Search

After preterm premature rupture of membranes (PPROM), antibiotics and antenatal steroids are effective evidence-based interventions, but the use of tocolysis is controversial. We investigated whether a unit policy of tocolysis use after PPROM is associated with prolonged gestation and improved outcomes for very preterm infants in units that systematically use these other evidence-based treatments. From the prospective, observational, population-based EPICE cohort study (all very preterm births in 19 regions from 11 European countries, 2011–2012), we included 607 women with a singleton pregnancy and PPROM at 24–29 weeks' gestation, of whom 101, 195 and 311 were respectively managed in 17, 32 and 45 units with no-use, restricted and liberal tocolysis policies for PPROM. The association between unit policies and outcomes (early-onset sepsis, survival at discharge, survival at discharge without severe morbidity and survival at two years without gross motor impairment) was investigated using three-level random-intercept logistic regression models, showing no differences in neonatal or two-year outcomes by unit policy. Moreover, there was no association between unit policies and prolongation of gestation in a multilevel survival analysis. Compared to a unit policy of no-use of tocolysis after PPROM, a liberal or restricted policy is not associated with improved obstetric, neonatal or two-year outcomes. [ABSTRACT FROM AUTHOR]

Purpose: In women with preterm premature rupture of membranes (PPROM), particularly those with suspected chorioamnionitis, the benefit of tocolysis on neonatal outcome remains unclear. Our purpose was to evaluate the effect of tocolysis on neonatal septic death in women with PPROM with and without chorioamnionitis.Methods: A retrospective cohort study was used to address our study objective. We created a cohort consisting of all live births between 24 and 32 weeks' gestation that were registered in the Linked Birth and Infant Death data files (2009-2013) from the United States. Multivariate logistic regression was used to evaluate the effect of tocolysis on neonatal septic death at 7 and 28 days in births with and without chorioamnionitis.Results: Of the 46,968 births that met our inclusion criteria, tocolysis was administered to 6264 (13.3%). Tocolysis was more commonly prescribed to Caucasians, smokers, in multiple birth pregnancies, and to women with a history of preterm births. Tocolysis was not significantly associated with neonatal septic death at 7 days (OR 0.66, 95% CI 0.39-1.13) or at 28 days (OR 0.85, 95% CI 0.60-1.19). This was consistent in pregnancies with and without chorioamnionitis. Furthermore, tocolysis was associated with a reduced risk of neonatal septic death at 7 days when administered between 24 and 27 weeks' gestation (OR 0.44, 95% CI 0.22-0.88).Conclusions: In the setting of PPROM, tocolysis does not appear to increase the risk of neonatal septic death at 7 and 28 days. Therefore, consideration should be given to its administration if clinically indicated. [ABSTRACT FROM AUTHOR]

Problem: Chorioamnionitis and infection‐associated inflammation are major causes of preterm birth. Magnesium sulfate (MgSO4) is widely used in obstetrics as a tocolytic; however, its mechanism of action is unclear. This study sought to investigate how MgSO4 modulates infection‐associated inflammation in fetal membranes (FMs), and whether the response was time dependent. Method of Study: Human FM explants were treated with or without bacterial lipopolysaccharide (LPS); with or without MgSO4 added either: 1 hour before LPS; at the same time as LPS; 1 hour post‐LPS; or 2 hours post‐LPS. Explants were also treated with or without viral dsRNA and LPS, alone or in combination; and MgSO4 added 1 hour post‐LPS After 24 hours, supernatants were measured for cytokines/chemokines; and tissue lysates measured for caspase‐1 activity. Results: Lipopolysaccharide‐induced FM inflammation by upregulating the secretion of a number of inflammatory cytokines/chemokines. Magnesium sulfate administered 1‐hour post‐LPS inhibited FM secretion of IL‐1β, IL‐6, G‐CSF, RANTES, and TNFα. Magnesium sulfate administered 2 hours post‐LPS augmented FM secretion of these factors as well as IL‐8, IFNγ, VEGF, GROα and IP‐10. Magnesium sulfate delivered 1‐ hour post‐LPS inhibited LPS‐induced caspase‐1 activity, and inhibited the augmented IL‐1β response triggered by combination viral dsRNA and LPS. Conclusion: Magnesium sulfate differentially modulates LPS‐induced FM inflammation in a time‐dependent manner, in part through its modulation of caspase‐1 activity. Thus, the timing of MgSO4 administration may be critical in optimizing its anti‐inflammatory effects in the clinical setting. MgSO4 might also be useful at preventing FM inflammation triggered by a polymicrobial viral‐bacterial infection. [ABSTRACT FROM AUTHOR]

Preterm birth accounts for nearly one million deaths among children under five years of age, and although its etiopathogenesis is not fully elucidated, ascending intrauterine infection and fetal inflammatory response seem to be the main triggers. The intense inflammatory response mediated by IL-1β, TNF-α, PAF, IFN-γ and IL-6, PGE2 and MMP-1 and MMP-9 causes fetal membrane damage and rupture, increased uterine contractions and biochemical and structural changes in the cervix. Furthermore, preterm neonates have deficient innate and adaptive immune responses characterized by reduced levels of IgG, opsonization and phagocytosis, as well as increased activation of Th1 cells in relation to Th2 cells. Therefore, this triad is favors the occurrence of neonatal complications, such as respiratory distress syndrome, necrotizing enterocolitis, retinopathy of prematurity and bronchopulmonary dysplasia. Due to serious maternal and child health complications of intrauterine infection, several studies have tried to identify biomarkers for the early diagnosis of this entity. This literature review aims to discuss the main scientific findings regarding the association between ascending intrauterine infection, immune system and preterm birth. [ABSTRACT FROM AUTHOR]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objectives: To evaluate whether the amniotic fluid (AF) cytokine profile in women with chorioamnionitis may differentiate between those with and without funisitis.Subjects and Methods: Forty women at high risk of chorioamnionitis were studied. Gestational age at study was 26.94. Amniocentesis, universal and specific polymerase chain reaction, and microbiological cultures were performed. AF IL-1β, IL-2, IL-4, IL-6, IL 8, IL-10, IL-12, TNF-alpha, IFN-gamma, and MMP-8 were measured by multiplex assay. After delivery, the placenta and umbilical cord were studied histologically. Comparisons were made between three groups: controls, and chorioamnionitis with and without funisitis.Results: In 25 cases, the histological findings were normal (61.5%). The remaining 15 composed of 9 cases of chorioamnionitis alone (9/40; 23.1%) and 6 cases of chorioamnionitis plus funisitis (6/40; 15.4%). All AF cytokine levels were significantly higher in the cases with chorioamnionitis in comparison to controls, except for IFN-gamma. The comparisons between the three groups showed significant differences between chorioamnionitis alone and chorioamnionitis plus funisitis in IL-1β, IL-6, IL-10, IL-12, IL-8, and TNF-alpha, with the levels being higher when funisitis was present. Logistic regression found a powerful predictive model for funisitis including the following cytokinesIL-4, IL-10, IL-12, and IL-8.Conclusions: Measurements of AF interleukins 4, 10, 12, and 8 allow to identify cases with funisitisin women at high risk of chorioamnionitis. [ABSTRACT FROM AUTHOR]

