T'sang-T'ang Hsieh

A Longitudinal Study of Oxidative Stress and Antioxidant Status in Women With Uncomplicated Pregnancies Throughout Gestation

Pregnancy is associated with increased oxidative stress, and exaggeration of oxidative damage is considered important in pregnancy complications such as preeclampsia. There is, however, only scattered information regarding the longitudinal change of oxidative stress during pregnancy. We surmised that the placenta is the cause of the increased oxidative stress during pregnancy and hypothesized that the amount of placenta-derived cell-free fetal DNA in maternal plasma is correlated with maternal oxidative stress status. Blood and urine samples were collected at different stages of gestation and 6 to 8 weeks postpartum from 105 women with uncomplicated pregnancies. Additionally, 40 healthy women of reproductive age, but not pregnant, were recruited as controls. All oxidative stress markers, including urinary 8-hydroxydeoxyguanosine (8-OHdG), plasma 8-isoprostane, total antioxidant capacity (TAC), and erythrocyte glutathione peroxidase (GPX) and superoxide dismutase (SOD) activities, were increased in the third trimester, and most of them returned to nonpregnant levels postpartum. Furthermore, the DYS14 gene of the Y chromosome was quantified from plasma samples obtained at 26 to 30 weeks’ gestation in 54 women who later delivered a male infant. Significant associations were noted between plasma concentrations of the DYS14 gene and the levels of urinary 8-OHdG and plasma 8-isoprostane, suggesting an association between the breakdown of syncytiotrophoblast and maternal oxidative stress during pregnancy.

Effectiveness of ultrasound-guided aspiration and sclerotherapy with 95% ethanol for treatment of recurrent ovarian endometriomas

OBJECTIVE To evaluate the effectiveness of transvaginal ultrasound aspiration and ethanol sclerotherapy in patients with recurrent ovarian endometriomas. DESIGN Retrospective study. SETTING Teaching hospital affiliated with Chang Gung University, Taipei. PATIENT(S) Patients (n = 108) with recurrent ovarian endometriomas >or=3 cm. INTERVENTION(S) Preoperative evaluation of previous pathology, midcycle serum CA-125 level, and color Doppler ultrasonography to exclude possibility of malignancies. After aspiration, sclerotherapy with 95% ethanol irrigation of the cystic cavity was performed (group 1, n = 78, 0-10 minutes of retention; group 2, n = 30, ethanol left in situ [retention]). MAIN OUTCOME MEASURE(S) Ultrasonography was performed at 3, 6, 9, and 12 months to determine persistence and size of cysts and the number of antral follicles. Pelvic pain score was also determined at those time points. RESULT(S) The 1-year recurrence rate for group 2 patients was significantly lower than for group 1 patients (13.3% vs. 32.1%). Antral follicle count was increased and pain score was decreased in both groups to a similar level. No significant change in CA-125 was observed. CONCLUSION(S) Ultrasound-guided sclerotherapy with 95% ethanol is an effective therapy for ovarian endometriomas. Retention of ethanol is more effective than irrigation only.

Tumor vascular pattern and blood flow impedance in the differential diagnosis of leiomyoma and adenomyosis by color Doppler sonography.

Purpose:Our objective was to evaluate the differences between leiomyoma and adenomyosis by color Doppler sonography with new criteria.Methods:A total of 78 patients with symptomatic uterine nodularities who were sonographically suspected to have leiomyoma or adenomyosis without other coexisting pathologic conditions was enrolled in the study. All patients underwent transvaginal color Doppler sonography (7.0-MHz vaginal probe) or transabdominal color Doppler sonography (5.0 MHz) during the early follicular phase. The morphology, tumor vascular pattern, and blood flow impedance of the uterine tumors were measured. All of the patients underwent surgery and the pathologic reports were used as references.Results:The mean age was not statistically significant in patients with adenomyosis versus leiomyoma (P > 0.05). The morphologic criteria for adenomyosis and leiomyoma by sonography detected 79% of adenomyosis and 84% of leiomyoma. Adenomyosis had 87% randomly scattered vessels or intratumoral signals and 88% of leiomyomas showed peripheral scattered vessels or outer feeding vessels. Eighty-two percent of adenomyoses had a pulsitility index (PI) of arteries within or around uterine tumors >1.17 and 84% of leiomyomas had a PI ≤ 1.17. The reliability test of tumor vascular pattern and blood flow impedance were better than that of using morphological criteria alone.Conclusions:With the aid of color Doppler sonography, tumor vascular pattern and blood flow impedance of the arteries within or around uterine tumors could more accurately diagnose adenomyosis and leiomyoma in addition to the morphologic criteria on transvaginal sonography.

