Tulin Ozcan

Increase of fetal hematocrit decreases the middle cerebral artery peak systolic velocity in pregnancies complicated by rhesus alloimmunization

Our hypothesis for this study was that an increase in fetal hematocrit would decrease the middle cerebral artery peak systolic velocity. Seventeen pregnancies complicated by Rh alloimmunization were included in this study. Middle cerebral artery peak systolic velocity was studied by Doppler ultrasound before and after intrauterine transfusion with adult packed red blood cells (hematocrit = 80-85%). Mean gestational age at time of study was 27 weeks. Paired t-test was used for statistical comparison. A P value of < 0.05 was considered statistically significant. The fetal hematocrit ranged from 5.9% to 30% prior to the procedure, and it was 24.8-53.4%, following the procedure. Mean middle cerebral artery peak systolic velocity was 46.2 +/- 10.7 cm/s prior to the procedure, and it decreased to 31.7 +/- 9.5 cm/s following the procedure (P < 0.01). The increase of fetal hematocrit significantly decreases the middle cerebral artery peak systolic velocity supporting data that this Doppler measurement may be useful for the diagnosis of fetal anemia.

Can a single measurement of amniotic fluid delta optical density be safely used in the clinical management of Rhesus-alloimmunized pregnancies before 27 weeks' gestation?

BACKGROUNDnTo assess the efficacy of a single measurement of amniotic fluid optical density deviation at 450 nanometers in predicting fetal anemia in Rhesus-alloimmunization before 27 weeks gestation.nnnMETHODSnIn this cross-sectional study, fetal blood and amniotic fluid samples from 43 Rhesus-alloimmunized pregnancies at 18 to 26 weeks gestation were obtained under ultrasound guidance. Amniotic fluid samples were scanned by spectrophotometry for optic density at various wavelengths. Deviation at 450 nanometers was calculated between 550 and 365 nanometers. The fetuses were divided into three groups based on their hematocrit levels and the predictive efficacy of optic density zones for anemia was evaluated.nnnRESULTSnA high number of false positive and false negative results were observed when the delta-amniotic fluid optical density of fetuses at risk for anemia was plotted to the zones recently proposed to manage Rhesus-alloimmunized pregnancies.nnnCONCLUSIONSnThese data confirm previous results that the diagnosis of fetal anemia in Rhesus-alloimmunized pregnancies before 27 weeks gestation cannot be accurately made by a single measurement of amniotic fluid optical density at 450 nanometers.

Cytogenetical diagnosis in paraffin-embedded fetoplacental tissue using comparative genomic hybridization.

Comparative genomic hybridization (CGH) is a FISH‐related technique used to assess global chromosomal aberrations in a variety of human tumours. Recently CGH has been applied to cytogenetic analysis of fresh frozen fetoplacental tissues. Here we report the application of CGH to paraffin‐embedded placental samples. Ten samples from paraffin‐embedded blocks of 6 control placentas and fetoplacental tissue from 10 aneuploidies, and 2 unbalanced aberrations were evaluated. Balanced karyotype profiles were obtained from samples of healthy placentas and all samples from the same placenta appeared to have similar confidence intervals. CGH analysis of four cases of trisomy 21, three cases of trisomy 18, one case of trisomy 13, one case of trisomy 15 and one case of trisomy 7 all showed overrepresentation of the respective trisomic chromosome. The CGH profile was also in accordance with the karyotyping of a case with isochromosome 21. The CGH profile of a case with der (2)t(2;6)(q37.3;q22.2) revealed partial trisomy for chromosome 6 between q21 and q27. CGH may be a useful adjunct in prenatal genetic diagnosis when retrospective diagnosis is needed from archival samples. Copyright

The effect of anticoagulation on antenatal ultrasound findings in pregnant women with thrombophilia

Objective. To assess whether treatment with heparin alters ultrasound findings in pregnant women with inherited thrombophilia. Methods. This was a retrospective study of a cohort of patients referred for pregnancy complications who were found to have genetic thrombophilia. Ultrasounds were reviewed in treated and untreated pregnancies for the presence of growth restriction, oligohydramnios or abnormal Doppler results. Results. There were a total of 178 pregnancies in 51 patients. The overall percentage of abnormal ultrasounds was significantly greater in the untreated compared with treated pregnancies (52.8% vs. 27.9%; p = 0.024.) Growth restriction and abnormal Doppler results were more common in untreated pregnancies. There was a significantly decreased risk of oligohydramnios with treatment (27.3% vs. 7%; p = 0.03). Overall outcomes were significantly improved with the use of anticoagulation ( p < 0.0001). Conclusions. Treatment markedly improves ultrasound parameters of growth, fluid and feto-placental blood flow in patients with thrombophilia. The presence of abnormalities despite treatment reinforces the need for close antenatal surveillance.

