Tal Biron-Shental

A comparison of surface acquired uterine electromyography and intrauterine pressure catheter to assess uterine activity

OBJECTIVEnIntrauterine pressure catheter (IUPC) is the primary device used to evaluate uterine activity. In contrast to the IUPC, electrical uterine myography (EUM) enables noninvasive measurement of frequency, intensity, and tone of contractions. The aim of this study was to determine the accuracy of EUM compared to IUPC.nnnSTUDY DESIGNnEUM measured myometrial electrical activity using a multichannel amplifier and a noninvasive position sensor. In all, 47 women in labor were monitored simultaneously with an IUPC and EUM. We compared the frequency, intensity, and tone of uterine contractions between the methods.nnnRESULTSnThe correlation of the frequency, intensity, and tone of contractions between uterine electromyography and IUPC was strong with significant r values of 0.808-1 (P < .0001).nnnCONCLUSIONnElectrical uterine electromyography yields information about uterine contractility comparable to that obtained with IUPC.

A comparison between electrical uterine monitor, tocodynamometer and intra uterine pressure catheter for uterine activity in labor

Abstract Objective: We aimed to evaluate the performance of a non-invasive EMG electrical uterine monitor (EUM) versus tocodynamometry (TOCO) by comparing both to internal uterine pressure catheter (IUPC). Study design: Prospective observational trial. Uterine activity was recorded continuously and simultaneously, in women during active term labor, with TOCO, EUM and IUPC. Uterine activity tracings were analyzed by three blinded physicians. Results: Overall, 385 tracings from 43 women were analyzed. A similar rate of interpretable tracings between physicians was demonstrated for EUM (87%; 95% CI 80.9–92.7%) and IUPC (94.8%; 95% CI 83.4–96.3%), with a significantly lower rate for TOCO (67.5%; 95% CI 59.4–76.8%, pu2009<u20090.001). There is a significant difference in the contraction frequency for EUM versus IUPC (0.77u2009±u20092.3) compared to TOCO versus IUPC (−3.34u2009±u20094.97). There is a high variability between the timing of TOCO contractions as compared to IUPC (4.74u2009±u200910.03 seconds), while a gap of 8.46u2009±u20094.24 seconds was detected for EUM. The sensitivity, positive predictive value and false positive rate for individual contraction identification by TOCO and EUM are 54.0%, 84.4%, 15.6% and 94.2%, 87.6%, 12.4%, respectively. Conclusion: EUM is efficient as IUPC for uterine activity assessment and both techniques are superior in comparison to external tocodynamometry. Our results support the use of non-invasive EMG technology to monitor uterine activity.

Telomeres in Trisomy 21 Amniocytes

Individuals with trisomy 21 have an increased risk of developing leukemia and premature dementia. They also have a higher rate of telomere loss. The aim of the study was to compare telomere length and the hTERC gene copy number, which encodes the telomerase RNA subunit, in amniocytes of trisomy 21 conceptions and normal pregnancies. A quantitative fluorescence-in-situ protocol (Q-FISH) was used to compare telomere length in amniocytes cultured from 11 trisomy 21 conceptions and from 14 normal pregnancies. Quantification was conducted using novel computer software. Fluorescence in situ hybridization (FISH) was used to assess the percentage of cells with additional copies of hTERC. We found that the immunofluorescence intensity, which represents telomere length, was significantly lower in amniocytes from trisomy 21 conceptions compared to the control group. The trisomy 21 group had a higher number of cells with additional copies of hTERC. This observation could be one of the cytogenetic parameters that represent a state of genetic instability and might play a role in the pathomechanism of typical features of Down syndrome, such as dementia and malignancy.

Senescence in amniocytes and placentas from trisomy 21 pregnancies.

Abstract Objective: Senescence has been described as a stable cell proliferation arrest resulting from the progression of primary human fibroblasts through a finite number of population doublings in vitro. Accelerated telomere shortening was observed in pregnancies complicated by intrauterine growth restriction, in placentas of diabetic mothers and trisomy 21 amniocytes. We hypothesized that under conditions of stress, telomeres in placentas will be shorter and there will be more cells with the senescence phenotype. Methods: The two study groups included placental biopsies from 7 cases of trisomy 21 and amniocytes from 10 cases of trisomy 21. The control groups consisted of placental biopsies from 6 cases and amniocytes from 10 pregnancies with a normal karyotype. The samples were analyzed for the presence of senescent cells based on the number of fragments in each cell. Results: A significantly higher percentage of cells in the senescent state, based on a higher percentage of cells with more fragmentations, were found in the amniocytes (20.8%) and in trophoblasts (94.3%) from placentas with trisomy 21 compared to the control groups. Conclusion: Among other genetic instability parameters, trisomy 21 amniocytes and trophoblasts express a higher prevalence of senescent cells than were previously reported.

