Erythropoietin levels in amniotic fluid and extraembryonic coelomic fluid in the first trimester of pregnancy.

OBJECTIVE: The aim was to measure erythropoietin levels in amniotic fluid and extraembryonic coelomic fluid from 7-12 weeks' gestation. SUBJECTS: Twenty healthy women with ultrasonographically normal first trimester pregnancies prior to surgical termination. METHODS: Paired samples of amniotic fluid and extraembryonic coelomic fluid were collected by transvaginal ultrasound guided needling. Erythropoietin was measured in both pregnancy fluids using a radioimmunoassay. RESULTS: There was a highly significant difference between erythropoietin levels in extraembryonic coelomic fluid (median level 15.45 mU/ml; range 6.8-32.1 mU/ml) and those in amniotic fluid (median 5.0 mU/ml; range < 5.0-5.8 mU/ml) (P < 0.0001; Mann-Whitney U-test). The levels of erythropoietin in maternal serum (median 15.4 mU/ml; range 5.6-29.4 mU/ml) were similar to those in the extra-embryonic coelom (P = 0.81; Mann-Whitney U-test). No relation was demonstrated between erythropoietin levels in amniotic fluid or coelomic fluid and stage of gestation. CONCLUSION: High levels of erythropoietin in coelomic fluid suggests that the hormone is involved in the process of human extraembryonic erythropoiesis. The exact regulatory role remains unknown.     

Biochemical composition of amniotic fluid and extraembryonic coelomic fluid in the first trimester of pregnancy.

OBJECTIVE: To determine the biochemical composition of amniotic fluid and extraembryonic coelomic fluid between 8 and 12 weeks gestation. DESIGN: Prospective observational study. SUBJECTS: 40 women with a normal pregnancy between 7 and 12 weeks gestation having termination of pregnancy. INTERVENTIONS: Before termination the women had a transvaginal ultrasound guided amniocentesis. Pure samples of amniotic fluid and extraembryonic coelomic fluid were obtained from each woman and standard biochemical variables were measured in each fluid sample immediately after collection. RESULTS: Levels of sodium, potassium and bicarbonate were significantly higher in amniotic fluid whilst chloride, urea, bilirubin, protein, albumin, glucose, creatinine, calcium and phosphate were present in higher concentrations in extraembryonic coelomic fluid. All differences in concentration were significant (P less than 0.05; unpaired t-test). No relation was demonstrated between electrolyte concentrations in amniotic fluid or coelomic fluid and stage of gestation. CONCLUSIONS: Amniotic fluid and extraembryonic coelomic fluid have a widely differing biochemical composition. The biological significance of these differences remains unexplained.     

Microvillar enzyme activity in amniotic fluid, extraembryonic coelomic fluid and maternal serum in the first trimester of pregnancy.

The activities of two microvillar enzymes, gamma-glutamyl transpeptidase and total alkaline phosphatase, have been measured in samples of amniotic fluid and extraembryonic coelomic fluid obtained by high-resolution transvaginal ultrasound-guided amniocentesis from 40 women between 7 and 12 weeks of gestation. There was a highly significant difference between gamma-glutamyl transpeptidase activity in amniotic fluid (median level 31 U/l; range 2-409 U/l) and extraembryonic coelomic fluid (median level 2 U/l; range less than 2-16 U/l) (P less than 0.001; Mann-Whitney U-test). Alkaline phosphatase activity was not detected in 84% of amniotic fluid samples and 97% of extraembryonic coelomic fluid samples. No difference was found between total alkaline phosphatase activity in these fluids (P = 0.14; Mann-Whitney U-test). Enzyme activities in amniotic fluid increased with gestational age. A significant linear correlation was found between amniotic fluid gamma-glutamyl transpeptidase activity and stage of gestation (r = 0.86; P less than 0.001) and total alkaline phosphatase activity in amniotic fluid and stage of gestation (r = 0.66; P less than 0.001).     

The effect of coelomic fluid on the production of cytokines by the first trimester human placenta

Objective

To investigate the modulatory effects of coelomic fluid (CF) on the production of tumour necrosis factor-alpha (TNFα) and its receptors, TNF-R1 and TNF-R2, interferon gamma (IFNγ) and interleukin (IL)-10 by placental villous explants cultured under physiological oxygen (O₂) concentration.

Study design

In vitro culture of placental villous explants at atmospheric and physiological (6%) O₂ levels at varying concentrations of CF.

Main outcome measures

Concentration of TNFα, TNF-R1, TNF-R2, IFNγ and IL-10 in culture medium and villous explant homogenates, measured using flowcytometric bead arrays.

