Bovine abortion by a vaccine strain of Bacillus anthracis / Aborto bovino por uma cepa vacinal de Bacillus anthracis

ABSTRACT: This paper reports the abortion of a male Aberdeen Angus bovine by a vaccine strain of Bacillus anthracis, describing the pathological and microbiological findings and the genome sequence. Necropsy findings included multifocal areas of hemorrhage in different organs. Histologically, various organs showed hemorrhage, fibrin exudation, necrosis associated with countless bacillary bacterial clumps and severe neutrophilic inflammatory infiltrate. In the microbiological examination, numerous rough, nonhemolytic, gray and dry colonies with irregular edges were isolated from liver, lung and abomasum content samples. Gram staining revealed square-ended Gram-positive rods arranged in chains. B. anthracis identification was confirmed by detection of the molecular chromosomal marker Ba813. The genomes from the isolated B. anthracis (named SPV842_15) and from the isolated vaccinal strain (Brazilian vaccinal strain), which was recovered from a commercial vaccine used in the pregnant cow, were sequenced. Genomic comparisons displayed a high level of nucleotide identity in the comparisons between B. anthracis SPV842_15 and the B. anthracis Brazilian vaccinal strain (98,2%). Furthermore, in both strains, only the plasmid pX01 sequence was detected. Although, vaccination against anthrax is characterized by an elevated protective profile and very low residual virulence, immunization with Sterne strains can cause abortion in cattle, presumably by the plasmid pX01 toxins in rare or special situations.

RESUMO: Este trabalho relata um aborto de um bovino, macho, Aberdeen Angus, por uma cepa vacinal de Bacillus anthracis, descreve os achados patológicos, microbiológicos e o sequenciamento do genoma. Os achados de necropsia incluíram áreas multifocais de hemorragias em diferentes órgãos. Histologicamente, órgãos afetados apresentaram hemorragia, exsudação de fibrina, necrose associada a miríades bacterianas bacilares e intenso infiltrado inflamatório neutrofílico. No exame microbiológico, foram isoladas numerosas colônias rugosas, não hemolíticas, cinzas e secas, com bordas irregulares a partir de amostras de fígado, pulmão e conteúdo do abomaso. A coloração de Gram revelou bastonetes Gram-positivos dispostos em cadeias. A identificação do B. anthracis foi confirmada pela detecção do marcador cromossômico molecular Ba813. Os genomas do isolado B. anthracis (SPV842_15) e do isolado vacinal (cepa vacinal brasileira), recuperado de uma vacina comercial utilizada na vaca prenhe, foram sequenciados. Comparações genômicas mostraram um elevado nível de identidade de nucleotídeos entre B. anthracis SPV842_15 e cepa vacinal brasileira (98,2%). Além disso, em ambas as estirpes foi detectada apenas a sequência do plasmídeo pX01. Embora a vacinação contra o antraz seja caracterizada por um perfil protetor elevado e uma virulência residual muito baixa, a imunização com estirpes de Sterne pode causar aborto em bovinos, presumivelmente pelas toxinas do plasmídeo pX01 em situações raras ou específicas.

Bovine abortion associated with Staphylococcus aureus infection - characterization of S. aureus strain isolated from fetal tissues / Aborto bovino associado à infecção por Staphylococcus aureus - caracterização da cepa de S. aureus isolada a partir de tecidos fetais

ABSTRACT: Staphylococcus aureus is a gram-positive bacterium, commonly found colonizing the skin and mucous membranes of humans and animals. This report describes a case of fetal loss associated with S. aureus infection in a cow. A six-month old, crossbred male bovine fetus from a beef farm was submitted for necropsy. At gross examination fibrinous pleuropneumonia was observed. Histologically, lesions were restricted to the lungs and consisted of marked multifocal to coalescing areas of inflammatory infiltrate of neutrophils, abundant fibrin exudation, necrosis of bronchiolar epithelium and numerous aggregates of coccoid bacteria. Lung and abomasal fluid bacterial culture yielded pure culture of S. aureus, which was characterized as a multidrug resistant strain. Molecular analysis indicated that the studied strain presented several genes of virulence factors including toxic shock syndrome toxin-1 (tst), staphylococcal enterotoxin type A (sea), Panton-Valentine leukocidin (pvl), alpha-hemolysin (hla) and delta-hemolysin (hld). This report documents an infrequent case of fetal loss in cattle due to infection with a highly virulent S. aureus strain.

