Sonia S. Hassan

Changes of placental syndecan-1 expression in preeclampsia and HELLP syndrome

Preeclampsia is characterized by maternal systemic anti-angiogenic and pro-inflammatory states. Syndecan-1 is a cell surface proteoglycan expressed by the syncytiotrophoblast, which plays an important role in angiogenesis and resolution of inflammation. Our aim was to examine placental syndecan-1 expression in preeclampsia with or without hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Placentas were obtained from women in the following groups: (1) late-onset preeclampsia (nu2009=u20098); (2) early-onset preeclampsia without (nu2009=u20097) and (3) with HELLP syndrome (nu2009=u20098); (4) preterm controls (nu2009=u20095); and (5) term controls (nu2009=u20099). Tissue microarrays (TMAs) were constructed from paraffin-embedded placentas. TMA slides were immunostained for syndecan-1 and evaluated using microscopy, virtual microscopy, and semi-automated image analysis. Maternal sera from patients with preeclampsia (nu2009=u200949) and controls (nu2009=u200932) were immunoassayed for syndecan-1. BeWo cells were treated with Forskolin or Latrunculin B or kept in ischemic conditions. SDC1 expression and syndecan-1 production were investigated with qRT-PCR, confocal microscopy, and immunoassays. Syndecan-1 was localized to the syncytiotrophoblast apical membrane in normal placentas. Syndecan-1 immunoscores were higher in late-onset preeclampsia (pu2009=u20090.0001) and early-onset preeclampsia with or without HELLP syndrome (pu2009=u20090.02 for both) than in controls. Maternal serum syndecan-1 concentration was lower in preeclampsia (median, 673xa0ng/ml; interquartile range, 459–1,161xa0ng/ml) than in controls (1,158xa0ng/ml; 622–1,480xa0ng/ml). SDC1 expression and syndecan-1 immunostainings in BeWo cells and syndecan-1 concentrations in supernatants increased during cell differentiation. Disruption of the actin cytoskeleton with Latrunculin B decreased syndecan-1 release, while ischemic conditions increased it. Syncytiotrophoblastic syndecan-1 expression depends on the differentiation of villous trophoblasts, and trophoblastic syndecan-1 release is decreased in preeclampsia and HELLP syndrome. This phenomenon may be related to the disturbed syncytiotrophoblastic cortical actin cytoskeleton and associated with maternal anti-angiogenic and pro-inflammatory states in these syndromes.

CXCL10 and IL‐6: Markers of two different forms of intra‐amniotic inflammation in preterm labor

To determine whether amniotic fluid (AF) CXCL10 concentration is associated with histologic chronic chorioamnionitis in patients with preterm labor (PTL) and preterm prelabor rupture of the membranes (PROM).

OC144: Clinical significance of the presence of amniotic fluid ‘sludge’ in patients with cervical cerclage

to 30 + 0) weeks + days in the TPTL group. Mean (SD) cervical length was similar in the control (36.1 (2.9) mm) and PPROM (36.6 (16.6) mm) groups, but shorter in the TPTL group (20.4 (9.2) mm; P = 0.01). Mean (SD) FMBV was lower in controls (9.4 (6.4)%) than in the PPROM (21.2 (10.0)%) and TPTL (18.9 (6.9)%) groups (P = 0.01). The median time between the first examination and delivery was 2 (range, 1–4) weeks in the PPROM group and 4 (range, 1–14) weeks in the TPTL group. In PPROM, 7/10 cases delivered within the 2 weeks after the first examination, and 6/7 had a FMBV above 18% in spite of a cervical length within normal values. In TPTL, there was a significant association between the cervical length and the time to delivery (r = 51, P = 0.001), but in most cases FMBV was similarly increased. Conclusions: In TPTL the cervical length correlated well with the time to delivery and FMBV did not improve this information. However, in PPROM an increment in FMBV appears to be independently associated with an earlier delivery.

Ultrasound, elasticity, and photoacoustic imaging of cervix: towards a more accurate prediction of preterm delivery (Conference Presentation)

Spontaneous preterm birth (sPTB) occurs in about one in ten infants born in the United States and is leading to almost 1 million neonatal deaths worldwide [1]. Diagnostic imaging of cervix is mostly limited to using ultrasound (US) to measure cervical length and has shown a low specificity to determine the risk of sPTB [2-7]. Quantitative functional imaging modalities such as elastography (EL) and photoacoustic (PA) imaging, are commonly used in conjunction with US imaging to provide additional information on tissue compositions and function. We propose using an endocavity probe to acquire US, PA, and EL information of the cervical tissue. Specifically, spectroscopic PA (sPA) is proposed to provide information on cervical tissue such as total hemoglobin (blood perfusion), tissue oxygenation level, and more importantly the collagen-to-water ratio in tissue. Shear wave elastography (SWE) measurements of cervical tissue indicates the correlation between cervical ripening and lower tissue elasticity. Our custom-designed imaging system consists of an endovaginal US transducer (ATL C9-5) capable of performing high frame rate US and acoustic radiation force shear wave imaging, and an optimized fiber-optic light delivery system’s for PA imaging. Our experimental results indicate the system’s ability to measure the presence of different concentrations of hemoglobin in tissue-mimicking phantoms as well as accurate measurement of hemoglobin oxygen saturation (SO2). In another set of experiments, we demonstrated the feasibility of monitoring collagen-to-water ratio in tissues through monitoring changes in sPA signature between 1100 and 1650 nm. Monitoring the variations of collagen in cervical tissue can help to predict sPTB.

OP12.09: The value of the sagittal view of the ‘ductal arch plane’ in the prenatal diagnosis and counseling of conotruncal anomalies using 4D ultrasonography

Objectives: Transposition of the great arteries is still one of the challenging cardiac defects to detect prenatally. The aim of the study was to ascertain whether 4D ultrasound (STIC) in combination with ultrasound tomography can be of help in facilitating the detection of fetuses with TGA. Methods: STIC volumes from 12 fetuses with TGA between 21 and 36 weeks were analyzed offline starting from the four-chamber view plane in a dorsoposterior fetal position and applying tomographic imaging evaluation (TUI). Results: In all 12 cases a demonstration of the known parallel course of both aorta and pulmonary trunk was possible using TUI. From the standardized four-chamber view plane this was achieved by performing a translation movement cranially and a rotation toward the right shoulder of the fetus. The translation distance was 4-mm (20–25 weeks), 5-mm (25–30 weeks) and 6-mm (30–36 weeks) depending on gestational age. The rotation was between 27◦ and 50◦ but did not depend on gestational age but on the position of the vessels to each other. Conclusions: STIC with TUI provides important information on the spatial relationship of the great vessels in fetuses with TGA. When TGA is suspected the examiner could move the transducer from the four-chamber view 4–6-mm toward the upper thorax before tilting the probe 25–50◦ to demonstrate whether the vessels are in parallel course or not. Whether this easy move can help in routine screening to detect fetuses with TGA remains to be shown.