Stefania Ronzoni

Association between the Activity of the System A Amino Acid Transporter in the Microvillous Plasma Membrane of the Human Placenta and Severity of Fetal Compromise in Intrauterine Growth Restriction

Primarily, our objectives were to compare system A amino acid transporter activity in the microvillous plasma membrane (MVM) of placentas from normally grown (appropriate for gestational age, AGA) and intrauterine growth-restricted (IUGR) fetuses delivered during the third trimester, as a whole and in relation to the severity of IUGR. Ten AGA and 16 IUGR pregnancies were studied at the time of elective cesarean section performed between 28 and 40 wk of gestation. Severity of IUGR pregnancies was assessed primarily by Doppler velocimetry and fetal heart rate monitoring. Placental MVM vesicles were prepared, and system A activity in these was measured. The transporter activity was significantly lower in IUGR compared with AGA pregnancies. Within the IUGR group system A activity was only significantly lower, compared with AGA, in cases that presented with a reduction in umbilical blood flow. We conclude that placental MVM system A activity is lower in IUGR compared with AGA pregnancies delivered during the third trimester. System A activity is related to the severity of IUGR.

Maternal and foetal resistin and adiponectin concentrations in normal and complicated pregnancies

Objective   The aim of this study was to evaluate how resistin and adiponectin (ApN) are involved in maternal energy metabolism and foetal growth.

Maternal concentrations and fetal-maternal concentration differences of plasma amino acids in normal and intrauterine growth-restricted pregnancies.

OBJECTIVES Our purpose was to determine whether maternal amino acid concentration changes during gestation in pregnancies with intrauterine growth restriction as in normal pregnancies and to verify whether these changes are related to changes in fetal-maternal differences. STUDY DESIGN Amino acid concentrations were measured in 5 nonpregnant women, in 11 second-trimester and 10 third-trimester pregnant women with appropriate-for-gestational-age fetuses, and in 23 pregnant women with intrauterine growth restriction. Umbilical venous amino acids were measured at the time of fetal blood sampling. The severity of intrauterine growth restriction was assessed by Doppler velocimetry and fetal heart rate and by evaluation of oxygenation and acid-base balance. RESULTS In normal pregnant women the maternal concentration of most amino acids was significantly lower in both the second and third trimesters compared with nonpregnant women. In intrauterine growth restriction the maternal concentrations of most essential amino acids were significantly higher than in appropriate-for-gestational-age pregnancies. This observation, coupled with lower fetal amino acid concentrations in intrauterine growth restriction, leads to significantly lower fetal-maternal differences. CONCLUSIONS Normal pregnant women have a significant decrease in amino acid concentrations compared with nonpregnant women, whereas in intrauterine growth restriction maternal amino acids are reduced less, Significantly lower fetal-maternal concentration differences are present in intrauterine growth restriction, independent of the degree of severity.

Laparoscopic vs vaginal hysterectomy for benign pathology

OBJECTIVE The objective of the study was to compare length of stay, blood loss, operative time, and pain of laparoscopic and vaginal hysterectomy. STUDY DESIGN This was a prospective, randomized, controlled comparison between vaginal (VH) and laparoscopic (LH) hysterectomy among 60 consecutive patients with a uterine volume of 300 mL or less and without uterine prolapse. Patients were followed up for 12 months. RESULTS The groups were significantly different for mean operative time (VH: 81 +/- 30 minutes; LH: 99 +/- 25 minutes; P = .033) and blood loss (LH: 83 +/- 57 mL; VH: 178 +/- 149 mL; P = .004). Bilateral adnexectomy was performed when preoperatively planned in 73% of cases of the vaginal arm, whereas it was always performed in the laparoscopic arm (P = .045). Postoperative pain on day 0 and the number of days of analgesic request were higher in the vaginal group (P = .023 and P = .017, respectively). LH was associated with a reduced hospital stay (LH: 2.7 +/- 0.5 days; VH: 3.2 +/- 0.6 days; P < .001).There were no differences between the groups at the follow-up. CONCLUSION Laparoscopic hysterectomy results in a shorter hospital stay, less blood loss, and less postoperative pain compared with vaginal hysterectomy.

