Role of apoptosis and fas expression in premature rupture of membranes

To examine the degree of apoptosis [programmed cell death] and to evaluate Fas [a cell surface receptor] receptor expressmon in human fetal membranes associated with premature rupture of membrane [PROM] as compared with normal pregnancies. Fetal membranes from 60 pregnancies were included in the study. Forty of 60 pregnancies had PROM. Twenty pregnancies with intact membranes served as controls. Chorioamniotic membrane biopsies were taken from the rupture site and periphery of the rupture site. In the control group, membrane biopsies were taken from the artificial rupture site, cervical pole of the membranes close1to the edge of the placenta. Samples were fixed in neutral buffered formalin and processed for paraffin embedded tissue. Sections were prepared for morphometric measurement and immunohistochemistry evaluation using Fas receptor expression. Patients with PROM showed reduction of the chorionic thickness [P<0.001] while decidual thickness showed non-significant difference versus control group [p>0.13]. Apoptotic cells were detected predominantly in the chorioaznniotic membrane, including the trophoblastic layer, and decidua. There was a statistically significant difference between the apoptotis [represented by Fas expression] of the PROM and control groups in both the rupture and peripheral sites [P<0.05]. Of the 40 cases that could be evaluated after immunohistochemical staining, Fas expression of the amniotic epithelial cells was observed in 40% of control cases and in 60% of cases with PROM. Fas expression was noticed to be increased in association with PROM group [p=0.0001] as well as with reduction of the chorionic thickness [p=0.001]. Negative Fas expression was noticed to be associated with increased thickness of the. chorionic layer. Fas receptor mediated apoptosis-has a role.in premature rupture of fetal membranes

Is chlamydia pneumoniae infection a major risk factor for preeclampsia?

To study whether preeclampsia is related to seroprevalence of immunoglobulins [Ig]G and M antibodies to Chlamydia pneumoniae, which is believed to be involved in the endothelial injury that marks atherosclerosis. Cross-sectional comparisons were made for 50 women with preeclampsia and 30 women with normal pregnancies at term. In these two groups, antibodies titers for IgG and IgM seroprevalence to C pneumoniae were compared. A titer of at least 1:16 was considered positive for IgG, where as a titer of at least 1:10 was considered positive for IgM. Odds ratios were the main measure used for the comparison. Immunoglobulin G antibodies to C pneumoniae at a titer of at least 1:16 were more common in women with preeclampsia [34 of 50, 68%] than in women with normal pregnancies [13 of 30, 43.3%], which is statistically significant [P<0.05]; [odds ratio 3.1; 95% confidence interval 1.2, 7.9]. This suggested a specific association between preeclampsia and Chlamydia pneumoniae that has been associated with atherosclerosis. However, positive titers for C pneumoniae IgM were not significantly more likely among preeclamptic women [3 preeclamptic women compared to no women with normal pregnancy]. At a cut off of 1:16, the risk of seropositivity to C pneumoniae was 3.1 [95% confidence interval 1.2, 7.9]. Odds ratios for antibody titers of 1:16 or 1:64, and at least 1:128 were 4.6, 3.1, and 2.6, respectively. This indicates a lack of higher risk of preeclampsia with higher titers of IgG antibodies to C pneumoniae. women with preeclampsia had an increased IgG seroprevalence to C pneumoniae. These preliminary data suggest a specific association between infection with Chlamydia pneumoniae and preeclampsia

Prediction of intrauterine growth restriction with customized estimated fetal weight centiles

1-To determine the value of third trimester customized estimated fetal weight centile ranking in the prediction of' infants born with anthropometric features of intrauterine growth restriction [IUGR]. 2-To compare the performance of customized centiles with fetal growth velocity in the prediction of IUGR. Prospective observational study. Two hundred women with low risk pregnancy were enrolled in this study. Third trimester estimated fetal weight customized centiles were obtained after adjustment for gestational age at the time of ultrasound measurements: biparietal diameter [BPD], femur length [FL], fetal abdominal circumference [AC], H/A ratio, F/A ratio, and estimated fetal weight [EFW]. Fetal growth velocity was calculated using the increment in the fetal abdominal area over a mean 28-day interval. [Fetal abdominal area growth velocity was expressed as a standard deviation [Z score]]. Receiver Operator Characteristics curves employed to determine an optimal cut off point for velocity to predict IUGR fetus. After delivery all neonates were subjected to the following anthropometric measurements: fetal body weight, length, head circumference, mid-arm circumference, and triceps and subscapular skin fold thickness. Gestational age was assessed using Ballard scoring system. Ponderal index [PI] was calculated and velocity standard deviation [Velocity Z score] was determined for BPD, AC and FL. The neonatal anthropometric measures were used to define IUGR: subscapular or triceps skin-fold thickness<10th centile, PI<25th centile, mid-ami circumference to occipito-frontal circumference<-1SD. The ability of estimated fetal weight customized centiles<5th centile and cloth centile to identi and growth restriction was determined by calculating likelihood ratios. Sixteen [8%] and eight [4%] infants had adjusted birth weights below the 10th and 5th centiles, respectively. 30 infants had one or both skinfold thickness measurements below the 10th centile, 36 had a ponderal index below the 25th centile and 16 had mid-arm circumference to occipito-frontal circumference<-1SD. The mean and range of estimated fetal weight [EFW] customized centiles was 39.3 [0.6-99.8]; the mean and range of interval between gestational age at calculation of the EFW customized centiles and delivery was 12 days [0-60]. The customized EFW centile of 5 or less had likelihood ratios [95% CI] of 4.9 [2.7-6.3], 6.8 [4.5-10.6] and 62 [17-14] for skinfold thickness<10th centile, ponderal index<25th centile and mid-arm circumference to occipito-frontal circumference<-1 SD, respectively. An EFW customized centile of 10 or less had likelihood ratios of 405 [2.6-8.6], 4.1 [2.5-7.2] and 7.1[3.5-24] for skinfold thickness<10th centile, ponderal index<25th centile and mid-arm circumference to occipitofrontal circumference<-1 SD, respectively. In the prediction of a ponderal index<25th centile, the fetal abdominal area velocity likelihood ratio for a positive test is higher than the likelihood ratio for the 10th EFW centile [r=0.04] but is not significantly higherforthe other outcomes. Serial ultrasound fetal abdominal circumference measurement is a good indicator for IUGR. Skin fold measurement and neonatal ponderal index are better indicators for IUGR than do birth weight alone. So for better detection of IUGR cases, serial ultrasound measurement during pregnancy even in low risk population is needed to pick up probably growth retarded infants, so possible fetal and/or neonatal complications could be dealt with