Results

The median level and interquartile range of cytokines and receptors present in CF were: TNFα 0.9 pg/ml (0.85, 0.95); IFNγ 5.38 pg/ml (4.96, 6.18); IL-10 1.59 pg/ml (1.45, 1.76); TNF-R1 6043.65 pg/ml (5961.39, 6187.35) and TNF-R2 3563.52 pg/ml (3390.26, 3635.19). The PO₂ of CF was 48.74 mmHg (SEM 1.59), equivalent to 6% O₂.Increasing doses of CF significantly (p < 0.05) increased the levels of TNFα, TNF-R1 and TNF-R2 in the culture medium at both O₂ concentrations.TNF-R1 levels measured in placental homogenate increased up to 2-fold at both O₂ concentrations, but were significantly lower (1.96 fold; p = 0.03) at 6% O₂ compared to 20% O₂.

Conclusions

The exocoelomic cavity in humans contains high levels of both soluble TNF-R1 and TNF-R2. The addition of CF to placental tissue explants in culture modulates the placental secretion of TNFα-receptors and TNFα at both physiological and atmospheric O₂ tension resulting in a concentration much higher than that found in the CF. This may contribute to the maternal inflammatory response previously reported in normal early pregnancy.     

Prenatal diagnosis in the first trimester of pregnancy

In the past 2 decades, the second trimester of pregnancy has been the most common time for prenatal diagnosis of fetal anomalies and chromosomal aneuploidies. More recently, screening for and diagnosis of chromosomal abnormalities are increasingly being performed in the first trimester. With improvements and technological advances in ultrasound, it is now possible to identify many fetal structural anomalies at 11 to 13 6/7 weeks' gestation. At 10 to 11 weeks' gestation, biochemical markers in serum-PAPP-A, free beta-hCG, AFP, and uE3-combined with sonographic measurement of nuchal translucency and the presence/absence of the nasal bone can achieve a Down syndrome detection rate of 97.5% at a false-positive rate of 5%. Structural anomalies of the central nervous system, and the cardiac, renal, and gastrointestinal tracts can now be diagnosed by either transabdominal or transvaginal scanning, achieving detection of up to 80% of CNS anomalies by 13 weeks' gestation. In future, the emphasis in prenatal diagnosis will likely be in the first trimester. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians. LEARNING OBJECTIVES: After completion of this article, the reader should be able to explain the rationale for first trimester combined ultrasound and serum analyte screening for fetal Down syndrome, describe the fetal anatomic structures that can be seen and evaluated in the first trimester, provide patient counseling about the relative benefits of genetic amniocentesis versus chorionic villous sampling, and discuss the application of Doppler technology to the evaluation of a first trimester fetus.     

Lipid peroxidation in the first trimester of pregnancy

Aim: To determine the existence and level of oxidative stress caused by lipid peroxidation in pregnancy. Methods: The research was conducted as prospective examination that included 60 healthy women (age 18–45). The women included in the examination were divided into two groups. The group I (N-31) included women in the first trimester of normal, healthy pregnancy. The group II included healthy nongravid women (N-29). Concentrations of markers of lipid peroxidation malondialdehyde (MDA) and thiobarbituric acid (TBARS) were determined using commercial ELISA tests OxiSelect^? TBARS Assay Kit and OxiSelect^? MDA ELISA Kit. Results: The results of this research indicate that the concentrations of the markers of lipid peroxidation TBARS and MDA are detectable in both groups. Higher mean values of MDA (>20 pmol/mg) were measured in the group of pregnant women, than in the group of nongravid women. The results indicate that mean values of TBARS markers are lower in pregnant women (≤50 µM) than in nongravid women (>100 µM). Conclusion: The marker of lipid peroxidation MDA proved to be a sensitive marker for following lipid peroxidation during pregnancy, therefore it can be considered as a good predictor of possible complications during pregnancy.     

Three-dimensional neurosonography in the first trimester of pregnancy

Three-dimensional sonography has tremendously improved the quality of visualization of the fetus. The advantages of three-dimensional sonography have particularly improved the first-trimester scan. The limited manipulative capacity of the transvaginal probe has no impact on the quality of the scans. The acquired volumes containing data on embryonic morphology, can be rotated and transsected in an unlimited number of planes. Specific details of importance can be emphasized by different modalities of image-rendering. Hidden details of inner embryo structures can be depicted and clearly presented by the use of the 'electronic scalpel'. Measurements have been improved to more accurate levels. The time of exposure of the embryo to the ultrasound energy is reduced to a minimum. Volume acquisition takes only a few seconds. Data are stored in a digital form and can be used for analysis at any time without any loss of quality and, in the same form, data are ready for telemedical application. Analysis of the developmental stages of the embryonic central nervous system is the most important issue of the first-trimester examination. In this review, we describe the state of the art of three-dimensional neurosonography in assessment of the normal anatomy and detection of anomalies during the first trimester of pregnancy.     

