Gene expression of placental hormones regulating energy balance in small for gestational age neonates

ObjectiveFetal growth restriction is associated with an increased risk for metabolic and cardiovascular disease in later life. To further elucidate mechanisms that might be involved in the process of prenatal programming, we measured the adipokines leptin, resistin, and adiponectin and the GH-releasing hormone ghrelin in the placenta of small for gestational age (SGA) neonates.Study designThe control group included 24 placentas of appropriate for gestational age (AGA) newborns, in the study group were 16 placentas of SGA neonates. Gene expression of leptin, resistin, adiponectin, and ghrelin was examined. For hormones showing alterations in gene regulation placental protein expression was measured by Western blot.ResultsPlacental mRNA expression of leptin was significantly increased in SGA placentas (p = 0.0035, related to β-actin). Protein concentration was increased, as well. There were no differences in placental resistin, adiponectin, or ghrelin gene expressions between SGA neonates and controls. Leptin was the only hormone to demonstrate a significant inverse correlation with birth weight (r = ?0.44, p = 0.01). Adiponectin correlated significantly with leptin (r = 0.53, p = 0.0023) and ghrelin (r = 0.50, p = 0.0045).ConclusionsPlacental leptin gene expression and protein concentration showed the expected increase in the SGA group. Leptin was inversely correlated with birth weight. Positive correlation of adiponectin with leptin and ghrelin expression suggests an interaction between these hormones in the placenta. However, the unchanged expression of resistin, adiponectin, and ghrelin in SGA placentas and the absence of correlation with birth weight cast doubt whether these hormones produced in the placenta play a key role in fetal programming.     

Plasma levels of S100B during pregnancy in women developing pre-eclampsia

ObjectiveS100B is suggested to be a peripheral biomarker of central nervous system injury with increased blood–brain barrier permeability. The aim of this study was to investigate if there is a difference in plasma levels of S100B throughout pregnancy between women developing pre-eclampsia and those who did not.Study designA nested case-control study within a longitudinal study cohort was performed. Healthy pregnant women were enrolled and plasma samples were collected at gestational weeks 10, 25, 28, 33 and 37. Levels of S100B throughout pregnancy were analyzed with an ELISA assay.ResultsThe levels of S100B did not change between gestational weeks 10 and 37 (0.047 vs. 0.052; p = 0.71) in the healthy controls, but the S100B levels increased between corresponding weeks in women who developed pre-eclampsia (0.052 vs. 0.075; p < 0.05). In gestational weeks 33 and 37 women who developed pre-eclampsia had higher levels of S100B than the controls (p = 0.047 and p = 0.010, respectively).ConclusionS100B levels increase during pregnancy in women who develop pre-eclampsia and there is an increased S100B level in women who develop pre-eclampsia compared with healthy pregnancies several weeks before clinical symptoms of the disease. The increased amount of plasma S100B in women developing pre-eclampsia might be secondary to cerebral vascular damage and S100B is a potential peripheral biomarker reflecting cerebral involvement in pre-eclampsia.     

Plasma antithrombin levels correlate with albumin and total protein in gestational hypertension and preeclampsia

ObjectiveTo analyze the antithrombin-III (AT-III) activity in the plasma in relation to the serum albumin and total protein in preeclampsia and gestational hypertension.Study designThe medical records of 139 patients who were diagnosed with gestational hypertension (n = 33) and preeclampsia (n = 106) were reviewed, and the relationships between the activity of AT-III and serum albumin or total protein were evaluated.Main outcome measuresThe plasma AT-III activity in gestational hypertension and preeclampsia was correlated with the serum albumin and TP levels.ResultsThere were significant correlations between AT-III activity and albumin in gestational hypertension (r = 0.504, p = 0.003) and preeclampsia (r = 0.343, p = 0.003). There were also significant correlations between AT-III activity and TP in gestational hypertension (r = 0.619, p = 0.001) and preeclampsia (r = 0.366, p = 0.001). Regression coefficients between AT-III and albumin and between AT-III and TP in gestational hypertension (23.7 and 14.0, respectively) were significantly steeper than those in preeclampsia (14.6 and 9.6, respectively).ConclusionsThe plasma AT-III activity in gestational hypertension and preeclampsia was correlated with the serum albumin and TP levels. This suggests that AT-III activity is more likely to decrease in gestational hypertension than in preeclampsia.     

