Single versus multiple courses of antenatal corticosteroids in pre-term rupture of membranes: risks and benefits

This is a prospective randomized study comparing single versus multiple courses of antenatal corticosteroids in women with preterm premature rupture of membranes [PPROM] as regard the potential benefit and risk. The study was conducted in Ain Shams maternity hospital in the period from January through July 2002. 52 women with established diagnosis of PPROM with gestational age ranging from 26 to 34 weeks were recruited and divided into two groups. The first group received single course of dexamethasone while the second group received weekly courses of dexamethasone. All patients were assessed regularly for laboratory and clinical evidence, of infection as well as tests for fetal well being. After delivery the placenta and membranes were examined for histological evidence of Chorioamnionitis and the neonates assessed for neonatal sepsis. Fetal outcome and the need for assisted ventilation were compared in both groups. The incidence of neonatal infection was higher among repeated course group while in Chorioamnionitis, the need for assisted ventilation was not statistically different. single course is as effective as repeated courses with less risk of neonatal sepsis

Antiphospholipid antibodies enhance monocyte procoagulant activity in primary antiphospholipid syndrome

Fifty cases with unexplained recurrent fetal loss were examined for antiphospholipid antibodies [APA] both by phospholipid-dependent coagulation tests to detect lupus anticoagulant [LA], and by a specific enzyme -linked immunosorbent assay [ELISA]. 18 patients were APA+ve : 6 [12%] by coagulation tests [LA+ve] and 12 [24%] by ELISA. Mononuclear cells were isolated from normal healthy volunteers by Ficoll-hypaque and cultured in RPMI-1640 medium [2 x 10[6] cells/ml]. LA+ve plasma, ELISA+ve plasma, and APA-ve control plasma were incubated with cultured cells for 4 hours in presence of lipopolysaccharide [LPS] at a concentration of 100 ng/ml. Significantly higher monocyte procoagulant activity [PCA] was induced by LA+ve and ELISA+ve plasma than by control APA-ve plasma. Immunoglobulin G [IgG] proteins were isolated from patient and control sera by anion exchange chromatography [DEAE Sephadex A50]and were incubated with cultured mononuclear cells under the same conditions. Antiphospholipid IgG [n = 5] induced significantly higher levels of PCA than control IgG [n = 6]. The stimulating effect of APA +ve plasma and antiphospholipid IgG on PCA was not detected in absence of LPS and was dependent on the presence of factor VII, but not factor IX, in the one stage clotting assay of PCA. This indicates that antiphispholipid antibodies probably increase monocyte PCA by enhancing the LPS-stimulated expression of tissue factor [TF]