Background High Mobility Group Box-1 (HMGB1) is considered a prototype alarmin molecule. Upon its extracellular release, HMGB1 engages pattern recognition receptors and the Receptor for Advanced Glycation End-products (RAGE) followed by an outpouring of inflammatory cytokines, including interleukin (IL)-6. Methods We assayed the amniotic fluid (AF) levels of HMGB1 and IL-6 in 255 women that either had a normal pregnancy outcome or delivered preterm. Immunohistochemistry on fetal membranes was used for cellular localization and validation of immunoassay findings. HMGB1 also was analyzed in amniochorion tissue explants subjected to endotoxin. Results AF HMGB1 levels are not gestational age regulated but are increased in women with intra-amniotic inflammation and preterm birth. The likely source is the damaged amniochorion, as demonstrated by immunohistochemistry and explant experiments. Conclusions Our research supports a role for HMGB1 in the inflammatory response leading to preterm birth. As a delayed phase cytokine, in utero exposure to elevated AF HMGB1 levels may have an impact on the newborn beyond the time of birth. [ABSTRACT FROM AUTHOR]

Chorioamnionitis is an important risk factor for vertical transmission of HIV/AIDS. We compared the prevalence and correlates of histologic chorioamnionitis (HCA) in HIV-positive and HIV-negative pregnant women. HIV-positive and -negative parturients were interviewed, examined and had their placentas examined histologically for chorioamnionitis. Data regarding HIV were also retrieved from their hospital records. A total of 298 parturients (150 HIV positive and 148 HIV negative) were enrolled. The two groups were similar in socio-demographic and obstetric parameters except for age. The prevalence of HCA was 57.1% in HIV-positive women and 61.6% in HIV-negative women (p = 0.43). HCA staging was associated with the number of intrapartum vaginal examinations in HIV-positive subjects and nulliparity in HIV-negative subjects. The number of intrapartum vaginal examinations and coitus in the week prior to delivery significantly affected the grade of HCA in HIV-negative subjects. The prevalence of HCA in both HIV-positive and HIV-negative is high. Most variables did not affect the occurrence of HCA in both groups studied except number of intrapartum examinations, coitus in the preceding one week and nulliparity, which were related to severity of the disease. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to determine whether the concentration of cytokines in the gastric fluid at birth was associated with chorioamnionitis or funisitis and with the white blood cell counts of very premature newborns. Methods We retrieved gastric fluid from 27 preterm infants with a gestational age of <29 weeks within 1 h of birth and used enzyme-linked immunosorbent assay to measure the concentrations of interleukin ( IL)-1beta, epithelial cell-derived neutrophil-activating peptide ( ENA)-78, IL-8 and growth-related oncogene (Gro)-alpha. The presence of histologic chorioamnionitis or funisitis in the placentas and the highest white blood cell count of the infants during the first week of life were compared to the cytokine concentrations. Results Gastric fluid concentrations of IL-1beta, ENA-78, IL-8 and Gro-alpha were strongly associated with chorioamnionitis and funisitis. In addition, chorioamnionitis and funisitis and gastric aspirate cytokine levels were associated with the highest white blood cell counts of the infants during the first week of life. Conclusion This study suggests that levels of inflammatory cytokines in the gastric fluid of premature infants at birth can be used to assess the exposure of the infants to antenatal inflammation. [ABSTRACT FROM AUTHOR]

Retention of the fetal membranes (RFM) is one of the most common postpartum diseases in dairy cows. Risk factors include poor prepartum body condition, dystocia, hypocalcaemia, and many others. Although the manual removal of the fetal membranes and the use of intrauterine antibiotics are common strategies, recent research has scrutinised these treatments and tested strategies where only pyrexic RFM cows received a systemic antibiotic treatment whereas cows with RFM but no fever remained untreated. Furthermore, the use of oxytocin or prostaglandin F2α seems to be of limited value. This review provides an overview of current literature with a focus on treatment strategies for retained fetal membranes. [ABSTRACT FROM AUTHOR]

Objective: To determine the cervical fluid interleukin (IL)-6 and IL-8 levels in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) and the association of these interleukins with microbial invasion of the amniotic cavity (MIAC) and histological chorioamnionitis (HCA). Methods: Sixty women with singleton pregnancies were included in this study. Cervical fluid was sampled at the time of admission using Dacron polyester swabs, which were placed into the endocervical canal for 20 s. IL-6 and IL-8 levels were determined by ELISA. The management of PPROM was active management (except for in pregnancies <28 weeks of gestation) and occurs not later than 72 h after the rupture of membranes. Result: The women with MIAC had higher IL-6 and IL-8 levels than did the women without MIAC (IL-6: p = 0.01; IL-8: p = 0.003). There was no difference in IL-6 levels between women with and without HCA ( p = 0.37). The women with HCA had higher IL-8 levels only in the crude analysis ( p = 0.01) but not after adjustment for gestational age ( p = 0.06). The women with both MIAC and HCA had higher levels of IL-6 and IL-8 than did the other women (IL-6: p = 0.003; IL-8: p = 0.001). IL-8 level of 2653 pg/mL was found to be the best cut-off point in the identification of PPROM pregnancies complicated by both MIAC and HCA with a likelihood ratio of 24. Conclusions: The presence of MIAC is the most important factor impacting the local cervical inflammatory response, which is determined by IL-6 and IL-8 levels in the cervical fluid. IL-8 levels seem to be a promising non-invasive marker for the prediction of pregnancies complicated by the presence of both MIAC and HCA. [ABSTRACT FROM AUTHOR]