Patients with high-risk pregnancies and complicated deliveries have an increased risk of maternal postpartum readmissions

ObjectivePostpartum readmission after initial hospitalization for delivery can be diminished if better understood. The aim of this study was to determine the risk factors and indications for maternal re-hospitalization after delivery, in order to identify preventable factors.Study designThis was a case control study based on retrospective cohort of patients who delivered at our institution. The patients that were readmitted within 2xa0weeks of their delivery were included in the study group while the control group was conducted from patients who delivered at the same time but were not re-hospitalized and included twice the number of patients. Demographic characteristics as well as pregnancy, labour and postpartum courses were compared between the two groups.ResultsA total of 227 women were re-hospitalized within 14xa0days after initial discharge. The control group consisted of 450 women. The demographic characteristics were similar among the two groups, so were the rates of obesity, gestational weight gain and smoking. The major indication for readmission was postpartum infections, most of which were not related to immediate postpartum febrile morbidity. Emergency cesarean section was found to be an independent risk factor for readmission.ConclusionsThe rate of patients with high-risk pregnancies and complicated deliveries is higher among postpartum maternal readmissions. These data might suggest more cautious postpartum care for those patients.

Reply to: “Cesarean section and tissue adhesions”

We appreciate the concern regarding the definition of adhesions. We are aware of the weakness of assessing adhesions retrospectively and, therefore, were cautious with our conclusions and recommended further research in that field [1]. Given that there is no standardized method to assess adhesions, we used parameters that were previously incorporated into other scoring systems and modified them to fit our computerized operative notes. The computerized structured operative notes were written immediately after the surgery was completed and included categorical information regarding the severity, location, density and amount of adhesions for each patient. Understanding mechanisms of adhesion formation, although very interesting, were beyond the scope of our study. We did not focus on the implications of adhesions after cesarean deliveries. Those are well established in the literature. Also, adhesion barriers were not used during the cesarean deliveries included in the study. There are not enough data in the literature to support their advantage in preventing adhesions related to cesarean deliveries. Since this is a common surgery which leads to repeated surgeries in subsequent deliveries, data regarding adhesion berries will be of great interest and importance, and as clinicians we are all looking forward to having that data.

The magnitude of elevated maternal serum human chorionic gonadotropin and pregnancy complications

Abstract This study assessed the correlation between the magnitude of the elevation in maternal serum human chorionic gonadotropin (MShCG) levels and pregnancy complications. Among 80,716 screened pregnancies, 120 with moderately elevated MShCG (3.00–5.99 MoM) were compared to 84 with extremely elevated MShCG >6.00 MoM. A control series of 120 women with normal MShCG (<3.00 MoM) were matched. Rates of intrauterine growth restriction, preterm labour, antepartum foetal death (APFD), pre-eclampsia, and placental abruption were analysed. We found that the study group had more adverse outcomes than the control group (73/204 [36%] vs. 18/120 [15%]; pu2009<u2009.0001). The rate was higher in the extremely elevated group than in the moderately elevated group (43/84 [51%] vs. 30/120 [25%]; pu2009<u2009.0001). All 12 cases of APFD (14%) occurred among the extremely elevated series. In conclusion, adverse pregnancy outcomes are more common in women with extremely elevated MShCG. The patients should receive counselling regarding this trend and undergo close pregnancy monitoring. Impact statement •u2003What is already known on this subject?In addition to its contribution to Down syndrome (DS) screening, maternal serum human chorionic gonadotropin (MShCG) levels are a marker for pregnancy complications such as intrauterine growth restriction (IUGR), preterm labour (PTL), antepartum fatal death (APFD), pre-eclampsia (PE), placental abruption (PA) and fetal malformations with or without chromosomal aberrations. •u2003What the results of this study add? We found that in the presence of elevated MShCG levels, the incidence of IUGR and PTL increased. PE increased clinically, but statistical significance was seen only when MShCG was extremely elevated (≥u20096.00 MoM). APFD and PA were associated with very high MShCG levels only. •u2003What the implications are of these findings for clinical practice and/or further research? Women with high MShCG levels should be counselled. In case of very high levels (≥u20096.00 MoM), the risk of APFD and PA should be discussed. The pregnancy should be monitored for IUGR, PTL and PE. In view of the limited number of enrolled patients with very high levels of MShCG, the experience of other institutions is needed to corroborate these findings.