Obstetric implications of fetal inherited thrombophilia in thrombophilic women

ObjectivesThe relationship between fetal thrombophilic polymorphism and adverse pregnancy outcomes is still unclear. The aim of this study is to evaluate if fetal thrombophilia may affect obstetric and perinatal outcomes in thrombophilic women.Study designFrom 2007 to 2011 all patients with a known inherited thrombophilic mutation consecutively admitted to our labor ward at ⩾25 weeks of gestation with a singleton viable pregnancy were considered eligible for the purpose of the study. At the age of 1 year, the infants were tested for inherited thrombophilic mutations. Patients were then divided into two groups according to the presence or absence of any neonatal mutation.Main outcome measuresThe following outcome variables were then compared between the two groups: gestational age at delivery, birth weight, incidence of hypertensive disorders of pregnancy and SGA neonates.ResultsOverall, 67 pregnancies of 49 women were studied. Among them, the G20210A Prothrombin (32/67 or 47.7%) mutation and the Factor V Leiden mutation (31/67 or 46.3%) were the commonest findings, with a single patient presenting both. A thrombophilic mutation was found in 38 mother–infant pairs. The risk of all maternal and perinatal events including the incidence of hypertensive disorders disorders (5/29 or 17.2% vs 6/38 or 15.7% p = 1.00) and of SGA neonates (3/29 or 10.3% vs 7/38 or 18.4%, p = 0.49) was comparable between the two groups irrespective of the associated fetal thrombophilia.ConclusionsOur data suggest that women with inherited thrombophilia carrying a thrombophilic fetus are not at increased risk of adverse pregnancy outcomes.     

OS001. Pregnancy outcome in subsequent pregnancies after eclampsia

IntroductionEclampsia in the previous pregnancy may have impact on future reproductive performance of the women. Few studies have been conducted in recent years to review the subsequent pregnancy outcome. In this study women with previous eclampsia were followed up in subsequent pregnancy and outcome was compared with normotensive control group.ObjectivesTo study the risk of recurrence of hypertension and associated complications in subsequent pregnancies following eclampsia.MethodsFifty-three pregnant women with previous history of eclampsia were supervised and delivered in PGIMER, Chandigarh, India (2001 April–2011 March) were studied prospectively. The pregnancy outcome was compared with 106 age and gravida matched controls who had remained normotensive in previous pregnancies. The data analysis was done by Chi-square test and Student ‘t’ test.ResultsAmongst women with previous eclampsia eight women (15%) were found to have underlying chronic hypertension. The incidence of gestational hypertension and pre-eclampsia was 37.7% amongst these women, compared to 7.5% in control group (p = 0.0001). Preterm deliveries mainly due to preterm inductions were higher (32%) amongst women with previous eclampsia compared to 12% amongst controls (p = 0.0004). Incidence of intra uterine growth restriction was significantly higher amongst cases (15% vs 1.5%, p = 0.0003).ConclusionWomen with previous eclampsia have higher incidence of chronic hypertension. These women are at significant risk to develop hypertensive disorders of pregnancy and its related complications. The recurrence of eclampsia is low with aggressive and vigilant antenatal care.     

Transient gestational hypertension: Not always a benign event

ObjectivePregnancy outcome in women with transient gestational hypertension (TGH);defined as de novo blood pressure elevation after 20 weeks gestation that normalizes by subsequent evaluation in a Day Assessment Unit.Study designRetrospective cohort analysis of hypertensive pregnancies between 2003 and 2008.Main outcome measuresFinal hypertensive delivery diagnosis and composites of adverse maternal and fetal outcome.ResultsOverall 1417 women were referred; 890 met criteria; 41% (65% of study population) had TGH. Twenty percent with TGH developed gestational hypertension and 19% preeclampsia. Women with TGH who developed preeclampsia had similar composite adverse maternal outcomes to other preeclamptic women (51% vs. 63%; p = 0.24) but fewer adverse fetal outcomes (50% vs. 71%; p < 0.01) due to less prematurity (30% vs. 45%; p = 0.02) and small for gestational age babies (33% vs. 51%; p = 0.02). Within the TGH population;developing gestational hypertension or preeclampsia was associated with referral at gestation <33 weeks (RRR 2.8; p < 0.01);initial average systolic blood pressure 130–139 mmHg (RRR 2.1; p < 0.01) and initial average diastolic blood pressure 80–89 mmHg (RRR 3.2; p < 0.01).ConclusionTGH after 20 weeks is common in pregnancy. Although initial assessment implies low risk;the risk of progression to gestational hypertension or preeclampsia is substantial and warrants appropriate clinical surveillance.     