The article investigate the effects of the treatment of dairy cows with analgesics, non-steroidal anti-inflammatory drug meloxicam at calving on the risk of retained fetal membranes. It finds that the administration of meloxicam to dairy cattle immediately after calving shows no differences in retained fetal membranes and the incidence of periparturient diseases. It also informs that meloxicam can be used on the day of calving in lactating cows without risk of retained fetal membranes.

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The relevance of microorganisms in preterm birth is still under discussion. Using a diagnostic fluorescence in situ hybridization probe panel, we visualized Staphylococcus aureus and Streptococcus mitis group in two cases of acute chorioamnionitis. This technique provides spatial resolution and quantity of bacteria, clarifying the epidemiology and pathogenic pathways of acute chorioamnionitis. [ABSTRACT FROM AUTHOR]

Background and objectives: Chorioamnionitis (CA) is an acute inflammation of the membranes and chorion of the placenta. The aim of this study was to determine the effect of histological CA on the short-term outcome of preterm infants. Subjects and methods: The clinical characteristics and outcomes of the preterm infant including respiratory distress syndrome, duration of mechanical ventilation, patent ductus arteriosus (PDA) requiring medical treatment or ligation, necrotizing enterocolitis, bronchopulmonary dysplasia, death and intraventricular hemorrhage (IVH; grade III-IV) were analyzed. Results: Two hundred and eighty-one infants born at ≤32 weeks gestational ages were included. Infants were divided into two groups: one with histological CA ( n = 145) and without histological CA ( n = 136). Mean gestational age was 28.8 ± 2.6 weeks and 29.1 ± 2.5 weeks, and mean birth weight was 1138 ± 350 g and 1210 ± 299 g, respectively. There were no differences in gestational age and birth weight among the groups. Compared with the group, histological CA was associated with early onset sepsis ( p = 0.007), PDA ( p = 0.003), IVH ( p = 0.03), and death ( p = 0.04). Conclusion: Maternal histological CA is an important risk factor for preterm deliveries and associated with serious morbidities such as early onset sepsis, IVH, PDA and increased mortality. [ABSTRACT FROM AUTHOR]

Scrapie in sheep is spread laterally by placental transmission of an infectious misfolded form (PrPSc) of a normal prion protein (PrPC) used as a template in PrPSc formation.We hypothesized that PrPC would be expressed in uterine and placental tissues and estradiol-17b (E2) would affect uterine PrPC expression. PrPC expression was evaluated in the uterus of long-term ovariectomized (OVX) ewes treated with an E2 implant for 2–24 h and in uteroplacental tissues from day 20 to day 30 of pregnancy. Expression of PrPC mRNA and PrPC protein increased in the uterus after E2 treatment of OVX ewes. In the maternal placenta, expression of PrPC mRNA and PrPC protein were unchanged, but in the fetal membranes (FM) PrPC mRNA and PrPC protein expression increased from day 20 to day 28. In the nonpregnant uterus, PrPC protein was immunolocalized at apical borders of the surface epithelium, in outer smooth muscle layers of large blood vessels, and in scattered stromal cells of the deep intercaruncular areas of the uterus. In the maternal placenta, PrPC protein was immunolocalized in the cytoplasm of flattened luminal epithelial cells apposed to the FM, whereas in the FM PrPC protein was in trophoblast cells and was also in several tissues of the developing embryo during early pregnancy. These data linking estrogen stimulation to increases in PrPC expression in uteroplacental tissues suggest that PrPC has a specific function during the estrous cycle and early pregnancy. Future studies should determine whether or not estrogen influences PrPC expression in other tissues, such as the nervous system and brain. [ABSTRACT FROM AUTHOR]

We examined 179 patients with and without preterm rupture of fetal membranes. The mothers and their newborns have been genotyped by two polymorphic loci of estrogen receptor α ( ESR1) gene: -397T > C[PvuII] (rs2234693) and -351A > G[XbaI] (rs9340799). The CG haplotype of the fetus should be regarded as a risk factor of preterm rupture of fetal membranes, while haplotype TA as a protective factor. Genotype -351A/A is a marker of the protective haplotype in the fetus, while genotype -397C/C is a marker of the risk haplotype, which can be used in combined analysis of both markers. These data attest to an important role of fetal genotype in the formation of genetic predisposition to preterm rupture of fetal membranes. [ABSTRACT FROM AUTHOR]

Objective: Wetestedthehypothesisthattheorderofexposuretomaternalbetamethasoneandintra-amniotic(IA)lipo- polysaccharide(LPS)willdifferentiallymodulateinflammationinthechorioamnion. StudyDesign: Time-matedMerinoewes withsingletonfetusesreceivedsalinealone,IALPSalone,maternalbetamethasonebeforeLPS,orbetamethasoneafterLPS. Weassessedinflammatorymarkersinthechorioamnionandtheamnioticfluid. Results: Inflammatorycellinfiltration, expressionofmyeloperoxidase,serumamyloidA3(acutephasereactant)inthechorioamnion,andlevelsofinterleukin(IL)-8in theamnioticfluidincreased7daysafterLPSexposure.BetamethasonepriortoLPSdecreasedinfiltrationoftheinflammatory cells,CD3+Tcells,anddecreasedthelevelsofIL-1ß andIL-8intheamnioticfluid.Conclusions:Betamethasone7dayspriorto LPSexposuresuppressedLPS-inducedinflammation.Themarkersofinflammationlargelyhadreturnedtothebaseline14days afterLPSexposure. [ABSTRACT FROM AUTHOR]

