R. N. Laurini

Expression of cytokines and chemokines in cervical and amniotic fluid: Relationship to histological chorioamnionitis

Objective. To correlate cervical and amniotic fluid cytokines and macrophage-related chemokines to the development of histological chorioamnionitis (HCA) in patients with preterm labor (PTL) and preterm prelabor rupture of the membranes (PPROM). Study design. Cervical and amniotic fluid interleukin (IL)-6, IL-8, IL-18, monocyte chemotactic protein (MCP)-1, MCP-2, and MCP-3 from pregnant women (at ≤34 weeks of gestation) in PTL (N = 42) were analyzed and related to the subsequent occurrence of HCA or inflammatory signs in the placenta. For the patients with PPROM (N = 30) only amniotic fluid proteins were analyzed. Results. Intra-amniotic levels of IL-6, IL-8, IL-18, MCP-1, and MCP-3 were significantly higher in PTL cases with HCA compared to non-HCA controls, whereas no such relationship was obtained in the PPROM group. Cervical IL-8 and IL-6 (but not IL-18, MCP-1, MCP-2, and MCP-3) in PTL patients was associated with HCA, and at a cut-off level of 10.0 ng/mL cervical IL-8 was a strong predictor of HCA in the PTL cases (sensitivity 100%, specificity 67%, positive predictive value 63%, negative predictive value 100%). The cytokine and chemokine levels in the group with inflammatory signs were generally higher than in controls but lower compared to the concentrations in the HCA group. Conclusions. The amniotic levels of IL-6, IL-8, IL-18, and the CC-chemokines MCP-1 and MCP-3 in PTL patients all predicted HCA, whereas only IL-8 was a clinically useful marker of HCA in the cervical fluid. In addition there is indication that the levels of inflammatory proteins are related to the degree of inflammatory infiltration in placental tissue samples.

Vascular mechanical properties and endothelial function in pre-eclampsia with special reference to bilateral uterine artery notch

Objectives. To assess whether women with pre‐eclampsia (PE) have different properties of the blood vessel wall compared to healthy pregnant controls. Further, to evaluate endothelial function and vascular mechanical properties in women with PE with special regard to its association with bilateral uterine artery notch and placental histopathology. Participants. Some 57 Caucasian pregnant women: 23 with uncomplicated pregnancies and normal uterine artery Doppler, and 34 with PE, the PE group comprising 2 subgroups according to the presence (n = 20) or absence (n = 14) of bilateral uterine artery notches. Methods. Ultrasonic echo‐tracking assessed the elastic properties of the common carotid artery, abdominal aorta and popliteal artery. Flow‐mediated dilatation (FMD) of the brachial artery was measured by ultrasonography. Histopathological examination of the placenta was carried out in 46 pregnancies: 18 uncomplicated pregnancies, 15 with PE with bilateral notch, and 13 with PE without bilateral notch. Results. There were no significant differences in carotid, aortic or popliteal vessel wall stiffness either between women with PE and controls or within the PE group. FMD was significantly lower in women with PE than in controls (p = 0.03). The lowest FMD was observed in pre‐eclamptic women with bilateral uterine artery notches 9.5% (SD: 5.3) compared to 11.6% (SD: 5.4) in pre‐eclamptic women without bilateral uterine artery notch, and 13.4% (SD: 4.0) in controls (p = 0.01). Bilateral uterine artery notching was significantly associated with a lower FMD (OR: 0.87; 95% CI: 0.77–0.98). There were significantly more placentas with high ischaemic score in the bilateral notch group than in the group with PE and normal circulation. Conclusions. There were no differences in vessel wall stiffness between women with PE and healthy controls. Women with PE showed signs of endothelial dysfunction, significantly more pronounced in women with bilateral uterine artery notch. Bilateral uterine artery notch was associated with ischaemic pathology of the placenta. Notwithstanding, a significant number of placentas in the PE group failed to show noteworthy ischaemic or other morphological changes that could explain the role of the placenta in the development of PE.

Uterine venous blood flow in normal and complicated pregnancies: a methodological study.

