Sean Keeler

Comprehensive amniotic fluid cytokine profile evaluation in women with a short cervix: which cytokine(s) correlates best with outcome?

OBJECTIVE The objective of this study was to determine whether an expanded amniotic fluid cytokine profile predicts spontaneous preterm birth in patients with short cervix in the midtrimester. STUDY DESIGN Amniocentesis was performed on singleton gestations between 16-24 weeks with a cervical length <or=25 mm. Amniotic fluid from patients who received no surgical or hormonal treatment was assayed for 25 cytokines. Univariate analysis identified cytokine(s) that correlated with the interval between amniocentesis to delivery. Stepwise regression identified which cytokine(s) was most predictive of delivery, followed by the generation of receiver-operator characteristic curves. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS Forty-four amniotic fluid samples were analyzed. After stepwise regression, only monocyte chemotactic protein-1 remained significant and was the most predictive of early delivery. With a cutoff of 1320 pg/mL, monocyte chemotactic protein-1 had a 69% sensitivity, 83% specificity, 36% positive predictive value, and 87% negative predictive value to predict spontaneous preterm birth within 1 week of amniocentesis (P = .015). CONCLUSION Among 25 cytokines, monocyte chemotactic protein-1 was most predictive of spontaneous preterm birth.

Universal tuberculosis screening in pregnancy.

We reviewed our practice of universal tuberculosis (TB) screening in an at-risk pregnant population with regards to utility and patient compliance. The Gouverneur Healthcare Services prenatal database was analyzed for compliance with TB screening. Age, ethnicity, country of origin, and education level were also analyzed. Of 4049 patients, 95.0% were compliant with their purified protein derivative (PPD) testing. Universal screening identified 1935 (50.4%) PPD+ patients, with chest X-rays (CXR) available for 95.1%. Only one patient had a CXR consistent with active TB, although sputum testing was negative for acid-fast bacilli. Asian women were more likely to be PPD-compliant (adjusted odds ratio [aOR]: 4.94, 95% confidence interval [CI]: 2.34 to 10.45). Similarly, PPD+ Asian women were more likely to be compliant with CXR (aOR: 12.67, 95% CI: 3.44 to 46.7). U.S.-born women were significantly less likely to be compliant with PPD (aOR: 0.44, 95% CI: 0.30 to 0.64) or with CXR (aOR: 0.22, 95% CI: 0.08 to 0.61). Universal prenatal TB screening is associated with excellent compliance rates and is an effective way to identify a high prevalence of latent TB, but not active disease.

Comparison of modes of ascertainment for mosaic vs complete trisomy 21

OBJECTIVE We sought to compare the indications for amniocentesis leading to the detection of either mosaicism of trisomy 21 (mosaic-T21) or complete trisomy 21 (T21). STUDY DESIGN A retrospective review of a large amniocentesis database (n = 494,163) was conducted. All specimens with mosaic-T21 (n = 124) were compared with a maternal age-matched group of T21 fetuses (n = 496). Samples with normal karyotypes were matched for maternal age and served as normal controls (n = 496). The chi(2) testing was used for statistical analysis. RESULTS The presence of an abnormal first-trimester screen, abnormal sonographic findings, and specifically the single sonographic abnormalities of either a cystic hygroma or a cardiac anomaly were significantly less common in the mosaic-T21 as compared with the T21 group. There were no such differences between the mosaic-T21 and the normal control group. CONCLUSION Fetuses with mosaic-T21, similar to those with normal karyotype, do not present with the same abnormal screening tests as fetuses with T21.

Complete trisomy 21 vs translocation Down syndrome: a comparison of modes of ascertainment

OBJECTIVE To compare the indications for invasive prenatal testing resulting in the detection of translocation Down syndrome and complete trisomy 21. STUDY DESIGN This case control study was based on a large amniocentesis and chorionic villi samples database (n = 534,795). All specimens with translocation Down syndrome (n = 203) comprised the translocation group and were compared with a maternal age-matched group (4 to 1, n = 812) in which complete trisomy 21 was detected. Women with a normal karyotype were randomly selected (n = 812) and served as controls. Indications for invasive testing were compared among the 3 paired groups using χ(2) analysis. RESULTS There were no differences in the incidence of abnormal first- and second-trimester screening tests between the translocation Down syndrome and the complete trisomy 21 groups. History of prior aneuploidy was significantly more frequent in the translocation Down syndrome group, as compared with either complete trisomy 21 fetuses or normal controls. CONCLUSION Fetuses with translocation Down syndrome present with the same screening abnormalities as fetuses with complete trisomy 21.

Controlled Fine Needle Biopsy of the Uterine Cervix During Pregnancy

Objective: Cervical sampling could furnish tissue-based information regarding premature cervical ripening and effacement. This report assesses the effect of cervical fine needle biopsy (FNB) in the evaluation of cervical shortening. Methods: Retrospective cohort study evaluating adverse events during the first week following FNB in women with short cervix. Patients with a cervical length(CL) ≤25 mm had a cervical FNB between 16 and 24 weeks. The risk of FNB was compared to a control group that was similarly evaluated but did not undergo FNB. Results: One hundred and thirty-two FNBs were performed in 94 participants. The mean gestational age and CL at enrollment were 20.4 ± 2.3 weeks and 15.7 ± 0.6 mm. Within 7 days of FNB, there were 3 adverse events (2.3%) in the study group compared to 5 in the control group (2.1%). Conclusions: FNB of the cervix in high risk gravidae is feasible in clinical situations. It did not increase the risk of adverse events compared to women studied under a similar protocol without FNB.

Metastatic Gestational Trophoblastic Disease Following a Complete Hydatidiform Mole Coexistent With an Anencephalic Fetus Diagnosed at 10 Weeks’ Gestation

hydatidiform mole is the most common type of gestational trophoblastic disease. It typically presents in the first trimester of pregnancy with vaginal bleeding and an elevated serum p-human chorionic gonadotropin (β-hCG) level. Histologically, complete molar tissue often appears swollen with hydropic chorionic villi and trophoblastic hyperplasia, and sonography is the primary means to establish this diagnosis. 1 The incidence of a twin gestation consisting of a complete hydatidiform mole (CHM) with a coexisting live fetus is between 1 per 22,000 and 1 per 100,000 pregnancies. 2 Complications associated with a molar pregnancy, such as hypertensive disorders of pregnancy, hyperthyroidism, hemorrhage, pulmonary edema, and thromboembolic phenomena, appear to be increased among CHMs coexistent with a live twin fetus. 3-8 Also, there may be a higher risk of persistent gestational trophoblastic disease (pGTD) in these patients than in patients with an isolated CHM pregnancy 3-8 In most reports of complete moles coexistent with a live fetus, the live fetus is structurally and karyotypically normal. We report the sonographic findings of metastatic gestational trophoblastic disease following a twin gestation with a complete mole and a live anencephalic fetus.