The Role of Serum Testosterone in Early Pregnancy Outcome: A Comparison in Women With and Without Polycystic Ovary Syndrome

ObjectiveHyperandrogenic conditions in women are associated with increased rates of miscarriage. However, the specific role of maternal testosterone in early pregnancy and its association with pregnancy outcome is unknown. The purpose of this study was to compare serum testosterone levels during early pregnancy in women with and without polycystic ovary syndrome (PCOS) who either had successful pregnancies or miscarried.MethodWe collected serum samples from women attending a university-based fertility centre at the time of their first positive serum beta human chorionic gonadotropin pregnancy test. The samples were subsequently assayed for total testosterone level. We used logistical regression modelling to control for PCOS diagnosis, BMI, and age.ResultsTotal testosterone levels were available for 346 pregnancies, including 286 successful pregnancies and 78 first trimester miscarriages. We found no difference in total testosterone levels between women who subsequently had an ongoing pregnancy (mean concentration 3.6 ± 2.6 nmol/L) and women with a miscarriage (mean 3.6 ± 2.4 nmol/L). Using the Rotterdam criteria to identify women with PCOS, we also found no differences in serum testosterone between women who had ongoing pregnancies or miscarriages, either with PCOS (P = 0.176) or without PCOS (P = 0.561).ConclusionsOur findings show that early pregnancy testosterone levels do not predict pregnancy outcome, and they call into question the role of testosterone in causing miscarriage in populations of women with PCOS. Further research is needed to elucidate the normal progression of testosterone levels during pregnancy and to investigate further the relationship between PCOS and miscarriage.     

Cardiovascular risk markers in pregnancies complicated by diabetes mellitus or preeclampsia

ObjectiveTo explore biomarkers indicating cardiovascular disease in pregnant women with diabetes or preeclampsia, since these women are at increased risk for future cardiovascular disease.Study designEDTA-plasma from 262 women in gestational week 24–42 (healthy pregnancies n = 71, preeclampsia n = 105, type 2 diabetes n = 17, gestational diabetes n = 61, diabetes with preeclampsia n = 8) was analyzed by immunoassay for neopterin, midregional pro-adrenomedullin (MR-proADM) and C-terminal pro-arginine vasopressin (CT-proAVP). The diabetes groups were also analyzed for midregional pro-atrial natriuretic peptide (MR-proANP), and compared to previously reported MR-proANP concentrations for healthy, normotensive and preeclamptic patients.ResultsIn contrast to preeclampsia, median plasma MR-proANP was not increased in pregnancies complicated by diabetes, but in fact lower, compared to healthy pregnancies. Neopterin was increased in diabetic pregnancies and in late onset preeclampsia, compared to healthy pregnancies. Median plasma MR-proADM was increased in pregnancies complicated by gestational diabetes or preeclampsia, compared to healthy pregnancies. Median plasma MR-proANP was increased in diabetic pregnancies complicated by preeclampsia compared to pregnant women with diabetes only.ConclusionWomen with pregnancies complicated by diabetes mellitus or preeclampsia are at risk for future cardiovascular disease, but differ in circulating cardiovascular biomarker profile. A cardiovascular biomarker profiling during pregnancy might prove helpful in identifying women at risk for future cardiovascular disease, thus enabling targeted prophylactic interventions and follow-up.     