Risk Factors for Placental Abruption in an Asian Population

The objective of this study was to identify risk factors for placental abruption in an Asian population. The authors conducted a retrospective review of 37 245 Taiwanese women who delivered between July 1990 and December 2003. Pregnancies complicated by placenta previa, multiple gestation, and fetal anomalies were excluded. Multivariable logistic regression was used to adjust for potentially confounding variables and to identify independent risk factors for placental abruption. Three hundred thirty-two women had placental abruption (9 per 1000 singleton deliveries). Women who smoked during pregnancy (adjusted odds ratio [OR] = 8.4; 95% confidence interval [CI] = 3.0-23.9), had gestational hypertensive diseases (adjusted OR = 4.9; 95% CI = 3.3-7.3), pregnancies complicated by oligohydramnios (adjusted OR = 4.2; 95% CI = 2.7-6.7), polyhydramnios (adjusted OR = 3.3; 95% CI = 1.4-7.7), preterm premature rupture of membranes (adjusted OR = 1.9; 95% CI = 1.1-3.1), entanglement of umbilical cord (adjusted OR = 1.6; 95% CI = 1.2-2.1), were of or more than 35 years of age (adjusted OR = 1.5; 95% CI = 1.1-2.0), and had a low prepregnancy body mass index (adjusted OR = 1.3; 95% CI = 1.0-1.6) were at increased risk for placental abruption. Some risk factors for placental abruption among Taiwanese women are the same as those of other ethnic groups, whereas some of the risk factors are different.

Management of primary abdominal pregnancy: twelve years of experience in a medical centre

Background. The aim of this study was to evaluate our institutions 12‐year experience in managing primary abdominal pregnancy by laparotomy or laparoscopy. Methods. We identified 11 cases of primary abdominal pregnancy treated at our institution between January 1994 and December 2005, and separated the cases into 2 groups based on type of surgical management. The outcome measures we evaluated were operative time, blood loss and duration of hospital stay. In addition, the incidence rates for all types of ectopic pregnancy were recorded. Analysis excluded secondary abdominal pregnancy. Results. Of the 11 primary abdominal pregnancies, 6 were treated with laparotomy and 5 with laparoscopy. The laparoscopy group had significantly better results in operative time, blood loss and hospital stay (p<0.05). The difference in gestational age was not significant (p = 0.141), even after excluding the patient whose abdominal pregnancy was only identified after cesarean delivery. Conclusion. Our experience shows a trend toward better management of primary abdominal pregnancy with laparoscopy. These patients had shorter operative time, reduced blood loss, and fewer days in hospital then patients treated with laparotomy. Choice of management should depend on the patients condition, gestational age of the pregnancy, and the physicians clinical experience.

Growth discordancy, birth weight, and neonatal adverse events in third trimester twin gestations

In order to understand the effects of intrauterine growth discordancy (15% or more birth weight difference), birth weight, and gestational age on the neonatal adverse events (including 1- or 5-min Apgar scores < 7, neonatal death, ICU admission, respiratory distress, hypoglycemia, hypocalcemia, perinatal infection, blood transfusion, and hyperbilirubinemia) in third trimester twin gestations, 279 consecutive twin pairs delivered from January 1986 to December 1991 were studied. Univariate analyses showed discordant twins were smaller than concordant twins in gestational age by 1.4 weeks (35.74 and 37.14 weeks respectively). When birth weight was compared, that of smaller (one with lower birth weight in a pair) discordant twins (1,951 g) was significantly lower than that of smaller concordant twins (2,423 g), while larger (one with higher birth weight in a pair) discordant twins (2,556 g) and concordant twins (2,594 g) showed no significant difference. Univariate analysis indicated there was a tendency for adverse events to occur in discordant twins, especially in the smaller twin. Through logistic regression analysis, it was found that birth weight and gestational age, but not discordancy, are the predictors of the occurrence of adverse events. A smaller twin weighing no more than 2,000 g has a 10 times greater risk to develop an adverse event as compared to a twin with a birth weight over 2,000 g and a similar gestational age; while a twin with a gestational age of less than 34 weeks has a 5 times greater risk than one 34 weeks or over with a similar birth weight.

The impact of interpregnancy interval and previous preterm birth on the subsequent risk of preterm birth

Objective: To examine the impact of the interpregnancy interval and a previous preterm birth on the subsequent risk of a preterm birth. Methods: A retrospective analysis was conducted on a group of 4072 women who had at least two consecutive births, excluding multiple gestation, fetal anomalies, cervical incompetence, and stillbirth. Multivariate logistic regression was used to investigate the association between interpregnancy interval, preterm birth of the first child in the pair (index pregnancy), and the risk of a preterm birth of the second child in the pair (outcome pregnancy). Results: Women with interpregnancy intervals of less than 12 months (odds ratio [OR] 1.3; 95% confidence interval [CI] 1.01. 1.7) were at increased risks of preterm birth with the outcome pregnancy. Furthermore, there was an increased risk for a subsequent preterm birth in women who had a preterm birth in the index pregnancy (OR 4.2; 95% CI 3.0-6.0). The risk decreased as the interpregnancy interval increased, with a relatively low risk at 18 to 48 months; subsequently, it increased sharply. In contrast, women who had delivered their previous infants at term carried an increased risk of preterm birth with the outcome pregnancy only if the interval was less than 6 months. Conclusion: A difference was found in the impact of the interpregnancy interval on the subsequent risk of preterm birth between women with a prior preterm birth and those who previously delivered an infant at term.

