Fetal DNA in maternal plasma in preeclamptic pregnancies

Cell-free fetal DNA present in maternal circulation has revolutionized non-invasive prenatal diagnosis of genetic diseases. In preeclampsia, the quantity of fetal DNA in maternal plasma has been studied and found to be higher in comparison to healthy pregnant women. Whether the quantity of fetal DNA can be used as a reliable predictive biomarker of preeclampsia is currently uncertain. This is a systematic review on studies quantifying fetal DNA in preeclamptic pregnancies. Using a PubMed search 22 studies were identified. In all of them, elevated levels of fetal DNA in maternal plasma in preeclampsia were found. In some of the studies, the higher concentration of fetal DNA was observed before the onset of clinical symptoms. This shows that fetal DNA levels might have a potential informative value as an early diagnostic biomarker of preeclampsia. However, in most of the studies important data are missing and there is an enormous variability in the reported results between the studies. From the available data it is currently not possible to perform a meta-analysis due to the variation between studies. If once fetal DNA should be used as a marker for determining preeclampsia at early stage, it is necessary to reduce these variations via standardized protocols for the quantification of cell-free fetal DNA as well as its reporting in the publications.     

Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in China

BackgroundIn March 2020, the World Health Organization declared coronavirus disease 2019 (COVID-19), which is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a pandemic. Currently, data on changes in sexual behavior during the COVID-19 outbreak are limited.AimThe present study aimed to obtain a preliminary understanding of the changes in people's sexual behavior, as a result of the pandemic, and explore the context in which they manifest.MethodsA convenience sample of 270 men and 189 women who completed an online survey consisting of 12 items plus an additional question were included in the study.OutcomesThe study outcomes were obtained using a study-specific questionnaire to assess the changes in people's sexual behavior.ResultsWhile there was a wide range of individual responses, our results showed that 44% of participants reported a decrease in the number of sexual partners and about 37% of participants reported a decrease in sexual frequency. Multiple regression analysis showed that age, partner relationship, and sexual desire were closely related to sexual frequency. In addition, we found that most individuals with risky sexual experiences had a rapid reduction in risky sexual behavior.Clinical ImplicationsThe current findings contribute to identifying another potential health implication associated with the COVID-19 pandemic and report preliminary evidence of the need to provide potential interventions for the population.Strength & LimitationsThis study is the first to perform a preliminary exploration of sexual behavior during the COVID-19 outbreak. The generalizability of the results is limited, given that only a small convenience sample was used.ConclusionDuring the height of the COVID-19 outbreak, overall sexual activity, frequency, and risky behaviors declined significantly among young men and women in China.Li W, Li G, Xin C, et al. Challenges in the Practice of Sexual Medicine in the Time of COVID-19 in China. J Sex Med 2020;17:1225–1228.     

Differences in female and male perception of information and decision-making in single-embryo transfer in in vitro fertilization in Sweden

Purpose The aim of this study was to evaluate the information and the factors that contribute to the decision to accept and choose single embryo transfer (SET) in females and males. Materials and methods Fifty-four females and males undergoing SET were interviewed separately using a structured questionnaire. Results The women were significantly more satisfied with the information than the men (odds ratio 3.3), but the decision to accept SET was nevertheless more difficult for women (OR 3.1). Only one-third of both female and males were aware of the increased maternal risks with twin pregnancies. There was a tendency that the women who accepted SET had previous children, shorter duration of infertility, and were younger. Cryopreservation of embryos and a good pregnancy chance were important irrespective of gender. Conclusion The female needs more support to choose SET. The male needs better information and further involvement in decision-making. The females were more aware of the fetal risks, but the awareness of the increased maternal risks with twin pregnancies was low. The female need more support to accept and choose single embryo transfer, compared to the male and information should in some areas be directed differently to females and males.     

Alterations in placental pendrin expression in pre-eclampsia

Abstract

Introduction: Pendrin is an integral membrane protein and plays a key role in extracellular fluid volume and blood pressure control. We aimed to investigate the relationship between pendrin immunostaining intensity in normal and pre-eclamptic placental tissue.

Methods: Fifty-six placental tissues, of which 26 were in pre-eclamptic, and 30 were in control group were evaluated by immunohistochemical staining. Positive immunostaining was evaluated using a semiquantitative score: 0, negative; +, mild; ++, moderate; and +++, intense.