Characteristics of hypertensive disorders in twin versus singleton pregnancies

ObjectiveTo determine the characteristics of hypertensive disorders of pregnancy in twin compared with singleton pregnancies.Study designAnalysis of a prospectively recorded database of 4976 hypertensive pregnancies.Main outcome measuresComparison of progression to pre-eclampsia and maternal and neonatal outcomes.ResultsThere were 3942 singleton and 214 twin pregnancies. De novo hypertension in twin pregnancy was diagnosed earlier (p < 0.001). In singleton pregnancies with de novo hypertension (n = 3161), 60% had an initial diagnosis of gestational hypertension (GH) and 40% had pre-eclampsia (PE). In twin pregnancies with de novo hypertension (n = 199), 35% of women were initially diagnosed with GH and 65% with PE (p < 0.001). At delivery, 46% of the singletons had GH and 54% had PE, compared with twin pregnancies where 23% had GH and 77 % had PE (p < 0.001). The progression from GH to PE for twins was twice that of singleton pregnancies (p < 0.001).There were 781 singleton and 15 twin pregnancies with chronic hypertension (CH). Twin pregnancies complicated by CH were more likely to progress to PE than singletons (p < 0.01). The gestation at delivery was earlier for twin pregnancies (p < 0.001) and there were more twins that were smaller for gestational age (p < 0.001). There were no differences in maternal outcomes.ConclusionWomen carrying twins with de novo hypertension are more likely to present earlier, have initial PE and to subsequently progress from GH to PE. Neonatal outcomes are worse in such pregnancies.     

Depleted mitochondrial DNA content in peripheral blood of women with a history of HELLP syndrome

ObjectiveTo test the hypothesis that a quantitative defect of maternal cellular mitochondria would play a role in the pathogenesis of HELLP syndrome.Study designPeripheral blood mitochondrial DNA (MtDNA) was measured in 20 non-pregnant women with a history of HELLP syndrome, 40 non-pregnant control subjects who had previous physiologic pregnancies, 59 subjects carrying physiologic pregnancies, seven pregnant women with a history of HELLP syndrome and five women in the active phase of the disease.Main outcome measurePeripheral blood Mt-DNA.ResultsThe median (interquartile range) mtDNA in women with a history of HELLP syndrome, in non-pregnant women who had previous physiologic pregnancies, in subjects carrying physiologic pregnancies, in pregnant women with a history of HELLP syndrome and in women in the active phase of the disease was 115 (81–194), 229 (199–319), 174 (136–211), 101 (82–178) and 92 (39–129) copies per nuclear DNA, respectively. Non-pregnant women with a history of HELLP syndrome had significantly lower levels than non-pregnant controls (p < 0.001). Moreover, blood mtDNA was lower in pregnant women with a history of HELLP syndrome and in those in the active phase of the disease when compared to pregnant controls (p = 0.002 and p = 0.025, respectively).ConclusionsAttenuated maternal mitochondrial function may favor HELLP syndrome development.     

Maternal serum CA-125 level is elevated in severe preeclampsia

AimThe aim of this study was to determine the relationship between serum concentrations of cancer antigen-125 (CA-125) and pre-eclampsia severity.MethodsWe evaluated 91 females with a singleton pregnancy. Serum CA-125 levels were measured in subjects with severe pre-eclampsia (n = 34) and those with mild pre-eclampsia (n = 24). Females with healthy pregnancies (n = 31) served as the control group. The three study groups were statistically similar in terms of maternal age, gestational age, and body mass index.ResultsThe CA-125 level was significantly higher in the severe pre-eclampsia group than that in the mild pre-eclampsia and control groups (p < 0.05). No significant difference in CA-125 levels between the mild pre-eclampsia and control groups was observed. CA-125 level was positively correlated with proteinuria (r = 0.489, p = 0.000), systolic blood pressure (r = 0.503, p = 0.018), and diastolic blood pressure (r = 0.532, p = 0.000). In contrast, CA-125 was negatively correlated with birth weight (r = 0.266, p = 0.012) and gestational age at birth (r = 0.250, p = 0.018).ConclusionsCA-125 level increased in severe pre-eclampsia, which reflected abnormal trophoblastic invasion and chronic inflammation. Elevated levels of CA-125 in pre-eclamptic patients may be a marker of the disease severity.     

Pregnancy outcomes in women with heart disease: Experience of a tertiary center in the Netherlands