Abstract: Ureaplasma spp. are members of the family Mycoplasmataceae and have been considered to be associated with chorioamnionitis and preterm delivery. However, it is unclear whether Ureaplasma spp. have virulence factors related to these manifestations. The purpose of the present study was to determine whether the immunogenic protein multiple-banded antigen (MBA) from Ureaplasma parvum is a virulence factor for preterm delivery. We partially purified MBA from a type strain and clinical isolates of U. parvum, and also synthesized a diacylated lipopeptide derived from U. parvum, UPM-1. Using luciferase assays, both MBA-rich fraction MRF and UPM-1 activated the NF-κB pathway via TLR2. UPM-1 upregulated IL-1β, IL-6, IL-12p35, TNF-α, MIP2, LIX, and iNOS in mouse peritoneal macrophage. MRF or UPM-1 was injected into uteri on day 15 of gestation on pregnant C3H/HeN mice. The intrauterine MRF injection group had a significantly higher incidence of intrauterine fetal death (IUFD; 38.5%) than the control group (14.0%). Interestingly, intrauterine injection of UPM-1 caused preterm deliveries at high concentration (80.0%). In contrast, a low concentration of UPM-1 induced a significantly higher rate of fetal deaths (55.2%) than the control group (14.0%). The placentas of the UPM-1 injection group showed neutrophil infiltration and increased iNOS protein expression. Our data indicate that MBA from the clinical isolate of U. parvum is a potential virulence factor for IUFD and preterm delivery in mice and that the N-terminal diacylated lipopeptide is essential for the initiation of inflammation. [Copyright &y& Elsevier]

Objective To estimate the risk of early-onset neonatal sepsis among newborns of mothers with chorioamnionitis and/or bacterial colonisation in Dhaka. Methods We conducted a cohort study at a maternity centre following 600 mother-newborn pairs. Women with a positive bacterial vaginal culture or positive Group B streptococcus ( GBS) rectal culture during labour were classified as colonised. Women with placental histopathology demonstrating signs of maternal or foetal inflammation were classified as having chorioamnionitis. Newborns were followed over the first 7 days of life. The primary outcome measure was physician or community health worker diagnosis of neonatal sepsis following modified World Health Organization Integrated Management of Childhood Illnesses criteria. Survival analysis was conducted with non-parametric, parametric and semiparametric models. Results Of the 600 mother-newborn pairs, 12.8% of newborns were diagnosed with early-onset sepsis. Five hundred and forty-three women had both colonisation and chorioamnionitis data, 55.4% of mothers were non-exposed, 31.7% were only colonised and 12.9% had chorioamnionitis regardless of colonisation status. After adjusting for birthweight, sex, maternal characteristics and wealth, newborns of only colonised mothers developed sepsis 63% faster and had a 71% higher risk of developing sepsis than their non-exposed counterparts ( RT = 0.37, 95% CI 0.14-1.03; RH = 1.71, 95% CI 1.00-2.94). Newborns of mothers with chorioamnionitis developed sepsis 74% faster and had a 111% higher risk of developing sepsis ( RT = 0.26, 95% CI 0.07-0.94; RH = 2.11, 95% CI 1.06-4.21). Conclusions Newborns born to mothers with colonisation or chorioamnionitis developed sepsis faster and were at higher risk of developing sepsis in Dhaka. [ABSTRACT FROM AUTHOR]

In this study, we aimed to investigate the predictive value of fetal thymus size for chorioamnionitis (CA) and early neonatal complications (ENC) in patients with preterm labor and preterm premature rupture of membranes (PPROM) in the etiology of whom intrauterine infections are frequently blamed. A total of 70 patients (40 control cases, 12 cases with preterm labor and 18 cases with PPROM) were included in this study. Thymus transverse diameter (TTD) and thymus perimeter (TP) were measured in all fetuses and the association of thymic involution (thymic size <5th percentile) with the development of CA or ENC during follow up was investigated. In the preterm labor group, there was no CA, and ENC was seen in 1 (8.3%) patient. In this group, TTD was normal in all patients and TP was <5th percentile in 4 (33.3%) patients. In the PPROM group, there were 6 (%33.3) CA and 5 (27.8%) ENC. There was no significant difference between the TTD's and between the TP's of patients with or without CA and/or ENC. The specificity and the negative predictive value (NPV) of TTD<5th percentile for the prediction of ENC in patients with PPROM was 76.9% and 66.7%, respectively. The specificity, positive predictive value (PPV), NPV and the accuracy ratio of TTD<5th percentile for the prediction of CA was 91.7%, 66.7%, 73.3% and 72.2% respectively. The sensitivity and NPV of TP<5th percentile for the prediction of CA in patients with PPROM were both 66.7%. A small TP in patients with PPROM can help the early diagnosis of CA, and a normal TTD can help the detection of those patients that will not develop CA. TTD can be measured more easily and more accurately than the TP. [ABSTRACT FROM AUTHOR]

Amniotic band sequence (ABS) is the term applied to a wide range of congenital anomalies, most typically limb and digital amputations and constriction rings, that occur in association with fibrous bands (1). These alterations may be associated or not with cutaneous and visceral abnormalities. This work, which is a literature review, examines several studies that relate to cases of amniotic band syndrome (SBA). In particular, our attention was focused on the causes and pathogenesis of the SBA. These for the most part are still unknown, but from what we observe in different jobs, are due to a mechanism of vascular damage. Therefore in this paper we examine chemical risk factors, like smoking, drug use, maternal hyperglycemia, mechanical risk factors such as the puncture of the amniotic sac after amniocentesis. We also speak of the altitude as a risk factor related to blood pressure, of the increased incidence of disease in primigravid, in women with a low level of education, in which the pregnancy was not planned, and then we talk of a higher incidence in young fathers and of the role of familiarity. [ABSTRACT FROM AUTHOR]

The article presents a study that evaluates that effectiveness of a limited course of antibiotics in treating patients with chorioamnionitis. It shows that of the 423 patients, 399 were treated successfully and 24 failed short-course treatment, of which 17 patients had endometritis and responded to continuation of antibiotics. It suggests that a limited course of antibiotics was sufficient for all patients with chorioamnionitis who had a vaginal delivery.

