Roni Levy

Infection by parvovirus B 19 during pregnancy: a review.

Fetal infection by Parvovirus B 19 is a common cause of fetal anemia and nonimmune hydrops fetalis and may result in fetal death. Recent improvements in diagnosing parvovirus infections by sensitive molecular biology techniques now allow for a new insight into its pathogenic rule, immunology, and the varied clinical manifestations. The estimated overall risk of fetal loss after maternal exposure is about 6.5 percent, which is much less than previously thought. Inasmuch as complete spontaneous reversal of fetal hydrops has been commonly described, controversy exists regarding the management of the fetus with clinical signs of infection by Parvovirus B 19. According to the experience that has accumulated, it seems that only cases with severe fetal anemia or signs of fetal compromise should be managed by intrauterine transfusion. This procedure, however, is not without risk. Although an association between fetal viral infection and structural abnormalities has been described, it has not been proved yet. However, infection by Parvovirus B 19 has been recently proposed as a causative factor for congenital red blood cell aplasia.

A randomised comparison of early versus late amniotomy following cervical ripening with a Foley catheter

Objectives Ripening of the cervix with a Foley catheter commonly results in cervical dilatation without contractions. We examined the outcome of labour in women who underwent induction of labour using a Foley catheter, followed by either 1. early amniotomy, or 2. augmentation of labour by oxytocin and late amniotomy

Conservative treatment of stage IA2 squamous cell carcinoma of the cervix during pregnancy

BACKGROUND: The standard management of early-stage invasive cervical cancer in early pregnancy is radical hysterectomy with the fetus in situ. We describe a case of early invasive cervical cancer in pregnancy that was treated with a conservative surgical approach. CASE: A nulliparous pregnant women at 15 weeks of gestation was diagnosed with stage IA2 invasive cervical cancer. She declined a radical hysterectomy, desiring to continue the pregnancy. A repeat cervical conization with retroperitoneal lymph node dissection was followed by radical trachelectomy 6 weeks after delivery. Currently she has 2 children, and there is no evidence of recurrence. CONCLUSION: Conservative stepwise surgical management of early invasive cervical cancer in the first half of pregnancy was a feasible approach in this woman who wished to continue the pregnancy.

Uriscreen, a rapid enzymatic urine screening test: useful predictor of significant bacteriuria in pregnancy

Objective To establish the reliability of a new rapid enzymatic screening test, the Uriscreen, in the detection of significant bacteriuria in pregnancy. Methods During a 6-month period, from July 1 to December 30, 1993, 313 consecutive pregnant patients were evaluated. Randomly voided, midstream, clean-catch urine specimens were used. Each sample was tested by routine laboratory culture and four rapid screening tests: the nitrite and leukocyte esterase dipstick, microscopic examination for pyuria, and the Uriscreen test. Results of the four rapid tests were compared with those of the urine culture. Results Twenty-four women (7.6%) had urine culture results indicating significant bacteriuria. The sensitivity of the nitrite test, the leukocyte esterase test, and a microscopic examination for pyuria was low (37, 52, and 56%, respectively). The Uriscreen test showed very high sensitivity (100%), lower specificity (81%), a high predictive value of negative results (100%), and a low positive predictive value (30%). Conclusions The Uriscreen test is a reliable alternative to culture screening of all pregnant patients. A policy of performing a urine culture during pregnancy only on patients with a positive Uriscreen test will save as much as 80% of unnecessary cultures.

Single fetal demise in twin gestation resulting in the resolution of severe pre-eclampsia.

A primigravida presenting with a twin pregnancy and severe pre-eclampsia which developed during early pregnancy is described. Complete resolution of symptoms and signs of pre-eclampsia were evident following the death of a growth-retarded single fetus. Pregnancy continued successfully until 35 weeks of gestation, when a single healthy infant was delivered. Few such cases of complete resolution of pre-eclampsia following the death of a single fetus are reported in the literature. The possibility that genetic susceptibility to pre-eclampsia is conferred by homozygosity for the same single recessive gene expressed by both mother and fetus is discussed.

Development of proliferative retinopathy in a gestational diabetes patient following rapid metabolic control

Rapid glucose control was achieved by insulin therapy in a patient diagnosed to have gestational diabetes at 8 weeks of pregnancy. A decrease of the initially high hemoglobin A1c level (16.2%) to normal values (5.9%) was achieved within 12 weeks. At 31 weeks severe bilateral proliferative diabetic retinopathy developed. To our knowledge this case is the first report of a patient with gestational diabetes who developed de novo proliferative diabetic retinopathy.

Induction of labor with oral misoprostol for premature rupture of membranes at term in women with unfavorable cervix: a randomized, double-blind, placebo-controlled trial.