ObjectivesClinical data of pregnant women with heart disease were obtained with the intention to provide input for local counseling and management guidelines.Study designRetrospective data from all pregnant women with congenital or acquired heart disease between 2000 and 2011 in the VU University Medical Centre Amsterdam.Main outcome measuresMaternal and neonatal outcomes were evaluated.ResultsData of 122 women with 160 pregnancies were obtained. The most common heart diseases were congenital heart disease (n = 65, 53.3%) and arrhythmia (n = 20, 16.4%). Based on the functional criteria of the New York Heart Association (NYHA), 114/122 patients (93.4%) were classified NYHA class I–II. Patients in NYHA class III–IV (n = 8/122, 6.6%), mainly had a history of myocardial infarction or pulmonary hypertension. There were 156 singleton and 4 twin pregnancies. 22 (13.5%) pregnancies were complicated by hypertensive disorders. Heart failure developed in 11 women (9.0%), 37.5% in NYHA class III–IV and 6.5% in NYHA class I–II. Mean gestational age and birth weight were 270 days and 3196 g in NYHA class I–II compared to 237 days and 1972 g for NHYA class III–IV. There were two maternal deaths (1.6%) and 5 fetal deaths (3.1%). There were 29 (12.8%) preterm births, 20 (12.8%) neonates small for gestational age and 34 (21.8%) admittances on the Neonatal Intensive Care Unit (NICU).ConclusionsPregnancy in women with pre-existing heart disease in all NYHA classes is associated with increased maternal morbidity and perinatal morbidity. Risk of structural fetal anomalies is especially high in women with congenital heart disease.     

Body mass index and hypertensive disorders of pregnancy

ObjectivesWe compared the incidence of the hypertensive disorders of pregnancy in obese women with women of a normal body mass index (BMI).Study designProspective observational study in which BMI was calculated accurately early in pregnancy. Women were enrolled after a sonographic confirmation of an ongoing pregnancy. To reduce confounding variables the study was confined to white European women with a singleton pregnancy.Main outcome measuresIncidence of pre-eclampsia and gestational hypertension.ResultsIn 2230 women, 16.8% were obese. Pre-eclampsia was diagnosed in 3.3% (n = 74) and gestational hypertension in 3.0% (n = 67). Both pre-eclampsia (p = 0.01) and gestational hypertension (p < 0.01) were common in obese women compared with normal weight women. Overall 13.1% of obese women developed a hypertensive disorder during pregnancy. When analysed by parity pre-eclampsia occurred in 2.1% of primigravidas and 0.3% of multigravidas. Pre-eclampsia was increased in obese multigravidas (p = 0.001), but not obese primigravidas, suggesting that parity is more influential than obesity in the development of pre-eclampsia.ConclusionsObese multigravidas are more likely to develop hypertensive disorders in pregnancy and obese primigravidas are more likely to develop gestational hypertension. This is important in clinical practice because maternal weight, unlike parity, is potentially modifiable before or during pregnancy.     

Baseline placental growth factor levels for the prediction of benefit from early aspirin prophylaxis for preeclampsia prevention

ObjectivePlacental growth factor (PlGF) levels early in pregnancy are lower in women who ultimately develop preeclampsia. Early initiation of low-dose aspirin reduces preeclampsia risk in some high risk women. We hypothesized that low PlGF levels may identify women at increased risk for preeclampsia who would benefit from aspirin.Study designSecondary analysis of the MFMU High-Risk Aspirin study including singleton pregnancies randomized to aspirin 60 mg/d (n = 102) or placebo (n = 72), with PlGF collected at 13 w 0 d–16 w 6 d. Within the placebo group, we estimated the probability of preeclampsia by PlGF level using logistic regression analysis, then determined a potential PlGF threshold for preeclampsia prediction using ROC analysis. We performed logistic regression modeling for potential confounders.ResultsROC analysis indicated 87.71 pg/ml as the threshold between high and low PlGF for preeclampsia-prediction. Within the placebo group high PlGF weakly predicted preeclampsia (AUC 0.653, sensitivity/specificity 63%/66%). We noted a 2.6-fold reduction in preeclampsia with aspirin in the high-PlGF group (12.15% aspirin vs 32.14% placebo, p = 0.057), but no significant differences in preeclampsia in the low PlGF group (21.74% vs 15.91%, p = 0.445).ConclusionsUnlike other studies, we found that high rather than low PlGF levels were associated with an increased preeclampsia risk. Low PlGF neither identified women at increased risk of preeclampsia nor women who benefitted from aspirin. Further research is needed to determine whether aspirin is beneficial in women with high PlGF, and whether the paradigm linking low PlGF and preeclampsia needs to be reevaluated.CondensationHigh-risk women with low baseline PlGF, a risk factor for preeclampsia, did not benefit from early initiation of low-dose aspirin.     