Chorioamnionitis is an important problem in perinatology today, leading to brain injury and neurological handicaps. However, there are almost no data available regarding chorioamnionitis and a specific damage of the cerebellum. Therefore, this study aimed at determining if chorioamnionitis causes cerebellar morphological alterations. Chorioamnionitis was induced in sheep by the intra-amniotic injection of lipopolysaccharide (LPS) at a gestational age (GA) of 110 days. At a GA of 140 days, we assessed the mean total and layer-specific volume and the mean total granule cell (GCs) and Purkinje cell (PC) number in the cerebelli of LPS-exposed and control animals using high-precision design-based stereology. Astrogliosis was assessed in the gray and white matter (WM) using a glial fibrillary acidic protein staining combined with gray value image analysis. The present study showed an unchanged volume of the total cerebellum as well as the molecular layer, outer and inner granular cell layers (OGL and IGL, respectively), and WM. Interestingly, compared with controls, the LPS-exposed brains showed a statistically significant increase (+20.4%) in the mean total number of GCs, whereas the number of PCs did not show any difference between the two groups. In addition, LPS-exposed animals showed signs of astrogliosis specifically affecting the IGL. Intra-amniotic injection of LPS causes morphological changes in the cerebellum of fetal sheep still detectable at full-term birth. In this study, changes were restricted to the inner granule layer. These cerebellar changes might correspond to some of the motor or non-motor deficits seen in neonates from compromised pregnancies. [ABSTRACT FROM AUTHOR]

Objective: To determine the combination of amniotic fluid (AF) tests with the best diagnostic accuracy for predicting intrauterine infection/inflammation (IUI) in patients with clinical suspicion of chorioamnionitis. Study design: This is a retrospective study of 34 pregnant women who presented with uterine tenderness, maternal fever, maternal tachycardia, and/or fetal tachycardia and underwent AF analysis. IUI diagnosis was based on placental histology, positive AF bacterial cultures, and/or Gram stain. Result: Logistic regression analysis revealed a significant relationship between IUI and AF glucose. Glucose is more sensitive than culture or Gram stain (64% vs. 40% and 20%, [iw-0.3]respectively). Culture and glucose combined achieved the best diagnostic accuracy (sensitivity, 71%; specificity, 100%; positive and negative predictive values, 100-83%, respectively). Conclusion: Positive AF Gram stain or glucose <15 mg/dL strongly suggests IUI in symptomatic patients. If both tests are negative, the result of culture should aid the management. [ABSTRACT FROM AUTHOR]

Abstract: Retention of fetal membranes is one of the most common life-threatening peripartum problems; however, its etiology is still unknown. Draft mares are more likely to retain fetal membranes than other breeds of mares. Because a strong connection between the fetal membranes and the endometrium has been observed in cases of retention, we studied the changes in the endometrium and the allantochorion of heavy draft mares with this condition. Tissue samples were taken from 90 mares that retained the fetal membranes and from 21 that did not. Retained fetal membranes were associated with adhesion of the allantochorion to the endometrium in 88% of the mares; this adhesion depended on the following factors: occurrence of fibrosis both in the lamina propria of the allantochorial villi and in the allantochorial stromal connective tissue, overdevelopment of the allantochorial stromal connective tissue, oversized allantochorial epithelial cells, and sparser and less-branched allantochorial villi. [Copyright &y& Elsevier]

Abstract: Objective: With the increased use of invasive fetal procedures, the number of patients facing postprocedure membrane rupture is increasing. We aimed to describe the use of platelets and fresh frozen plasma for sealing iatrogenic fetal membrane defects. Patients and methods: We describe the mechanisms of action of the amniopatch procedure as well as published experience. Results: Amniopatch effectively sealed the fetal membranes in over two thirds of published cases (n =44). There is a risk of 17% of in utero fetal death, which may occur remotely from the procedure and is often unexplained. Discussion and conclusion: In case of early onset but persistent amniotic fluid leakage following an invasive fetal procedure, amniopatch may be offered. [Copyright &y& Elsevier]

Copyright of Ginecología y Obstetricia de México is the property of Federacion Mexicana de Ginecologia y Obstetricia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Mid-trimester pregnancy loss defined as miscarriage at 14-23 weeks' gestation and preterm birth between 24 and 28 weeks are in essence clinical manifestations of the same disease process. The pathogenic and socio-biologic risk factors are the same, but the timing of onset of uterine activity and cervical dilatation may be delayed in the case of preterm birth. The overwhelming majority of cases are associated with ascending infection from the lower genital tract. Women with a prior history of late miscarriage are at increased risk of preterm delivery and vice versa. The risk of preterm delivery in women with prior mid-trimester pregnancy loss approximates the same recurrence risk documented for women with a previous history of preterm delivery, suggesting that mid-trimester miscarriage represents the lower end of the spectrum of preterm birth. There are many causes of mid-trimester pregnancy loss including abnormal placentation, immunological interactions, thrombophilias, cervical insufficiency and upper genital tract anomalies to name a few. This paper, however, will focus on the role of chorioamnionitis in the pathogenesis of mid-trimester pregnancy loss and the value of current interventions to reduce recurrence. Copyright © 2010 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Objective. Pentraxin 3 (PTX3) is an acute-phase protein that has an important role in the regulation of the innate immune response. The aim of this study was to determine if maternal plasma PTX3 concentration changes in the presence of intra-amniotic infection and/or inflammation (IAI) in women with preterm labor (PTL) and intact membranes, as well as those with preterm prelabor rupture of membranes (preterm PROM). Study design. This cross-sectional study included women in the following groups: (1) nonpregnant ( n = 40); (2) uncomplicated pregnancies in the first ( n = 22), second ( n = 22) or third trimester ( n = 71, including 50 women at term not in labor); (3) uncomplicated pregnancies at term with spontaneous labor ( n = 49); (4) PTL and intact membranes who delivered at term ( n = 49); (5) PTL without IAI who delivered preterm ( n = 26); (6) PTL with IAI ( n = 65); (7) preterm PROM without IAI ( n = 25); and (8) preterm PROM with IAI ( n = 77). Maternal plasma PTX3 concentrations were determined by ELISA. Results. (1) Maternal plasma PTX3 concentrations increased with advancing gestational age ( r = 0.62, p < 0.001); (2) women at term with spontaneous labor had a higher median plasma PTX3 concentration than those at term not in labor (8.29 ng/ml vs. 5.98 ng/ml, p = 0.013); (3) patients with an episode of PTL, regardless of the presence or absence of IAI and whether these patients delivered preterm or at term had a higher median plasma PTX3 concentration than normal pregnant women ( p < 0.001 for all comparisons); (4) similarly, patients with preterm PROM, with or without IAI had a higher median plasma PTX3 concentration than normal pregnant women ( p < 0.001 for both comparisons); and (5) among patients with PTL and those with preterm PROM, IAI was not associated with significant changes in the median maternal plasma PTX3 concentrations. Conclusions. The maternal plasma PTX3 concentration increases with advancing gestational age and is significantly elevated during labor at term and in the presence of spontaneous preterm labor or preterm PROM. These findings could not be explained by the presence of IAI, suggesting that the increased PTX3 concentration is part of the physiologic or pathologic activation of the pro-inflammatory response in the maternal circulation during the process of labor at term or preterm. [ABSTRACT FROM AUTHOR]