To investigate the possibility of recording Doppler flow signals from the maternal uterine veins (UtVs) during pregnancy and to assess the relationship between UtV signals and other Doppler parameters as well as pregnancy outcomes.

Umbilical artery Doppler in relation to placental pathology and FV Leiden in pregnant women and their offspring

Abstract Objective: Abnormal umbilical artery blood flow has been implicated in pregnancy complications and fetal demise. Its relation to histopathological changes in the placenta and to maternal or fetal thrombophilia is less well understood. The aim of this study was to evaluate the relation between umbilical artery Doppler findings, placental histopathology, and maternal and fetal coagulation factor V Leiden (FVL) status. Methods: Two previous studies on FVL in pregnancy made the placentas of 25 women with maternal FVL carriership and 43 randomly selected non-carriers available for a histopathological examination. Umbilical artery Doppler velocimetry was performed on 54 women in late pregnancy. Results: Abnormal umbilical artery Doppler velocimetry was associated with an approximately sevenfold increased risk of fetoplacental thrombotic vasculopathy (odds ratio [OR]: 7.5, 95% confidence intervals [CI]: 1.3–44.3), ischemic lesions (OR: 7.5, 95% CI: 1.2–46.1) and fetal carriership of FVL (OR: 8.2, 95% CI: 1.5–43.5), but not maternal FVL. Fetal FVL carriership was also associated with a sevenfold increased risk of ischemic lesions (OR: 6.7, 95% CI: 1.3–35). Conclusions: Our results indicate that the fetal – not the maternal – FVL carriership matters regarding the umbilical artery blood flow and placental pathology, which might explain some of the heterogeneity of studies.

Placental ischemia and changes in umbilical and uteroplacental arterial and venous hemodynamics.

Objective: To relate Doppler velocimetry findings in fetoplacental and uteroplacental circulation to placental histomorphology. Material and methods: In 14 uncomplicated and 31 high-risk pregnancies Doppler velocimetry was performed in umbilical artery and vein, and in maternal uterine veins and arteries during the second half of gestation. Histopathology of the placentas was examined, especially for signs of ischemia and inflammation. Results: All fetuses in uncomplicated pregnancies had normal flow velocity waveforms in umbilical artery; in the high-risk group, 18 fetuses had abnormal flow (increased PI or absent/reverse end-diastolic flow). The latter group had more often high ischemic score and infarctions in the placenta than found in pregnancies with normal umbilical artery flow (p < 0.001 and p = 0.02, respectively). Similarly, the abnormal uterine artery flow pattern (uterine artery score 3–4) occurred more often with high ischemic score and placenta infarctions (p < 0.001 and p < 0.001, respectively). No significant associations were found between the uterine venous flow type and placental ischemia. Conclusion: Placental ischemic morphological changes were associated with Doppler ultrasound signs of increased resistance to arterial blood flow, both on the fetal and maternal sides of the placenta. No significant relation to the uterine venous flow velocities was found.

P37.07: Comparison between transabdominal multiplanar V-Mode vs. B-Mode in mid-sagittal scanning of the abnormal fetal brain

Introduction: Subarachnoid space normally exists around the cerebral hemispheres in fetuses with normal intracranial structure and demonstrated by transvaginal sonography or MRI. Recent advanced technology of high-frequent ultrasound scan can reveal the detailed structure around the hemispheres. Material and method: Transvaginal 3D image datasets of parietal region were obtained from 168 fetuses with no structural abnormalities between 18 and 36 weeks of gestation. The equipment used in the study was Voluson E8 with 12-MHz transvaginal 3D/4D transducer. The datasets were obtained with highest resolution and maximum 3D acquisition. Each 3D image dataset was carefully evaluated on the three orthogonal view. Results: Subarachnoid space was clearly demonstrated in all cases. In 12 cases between 23 and 32 weeks of gestation, translucent subdural space was recognizable between the dura mater and arachnoid mater. The echogenicity was clearly different from subarachnoid space. Discussion: Subarachnoid space, demonstrated by sonography or MRI, has been thought as a physiological phenomenon in fetal life. In postnatal life, subdural space between the dura mater and arachnoid mater is one of pathological phenomena, such as subdural hemorrhage or fluid collection due to trauma. In this study, the subdural space was demonstrated in 7% of normal fetuses. This space has not been recognizable even by high frequency vaginal scan and not reported so far. The advanced new technology of ultrasound equipment and transducer may have discovered a new phenomenon. Conclusions: Subdural space was detected by 12-MHz transvaginal ultrasound scan in normal fetuses. The existence of subdural space may be one of normal variations during fetal life. Further investigation will be required.