Abstract Aim: To evaluate the efficacy and safety of oral misoprostol for labor induction in women with term premature rupture of membranes (PROM) and an unfavorable cervix. Methods: We randomized 130 women with PROM of ≤4 h to either oral misoprostol, 50 μg, or a placebo given every 4 h for up to three doses. Intravenous oxytocin was initiated if active labor did not begin within 12 h. Results: Sixty-four women received oral misoprostol and 66 received placebo. The PROM-to-delivery interval was shorter with misoprostol than with placebo (13.7±5.8 vs. 20.3±6.8 h, respectively, P<0.05). Misoprostol significantly reduced the need for oxytocin (28.1 vs. 72.7%, P<0.001) and antibiotics (25 vs. 69.7%, P<0.001). No significant differences in cesarean section or hyperstimulation rate were noted. Conclusion: Oral misoprostol given to women with unfavorable cervix soon after term PROM significantly reduces the induction-to-delivery time and the need for oxytocin and antibiotics.

Ischemic reperfusion brain injury in fetal transgenic mice with elevated levels of copper-zinc superoxide dismutase

Abstract Aim: To examine the effect of overexpression of human intracellular copper-zinc superoxide dismutase (CuZnSOD1) gene on fetal mice brain exposed to in-utero ischemic reperfusion injury. Design: Transient in-utero ischemia (7 min) was induced in pregnant transgenic mice overexpressing human CuZnSOD1 and wild-type mice by occluding the blood supply to the uterine artery on day 17 of pregnancy, followed by 24 hours of reperfusion. The level of lipid peroxidation in fetal mice brains was compared between the transgenic and non-transgenic (control) fetal mice. Motor and coordination skills of transgenic and control adult mice (six to eight months old) which were exposed to ischemic reperfusion injury in-utero were compared by the rope grip test and visible platform task. Results: We first measured CuZnSOD1 activity in the brains of the transgenic fetal mice and confirmed that the enzyme activity is 4.2-fold higher than control. We also established that ischemia reperfusion on day 17 of pregnancy led to increased level of TBARS (Thiobarbituric acid reactive substance) in brains of wild-type fetal mice when compared to sham operated mice (72.5 ± 3.4 vs. 49.4 ± 1.5 nmol/mg. p < 0.001). The increase was markedly accentuated in the CuZnSOD1 transgenic mice, and significantly higher compared to control mice exposed to ischemia-reperfusion (85.6 ± 4.0 vs. 69.5 ± 2.3 nmol/mg, p < 0.001). Moreover, we found that the transgenic mice that were subjected to in-utero ischemia reperfusion exhibited a significantly higher rate of failures in the rope grip test and poorer performance in the visible platform task, when compared to non-transgenic mice exposed to identical insult. Conclusions: Oxygen free radicals play an important role in the pathogenesis of perinatal hypoxia. Overexpression of the enzyme CuZnSOD1 in transgenic mice exposes their brains to increased damage during ischemic-reperfusion insult.

The effect of betamethasone administration to pregnant women on maternal serum indicators of infection

Abstract Objective: To study the effect of betamethasone therapy on maternal white blood cell count, C-reactive protein and erythrocyte sedimentation rate in women at high risk for preterm delivery. Study design: We included women at gestational age of 24 to 34 weeks who were treated by betamethasone for enhancement of fetal lung maturity, because of imminent preterm labor with intact membranes. Blood tests for white blood cell and differential count, C-reactive protein and erythrocyte sedimentation rate were drawn before betamethasone injection, 2 hours after, and then every 24 hours for three days. Results: 105 women were included. The mean white blood cell count increased by 33% on day one, and returned to baseline level three days after the first injection of betamethasone. A significant rise in neutrophil count, and drop in lymphocyte count was noted as early as two hours after the first injection and lasted for two days. Mean C-reactive protein and erythrocyte sedimentation rate levels were not changed significantly by betamethasone treatment. Conclusions: Antenatal betamethasone therapy causes a transient increase in maternal leukocyte count but has no effect on serum C-reactive protein and erythrocyte sedimentation rate. This information is relevant for preterm pregnant women who are at high risk for chorioamnionitis.

The Routine Use of Intrapartum Ultrasound in Clinical Decision-Making during the Second Stage of Labor - Does It Have Any Impact on Delivery Outcomes

Background/Aims: The study aimed to assess whether the use of intrapartum transperineal ultrasound (US) can reduce the rate of failed vacuum extraction (VE). Methods: This is a retrospective cohort study including all women delivering at term with the diagnosis of protracted second stage of labor. The mode of delivery and rate of failed VE were compared between women who underwent a US examination prior to the decision on obstetrical interventions (“+US” group) and those in whom clinical decisions were based upon digital assessment only (“no-US” group). Results: The study included 635 women. Among the “no-US” group (536), there were 13 failed VE attempts (3.6%) vs. none in the “+US” group (99, p = 0.1). There was a significant difference between the groups regarding mode of delivery (p = 0.001), with a lower cesarean section (CS) rate (20.2 vs. 27.8%) among the “+US” group. Maternal age, body mass index, nulliparity, gestational age at delivery, and birth weight, as well as neonatal short-term outcome did not differ significantly between the 2 groups. Conclusions: We demonstrate that among women who had the addition of intrapartum US during the second stage of labor there was a trend toward a lower rate of failed VE (although not reaching statistical significance), with a lower rate of CS but not affecting neonatal outcome.