Macular thickness measured by optical coherence tomography correlates with proteinuria in pre-eclampsia

ObjectivesPre-eclampsia is associated with ocular changes. The aim of this study was to examine the macular changes of patients with early-onset severe pre-eclampsia using optical coherence tomography (OCT).MethodsThis prospective study was performed at Tygerberg Academic Hospital, a secondary and tertiary referral centre in Cape Town, South Africa. Twenty women with early onset pre-eclampsia and 20 women without hypertensive or vascular complications, matched for gestational age, were examined before and after delivery.ResultsThere was a trend showing a positive correlation between increased central retinal thickness and increasing proteinuria in patients with pre-eclampsia antepartum (left eye r = 0.52, p = 0.04) and postpartum (left eye r = 0.60, p = 0.01). A positive correlation between average central 1 mm and proteinuria was noted antepartum (left eye r = 0.63, p = 0.01) and postpartum (right eye r = 0.52, p = 0.03). There were no significant correlations between blood pressure and any of the retinal parameters. Two of the 23 patients with pre-eclampsia developed serous retinal detachments, both of which resolved completely postpartum.ConclusionsMacular thickness parameters measured using OCT correlated with the degree of proteinuria in pre-eclampsia. These changes reversed soon after delivery.     

2-Methoxyestradiol deficiency is strongly related to hypertension in early onset severe pre-eclampsia

Objective2-Methoxyestradiol (2ME) deficiency leading to placental insufficiency has been related to pre-eclampsia (PE). Here we investigate whether 2ME is related to clinical profiles and vasoactive factors in early onset severe PE patients.Methods28 severe PE patients and 20 uncomplicated normal pregnant women, with gestational weeks between 24 and 32 weeks, were recruited. All cases and controls had singleton pregnancies and were matched for maternal age, parity, body mass index, and gestational weeks. Plasma levels of 2ME, estradiol (E2), soluble Fms-like tyrosine kinase-1 (sFLT-1), endothelin-1 (ET-1), nitric oxide (NO) were determined.ResultsPE patients had significant lower 2ME [906(422–1768) vs. 2032(1400–2910) pg/mL, P = 0.002], higher sFLT-1 [5.55(3.24–11.22) vs. 3.13(2.17–5.36) ng/mL, P = 0.015] and higher NO [122.40(72.92–168.23) vs. 45.83(25.52–61.46) μmol/L, P = 0.0008] levels in their plasma than the controls. In the PE group, plasma 2ME level correlated negatively with systolic pressure (r = −0.48, P = 0.012), diastolic pressure (r = −0.52, P = 0.007) and mean arterial pressure (r = −0.54, P = 0.005) even after controlling for maternal age; 2ME level did not correlate with proteinuria, plasma levels of E2, sFLT-1, ET-1 or NO. In the control group, plasma 2ME level did not correlate with any of the above clinical profiles or laboratory measurements.Conclusions2ME levels were markedly lower in early onset severe PE and they correlated inversely with blood pressure only in women with PE. Although we cannot tell whether lower 2ME level is the causation or the result of PE, our study provides clinical evidences that 2ME deficiency is strongly related to hypertension in early onset severe PE patients.     

Accuracy of Gestational Age Estimated by Menstrual Dating in Women Seeking Abortion Beyond Nine Weeks

ObjectiveWe sought to quantify the accuracy of estimating gestational age by reported last menstrual period among women seeking surgical abortion. We observed that women seeking surgical abortion underestimated their gestational age when making the appointment, leading to poor allocation of resources. This tendency to underestimate has not previously been reported and differs from the accurate dating reported among women choosing either medical abortion or continuation of the pregnancy.MethodsWe performed a retrospective review of randomly selected medical records for women with abortions scheduled at 9 to 20 weeks’ gestation (n = 415) at two clinics in Vancouver between 2002 and 2008.ResultsThe mean gestational age calculated by menstrual dates (14.3, SD 3.9) was 1.2 (95% CI 0.9 to 1.4) weeks less than that calculated by ultrasound (15.5, SD 3.4) (P < 0.001). Greater gestational age was associated with a larger discrepancy (r = 0.192, P < 0.001). Variables other than gestational age (maternal age, parity, previous abortions, illicit drug use, and contraceptive method at conception) were not significant predictors of inaccurate menstrual dating.ConclusionWomen seeking surgical abortion for pregnancies of 9 to 20 weeks underreport gestational age by an average of 1.2 weeks using menstrual dating. We found that women who intended to continue with their pregnancy overestimated their gestational age, those seeking very early abortion estimated most accurately, and those seeking surgical abortion at more than nine weeks had a clinically significant underestimation of their gestational age. Clinicians referring and counselling women who are considering surgical abortion must facilitate timely access to clinical or ultrasound dating of their pregnancy.     