Evaluation of different techniques in diagnosing chlamydial endocervical infection among Egyptian females

To detect the prevalence of Chlamydia. Trachomatis infection symptomatic and asymptomatic in Egyptian females and to evaluate the diagnostic utility of polymerase chain reaction [PCR], direct immunofluorescence technique [DIF], and enzyme-linked immunosorbent assay [ELISA] for detection of C, Trachomatis DNA, antigen and antibody respectively. The study included 70 females who have been classified into: 20 patients with tubal infertility, 15 patients with ectopic pregnancy, 20 patients with premature rupture of membrane [PROM] and 15 apparently healthy women [asymptomatic group]. Endocervical specimens, vaginal swab and 3 ml blood samples have been collected from all subjects and stored at -20[degree]C till being processed. PCR, DIF and ELISA techniques have been done to detect C. Trachomatis DNA, antigen and antibody respectively. C. Trachomatis DNA was detected by PCR in the endocervix of 17 out of 55 infected cases [30.9 %]. However DIF technique was positive for 21.6% of patient groups and 13.3% of asymptomatic group. The tubal infertility group showed the highest percentage of active C. Trachomatis infection [45%] [P<0.05] PCR showed better sensitivity than DIF for detection of C. Trachomatis infection [96.2% versus 70% respectively], however both techniques had 100% specificity. Tubal infertility group showed highest sero prevalence [45%], followed by ectopic pregnancy group [35%] [P= 0.001 and P<0.05 respectively]. PCR procedure is suitable for confirmation of ELISA results in high-volume laboratories. Cost, experience of the laboratory personnel and the patient well-being must be taken into account to select the test for the detection of C.Trachomatis infections

Female genital schistosomiasis: prevalence disease associated morbidity and intensity of infection as detected by soluble egg antigen in urine

This study was done to assess the prevalence and morbidity pattern of S. haematobium infection in women of reproductive age [15 - 45 years] in schistosomiasis endemic area. One hundered and eighty women involved in this study and grouped as follows: group I: women with proven femal genital schistosomiasis [FGS] [n = 80], group II: endemic referents [n = 80] and group III: women living in schistosomiasis-free area [n= 20] serve as controls. Full history, general gynaecological and parasitological examinations were done to every women, a s and wich ELISA was carried to detect soluble egg antigen [SEA] in urine of all cases.Evaluation of the applicability of this assay as a diagnostic and morbidity indicator was done. revealed that significantly more FGS reported a history of spontaneous abortion [P < 0.01], complaints of irregular menstruation [P < 0.001], pelvic pain [P < 0.01] vaginal discharge [P < 0.0001], dysuria [P < 0.01] and haematuria [P < 0.0001] than in the referents. Biopsies were taken from the cervix of 80 women with macroscopical lesions and from them 24 cases, S. haematobium eggs were found by histological sectioning [30%]. In the control group [referents] no eggs were detected in the cervical biopsies of 10 of them [50%]. Infections with C and ida albicans, Trichomonas vaginalis were found in similar frequencies in all groups. Ecographic abnormalities of the urinary tract were present in 24% and 0% of the infected women and referents respectively. These findings were accompanied by an elevated frequency of haematuria [55.6% versus 10%] and proteinuria [70% versus 20%] in the FGS and referent groups. Our study indicates that S. haematobium infection in women may not only cause symptoms in the urinary tract but also frequently in the lower reproductive tract [LRT]. SEA levels in urine of S haematobium infected women significantly correlated with egg counts and with clinical findings [P < 0.001]. In addition lower genital tract pathology as determined by cervical smear and biopsy significantly correlated with the SEA levels in urine