孕早期双胎妊娠甲状腺功能减退对妊娠结局的影响

Objective?To investigate the impact of hypothyroidism of twin pregnancy in first trimester on pregnancy outcomes. Methods?A total of 1 203 cases of twin pregnant women were enrolled in this retrospective study and divided into three groups based on maternal TSH concentration in first trimester. Normal TSH group contained twin pregnant women with TSH levels between 0.01 to 3.35 mIU/L in first trimester, TSH>3.35 group contained twin pregnant women whose TSH concentrations between 3.35 to 4 mIU/L, TSH>4 group included those with TSH levels beyond 4 mIU/L. The pregnancy outcomes were analyzed between three groups. Results?Logistics analysis between maternal TSH levels and pregnancy outcomes of twin pregnancy showed TSH beyond 4 mIU/L in first trimester was corelated with the incidence of gestational diabetes mellitus (GDM), and its OR was 3.48, 95% CI was 1.27~9.55. Conclusion?The risk of GDM in twin pregnant women with hypothyroidism in first trimester may increase and TSH>4 mIU/L was one of independent risk factors of GDM.     

Spine length measurement in the first trimester of pregnancy

OBJECTIVES: The aim of the study was to evaluate spine length as an indicator of skeletal growth in the first trimester of pregnancy and to provide a nomogram of spine length at the end of the first trimester of pregnancy. METHODS: The study was carried out on 420 single pregnancies, at gestational ages ranging from 11 to 14 weeks, using high-resolution transabdominal echography. Biparietal diameter and crown-rump length (CRL) were measured to date the pregnancy. Using the same scanning plane used to measure CRL, the whole spine length in antero-dorsal position can be visualized as a double hyperechoic line from 10 weeks of gestation onwards. Spine length was measured three times by one observer and the mean of the three measurements was considered as definitive. Forty fetuses had multiple measurements for interobserver and intraobserver error analysis. RESULTS: Linear relationship between spine length, and gestational age, biparietal diameter and CRL were demonstrated. Spine length (millimetres) as a function of gestational age (days) was expressed by the regression equation: spine length = 1.09 x (gestational age in days) -60.56, with a determination coefficient of R(2) = 0.744. Spine length ranged from 21.5 mm at 11 weeks to 41.9 mm at 14 weeks. CONCLUSION: The data obtained showed that spine length increased progressively from the end of the first trimester to the beginning of the second. A high correlation between spine length, gestational age, biparietal diameter, and CRL was observed. Spine length measurement could therefore be considered a good indicator of fetal growth.     

Ultrasonic diagnosis in the first trimester of multiple pregnancy

Higher rate of morbidity and mortality has been noted in tween pregnancies comparing to singleton pregnancies. Early ultrasound investigation between 6 and 12 week of gestation is useful in determining time of gestation, amniocity and chorionicity (adequacy of diagnosis ranged from 95 to 100%). Determining of chorionicity and amniocity is extremly important in monozygotic twins, because of high risk of complications during next stages of pregnancy. First trimester ultrasound investigation allows to define abnormalities commonly associated with twin pregnancy and is useful in monitoring of fetal well-being.     

Hormonal monitoring of the first trimester of pregnancy

The hormonal changes and maternal adaptations of human pregnancy are among the most remarkable phenomena in nature. Endocrinologic parameters in the early gestation period have been used to predict abnormal pregnancies and to identify fetuses that have chromosomal aberrations. This article focuses on the changes in hormones that are secreted by the maternal-fetal-placental unit that are unique for the first trimester of pregnancy and their impact on clinical outcome.     

Ovarian thecoma associated in the first trimester of pregnancy

Ovarian thecoma is a relatively rare tumor which occurs before and after menopause. It is extremely rare that pregnancy is complicated with thecoma. Diagnosis of ovarian tumors during pregnancy is highly problematic due to difficulties in obtaining clinical manifestations, and treatment of these tumors poses an even greater challenge. Our patient was found to have estrogen-producing thecoma accompanied by accumulation of ascites in an early phase of pregnancy. The patient underwent abdominal surgery to remove the tumor on the 13th week of gestation. This resulted in disappearance of the ascites and a favorable clinical course. Diagnosis and treatment of ovarian thecoma occurring during pregnancy are discussed with relevant references.     

Atypical abdominal pain in the first trimester of pregnancy

We report the case of a 22-year-old woman who presented a violent epigastric pain at eight-weeks gestation. Superior mesenteric vein thrombosis was detected, with an extension to portal vein and remaining blood flow. Screening for thrombophilia revealed a heterozygote prothrombin gene mutation. Portal vein thrombosis is uncommon and difficult to diagnose. Diagnosis is made by Doppler ultrasound, a second intention test to be done in case of unusual upper abdominal pain during pregnancy.