Results: There was more positive immunstaining in the pre-eclamptic placenta compared to the controls (p?<?0.001). A significant positive correlation was observed between immunostaining level and diastolic blood pressure (r?=?0.533, p?=?0.005) in the pre-eclamptic group. However, no significant correlation was observed between any condition and immunostaining level in the control group.

Conclusions: Placentas in the pre-eclamptic group were significantly more immunostained with pendrin than were those in the control group. In addition, a positive correlation between immunostaining intensity with pendrin and both systolic and diastolic blood pressure were observed. Pendrin may play a role in the mechanism of severe hypertension in women with pre-eclampsia.     

Changes in lipid metabolism in pregnancy in relation to gestoses

In 21 healthy pregnant women and 21 women with toxemias in pregnancy between 34 and 36 gestational weeks were the following parameters lipid metabolism have been analyzed: triglyceride, cholesterol, HDL cholesterol, LDL cholesterol. The lipid data of the healthy pregnant women did not differ significantly from these of the hypertensive women. A tendency to lesser quantities at HDL cholesterol has been observed in the group of women with toxemias. We did not find any reference to a connexion between changes in lipid metabolism and the development of toxemias in pregnancy. The hyperlipidemia of pregnancy is probably a physiological process because of the hyperestrogenism in pregnancy.     

Heterogeneity in patient populations explains differences in in vitro fertilization programs

OBJECTIVE: To evaluate the efficacy of in vitro fertilization and embryo transfer (IVF-ET). DESIGN: Two different models for pregnancy rates in IVF-ET have been developed: a beta-geometric model and a split population model. SETTINGS: All IVF cycles were performed at the Yale University School of Medicine in New Haven, Connecticut. PATIENTS, PARTICIPANTS: All patients undergoing 1,257 IVF-ET cycles performed between the years 1983 through 1987. INTERVENTIONS: None. MAIN OUTCOME MEASURE: The probability of achieving a viable pregnancy per cycle. RESULTS: Because both models provide excellent explanations for our data distribution, the decline in the conditional probability of achieving pregnancy after a given number of unsuccessful cycles may be inferred. CONCLUSIONS: These findings question the justification of continuing IVF-ET treatment beyond some threshold number of cycles.     

Ultrasonic assessment of endometrial changes in stimulated cycles in an in vitro fertilization and embryo transfer program

Four distinct patterns in the ultrasonic appearance of preovulatory endometrium can be identified and described in patients undergoing stimulated cycles in an in vitro fertilization program. Ultrasonically, this endometrial response can be seen as a quantitative change in thickness and a qualitative change in gray-scale appearance or reflectivity. The application of this additional parameter of endometrial assessment together with the conventional measurement of follicular diameter as a means of optimally timing oocyte collection has been associated with a reduction in the preoperative ovulation rate from 10.9 to 3.2%, an increase in the fertilization rate from 59.2 to 82.5%, and in a pregnancy rate per embryo transfer of 20.5% in our program without the use of hormonal assays.     

Antibiotic usage in community-acquired infections in hospitals in Taiwan.

BACKGROUND AND PURPOSE: Using an epidemiologically meaningful in-hospital population with community-acquired infections, we evaluated antibiotic therapy in terms of indication and choice of antibiotic and microbiologic work-up. METHODS: Infectious disease specialists evaluated charts of 436 patients from 9 hospitals and selected those who received antibiotics within 3 days of admission. Each antibiotic prescribed was marked for appropriateness of indication and choice. Microbiologic isolates were evaluated for their clinical significance. RESULTS: The most common infections were in the lower respiratory tract (46.1%). Each patient received a mean of 2.25 antibiotics for 8.1 +/- 6.4 days. Of the 975 courses of antibiotics given in the study period, indication and choice were correct in 37.4% and unsatisfactory in 14.5%. The vast majority of antibiotics used (79.2%) were first-line antibiotics--usually first-generation cephalosporins, aminoglycosides, and aminopenicillins. Most patients (66%) had a microbiology laboratory work-up, but only 37.4% were judged by evaluators to have a meaningful microbiologic diagnosis. Among the 201 patients with lower respiratory tract infections, 105 (52.2%) had a diagnosis of pneumonia. A positive isolate was recovered in 30 (28.6%) patients, and most of these isolates (20, 68.7%) were aerobic gram-negative rods. There were three positive blood cultures but none grew Streptococcus pneumoniae. CONCLUSIONS: Antibiotics were used excessively in number and duration. The microbiologic work-up had little effect on the indication and choice of antibiotics. Community-acquired pneumonia differed markedly from that in Western countries in that only 3.3% were caused by S. pneumoniae.     

