Tanja Premru-Srsen

Prevention of Congenital Toxoplasmosis in Slovenia by Serological Screening of Pregnant Women

A programme for the prevention of congenital toxoplasmosis in Slovenia involving the screening of pregnant women for Toxoplasma infection is presented. Of 21,270 pregnant women screened for toxoplasmosis between, 1996 and the end of 1999, 13,987 (66%) were seronegative, 7,151 (34%) seropositive and 132 had primary infection; ≈ 9/1,000 women were at risk of acquiring the primary infection. One hundred live-born infants of primary infected women were available for follow-up. Nine infected but asymptomatic children were born to mothers who were screened and treated in time and two congenitally infected babies were born to mothers in whom infection was detected too late in pregnancy and who therefore received no adequate treatment. It is suggested that the results obtained in this study outweigh the cost of screening for toxoplasmosis in pregnancy. Pregnant women should always be tested at the beginning of pregnancy and, in cases of seronegativity, should be re-tested in the second and third trimesters of the pregnancy. Toxoplasma primary infected pregnant women and neonates should be treated as soon as possible. However, long-term follow-up of children born to primary infected women would be necessary for an accurate evaluation of the effectiveness of the screening because of the possibility of late onset of symptoms.

Severe human granulocytic anaplasmosis transmitted by blood transfusion.

A 36-year-old woman acquired severe human granulocytic anaplasmosis after blood transfusion following a cesarean section. Although intensive treatment with mechanical ventilation was needed, the patient had an excellent recovery. Disease caused by Anaplasma phagocytophilum infection was confirmed in 1 blood donor and in the transfusion recipient.

Neutrophil defensins but not interleukin-6 in vaginal fluid after preterm premature rupture of membranes predict fetal/neonatal inflammation and infant neurological impairment.

Objective. To determine whether neutrophil defensins (HNP1–3) and interleukin‐6 (IL‐6) in vaginal fluid after preterm premature rupture of membranes predict fetal inflammatory response syndrome (FIRS), neurological impairment or chorioamnionitis. Design. Prospective study. Setting. Tertiary referral university hospital. Population. Forty‐two patients with preterm premature rupture of membranes at <32 weeks. Methods. Levels of HNP1–3 and IL‐6 were measured in vaginal fluid obtained by swabs. Mann–Whitney U‐test was used to compare HNP1–3 and IL‐6 levels in groups with vs. without FIRS, infant death or neurological impairment, and chorioamnionitis (p<0.05 significant). Logistic regression was used to control for potential confounders. Diagnostic accuracies of HNP1–3 and IL‐6 were determined by receiver operator characteristics analysis. Main Outcome Measures. Fetal inflammatory response syndrome was defined as neonatal inflammation within 72hours postpartum. Neurological impairment was defined as motor and/or tone abnormalities at one year of corrected age. Chorioamnionitis was diagnosed histologically. Results. Levels of HNP1–3, but not IL‐6, were higher in 12 cases of FIRS (p=0.019 and p=0.256, respectively). Levels of HNP1–3, but not IL‐6, were higher in 14 cases of infant death or neurological impairment (p=0.015 and p=0.100, respectively) and, when only survivors were analyzed, in nine cases of neurological impairment (p=0.030 and p=0.187, respectively). Levels of HNP1–3 and IL‐6 were higher in 29 cases of chorioamnionitis (p=0.005 and p=0.003, respectively). The differences remained significant after adjustment for gestational age. Levels of HNP1–3 predicted FIRS, infant death or neurological impairment and chorioamnionitis with an area under the curve of 0.75, 0.79 and 0.78, respectively. Conclusions. Elevated vaginal fluid HNP1–3 and IL‐6 levels are associated with histological chorioamnionitis. Elevated HNP1–3 can also identify FIRS and predict infant death or neurological impairment.

Infant mortality and causes of death by birth weight for gestational age in non-malformed singleton infants: a 2002–2012 population-based study

Abstract Objective: To explore the associations between birth weight for gestational age (GA) and infant mortality as well as causes of infant death. Study design: A population-based observational study conducted between 2002 and 2012 included 203,620 non-malformed singleton live births from Slovenia. Poisson regression analyses were performed to estimate the crude relative risk (RR) and adjusted RR (aRR) for infant mortality by birth weight percentiles stratified by the GA subgroups term, moderate-to-late preterm, very preterm and extremely preterm. Results: Compared with appropriate for GA (AGA) term infants (referent-AGA), infant mortality was significantly higher in small for GA (SGA) term infants [aRR=2.79 (1.41–5.50)], with significant cause-specific infant mortality risk for neuromuscular disorders [RR=10.48 (2.62–41.91)]. The differences in infant mortality and cause-specific infant mortality in preterm subgroups between referent-AGA and SGA were insignificant. Conclusions: In the Slovenian population, birth weight for GA is significantly associated with infant mortality only in infants born at term.