Comparison of maternal serum levels of interleukin-10, interleukin-12, and interleukin-2 in normal and preeclamptic pregnancies

ObjectiveThe aim of this study was 2 fold: (1) to compare the maternal serum levels of IL-10, IL-12, and IL-2 in preeclamptic and normal pregnant women, and (2) to study the serum levels of these cytokines in preeclamptic pregnancies with and without intrauterine growth retardation.Study designForty women with singleton pregnancies complicated by preeclampsia (32 severe and 8 mild) and 29 normotensive healthy pregnant women were included in the study. Preeclamptic patients were further divided into 2 groups according to the presence or absence of intrauterine growth retardation. Maternal serum levels of IL-10, IL 12, and IL-2 were compared between these groups using enzyme-linked immunosorbent assays.ResultsMaternal serum levels of IL-10 were significantly higher in the preeclampsia group than in controls (p < 0.001). There were no statistically significant differences in maternal serum concentrations of IL-2 and IL-10 between the study and control groups (p > 0.05). Serum levels of IL-2 and IL-10 in the patients with preeclampsia complicated by IUGR were elevated in comparison with the uncomplicated preeclampsia group. These differences were statistically significant (p < 0.05 for both).ConclusionsIL-10 may be involved in the pathologic process of preeclampsia. Increased serum levels of IL-10 and IL-2 in preeclampsia complicated with IUGR suggests a possible role of these cytokines in IUGR.     

Three-dimensional ultrasonography using the VOCAL technique for estimation of reference range between 7 and 11 weeks embryonic volume

ObjectiveAccurate estimation of gestational age (GA) is the basis of vital decisions in pregnancy and hence its importance in obstetric management. This study tries estimating a reference range of 3D embryonic volume using the VOCAL technique for pregnancies between 7 and 11 weeks.Materials and methodsThis cross-sectional study included 62 singleton normal uneventful pregnancies. All women were essentially sure of the date of last menstrual period. All women were submitted to 3D ultrasonographic examination with VOCAL technique to determine the embryonic volume. In addition the crown-rump length was measured. Regression analysis was performed to predict the gestational age from the fetal volume.ResultsThere was a strong positive correlation between embryonic volume and menstrual age, gestational age and crown-rump length (r = 0.919, 0.938 and 0.941, respectively). Power regression model produced R² value of 0.838 with a regression equation (y = 52.22 + 6.5 x).ConclusionThis study demonstrated that embryonic/fetal volume is a good predictor of gestational age with a power regression equation (y = 52.22 + 6.5 x) for the period from 7 to 10 weeks + 6 days. We suggest using the embryo volume as an early evidence of growth restriction in high risk pregnancy.     

Use of first or second trimester serum markers,or both,to predict preeclampsia

ObjectivesPreeclampsia is a serious complication of pregnancy, threatening fetal and maternal health. The aim of our study is to examine the association between preeclampsia and biochemical markers, in matched first and second trimester maternal serum samples.Study designThis is a nested case/control study derived from the cohort of pregnancies delivering at Women & Infants Hospital. Cases were identified at a clinic or by hospital codes, and individually confirmed by record review. Stored samples were available from ‘integrated’ Down syndrome screening. Results were expressed as multiples of the median (MoM).Main outcome measuresPreeclampsia was classified as early/severe, late/severe, or mild based on professional guidelines. An additional adverse outcome group had only gestational hypertension.ResultsNinety-eight cases were each matched with five control pregnancies. Population distribution parameters and within and between trimester correlations were derived for cases and controls for six markers, as well as in case subgroups. The strongest associations were for early/severe preeclampsia with second trimester PAPP-A (rank sum test 2.30, p < 0.01); PlGF (2.60, p < 0.05) inhibin A (4.45, p < 0.05) and endoglin (4.25, p < 0.05). No strong associations were found for sVEGF-R and FLRG. Second trimester associations were stronger than those in the first (e.g., PAPP-A 2.45, p < 0.01). No between-trimester associations were found that would provide important improvements in prediction.ConclusionsThis matched analysis of the serum markers in early pregnancy allows for direct comparison of first and second trimester associations with preeclampsia. PAPP-A and PlGF are equally and highly predictive of early/severe preeclampsia.