The temporal effect of Category II fetal monitoring on neonatal outcomes

OBJECTIVEnTo correlate the duration of Category II cardiotocograms (CTG) with adverse neonatal outcomes associated with perinatal asphyxia and determine the duration before fetal compromise.nnnSTUDY DESIGNnThis retrospective, observational study used electronic medical record data from a cohort of 271 patients, delivered by C-section due to non-reassuring fetal heart rate, at a tertiary medical center, from 2015 through 2017. Duration of Category II CTG, variability, tachycardia and deceleration frequency were analyzed and correlated to immediate postnatal outcomes. including cord pHu2009≤u20097, cord base excess >12, 1- and 5-min Apgar scores ≤7, need for ventilation, need for chest compressions, NICU admission, hypoglycemia and convulsions. Intrapartum fever and meconium stained amniotic fluid were correlated to the same outcomes. Categorical and continuous variables were analyzed using chi-square and t-tests, respectively. Pu2009<u20090.05 was considered significant.nnnRESULTSnThe mean duration of Category II CTG was 146u2009min (range 17-553). Longer duration did not result in increased rates of adverse neonatal outcomes. In contrast, reduced fetal heart rate (FHR) variability, fetal tachycardia and intrapartum fever did show increased rates of adverse neonatal outcomes, as follows: patients exhibiting reduced vs. normal (FHR) variability had 12.9% vs. 1.4% cord pHu2009≤u20097, Pu2009=u20090.006 and 12.5% vs. 1.3% cord BEu2009>u200912, Pu2009=u20090.004: patients with fetal tachycardia vs. normal baseline FHR exhibited 48% vs. 17.9% 1-minute Apgar score ≤7, Pu2009=u20090.0004; 8% vs. 0.8% 5-minute Apgar score ≤7, Pu2009=u20090.04; and 48% vs. 18.7% ventilation support, Pu2009<u20090.001; patients with intrapartum fever vs. normal temperature, cord BEu2009>u200912 was seen in 9.7% vs. 1.7%, Pu2009=u20090.035; 1-minute Apgar score was ≤7 in 35.5% vs. 18.7%, Pu2009=u20090.03; 5-minute Apgar score ≤7 in 9.7% vs. 0.4%, Pu2009=u20090.005; need for ventilation in 35.5% vs. 19.6%, Pu2009=u20090.042; need for chest compressions in 6.45% vs. none, Pu2009=u20090.013; and NICU admission in 12.9% vs. 2.5%, Pu2009=u20090.018.nnnCONCLUSIONSnOur results suggest that the duration of Category II CTG alone does not appear to predict perinatal asphyxia. Parameters associated with perinatal asphyxia are reduced FHR variability, fetal tachycardia and intrapartum fever. Therefore, when contemplating intervention during labor to avoid fetal asphyxia, these parameters should be strongly considered.

The yield of the prenatal work-up in intrauterine growth restriction and the spectrum of fetal abnormalities detected postnatally

Abstract Objective: To evaluate the yield of work-up in intrauterine growth restriction (IUGR) pregnancies and their outcomes. Materials and methods: Retrospective data regarding prenatal work-up (serology, genetic testing and imaging), and neonatal outcomes of 198 IUGR pregnancies (estimated fetal weight <10th percentile) were analyzed. Results: IUGR was isolated in 72 cases. Work-up performed in 158 (80%) cases was positive in 4 (2.5%). No abnormalities were detected in prenatal genetic testing. Echocardiogram performed in 27 cases was abnormal in 3 (11.1%). Serological testing performed in 150 pregnancies (75.8%) detected 1 case (0.7%) of cytomegalovirus (CMV) infection. Thirteen neonates (6.5%) were diagnosed with significant health problems. A positive work-up and significant postnatal health problems were not correlated with IUGR severity, symmetry or additional concurrent findings. Conclusion: The yield of IUGR work-up is not clear and is probably highest for fetal echocardiography. The rate of significant adverse outcomes after birth is increased in IUGR pregnancies.