Communication competence in ultrasound examination in pregnancy

INTRODUCTION: 293 physicians in the German-speaking part of Switzerland were questioned about their practices of providing information during prenatal ultrasound examinations. Physicians were asked both how they provide information about the examination procedure itself as well as how they inform the pregnant woman if a fetal anomaly is detected. METHOD: In January 2000, a questionnaire was mailed to a sample of 500 physicians with a specialized qualification in pregnancy ultrasound examinations. The response rate was 59.2%. RESULTS: 90.1% of the physicians reported that they offer information consultations for routine ultrasound examinations. 50.2% mentioned in their answers to an open question that the screening for fetal anomalies is a component of their consultation. Female physicians mentioned this aspect significantly more often than male physicians. Regarding difficulties in the communication of a diagnosis of fetal malformation, the physicians reported most frequently the excessive strain on the pregnant woman, but also their own feelings of helplessness. The subjective emotional stress was considered as high; female physicians with experience of motherhood reported the highest levels of stress. CONCLUSIONS: Screening for fetal anomalies is a difficult and often neglected subject when providing information on prenatal ultrasound examinations. The communication of the diagnosis of a fetal anomaly is not only emotionally stressful for the parents, but also for the physicians and requires high levels of communication competence. These communication aspects should be considered in the training for ultrasound examinations during pregnancy.     

Biochemical changes in prolonged labour in the tropics

Serum electrolytes, creatinine, urea and urine osmolality were estimated in 25 healthy pregnant women at term, 25 women in early normal labour, and 25 healthy parturients in prolonged labour. A statistically significant fall in serum potassium was found in early labour with a further significant fall in prolonged labour. Bicarbonate changes followed the same pattern of a progressive fall. Sodium fell slowly, reaching significant levels only in prolonged labour and chloride fell even more slowly. There was a conspicuous or significant rise in serum urea with a smaller, not significant rise in creatinine. The rapid insensible loss of water in tropical areas was reflected in the rise in serum urea while homeostatic mechanisms maintained a slower fall in sodium and chloride by renal conservation.     

Placental proteins in the normal menstrual cycle, in occult pregnancy and in early normal pregnancy in the same subject

Assays of SP1 and of hCG were done in three successive menstrual cycles in a woman undergoing artificial insemination from a donor. The day of ovulation was determined by basal body temperature, and by assays of oestradiol and progesterone. In the first cycle no placental proteins were detected, in the second cycle there was a transient peak of SP1 and hCG 4 days after ovulation. In the third cycle both proteins were first detected 12 days after ovulation, then increased rapidly in concentration and the patient went on to a normal pregnancy.     

Recent Trends in Cesarean Delivery Rates in California

ABSTRACT: To determine the effect in California of the 1980 Consensus Development Task Force recommendations to lower cesarean delivery rates, we analyzed California vital statistics for 1978 through 1982. There was no evidence of either a decline or a leveling off of cesarean delivery rates in California as a whole. In university-affiliated teaching hospitals cesarean rates were lower in 1982, but not as low as in 1981. A change in the attitudes of doctors now being trained may have a noticeable effect within 5 years as they assume full practices in the community.     

Reproductive motivation in Russian women in the family context

Objective: This article presents an investigation of characteristics of reproductive motivation, reasons for not having children, and the propensity towards attempting a premeditated abortion in Russian women in early and middle adulthood. Method: Sixty-eight married women (34 childless women (20–25 years old) and 34 women with children (26–35 years)) were assessed on a number of measures. Results: There was no difference in reproductive motives between the two groups of women. The most significant difference is that, unlike younger women’s, middle-aged women’s reproductive motives correlate with life goals and locus of control. However, a large difference was found across two groups in the reasons for not having a baby. Younger women give more reasons for not having children. They specify that a child interferes with self-actualisation, limits social contacts and creates marital problems. In middle adulthood women tend to specify material (financial) difficulties as a reason for not having baby. Regarding premeditated abortion, there is no big difference between groups in attitudes towards it, but the reasons differ from a conflict between children and career in younger women to problems in the wider family system for more mature women. Conclusion: Although there is no significant difference in direct reproductive motivations between both groups, each age has its own specific instrumental reproductive and reproductive refusal motives.     