Abstract: Background: A systemic fetal inflammatory response, reflected by histological funisitis is associated with pulmonary morbidity and increased mortality after premature birth. The receptor for advanced glycation end products (RAGE) is a membrane-bound multiligand receptor with a key role in inflammation. Soluble RAGE (sRAGE) is created by alternative mRNA splicing or shedding of the receptor''s extracellular domain and can inhibit RAGE-activation. Aims: To assess the association of funisitis with airway and systemic concentrations of sRAGE in very premature infants. Methods: Forty-two ventilated infants (gestational age: 27.4±1.8weeks, birth weight: 1017±229g [mean±SD]) were studied. sRAGE concentrations were measured in tracheobronchial aspirate fluid (TAF) on days of life 1, 3, 5, 7 and 10 and in umbilical cord serum of 28 infants by ELISA. The secretory component for IgA (SC) served as reference protein in TAF. Placental tissue, membranes and umbilical cords were examined microscopically to distinguish three groups: chorioamnionitis (n =9), funisitis (n =17) and controls (n =16). Results: The funisitis group had lower sRAGE concentrations than both other groups in cord blood serum (median: 0.52ng/ml [25th–75th centile: 0.32–0.91]; control, 1.72 [1.02–2.69]; chorioamnionitis, 1.44 [0.92–1.63], p <0.01) and TAF on day 1 (290ng/ngSC [140–400]; control, 2750 [1470–28920]; chorioamnionitis, 2150 [1220–7140], p <0.01). sRAGE in TAF remained lower in the funisitis than in the chorioamnionitis group on days 3 and 10, p <0.01 respectively. Conclusions: Decreased sRAGE in airways and circulation after funisitis may contribute to an imbalance between pro- and anti-inflammatory factors priming very premature infants for pulmonary injury and increasing the risk of adverse outcome. [Copyright &y& Elsevier]

Objective-To describe the health status of foals derived by use of somatic cell nuclear transfer (NT) at a university laboratory. Design-Retrospective case series. Animals-14 live-born NT-derived foals. Procedures-Medical records from 2004 through 2008 were evaluated to identify all pregnancies resulting in live-born NT-derived foals, Information obtained included gestation length, birth weight, foaling complications, gross abnormalities of the fetal membranes, appearance of the umbilicus, mentation of the foal, limb deformities, and any other abnormalities detected in the neonatal period. Clinicopathologic data were also evaluated when available. Records of 4 recipient mares during gestation were included. Results-Six foals were clinically normal for all evaluated variables. The most common abnormalities detected in the remaining 8 foals included maladjustment, enlarged umbilical remnant, and angular deformity of the forelimbs. Two foals died within 7 days after parturition; in the remaining foals, these conditions all resolved with medical or surgical management. Large offspring syndrome and gross abnormalities of the fetal membranes were not detected. The 12 surviving foals remained healthy. Conclusions and Clinical Relevance-Associated problems of calves resulting from use of NT have been reported, but there are few data on the outcome of foals resulting from adult somatic cell NT in horses. Although this population of foals had a lower perinatal mortality rate than has been reported for NT-derived calves, some NT-derived foals required aggressive supportive care. Birth of foals derived from NT should take place at a center equipped to handle critical care of neonates. [ABSTRACT FROM AUTHOR]

In a 2002–2004 prospective cohort study of deliveries of infants at <28 weeks at 14 US centers, the authors sought the antecedents of white matter damage evident in newborn cranial ultrasound scans (ventriculomegaly and an echolucent lesion) and of cerebral palsy diagnoses at age 2 years. Of the 1,455 infants enrolled, those whose mothers received an antenatal steroid tended to have lower risks of ventriculomegaly and an echolucent lesion than their peers (10% vs. 23%, P < 0.001 and 7% vs. 11%, P = 0.06, respectively). Risk of ventriculomegaly was increased for infants delivered because of preterm labor (adjusted odds ratio (OR) = 2.3, 95% confidence interval (CI): 1.1, 4.9), preterm premature rupture of fetal membranes (OR = 3.6, 95% CI: 1.5, 8.7), and cervical insufficiency (OR = 2.8, 95% CI: 1.4, 5.5) when compared with infants delivered because of preeclampsia. Risk of an echolucent lesion was increased for infants delivered because of preterm labor (OR = 2.7, 95% CI: 1.2, 5.7) and intrauterine growth retardation (OR = 3.3, 95% CI: 1.2, 9.4). The doubling of diparesis risk associated with preterm labor and with preterm premature rupture of fetal membranes did not achieve statistical significance, nor did the doubling of quadriparesis risk and the tripling of diparesis risk associated with cervical insufficiency. [ABSTRACT FROM PUBLISHER]