High rate of endometriosis recurrence in young women.

OBJECTIVE To evaluate rate and determinants of long-term recurrence of endometriosis in a population of young women. DESIGN Retrospective cohort study. SETTING University tertiary care referral center for women with benign gynecologic diseases. PARTICIPANTS Young women undergoing first-line conservative surgery for endometriosis were eligible for the study. Data on age at surgery, disease stage, anatomical characteristics of endometriotic lesions, and endometriosis-related symptoms were collected. After diagnosis, patients were treated according to the standard care of the center. The protocol required all women to be followed up 1 month after surgery, and every 6 months afterward, with an interview to investigate persistence of symptoms, a clinical examination, and an ultrasound pelvic assessment. RESULTS Fifty-seven women aged ≤ 21 (mean age at diagnosis ± SD: 19.0 ± 1.1 years) entered the study. During a 5-year follow-up, 32 (56%, 95% confidence interval [CI]: 43%-68%) recurrences of endometriosis were diagnosed. A second laparoscopy to treat the recurrence was performed in 11 (34%) cases and confirmed the presence of the disease in all of them. In the remaining 21 (66%) cases, the recurrence was based on the reappearance of the symptoms or clinical or sonographic findings. The recurrence rate increased constantly with time from first surgery. No association emerged between recurrence rate and endometriosis-related symptoms, site/stage of the disease, type of surgery, and post-surgical medical treatment. CONCLUSIONS The recurrence rate of endometriosis in young women appears higher than in older women. Since no determinants for recurrence have been detected among the factors examined, a profile of women at increased risk cannot be drawn.

Adjustment of L-T4 substitutive therapy in pregnant women with subclinical, overt or post-ablative hypothyroidism

Objective  Maternal hyperthyrotropinaemia is associated with an increased risk of adverse maternal and neonatal outcomes. Physiological changes during pregnancy require an increased production of thyroid hormones (or an increase in daily substitutive doses of L‐T4 in hypothyroid patients) to meet the maternal and foetal needs. The aim of the study was to evaluate variations of substitutive L‐T4 doses that are able to maintain serum TSH between 0·5 and 2·5 mU/l in pregnant women with subclinical‐ (SH), overt‐ (OH) and post‐ablative (PH) hypothyroidism.

Comparison of Fetal and Neonatal Growth Curves in Detecting Growth Restriction

OBJECTIVE: To evaluate the outcome of intrauterine growth restriction (IUGR) infants with abnormal pulsatility index of the umbilical artery according to the neonatal birth weight/gestational age standards and the intrauterine growth charts. METHODS: We analyzed 53 pregnancies with severe IUGR classified as group 2 (22 IUGR: abnormal pulsatility index and normal fetal heart rate) and group 3 (31 IUGR: abnormal pulsatility index and fetal heart rate). Neonatal birth weight/gestational age distribution, body size measurements, maternal characteristics and obstetric outcome, and neonatal major and minor morbidity and mortality were compared with those obtained in 79 singleton pregnancies with normal fetal growth and pulsatility index, matched for gestational age (appropriate for gestational age [AGA] group). Differences were analyzed with the &khgr;2 test and the Student t test. Differences between means corrected for gestational age in the different groups were assessed by analysis of covariance test. A P<.05 was considered significant. RESULTS: At delivery, using the neonatal standards, 25 of 53 (47%) IUGR showed a birth weight above the 10th percentile (IUGRAGA), whereas in 28, birth weight was below the 10th percentile (IUGR small for gestational age [SGA]—IUGRSGA). All body size measurements were significantly higher in AGA than in IUGRAGA and IUGRSGA. Forty-nine of 79 (62%) AGA and 49 of 53 (92%) IUGR were admitted to the neonatal intensive care unit (P<.001). One of 79 (1%) AGA and 6 of 53 (11%) IUGR newborns died within 28 days (P<.02). Major and minor morbidity was not different. CONCLUSION: This study shows that neonatal outcome is similar in IUGR of the same clinical severity, whether or not they could be defined AGA or SGA according to the neonatal standards. Neonatal curves are misleading in detecting low birth weight infants and should be used only when obstetric data are unavailable. LEVEL OF EVIDENCE: II