Quality control in human in vitro fertilization

The implementation of suitable quality control (QC) is not only required for the accreditation of a human in vitro fertilization (IVF) laboratory, but is also fundamental to its success. Several assays have been employed to screen culture media and contact supplies. The suitability of one assay in particular, the mouse embryo assay (MEA), has been questioned over the years. Here we discuss how the conditions of such an assay, together with the stage of embryonic development used, have a profound effect on the outcome of the assay. Furthermore, by assessing embryos at multiple time points during the preimplantation period (rather than simply determining blastocyst formation), together with quantitating key parameters such as blastocyst cell number, it is possible to identify suboptimal components of a culture system. As well as identifying those components that result in outright embryonic demise, under the appropriate conditions the MEA can detect components that lead to impaired development. It is proposed that under the appropriate conditions, the MEA is a useful adjunct to quality control in human IVF, but several assays used in concert are better than a single test.     

The role of continuous glucose monitoring in clinical decision-making in diabetes in pregnancy

BACKGROUND: The continuous glucose monitoring system (CGMS) is a novel tool to assess 24-h glucose fluctuations. In pregnancies complicated by diabetes, where excellent glucose control is desired to improve maternal and fetal outcomes, CGMS may have a role in fine-tuning management. AIMS: To assess the usefulness of CGMS in pregnant women with diabetes for medical decision-making and to evaluate patient tolerability and perception of usefulness. METHODS: Pregnant women with diabetes at the Werribee Mercy Hospital were offered CGMS in the setting of their standard diabetes care. Treating clinicians were asked if the CGMS altered management decisions from those based on conventional glucose monitoring. The accuracy of the CGMS was assessed by comparison with the patients' finger-prick glucose readings. Patients completed a feedback questionnaire after having the CGMS and viewing their results. RESULTS: CGMS traces (n = 68) were obtained in 55 pregnant women - 37 with gestational diabetes, ten with type 2 and eight with type 1 diabetes. Forty-two of 68 (62%) traces were assessed as providing additional information which altered clinical management decisions. This included showing undetected postprandial hyperglycaemia and overnight hypoglycaemia. Subject feedback was generally positive, with 37 of 48 (77%) respondents reporting that the benefits of the CGMS outweighed the inconvenience. CONCLUSION: CGMS is a well-tolerated clinically useful tool in the management of gestational diabetes and pre-existing diabetes in pregnancy.     

Abnormal DNA methylation in oocytes could be associated with a decrease in reproductive potential in old mice

Purpose

This study was designed to evaluate DNA methylation and the expression of DNA methyltransferases (Dnmt1, Dnmt3a, Dnmt3b and Dnmt3L) in metaphaseII (MII) oocytes and the DNA methylation of pre-implantation embryos during mouse aging to address whether such aging-related changes are associated with decreased reproductive potential in aged mice.

Methods

Oocytes (MII) from 6 to 8 weeks old female mice are referred to as the ‘young group’; oocytes from the same group that were maintained until 35–40 weeks old are referred to as the ‘old group.’ The oocytes were fertilized both in vitro and in vivo to obtain embryos. The DNA methylation levels in the oocytes (MII) and pre-implantation embryos were assessed using fluorescence staining. The expression levels of the Dnmt genes in the oocytes (MII) were assessed using Western blotting.

Results

The DNA methylation levels in the oocytes and pre-implantation embryos (in vivo and in vitro) decreased significantly during the aging of the mice. The expression levels of all of the examined Dnmt proteins in the old group were lower than young group. Both the cleavage and blastocyst rate were significantly lower in the oocytes of the older mice (69.9 % vs. 80.9 %, P < 0.05; 33.9 % vs. 56.4 %, P < 0.05). The pregnancy rate of the old mice was lower than that of the young mice (46.7 % vs. 100 %, P < 0.05). The stillbirth and fetal malformation rate was significantly higher in the old group than in the young group (17.2 % vs. 2.9 %, P < 0.05).

