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Abstract: Objectives: To verify the effect of vibroacoustic stimulation on biophysical profile score, with a prospective randomised study. Study design: All women with singleton pregnancy, gestational age ≥30 weeks, intact membranes and biophysical profile score ≤8/10 entered the study, after giving written consent, and were randomised to two groups. In group A, a 3-s stimulus with an artificial larynx was applied; if biophysical profile remained abnormal for 30 min, a second stimulus was applied and it was assessed again. In group B, the observation time was extended for 60 min to match the time periods of group A. Pregnancies were managed by final test score and patients delivering more than 24 h apart from last examination were disregarded from the study. Outcome criteria were intrauterine deaths, caesarean sections for fetal distress, Apgar score <7 at 5 min postpartum, meconium-stained amniotic fluid and neonatal intensive care unit admissions. Our null hypothesis was that application of vibroacoustic stimulation does not alter test''s statistical parameters. Results: 1349 patients were randomised in group A and 1484 in group B (2833 in total). When comparing group A to B, application of vibroacoustic stimulation significantly decreased the number of positive tests (4.74% vs. 6.67%, p <0.05) and increased the prevalence of outcome criteria in this subgroup (positive likelihood ratio: 24.1 95% CI: 11.12–52.46 vs. 7.52 95% CI: 4.93–11.46), without altering perinatal outcome. Furthermore, specificity, positive predictive value and test accuracy were significantly improved, as well as negative predictive value for intrauterine death. Conclusion: Vibroacoustic stimulation improves the efficiency of biophysical profile score by decreasing false positive tests and improving test accuracy and should be considered as a means of a more thorough fetal evaluation when fetal compromise is suspected. [Copyright &y& Elsevier]

Abstract: Objective: To assess the effect of selected maternal medical conditions and complications of pregnancy on the risk for morbidity among late preterm neonates. Design: Prospective cohort study. Material and methods: A total of 548 late preterm neonates (340/7 to 366/7 weeks'' gestation) delivered from August 2006 to July 2009, were included. Information regarding demographics, gestational age, mode of delivery, maternal age and parity, pre-existing medical conditions and complications of pregnancy were obtained and associated with neonatal morbidity, both independently and as joint exposures. Newborn morbidity was defined by combining specific diagnoses, length of hospital stay, and transfer to the Neonatal Intensive Care Unit. Results: Overall, 165 (30.1%) of the late preterm infants suffered from morbidity. The morbidity rates were 16.8% at 36weeks'' gestation, and then approximately doubled from 38.2% at 35weeks to 59.7% at 34weeks. The joint effect of gestational age (OR 8.43 for 34weeks and 3.60 for 35weeks'' gestation), small for gestational age (SGA) (OR 4.18), multiple gestation (OR 3.68) and lack of antenatal steroid administration (OR 4.03), was greater than the independent effect of each of these factors, and greater than additive. Emergency caesarean section (OR 1.43) and antepartum haemorrhage (OR 3.07) were also associated with a significant impact on neonatal morbidity. Conclusions: The risk for morbidity among late preterm infants, changes with each passing week of gestation. This risk seems to be intensified, when other exposures such as SGA, multiple gestation, emergency caesarean section, lack of antenatal steroid administration and antepartum haemorrhage, are also present. [Copyright &y& Elsevier]

Abstract: Objective: To assess total, active and active to total serum ghrelin ratio in normal weight women with polycystic ovary syndrome (PCOS) and in healthy ovulatory control women.Study design: The study included 50 normal weight women with PCOS with a mean age of 23.70±4.99 years and 10 control women with a mean age of 30±5.80 years. The diagnosis of PCOS was based on the presence of biochemical hyperandrogenemia, chronic anovulation and polycystic ovarian morphology according to the Rotterdam ESHRE/ASRM-sponsored PCOS Consensus Workshop Group. Serum total and active ghrelin were measured by RIA, using commercially available kits. Results: A significantly lower serum active/total ghrelin ratio was noted in the more severe form of PCOS with hyperandrogenemia, chronic anovulation and polycystic ovarian morphology. Both total and active serum ghrelin levels were negatively correlated to hirsutism score, to plasma glucose levels and to QUICKI and HOMA-IR indices of Insulin Resistance. A statistically significant difference was detected between the more severe and the milder forms of PCOS, concerning serum levels of total ghrelin (p =0.017), active ghrelin (p =0.007) and the active/total ghrelin ratio (p =0.026). Conclusions: The results of the present study demonstrate an altered active to total ghrelin ratio, as well as a tendency towards lower both total and active fasting serum ghrelin levels in normal weight PCOS, more pronounced in the more severe forms of the syndrome. [Copyright &y& Elsevier]