Early prediction of spontaneous twin very preterm birth: a population based study 2002–2012

Abstract Objective: The aim of this study was to establish early pregnancy risk indicators for spontaneous twin very preterm birth. Methods: We conducted a retrospective observational population-based study. Twenty-one potential early pregnancy risk factors were analyzed using multivariable logistic regression to determine which of them was independently associated with spontaneous twin very preterm birth. Results: Of 1815 spontaneous twin births 15.3% (277) occurred before 32 weeks. Previous preterm delivery (aOR 3.73; 95% CI, 2.52–5.52), nulliparity (aOR 2.94; 95% CI, 2.09–4.14), body mass index <18.5 (aOR 1.86; 95% CI, 1.12–3.10), body mass index ≥30 (aOR 1.87; 95% CI, 1.21–2.89), hysteroscopic metroplasty (aOR 1.63; 1.07–2.49), conization (aOR 2.05; 95% CI, 1.07–3.94) and monochorionicity (aOR 1.83; 95% CI, 1.28–2.63) were significantly associated with twin very preterm birth. Conclusions: Pending verification in other populations, twin pregnancies at significant risk for spontaneous very preterm birth can be identified in early pregnancy using several risk indicators.

Peripheral arterial tonometry and angiogenic biomarkers in preeclampsia

ABSTRACT Objective: To evaluate changes in vascular function and serum biomarkers in women with and without preeclampsia (PE) to create a model for the easier and more precise diagnosis of PE in the future. Methods: Endothelial function and arterial stiffness were evaluated using peripheral arterial tonometry and concentrations of placental growth factor (PlGF), soluble fms like tyrosine kinase 1 (sFlt-1) and soluble endoglin (sEng) were determined by immunoassay. Results: Arterial stiffness deteriorates and endothelial function is better in women with PE compared with a healthy pregnancy. Women who developed PE had a decreased PlGF and PlGF/(sFlt-1+ sEng) ratio and an increased sEng, and sFlt-1/PlGF ratio. Conclusion: Peripheral arterial analysis did provide additional information beyond serum biomarkers in the diagnosis of PE.

Prophylactic Systemic Antifungal Agents to Prevent Mortality and Morbidity in Very Low Birth Weight Infants

Meta-analysis found a statistically significant reduction in the incidence of invasive fungal infection in infants who received systemic antifungal prophylaxis (typical risk ratio (RR) 0.41, 95% confidence interval (CI) 0.27–0.61; risk difference (RD) –0.09, 95% CI –0.14 to –0.05). The average incidence of invasive fungal infection in the control groups of the trials (16%) was much higher than that generally reported from large cohort studies (<5%). Meta-analysis did not find a statistically significant difference in the risk of death prior to hospital discharge (typical RR 0.74, 95% CI 0.52–1.05; RD –0.04, 95% CI –0.08 to 0.01). Very limited data on long-term neurodevelopmental outcomes were available. Two trials that compared systemic versus oral or topical non-absorbed antifungal prophylaxis did not detect any statistically significant effects on invasive fungal infection or mortality. Two trials that compared different dose regimens of prophylactic intravenous fluconazole did not detect any significant differences in infection rates or mortality.

P26.24: Unusual ultrasonographic features of isolated vaginal atresia: case report

A 30-year-old primigravida was referred at 30 weeks of gestation because of fetal hydrops and hydronephrosis. Ultrasound examination revealed singleton female fetus with edema, ascites, bilateral hydrotorax and polyhydramnion. Biometry exept AC was normal. Bilateral dilatation of the renal pelvis and calyces was of Grade 2. The bladder was dilated and did not empty during examination. Bowel loops were compressed among the bladder, right kidney and liver. Anal stella was clearly seen. Female external genitalia were of normal appearance. The rest of the abdomen was filled with multicistic formation. Karyotype was normal. First and second trimester anomaly scan revealed no structural abnormalities. Next ultrasound examination at 23 weeks revealed mild hydronephrosis. Cardiotocograms during the course of diagnostic treatment were nonreactive with normal frequency and decreased variability. Umbilical artery Doppler was normal. At 31 weeks of gestation after discussion with parents we decided on induction of labour during which the fetus died in utero. A 2750 g female stillborn was delivered. Postmortem examination revealed vaginal atresia and hydrocolpos. Mild bilateral hydroureter and hydronephrosis, dilated bladder, diffuse peritonitis with calcinations and fetal hydrops were confirmed. Uterus was only slightly enlarged. Urethra was easily probed. Bowel loops were partly adhered to each other and to the liver but anatomically normal with no sign of lumen obliteration. Sigmoid colon was slightly dilated. There were no other malformations found. The presence of hydrocolpos obviously caused compression of urethra which in turn caused bladder dilatation, bilateral hydroureter and hydronephrosis. Ascites and aseptic peritonitis with calcinations could result from retrograde flow of uterine secretions through fallopian tubes. Hydrops most probably developed as a consequence of compression of inferior vena cava and impaired venous return to the heart with final heart failure.