Conclusions

The decreased expression of Dnmt1, Dnmt3a, Dnmt3b and Dnmt3L in oocytes (MII) and the change of genome-wide DNA methylation in oocytes and pre-implantation embryos due to aging may be related to lower reproductive potential in old female mice.     

Partnership in midwifery care in New Zealand

OBJECTIVE: to examine whether equal power is essential to the perceptions of partnership in midwifery practice and to propose an alternative model of how power might best be shared. DESIGN: a cross-sectional design was employed using the predominant methods of interview, questionnaires and thinking aloud tape recordings as triangulation of data. SETTING: two large metropolitan hospitals in Auckland, New Zealand and home birth settings. SAMPLE: Forty one independent and hospital-based midwives and 37 nulliparous women at low obstetric risk for whom labour care was provided. FINDINGS: the majority of the midwives and the women in the two studies presented believed they had achieved a midwifery partnership with little emphasis placed on the need for equality in decision making. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: the model proposed provides a framework that identifies how power can be shared without the need for equality. The integration of this model into practice may assist midwives and women to recognise and utilise differences in their experience and knowledge to achieve their aims of achieving a partnership and a successful birth.     

新生大鼠卵母细胞凋亡信号通路SCF-FOXO3a的体外实验研究

目的:研究FOXO3a(forkhead box group O)转录因子是否参与调控哺乳动物卵巢中裸露卵母细胞和原始卵泡内卵母细胞的凋亡。方法:体外分离培养新生大鼠卵母细胞巢和原始卵泡内的卵母细胞,干细胞因子(stem cell factor,SCF)单独或与磷脂酰肌醇-3激酶(phosphoinositide 3-kinase,PI3K)抑制剂LY 294002联合作用于卵母细胞,TUNEL法凋亡染色观察卵母细胞凋亡状况;RT-PCR、Western blotting检测FOXO3a及其下游靶分子与卵母细胞凋亡的关系。结果:SCF不影响卵母细胞FOXO3a总蛋白表达水平,但使其磷酸化水平增加,从而抑制了卵母细胞凋亡;LY 294002可完全阻断上述效果。SCF使FOXO3a的靶基因Bim和p27kip1表达下调,此作用同样可被LY 294002逆转。结论:FOXO3a和其下游靶基因Bim及p27kip1可能参与了SCF信号通路对新生大鼠卵母细胞的凋亡调控。     

Changes in insulin-glucose quotients in a glucose tolerance test in the third trimester]

OBJECTIVE: In comparison a higher insulin-glucose-index is usually associated with an increased insulin resistance. In the present study changes in insulin-glucose-indices were examined in relation to a defined glucose tolerance in the last trimester of pregnancy. MATERIAL AND METHODS: 249 pregnant women were challenged with a 75 gm oral glucose tolerance test (oGTT). Serum samples for glucose (glucose-dehydrogenase-method) and insulin measurements (RIA) were drawn before and at 30, 60, 120, and 180 minutes after glucose load during oGTT. Patients were assigned to five groups with increasing glucose intolerance according to maximal glucose levels during the test. RESULTS: There were no significant differences in insulin-glucose-indices prior to glucose load. Pregnant women with gestational diabetes were shown to have significantly lower insulin-glucose-indices in the early and intermediate phase of the challenge test while the indices were higher in the final phase of the test. CONCLUSIONS: Women with gestational diabetes demonstrated an initial delay in insulin secretion in combination with a higher insulin-glucose-index, corresponding to an increased insulin resistance, only in the end of the test. These characteristics may possibly be a cause of the observed disorder in glucose metabolism in these patients.     

Trends in birth statistics in Europe

Obstetrics services in Europe are dominated by a persistently low birth rate, the average number of children born to a woman in her lifetime now being 1,45 for the European Community in general. This low rate has persisted for the last 20 years. During the past 10 years, childlessness has been steadily increasing. Maternal age at first delivery has also increased. Obstetric departments are increasingly subject to market principles and the trend towards centralization, which has been developing for some years, will continue.