8 pg/ml [7.2-10.7] vs. 5.5 pg/ml [5.0-6.3]). AF IL-6 and TNF-alpha concentrations of >99.3 pg/ml and of >6.6 pg/ml respectively, had a sensitivity of 89.6% and 81.3% and a specificity of 80.3% and 79.2% for the prediction of spontaneous PTD. Moreover, AF IL-6 and TNF-alpha concentrations of >99.3 pg/ml and of 6.3 pg/ml respectively, had a sensitivity of 91.9% and 78.4% and a specificity of 73.8% and 70.1% for the prediction of a positive AF culture. CONCLUSIONS Elevated mid-trimester concentrations of AF IL-6, or/and of TNF-alpha can identify women at risk for intra-amniotic infection and for spontaneous PTD.

Impact of placenta previa on obstetric outcome

To determine the maternal and perinatal outcome for different types of placenta previa (PP).

Bacterial Vaginosis and Group B Streptococcal Colonization and Preterm Delivery in a Low-Risk Population

Objective: To evaluate the relationship between bacterial vaginosis (BV) and group B streptococcal (GBS) colonization in the 2nd trimester of pregnancy and preterm delivery. Methods: 1,197 pregnant women between 22 and 25 weeks’ gestation had a high vaginal swab for assessment of BV and GBS. Exclusion criteria were: previous preterm delivery, or mid-trimester abortion or termination of pregnancy, multiple gestation, oligo- or polyhydramnios, placenta previa, fetal abnormalities, uterine malformations, cervical incompetence, cervical cerclage, or receipt of an antibiotic effective against BV or GBS following the screening. All women had no risk factors for preterm delivery. The primary outcome measure in this analysis was spontaneous preterm delivery before 37 weeks’ gestation. Results: The preterm delivery rate was 8.7%, while the maternal BV and GBS colonization rates were 7.9 and 12.5%, respectively. Following adjustment for potential confounders BV was associated with an increased risk of preterm delivery (RR 2.19; CI: 1.21–3.98) (p = 0.01). On the contrary, GBS colonization was found to have a negative correlation with preterm birth (RR 0.43; 95% CI: 0.19–1.00). Conclusions: Although BV is a risk factor for preterm delivery, GBS colonization in the 2nd trimester of pregnancy has an inverse correlation with preterm delivery.

Invasive techniques for fetal diagnosis in multiple pregnancy

During a 12‐year period, a variety of fetal diagnostic techniques were performed in 112 twin, 3 triplet and 1 quintuplet pregnancies, respectively. Tissues sampled included amniotic fluid, fetal blood and chorionic villi. Two spontaneous abortions occurred and one case of twins was stillborn. Four selective feticides were performed in twins for specific indications and four healthy surviving infants were delivered. It is concluded that fetal diagnosis in multiple pregnancy is safe and accurate without significant perinatal morbidity and mortality.

Preterm Labor and Birth Management: Recommendations from the European Association of Perinatal Medicine

These guidelines are based upon most recent and updated evidence and they are adapted to a European perspective by an expert view of the problem. These guidelines are not intended to be a meta-anal...

Maternal cardiac troponin levels in pre-eclampsia: a systematic review

Abstract Objective: We systematically review the literature for potential alterations in cardiac troponin I (cTnI) in patients who suffer from pre-eclampsia. Methods: We used the Medline (1966–2015), Scopus (2004–2015), Popline (1974–2015), ClinicalTrials.gov (2008–2015) and Cochrane Central Register of Controlled Trials (CENTRAL) (1999–2015) databases for our primary search; we also employed the reference lists of the full-text articles that we retrieved electronically. Results: We included nine studies involving 719 women. Five of these studies suggested that cTnI increases in pre-eclamptic patients above the normal threshold. However, all studies reported outcomes at a single time point, and they failed to perform consecutive measurements to observe whether this effect was long lasting and whether it evolved during the course of pregnancy. Conclusions: Current evidence suggests that cTnI might be elevated in pre-eclamptic pregnant women, although this observation is not always reported. Future studies are necessary to consistently observe cTnI levels throughout the prenatal period and during the first few postnatal weeks. A concurrent evaluation of other cardiovascular hemodynamic parameters could be of use in mechanistic models for predicting future cardiovascular morbidity in these women.

Increasing the noninvasive management of rhesus isoimmunization

To determine the clinical outcome of isoimmunized pregnancies managed by middle cerebral artery peak systolic velocity (MCA‐PSV) in an intention‐to‐treat study.

In utero diagnosis and treatment of severe rhesus iso-immunisation by use of intravascular techniques

SummaryForty-one pregnancies complicated by rhesus (D) iso-immunisation were managed by serial fetal blood sampling and in utero intravascular transfusion.Eighteen patients were only monitored with fetal blood sampling during pregnancy. Fetal blood group and rhesus factor, haematocrit, bilirubin levels, albumin concentrations and acid-base balance were determined. In this group all patients delivered at term without complications.Twenty-three patients had 42 intravascular transfusions. The ‘procedure related’ fetal loss rate was 2.3 per cent. Obstetric management was individualised according to serial fetal haematocrit estimations, acid base balance and cardiotocographic monitoring of each patient. The overall perinatal survival rate was 87 per cent.

P03.09: 2D or off-line 3D ultrasound during the 1st trimester scan

accuracy according to the initial, lower and higher angle was calculated. Cases with wrong fetal assignment were individually analyzed. Results: Overall, 95 cases were included in the analysis. Following online genital angle calculation fetal gender assignment was possible in all but one woman (98.9%) in which the angle fell inside the cut-off (28◦). The assigned gender was correct in 90 of the 95 cases (94.7%). Among the 5 cases with wrong fetal gender assignment 2 cases were < 12 weeks and two cases had an angle calculated from the second volume which fell inside the cut-off (undetermined gender). Using the narrower and higher angle the accuracy of fetal gender determination was 93.7% and 96.8% respectively. Conclusions: 3DUS is a highly accurate tool for fetal gender assignment in the first trimester. A second look may have a role in reducing the margin of error in fetal gender determination. In case of discrepancy the wider angle seems to perform better.