Valeria Bezzeccheri

Transabdominal amnioinfusion in preterm premature rupture of membranes: a randomised controlled trial

Objective  To evaluate the role of transabdominal amnioinfusion in improving the perinatal outcomes of pregnancies complicated by preterm premature rupture of membranes (pPROM).

Amniotic vascular endothelial growth factor (VEGF) and nitric oxide (NO) in women with subsequent preeclampsia.

OBJECTIVE To assess whether amniotic fluid concentrations of nitric oxide (NO) and vascular endothelial growth factor (VEGF) in early pregnancy correlate to subsequent preeclampsia. STUDY DESIGN We performed a retrospective study to assess VEGF and NO on the second trimester amniotic fluid of 15 healthy women, and 15 women who subsequently developed preeclampsia. RESULTS In women with subsequent preeclampsia, both VEGF (213.19+/-78.42 pg/ml) and NO concentrations (4.31+/-1.02 micromol/mg creatinine) were significantly lower than healthy controls (VEGF 255.05+/-88.66 pg/ml; NO 5.02+/-1.57 microg/mg creatinine; P<0.05). CONCLUSIONS Our findings suggest that reduced VEGF may be responsible, at least in part, for the impaired vascular development which occurs in preeclampsia. Low concentrations of VEGF and NO in the second trimester may represent an impaired stimulus to vascular formation and endothelial regulation that induce placental disease and preeclampsia.

Amniotic levels of vascular endothelial growth factor and nitric oxide at the second trimester in Down's syndrome

Objective: Since placentae in trisomy 21 show trophoblastic hypoplasia and hypovascularity, we investigated amniotic fluid vascular endothelial growth factor (VEGF) and nitric oxide (NO) in normal pregnancy and pregnancy complicated by trisomy 21. Furthermore, we investigated a possible role of NO in neurodegeneration of the brain in Downs syndrome. Methods: We retrospectively assessed NO and VEGF on mid-trimester amniotic fluid from 15 women who had fetal Downs syndrome, and compared the results with those of 15 controls matched for age and gestation. Results: In pregnancies complicated by trisomy 21, NO levels were significantly higher than in healthy controls (p < 0.001), whereas VEGF levels were significantly lower than in healthy controls (p < 0.05). Conclusions: Our results suggest that the high levels of NO and the low levels of VEGF observed in the amniotic fluid of fetuses with Downs syndrome may be a sign of an imbalance of placental vascularization and altered endothelial function. Overproduction of NO could contribute to pathological cell death in the central nervous system, a process that has been demonstrated in many neurodegenerative diseases.

Amniotic levels of nitric oxide in women with fetal intrauterine growth restriction.

Objective: Many biochemical observations have shown that nitric oxide (NO) is involved in the vascular angiogenic activity of the fetoplacental unit. The aim of this study was to determine whether NO is implicated in the pathogenesis of intrauterine growth restriction (IUGR). Methods: We retrospectively assessed amniotic fluid NO from second-trimester amniocentesis of 20 healthy normotensive women who subsequently developed IUGR and 20 controls. The same women were re-assessed at the third trimester when IUGR had developed and when the same 20 controls had shown normal pregnancy. Amniotic fluid NO was detected by discontinuous spectrophotometry and the Griess reaction. Results: At the second trimester, NO levels in women with subsequent IUGR were significantly lower than in controls (4.1 ± 0.2 μg/mg creatinine vs. 6.02 ± 1.57 μg/mg creatinine, p < 0.001). At the third trimester, in women with IUGR, NO levels were significantly higher than in normal pregnancies (7.4 ± 1.5 vs. 5.02 ± 0.9 μg/mg creatinine, p < 0.001), and directly correlated with gestational age when growth restriction was diagnosed (r = 0.69, p < 0.001). Conclusions: Low levels of NO during the early second trimester may represent an impaired stimulus to vascular formation and endothelial regulation, inducing placental disease and subsequent fetal growth restriction. High levels of amniotic fluid NO during the third trimester may represent a compensation factor for maintaining adequate uteroplacental perfusion in pregnancies with IUGR.

Doppler analysis and placental nitric oxide synthase expression during fetal growth restriction

Objective. To assess placental nitric oxide (NO) metabolism related to changes in the uteroplacental circulation during fetal growth restriction (FGR). Methods. The resistance index (RI) from the uterine arteries and pulsatility index (PI) from the umbilical artery were determined by Doppler analysis in 15 patients with FGR and 12 healthy controls, before elective cesarean section. Inducible (iNOS) and endothelial (eNOS) NO synthase expression were measured in placental samples. Immunohistochemistry was performed for iNOS location in the placenta. Results. During FGR, we observed a significant elevation of iNOS when compared with controls. Conversely, eNOS did not differ between the two groups. A negative correlation with eNOS (r = −0.85) and a positive correlation with iNOS (r = 0.91) was found correlating to umbilical PI. The iNOS proteins were reduced in syncytiotrophoblast cells and increased in endothelium in the FGR group compared to the controls. Conclusions. During FGR, placental iNOS expression is significantly increased; this increase possibly represents an adaptive physiological mechanism for overcoming a fetoplacental circulation deficiency.