Objective: To evaluate the association of an activating single-nucleotide polymorphism (SNP) at position −71 of the promoter of 17β-hydroxysteroid dehydrogenase type 5 gene (−71A/G HSD17B5 SNP) and polycystic ovary syndrome (PCOS) in a well characterized cohort of caucasian PCOS women with biochemical hyperandrogenemia. Design: The PCOS patients and unrelated healthy control subjects were genotyped for the −71A/G HSD17B5 SNP. The acquired genotypic data was tested for association with PCOS and other quantitative phenotypic traits of the syndrome in PCOS patients. Setting: Subjects were recruited from the Division of Reproductive Endocrinology, Department of Obstetrics and Gynecology, at the University Hospital of Patras, Greece. Genotyping and biochemical determinations took place at the Laboratory of Molecular Endrocinology, University of Patras Medical School, Rion, Greece. Patient(s): Participants comprised 150 caucasian Greek PCOS women with biochemical hyperandrogenism and chronic anovulation and polycystic ovarian morphology on ultrasound and 51 healthy control subjects. Main Outcome Measure(s): HSD17B5 genotype, serum testosterone, serum androstenedione. Result(s): No association of the −71A/G HSD17B5 SNP with PCOS was detected. However, the −71G HSD17B5 variant was associated with increased serum testosterone levels and decreased androstenedione/testosterone ratio. Conclusion(s): The −71G HSD17B5 variant is not a major component of the molecular pathogenetic mechanisms of PCOS, although it might contribute to the severity of hyperandrogenemia in women with PCOS and biochemical hyperandrogenism. [Copyright &y& Elsevier]

Objective: To evaluate basal metabolic rate (BMR) in women with PCOS and to determine its association with insulin resistance (IR). Design: Prospective assessment of BMR in women with PCOS. Setting: Outpatient clinic of the Division of Reproductive Endocrinology. Patient(s): The study included 91 Greek women with PCOS and biochemical hyperandrogenemia, with mean age 24.03 ± 0.55 years and mean body mass index (BMI) 26.67 ± 0.69 kg/m2, and 48 matched regularly menstruating women, with mean age 26.33 ± 0.93 years and mean BMI 23.35 ± 0.85 kg/m2, as control subjects. Intervention(s): Assessment of BMR by indirect calorimetry, IR by HOMA and QUICKI indices, fasting insulin, and fasting glucose/insulin ratio. Main Outcome Measure(s): Reduced BMR in PCOS with or without IR. Result(s): Adjusted BMR was 1,868 ± 41 kcal/day in the control group, 1,445.57 ± 76 in all PCOS women, 1,590 ± 130 in PCOS women without IR and 1,116 ± 106 in PCOS women with IR. Adjusted BMR showed a statistically significant difference between women with PCOS and control subjects, with lowest values in the group of PCOS women with IR, even after adjusting all groups for age and BMI. Conclusion(s): Women with PCOS, particularly those with IR, present a significantly decreased BMR. [Copyright &y& Elsevier]

Abstract: Hemangiomas of the umbilical cord are extremely rare benign vascular tumors, not always detected prenatally. They have been associated with increased alpha-fetoprotein (AFP), hydramnios, congenital anomalies, and increased perinatal mortality. Impaired umbilical circulation has been proposed as the predisposing factor for fetal compromise. We report a case of an antenatally detected umbilical cord hemangioma with one artery crossing the tumor, and we reviewed the literature. Close surveillance with Doppler flow studies of the umbilical vessels were carried out throughout the pregnancy. All indices were normal, except from the intra-tumoral part of the umbilical artery under discussion that showed increasing resistance from 32 weeks onwards. Our review confirmed the reported association with increased AFP and hydramnios. The placental end of the cord was the preferred site of location, and the umbilical artery the commonest vessel of origin. Association with cutaneous vascular malformations, and single umbilical artery were assessed. [Copyright &y& Elsevier]

Abstract: Objective: The purpose of this prospective study was to record endothelin-1 (ET-1) concentrations in the second trimester amniotic fluid and compare these values in women who developed intrauterine growth restriction (IUGR) later in pregnancy with those with uneventful pregnancies. Method: Amniotic fluid was retrieved by amniocentesis from 125 women in the second trimester of pregnancy. The levels of ET1 were measured by a sensitive and specific radioimmunoassay. Results: From the 125 women included in the study 12 had pregnancies that later developed IUGR and 88 had uneventful pregnancies. The ET1 concentration was significantly higher (P <0.005) in women who later developed IUGR than in normal pregnancy (106pg/ml versus 64.7pg/ml). Conclusion: The amniotic fluid concentration of ET1 is elevated by the second trimester in women who later develop IUGR. [Copyright &y& Elsevier]