Comparison of Down's syndrome screening strategies in Asians combining serum free beta-hCG and alpha-fetoprotein with maternal age.

High free beta human chorionic gonadotropin (β‐hCG) and low alpha‐fetoprotein (AFP) levels were found in 47 Asian Downs syndrome pregnancies (median values 2·79 and 0·77 MOM, respectively). At a 5 per cent false‐positive rate, free β‐hCG alone would identify 46·8 per cent of Downs syndrome pregnancies, age alone detected 34·5 per cent of affected cases, whilst AFP alone detected 17 per cent and free β‐hCG/AFP MOM ratios detected 48·9 per cent of Downs syndrome cases. When combined with maternal age‐specific risk, free β‐hCG could achieve a 59·6 per cent detection rate, with AFP achieving 42·6 per cent, free β‐hCG/AFP MOM ratios 61·7 per cent, and combined free β‐hCG and AFP a detection rate of 63·8 per cent for a 5 per cent false‐positive rate. Downs syndrome screening at an early gestational age (before 18 weeks) could achieve a 68 per cent detection rate with a 5 per cent false‐positive rate, compared with a 59·1 per cent detection rate for a 5·2 per cent false‐positive rate when screening at a late gestational age. The use of free β‐hCG in Downs syndrome screening programmes can yield an improved efficacy in the detection of Downs syndrome in an Asian population.

First- and Second-trimester Down Syndrome Screening: Current Strategies and Clinical Guidelines

Down syndrome (DS) is the most common human disease caused by a structural chromosome defect. The original screening test for DS was maternal age or a history of a previously affected infant. Maternal serum screening has been incorporated into routine prenatal checkup in Taiwan since 1994. We used free beta-human chorionic gonadotropin and alpha-fetoprotein (double test) as the serum markers, and this was carried out between the 15th to 20th week of gestation. The overall detection rate was 56% and was compatible with studies of Caucasian populations. The impact of double tests in Taiwan has shown itself by a dramatic lowering of the rate of DS live birth from 0.63 before screening to 0.16 per 1,000 live births at present. However, because of its relatively low detection rate and poor cost-effectiveness, the double test is not justified as a routine screening tool currently. First-trimester combined test is now becoming more widely available and provides increased sensitivity when detecting DS; it has a detection rate of approximately 85% with a false-positive rate of 5%. Nuchal translucency measurement requires ongoing quality control and sufficient certified obstetricians; therefore, first-trimester ultrasound is limited only in designated centers. The quadruple test, having comparable detection rate, should be considered for incorporation into second-trimester screening in Taiwan in the near future. Other screening approaches and combinations have also been utilized in the Western countries. In this review, we outline the various options with respect to DS screening and hope that this will provide practical information for physicians offering such screenings.

Tumor Necrosis Factor—α Converting Enzyme in the Human Placenta Throughout Gestation

Ectodomain shedding of epidermal growth factor receptor ligands such as transforming growth factor— α (TGF-α), heparin-binding epidermal growth factor—like growth factor (HBEGF), and amphiregulin (AREG) is considered to be important during implantation. Tumor necrosis factor—α converting enzyme (TACE) has been suggested as the major sheddase for these molecules. The objectives of this study are (1) to characterize the expression of TACE in the human placenta throughout gestation; (2) to determine the association between the expression of TACE with TGF-α, HBEGF, and AREG; (3) to ascertain whether TACE mediates TGF-α, HBEGF, and AREG shedding; and (4) to examine the effect of hypoxia on the expression of TACE. By analyzing a total of 55 villous samples representing different gestational ages, the authors found that TACE was continuously expressed in the placentas throughout gestation and that the levels of TACE were positively correlated with the levels of TGF-α, HBEGF, and AREG. Preadministration of a TACE inhibitor in villous explant cultures or transfection of cytotrophoblastic cells with TACE-specific small interference RNA decreased the shedding of HBEGF and AREG. Moreover, hypoxia (2% O2) caused an increase in the levels of TACE mRNA and protein in villous explants and primary cytotrophoblastic cells in vitro. These results indicate that oxygen regulates the expression of TACE and that TACE may be important for placental development during human pregnancy.