Computerized analysis of the fetal heart rate in pregnancies complicated by preterm premature rupture of membranes (pPROM)

Objective. We aimed to show that in pregnancies complicated by preterm premature rupture of membranes (pPROM), there are alterations to the fetal heart rate pattern that can be detected by computerized analysis. Methods. The study population consisted of 27 pregnant women with pPROM at 29–34 weeks of gestation and 33 normal pregnancies matched according to age, parity and gestation. A 30-minute fetal heart rate (FHR) tracing was analyzed by computer and umbilical artery cord blood was collected at birth. Results. The baseline heart rate, the number of decelerations exceeding 20 beats per minute and the duration of episodes of low variation were higher in the pPROM group versus the controls. The number of decelerations exceeding 20 beats per minute had an independent, statistically significant association with umbilical artery pH at birth. Conclusions. Even if our data require a prospective validation involving a larger number of pathological cases, a computerized FHR tracing analysis may improve the clinical care and the timing of delivery during pPROM by definition of the risk of acidemia and pre-acidemia.

Placental expression of nitric oxide synthase during HELLP syndrome: the correlation with maternal–fetal Doppler velocimetry

Background.  To correlate Doppler waveform of the uterine and umbilical vessels to placental nitric oxide synthase (NOS) expression in pregnant women with HELLP (hemolysis, elevated liver enzymes, low platelets count) syndrome.

PP047. Outpatient management of pregnancy complicated by mild hypertensive disorders

INTRODUCTION Antenatal day care units have been experienced as an alternative to inpatient care for women with pregnancy complications including hypertensive disorders. OBJECTIVES To assess the outcomes of outpatient management in women with gestational hypertension and mild preeclampsia and compare them to inpatient management. METHODS Perinatal records of 294 patients (OUT group) attending the obstetric outpatient clinic were reviewed and compared with records of 398 women (IN group) attending the obstetric unit of the same tertiary referral center. The patients were divided as: GH, gestational hypertension (OUT: 194; IN: 244), GH with Intrauterine Growth Restriction (OUT: 52; IN: 78) and PE, mild preeclampsia (OUT: 48; IN: 76). The groups were comparable for age, parity, body mass index and gestational age at enrollment. RESULTS When compared with patients treated in hospital, GH OUT women showed a higher gestational age at delivery (38±1.7 vs 35.5±2.3 weeks; p<0.001), longer time to delivery (62.0±4.8 vs 31.3±5.4days; p<0.001), higher birthweight (3251±389 vs 2271±759.1g; p<0.001), and a lower admission to neonatal intensive care unit (21.3% vs 0%; p<0.001) (hospitalization rate: 25%). Similarly, Mild PE women treated as out patient showed later gestational age at delivery (37±1.2 vs 34.4±1.7weeks), longer time to delivery (55.4±6.9 vs 35.3±4.5days), higher birthweight (3168±363 vs 2196±685.17g), and a lower admission to NICU (15.6% vs 35.5%) (hospitalization rate: 55.6%), than the inpatient controls. In the gestational hypertension with IUGR no significant differences were observed between out- and in-patient management. CONCLUSION Women attending day care units have better or comparable perinatal outcomes than inpatients. Ambulatory management at a day-care unit is an option for monitoring and following up women with mild gestational hypertension or preeclampsia remote from term. Hospitalization remains an absolute indication if worsening of preeclampsia is diagnosed.

575 Amniotic levels of nitric oxide (NO) and vascular endothelial growth factor (VEGF) in pregnancy with subsequent intrauterine fetal death

Objective: Nitric oxide (NO) and vascular endothelial growth factor (VEGF) regulate angiogenesis and seem involved in the early stages of placentation. If angiogenesis is reduced, this may lead to poor placentation and fetal death. This study was aimed to determine whether VEGF and NO are associated to subsequent fetal death. Study design: We retrospectively assessed NO and VEGF on midtrimetster amniotic fluid from seven women who had subsequently had intrauterine fetal death before 20 weeks, and compared the results with those of 14 controls matched for age and gestation. All women had undergone amniocentesis for maternal age. All were at 16 weeks of gestation. None had shown chromosomal abnormalities. Results (mean S:D:) were tested for statistics with Student’s t-test with significance at P < 0:05. Results: Women with subsequent fetal death had both amniotic NO and VEGF lower than women with normal pregnancy (NO 3:28 1:20 mg/mg creatinine versus 6:02 1:57 mg/mg creatinine, P < 0:05; VEGF 210:10 69:55 pg/ml versus 255:05 88:66 pg/ml). Conclusions: An early reduction of both NO and VEGF may be responsible of an impaired placental vascular development and endothelial regulation that may lead to fetal death. # 2003 Elsevier Ireland Ltd. All rights reserved.