OC07: Transabdominal B‐mode and V‐mode vs B‐mode/and V‐mode/sono‐MRI in achievement and examination of fetal physiologic mid‐sagittal scan: the experience in 1998–2006 period

Aim: To compare the individual quantity of the movements preand postnatally. Methods: Twenty eight out of 45 pregnant women in the third trimester of pregnancy (28–35 weeks) during the six month period (November 2003–May 2004) and 28 term, appropriatefor-gestational-age newborns took part in the study. All 4D examinations were performed on Voluson 730 (Kretztechnik, Zipf, Austria). 4D images were displayed on the screen and recorded on the videotape during 30 min observation period. Recordings were performed in the moming and no meal was taken within two hours of the beginning of the study. Examinations of the newborsn were performed while the newboms were in bed, separated from other infants in the nursery, dressed, and lying on their backs in a supine position with unrestrained hands. The video recording was processed mainly while children were actively awake or during alert inactivity. Video recording was not performed during prolonged episodes of fussing and crying, during drowsiness and episodes of hiccupping. Results: Hand to mouth and hand to face movements were more frequent in fetuses than in neonates, while all other hand movements were less frequent in neonates than in fetuses. Wilcoxon rank-sum test reached statistically significant differences between the fetuses in third trimester and the newboms (p < 0.05) in hand to head, hand to mouth, hand to eye, hand to face, and hand to ear movements. Spearman rank order correlation reached statistical significance between the fetuses in the third trimester and in the newborns (p < 0.05) in hand to head (r = 0.42; t = 2.33; p = 0.03), hand to mouth (r = 0.76; t = 5.91; p < 0.05), hand to eye (r = 0.56; t = 3.42; p < 0.05), hand to face (r = 0.86; t = 8.53; p < 0.05) and in hand to ear movements (r = 0.66; t = 4.95; p < 0.05). Conclusions: There is continuity between fetal and neonatal movement pattems concerning the quantity of hand movements. 4D is a good tool for the assessment of the quantity of fetal movements.

P10.09: Uterine venous flow in normal and complicated pregnancies—a methodological study

Objective: Our hypothesis was that the ability of the product of the middle cerebral artery (MCA) peak systolic velocity (PSV) and ductus venosus (DV) pulsatility index (PI) to predict perinatal mortality in IUGR fetuses delivered at less than 28 weeks’ gestation is superior to MCA PSV and DV PI. Study design: Patients with a diagnosis of IUGR, defined as fetuses with either estimated weight or abdominal circumference below the 10th percentile and an abnormal umbilical artery, were included in this study. The ductus venosus PI and the MCA PSV were measured and expressed as multiples of the median. To determine the relationship between the three parameters and perinatal mortality, we performed a receiver operator curve (ROC) analysis for each parameter. A p-value < 0.05 was considered statistically significant. Results: Seventeen fetuses met the inclusion criteria. Gestational age at diagnosis ranged between 23.3 weeks and 27.6 weeks. The median interval between the last examination and delivery was one day. There were seven perinatal deaths. All three indices produced a very similar area under the curve (MCA PSV AUC: 0.743; p = 0.097; DV PI AUC: 0.757, p = 0.079; MCA PSV × DV PI AUC: 0.77, p = 0.064). At 100% sensitivity, the specificities were 30% for the DV PI and the product of the MCA PSV and DV PI, whereas it was 50% for the MCA PSV. Conclusions: These data suggest that the MCA PSV, and the product of the MCA PSV and DV PI may predict perinatal outcomes in very preterm growth-restricted fetuses at least as well as the DV PI. The results may have not reached statistically significance because of the small sample size of the study group. A serial study involving IUGR fetuses that includes the MCA PSV, the product of MCA PSV, and the DV PI is warranted. These might represent the best fetal Doppler parameters in predicting perinatal outcomes in very early preterm IUGR fetuses.