Abstract: We have previously shown that separation of the amnion from choriodecidua occurs as an integral part of the fetal membranes (FM) rupture process. We have also reported that spontaneous separation of FM is nearly universal with term vaginal delivery. The etiology of this spontaneous FM separation is unknown. If biochemical degradation at the amnion–choriodecidua interface is a factor, decreased adhesive force between the FM components prior to their complete separation would be expected. The purpose of this project was to develop and validate machinery and procedures to measure the adhesive force between amnion and choriodecidua. Commercial tensile testing equipment was adapted to perform a standard T-peel test, per the American Society for Testing and Materials (ASTM) guidelines. FM test strip dimensions, peel speed, and peel force data measurements from force versus displacement curves were optimized for reproducibility. Test system validation was performed using Shurtape CP 60 (slow release painter''s masking tape) as the standard. Equipment and procedures for a standard T-peel test on FM were developed. Shurtape CP 60 of decreasing widths showed reproducible, linear changes in the adhesive force range for FM (r 2 =0.96). The adhesive force between FM components ranged from 0.017 to 0.262N/cm. Reproducibility was optimal with FM test strips of 4×6cm and a peel speed of 25.4cm/min. FM showed greater adhesive force adjacent to the placental disc than distal from the disc (p <0.05). We have developed equipment and procedures to accurately and reproducibly measure adhesive force between the FM amnion and choriodecidua. [Copyright &y& Elsevier]

Objectives Our objective was to use maternal self-reported data to estimate the prevalence of urinary tract infections, placenta disorders, and preterm rupture of the membranes (PROM) and to explore the association between these complications and race, ethnicity, and economic status. Methods We used data for the years 2000–2002 from the Pregnancy Risk Assessment Monitoring System (PRAMS), an ongoing survey of women with a recent live birth, to examine the prevalence of and hospitalizations for self-reported urinary tract infections, placenta disorders, and PROM and to investigate differences by maternal race, Hispanic ethnicity, and economic status. Prevalence and hospitalizations were calculated as a percent of the represented population using SUDAAN to account for the sampling design. Results Urinary tract infections were commonly reported, occurring in more than 17% of women during their pregnancy. Placenta disorders and PROM were each reported by approximately 6% of women. Poverty and race had independent effects on each of the pregnancy complications examined. Fewer than half of the women who experienced these pregnancy complications were hospitalized. Conclusions Pregnancy complications are common and not adequately measured by hospitalizations alone. Both more research and improved surveillance are needed to understand the effect of pregnancy complications on women’s health and the reasons for the increased risk among poor or black women. [ABSTRACT FROM AUTHOR]

AbstractObjectives:The interaction between inflammation and transepithelial Na+transport is poorly understood. Chorioamnionitis has been shown to be associated with preterm labor and postnatal pulmonary morbidity of preterm infants. The human isoform of serum and glucocorticoid-inducible kinase (SGK1) is upregulated by proinflammatory cytokines and stimulates epithelial Na+channel ENaC and the Na+/K+-ATPase activity, an effect presumably participating in the regulation of transepithelial Na+transport. Study Design:Lung tissue sections from 31 stillborn fetuses (range 21–41 weeks of gestational age) with or without chorioamnionitis were analyzed. Macrophages, neutrophils and lymphocytes were stained immunohistochemically. In addition, in situ hybridization for the detection of SGK1 mRNA was performed in fetal lung tissue. Positively labeled cells were compared by semiquantitative assessment. Results:A marked influx of macrophages into the pulmonary tissue of fetuses exposed to intrauterine inflammation when compared to fetuses without exposure to chorioamnionitis was observed (p < 0.05). There was also a tendency towards an increased density of neutrophils in fetuses exposed to chorioamnionitis. However, only small numbers of lymphocytes were detected in both groups. In fetuses exposed to chorioamnionitis, 6 of 8 fetuses did not express SGK1; however, in the group of fetuses without exposure to intrauterine inflammation 15 of 23 cases exhibited a profound SGK1 detection rate in lung tissue and airway epithelium, independent of the gestational age of the fetuses (p < 0.05). Conclusions:Human serine threonine kinase SGK1 mRNA is observed in fetal lung tissue. On the basis of this study, we speculate that exposure to chorioamnionitis is associated with a downregulation of SGK1 in fetal lung tissue. The possible consequences of a decreased rate of SGK1 mRNA could be an impaired ability to clear the lungs from excessive fluid immediately after preterm birth.Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

The aetiology of amniotic band syndrome (ABS) (Streeter's dysplasia, ADAM complex, amniotic deformities, adhesion, mutilation, amniotic band sequence, the amniotic disruption complex, annular grooves, congenital amputation, congenital constriction bands, transverse terminal defects of limb, aberrant tissue bands and amniochorionic mesoblastic fibrous strings amniotic bands) can present a wide range of clinical entities. The reported case concerns monochorionic, diamniotic twins with ABS at exactly the same site, which is extremely rare, raising questions about the aetiology of ABS. The twins had suffered from twin to twin transfusion syndrome (TTTS), where intra-uterine laser therapy had been performed at 20 weeks. [ABSTRACT FROM AUTHOR]

Background: Second trimester emergency cerclage is an option for pregnant women presenting bulging fetal membranes. Despite a significant prolongation of pregnancy might be achieved, serious fetal and maternal events have been reported. Exclusion of infections through preprocedure amniocentesis has been proposed. Methods: A 37-year-old woman, gravida 4 para 1, was admitted at 21 weeks of gestation to our University Hospital due to bulging fetal membranes. An amniocentesis was performed in order to exclude an actual amniotic infection. Our Microbiology Department found a negative amniotic culture for bacteria and Mycoplasma and a normal glucose and interleukin-6 level, so a cervical cerclage was performed. The patient was discharged home on oral erythromycin. Results: After 48 h, the patient complained of hyperpyrexia, shivers and reduced fetal movements. Ultrasound at admission showed absent cardiac activity and after cerclage removal a non-viable fetus was delivered vaginally. Piperacillin and tazobactam were started, but the clinical course of the patient deteriorated and she developed a cold septic shock and was submitted to hysterectomy and transferred to the ICU of our hospital. Conclusion: This report heralds that even after negative amniocentesis, a life-threatening infection may not be excluded in women candidate for emergency cerclage due to bulging fetal membranes. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: We measured circulating ADMA concentrations in a group of very premature newborns at birth and during the first week of life. ADMA levels resulted significantly higher in infants born to mothers with histologic chorioamnionitis than in infants delivered for other maternal or fetal indications, both at birth and through the first week of life. We speculate that ADMA might be involved in the complex biological events associated with fetal exposure to chorioamnionitis. [ABSTRACT FROM AUTHOR]