Does lispro improve blood glucose control and birth weight

Abstract Objective: We compared the impact of Lispro insulin on Hb A1C and birth weight (BW) with the impact of standard insulin. Study design: Patients with pregestational or gestational diabetes who needed insulin before 20 weeks in pregnancy were evaluated. Patients with iatrogenic preterm delivery were excluded. Demographic and clinical data were collected, including Hb A1Cfrom each trimester and BW percentiles (BW%). The Hb A1Clevels and BW% of Lispro (Group 1) and standard insulin (Group 2) were compared using the Mann-Whitney U test for continuous variables and Fisher’s exact test for categorical variables. Results: Fifty patients were evaluated (Group 1 = 21, Group 2 = 29). There were no significant differences in demographics. Group 1 Group 2 P Hb A1C 1st trimester 8.04 ± 1.74 9.24 ± 2.14 NS Hb A1C 2nd trimester 7.28 ± 1.74 7.57 ± 1.44 NS Hb A1C 3rd trimester 6.95 ± 1.51 7.5 ± 1.27 NS GA (weeks) 36.7 ± 1.4 36.7 ± 1.6 NS BW >90% 1/21 (4.8%) 6/29 (20.7%) 0.051 C/S 13/21 (61.9%) 17/29 (58.6%) NS Conclusions: Lispro does not appear to improve blood glucose control as represented by Hb A1C levels. There is a trend toward less macrosomia with Lispro. Further study is needed to determine whether Lispro improves perinatal outcomes.

Genetic thrombophilia and hypertensive complications of pregnancy

Abstract Objective: To assess the frequency of genetic thrombophilia in patients with a history of hypertensive complications. Study design: We did a retrospective study of women referred for consultation with a history of severe preeclampsia, eclampsia, or HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) from January 1998 to May 2000. Patients were tested for factor V Leiden (FVL), methylenetetrahydrofolate reductase (MTHFR), and prothrombin G (ProG) mutations. Maternal demographics were collected. Prevalence data adjusted to match the ethnic origin of the study population were used for comparison. Results: Fifty-four patients were evaluated. The median age, gravidity, and parity were 31.5 years (range, 18–52), 3 (range, 1–8), and 1 (range, 1–3). Of the patients, 46% were Caucasian, 36% African-American, 16% Hispanic, and 2% Asian. There were complications from HELLP syndrome and eclampsia in 17% and 5% of cases, respectively. Prevalence OR (CI) P FVL 10.2% 7.7 (1.3–44.3) ProG 0% — NS MTHFR 32.1% — NS Conclusions: The prevalence of ProG and MTHFR were not higher than in controls. The increased frequency of the Leiden mutation suggests that a thromboembolic pathophysiology is important in preeclampsia. In a referral population, evaluation of the FVL mutation may be helpful for selection of women who potentially may benefit from anticoagulation treatment.

Genetic thrombophilia mutations are not increased in patients with recurrent losses

Abstract Objective: To assess the frequency of genetic thrombophilia mutations in patients with recurrent pregnancy loss. Study design: We did a retrospective study over 30 months of women referred for consultation with two or more first-trimester or a second- or third-trimester loss. Patients were tested for the factor V Leiden (FVL), prothrombin G20210A (ProG), and methylenetetrahydrofolate reductase (MTHFR) mutations. Maternal demographics were collected. Prevalence data adjusted to match the ethnic origin of the study population were used for comparison. Results: One hundred patients were evaluated. The median age, gravidity, and parity were 33 years (range, 17–46 years), 4 (range, 1–11), and 1 (range, 0–5), respectively. Of the patients, 61% were Caucasian, 26% African-American, 11% Hispanic, and 2% Asian. First-, second-, and third-trimester loss frequencies were 32%, 36%, and 48%, respectively. The prevalence of any mutation was not different between patients with first-trimester loss (n = 22) or second- or third-trimester losses (n = 78). Prevalence P FVL heterozygous 5.68% NS ProG 2.86% NS MTHFR heterozygous 33.8% NS MTHFR homozygous 4.84% NS Conclusions: Thrombophilia mutations do not appear to be higher in a referral population with pregnancy losses.