Neonatal Morbidity and Mortality in Intrauterine Growth Restricted (IUGR) Pregnancies Is Predicated Upon Prenatal Diagnosis of Clinical Severity

The objective of this work was to determine whether the prenatal determinates of clinical severity in intrauterine growth restricted pregnancies, established by abdominal circumference measures, correlates with neonatal morbidity and mortality. A total of 336 singleton pregnancies with intrauterine growth restriction were subdivided into group 1 (normal fetal heart rate and pulsatility index of the umbilical artery: 251 cases), group 2 (normal fetal heart rate and abnormal pulsatility index: 50 cases), and group 3 (abnormal fetal heart rate and pulsatility index: 35 cases). Gestational age, birth weight, body mass index, placental weight, and Apgar score were significantly related to the severity of intrauterine growth restriction (P < .001). Neonatal survival was 100%, 96%, and 57% in the 3 groups, respectively (P < .001). Greater than 80% of neonates of group 1 had no complications when compared to group 2 (54%) and group 3 (10%); P < .001. Gestational age was the only independent variable significantly associated with neonatal outcomes. The data confirm that the classification of clinical severity of intrauterine growth restriction based on biophysical parameters is clinically relevant to predict neonatal outcome.

Adnexal masses in pregnancy: fetomaternal blood flow indices during laparoscopic surgery.

STUDY OBJECTIVE To assess changes in uterine and umbilical arteries during laparoscopy in human pregnancy. DESIGN Case series (Canadian Task Force classification III). SETTING University tertiary care referral center for high-risk pregnancy and minimally invasive surgery. PATIENTS Nine pregnant women who underwent first- and second-trimester laparoscopic surgery because of an adnexal mass. INTERVENTION Laparoscopic cyst enucleation or annessiectomy. MEASUREMENTS AND MAIN RESULTS No maternal complications and no miscarriages or adverse pregnancy outcome occurred. Mean (SD) gestational age at delivery was 39.1 (0.7) weeks, birth weight was 3390 (298) g, and Apgar score at 5 minutes was 9.6 (0.5). Mean uterine resistance index, umbilical artery pulsatility index, and fetal heart rate were measured using transvaginal ultrasonography at various times during surgery. Mean uterine resistance index and umbilical artery pulsatility index values remained constant during laparoscopy. Fetal heart rate was maintained in the normal range (120-160 bpm) but progressively decreased during the surgical procedure. CONCLUSION In human pregnancy, laparoscopic techniques do not seem to modify uteroplacental perfusion evaluated using noninvasive ultrasonography.

Effect of antenatal betamethasone on maternal and fetal amino acid concentration

OBJECTIVE To determine the concentration of amino acids in women receiving the first course of antenatal betamethasone and to evaluate the umbilical venous and arterial amino acid concentrations at the time of elective cesarean section after betamethasone administration. STUDY DESIGN Blood samples were collected from 34 pregnant women at risk of premature delivery before and 24 and 48 hours after the first course of betamethasone. In addition, maternal and cord blood samples were collected in 13 women undergoing an elective cesarean section between 24 and 192 hours after betamethasone. RESULTS Maternal amino acid concentrations were significantly increased after the first dose of betamethasone. Overall total amino nitrogen increased 17.5% 24 hours after betamethasone administration and 20.5% after 48 hours. The concentration of most amino acids was increased both in the umbilical vein and artery after maternal betamethasone administration. CONCLUSION The concentration of maternal and fetal amino acids increases significantly after betamethasone administration.