P15.11: V‐Mode vs. B‐Mode in the differential diagnosis between cerebellar vermis rotation and Dandy Walker complex

Objective: Identification of ultrasonographic (US) markers useful in the differential diagnosis between cerebellar vermis rotation (CRV), Dandy Walker malformation (DWm), DW variant (DWv) and megacisterna magna (MCM). Trans-abdominal (TA) multiplanar/Volume-Mode (MP/V-Mode) and TA B-Mode were compared. Methods: 13 patients (g.a. 18 w1d–25 w6d) were examined by TAB-Mode and by TA-MP/V-Mode. Material: DWm (4 cases), DWv (6 cases), MCM (2 cases), CVR (1 case). The looked for US signs were: cerebellar vermis (VH) and lobes (LH) hypoplasia, enlarged 4th ventricle (e4V), vermis primary and secondary fissures (PF and SF), high tentorium (HT), enlargement of posterior cranial fossa (ePCF), brainstem distortion against the clivus (BDC). Results: DWm (4 cases). Visualisation of VH (4/4 cases): 4/4 cases in V-Mode vs 4/4 in B-Mode. LH (4/4): 4/4 vs 4/4. PF and SF: (both absent). e4V (4/4): 4/4 vs 4/4. HT (4/4): 4/4 vs 1/4. ePCF (3/4): 3/3 vs 0/3. BDC (4/4): 4/4 vs 0/4. DWv (6 cases). Visualisation of VH (6/6): 6/6 (easy) vs 6/6 (difficult). LH absent. PF (6/6): 6/6 vs 1/6. SF: absent. e4V (6/6): 6/6 (easy) vs 6/6 (difficult). HT (3/6): 3/3 vs 1/3. ePCF (1/4): 1/1 vs 0/1. BDC: absent. MCM (2 cases). Visualisation of VH: absent. LH: absent. PF (2/2): 2/2 vs 0/2. SF: (2/2): 2/2 vs 0/2. e4V (4/4): absent. HT absent. ePCF absent. BDC: absent. CVR (1 case). Visualisation of VH: absent. LH: absent. PS: 1/1 vs 0/1. SF: 1/1 vs 0/1. e4V: 1/1 vs 0/1. HT absent. ePCF absent. BDC: absent. Conclusions: In a case of CVR we observed an enlarged 4th ventricle with presence of PF and SF in the cerebellar vermis. PCF assessment can greatly benefit of TA-MP/V-Mode.

OC167: V-Mode vs. B-Mode in the visualisation of cerebellar vermis primary and secondary fissures: a tool in the differential diagnosis of vermis anomalies

(7 cleft lip or cleft lip and palate, 2 cyst of oral cavity), chest (3 right diaphragmatic hernia, 1 sequestration, 3 displaced heart, 1 thymic hyperplasia, 1 axillary lymphangioma), urinary system (1 duplex kidney), abdomen (4 bowel dilatation, an intra-hepatic artero-venous fistula, a pelvic cyst, 1 ascites and bowel calcifications), were represented. Results: In 27 of 32 cases with CNS anomalies, US and MR provided diagnostic images of similar and adequate quality. In the 5 remaining cases US performed better. The antenatal diagnosis was however confirmed after birth in all cases. Among the fetuses with extraCNS anomalies, either antenatal MR or postnatal findings were consistent with sonographic diagnosis in 22 out of 26 cases. A discordance between MR and US was noted in 3 cases. In two fetuses with sonographic diagnosis of cleft lip an unsuspected cleft palate was revealed at MR and confirmed after birth. In a fetus with right deviation of the heart and normally placed stomach, intrathoracic bowel loops were detected at MR and diaphragmatic hernia was documented after birth. The antenatal diagnosis was not confirmed after birth in one case of meconium peritonitis, an abdominal teratoma was diagnosed postnatally. Conclusions: In our own experience, ultrasound and MR performed similarly in CNS anomalies, and ultrasound provided in general better results in early gestation. It is of note that MR was superior in the specific diagnosis and surgical staging of cranial clefts.