The article discusses the benefits of vitamin E in pregnant women. It mentions that vitamin E has an antioxidant properties that decrease oxidative stress within the body. It notes that Vitamin E supplementation in newborns increased oxidative stress that has been linked to pre-eclampsia, intrauterine growth restriction and premature rupture of membrane (PROM).

The article describes the case of hydroallantois in a Jafarabadi buffalo in its 4th gestation. Hydoallantois or dropsy of allantois is a sporadic pathological condition of dairy cattle and buffaloes affecting late gestation. Other topics covered include the medical history of the animal, clinical findings and disease management.

Septic Metritis in bovines were studied in six crossbred cows which were reported with recent calving, continuous straining and expulsion of foul smelling mucopurulent discharge from vagina. All six animals showed elevated temperature, increased respiration, anorexia, drop in milk production and painful defecation and urination. The cases were diagnosed as septic metritis, sequalae to retention of foetal membrane. All animals were successfully treated with systematic and intrauterine antibiotics and other supportive drugs. The animals recovered completely after treatment. [ABSTRACT FROM AUTHOR]

The article presents a case study of a two-year-old Awassi ewe who was brought to the clinic of University of Mosul's College of Veterinary Medicine due to dystocia. Vaginal examinations showed that the cervix of the ewe was dilated and the fetal membranes ruptured. Two tablets of misoprostol dissolved in 10ml of saline solution were administered to treat the dilated cervix of the ewe. Caesarian section was applied to deliver the second lamb of the ewe.

The article discusses a study on the novel role for transcription factors in fetal membrane rupture conducted by Martha Lappas and colleagues published within the issue. The authors of the study suggest that membrane rupture during labor may be influenced by forkhead box transcription factors (FOX-O). Based on the results of the study, regulating cell death and initiating labor may be caused by FOX-O proteins (FOX-O1).

An abstract of the article "To screen fetal major abnormalities early by sequential planes NT ultrasound at 12+3?13+6 week" by W. Song is presented.

An abstract of the article "Fluorescence in situ hybridization for identification of microorganisms in acute chorioamnionitis" by D. Schmiedel, J. Kikhney, J. Masseck, P. D. Rojas Mencias, J. Schulze, A. Petrich, A. Thomas, W. Henrich and A. Moter is presented.

Abstract: The objective of the study was to find out if human amniotic membrane could be used for corrective surgery after trauma to the orbital wall. Because of its proposed antiadhesive qualities, it seemed to be potentially suitable. We studied 8 men (mean age 37 (range 19–74) years) who had deficient ocular movement after fractures of the orbital floor. Five of them had already been operated on. Inclusion criteria were trauma dating back more than 4 months and a soft tissue stricture in the orbital floor diagnosed by magnetic resonance imaging. Patients were treated secondarily with lysis of adhesions and insertion of allogeneic human amniotic membrane laminated on to polyglactin 910/polydioxanone foil, which functioned as the carrier material. Patients were followed up for 3 months, by which time disorders of motility of the ocular bulb had disappeared completely in 5. Two patients had improved motility and a reduction in both their subjective and objective symptoms. One patient had no improvement. The considerable reduction in adhesions and scarring after insertion of the membrane confirms previous assumptions, according to which the epithelial side of the human amniotic membrane has an antiadhesive effect because of its smooth surface. [Copyright &y& Elsevier]

Objective: We sought to determine if children born preterm and exposed to chorioamnionitis have differences in brain structure measured at 6-10 years of age using magnetic resonance imaging (MRI). Study Design: Structural MRI was performed with 11 preterm children (8.5 ± 1.7 years) with chorioamnionitis and 16 preterm children (8.7 ± 1.4 years) without chorioamnionitis. Cortical surface reconstruction and volumetric segmentation were performed with FreeSurfer image analysis software. Subcortical structures were analyzed using multivariate analysis. Results: Widespread regional differences in cortical thickness were observed. With chorioamnionitis, the frontal and temporal lobes were primarily affected by decreased cortical thickness, and the limbic, parietal, and occipital lobes were primarily affected by increased cortical thickness when compared to the comparison group. Subcortical differences were observed in the hippocampus and lateral ventricle. Conclusion: Using MRI, chorioamnionitis is associated with long-term widespread regional effects on brain development in children born prematurely. Our study is limited by its small sample size. [ABSTRACT FROM AUTHOR]

Objective: This study was aimed at assessing the role of leptin on human myometrium, by studying its receptor expression in pregnant myometrium and the interaction of leptin with inflammation-induced apoptosis. Study Design: Myometrial samples were obtained from women with uncomplicated pregnancies who underwent cesarean delivery at term before labor onset. The effect of leptin on apoptosis was assessed by the incubation of myometrial strips with leptin (10–10 to 10–8 mol/L; 48 hours) before lipopolysaccharide treatment (10 μg/mL; 48 hours). Results: Long and short leptin receptor isoforms were expressed in myometrial cells of pregnant women. Leptin prevented lipopolysaccharide-induced apoptosis, in a concentration-dependent manner, by down-regulating cleaved caspase-3 and BCL2–associated X protein and up-regulating BCL2 expression. This effect was mediated specifically through leptin receptor stimulation, followed by ERK1/2 signaling pathway activation. Conclusion: These results suggest a new potential pathway that is involved in delivery disorders of obese women and propose a role for the leptin-induced inhibition of myometrial apoptosis in the development of such disorders. [ABSTRACT FROM AUTHOR]