RESUMO: Staphylococcus aureus é uma bactéria gram-positiva, comumente encontrada colonizando a pele e as membranas mucosas de humanos e animais. O presente relato descreve um caso de aborto bovino associado à infecção por S. aureus. Um feto bovino, macho, cruzado, com seis meses de idade gestacional proveniente de uma fazenda de gado de corte foi submetido para a necropsia. Pleuropneumonia supurativa foi observada na avaliação macroscópica. Histologicamente as lesões encontravam-se restritas aos pulmões e eram representadas por infiltrado inflamatório acentuado, multifocal a coalescente de neutrófilos, acentuada exsudação de fibrina, necrose do epitélio bronquiolar e numerosos agregados bacterianos cocoides. A cultura bacteriana de fragmento de pulmão e líquido do abomaso revelou o crescimento puro de S. aureus, que foi caracterizado como uma cepa multirresistente a drogas. Análises moleculares indicaram que a cepa estudada apresentava vários fatores de virulência, incluindo toxina 1 da síndrome do choque tóxico (TSST-1), enterotoxina estafilocócica tipo A (sea), leucocidina Panton-Valentine (pvl), hemolisina alfa (hla) e hemolisina delta (hld). O presente relato documenta um caso infrequente de aborto bovino devido à infecção por uma cepa altamente virulenta de S. aureus.

Amniocentesis precoz y biopsia de vellosidad corial. Pérdidas fetales y anomalías congénitas en un grupo de gestantes brasileñas / Early amniocentesis and chorionic villus biopsy. Fetal losses and congenital anomalies in a group of Brazilian pregnant women

Resumen En el Instituto de Medicina Fetal y Genética Humana de São Paulo se ofrecen, a las gestantes que tienen un riesgo aumentado para anomalías cromosómicas, diferentes técnicas, entre ellas, la Biopsia de Vellosidad Corial Transabdominal (BVCTA) y la Amniocentesis Precoz (AP). El objetivo del presente estudio es realizar una comparación de la frecuencia de pérdidas fetales y anomalías congénitas presentadas en cada uno de los procedimientos, ambos realizados por los mismos operadores, en la misma edad gestacional (12-14 6/7 semanas) y bajo un abordaje transabdominal. Fueron analizadas retrospectivamente 432 AP y 418 BVCTA. Todos los procedimientos de colecta fueron monitorizados por ultrasonografía. La frecuencia de pérdidas fetales espontáneas fue del 4,9 % en AP y de 5,3 % en BVCTA, una diferencia no significativa. No se encontraron diferencias significativas entre los dos procedimientos al comparar las frecuencias de pérdidas en cada semana de gestación. Sangrado y pérdida de líquido amniótico fueron más frecuentes en AP que en la BVCTA. Esa diferencia fue significativa en el caso de la pérdida de líquido amniótico. En algunos casos este hallazgo se relacionó con pérdida fetal. La incidencia de prematuridad y bajo peso al nacimiento no difirió significativamente entre los dos procedimientos. La mayor frecuencia de problemas respiratorios registrada en AP no fue significativa en comparación con BVCTA. No se observó diferencia significativa en la incidencia de anomalías músculo-esqueléticas. La amniocentesis después de catorce semanas presenta un bajo riesgo de pérdida fetal o anomalías congénitas. La BVCTA, debe ser realizada alrededor de la semana doce de gestación.

Abstract In the Institute of Fetal Medicine and Human Genetics of São Paulo are offered, pregnant women have an increased risk for chromosomal abnormalities, different techniques, among them, Transabdominal Corial Vellosity Biopsy (BVCTA) and Precocious Amniocentesis (AP). The objective of this study is to compare the frequency of Hepatitis and congenital anomalies presented in all procedures, both performed by operators, in the same gestational age (12-14 6/7 weeks) and under a transabdominal approach. 432 AP and 418 BVCTA were analyzed retrospectively. All collection procedures were monitored by ultrasonography. The spontaneous fetal frequency was 4.9% in AP and 5.3% in BVCTA, a non-significant difference. There is no difference in results compared to gestation times. Bleeding and loss of amniotic fluid were more frequent in AP than in BVCTA. That difference was significant in the case of the loss of amniotic fluid. In some cases, this finding was related to fetal loss. The incidence of prematurity and birth weight without difference between the two procedures. The highest frequency of respiratory problems recorded in AP was not significant compared to BVCTA. There is no significant difference in the incidence of musculoskeletal abnormalities. Amniocentesis after 14 weeks presents a low risk of fetal loss or congenital anomalies. The BVCTA should be close to the twelfth week of gestation.

Resultados maternos y perinatales en mujeres con diabetes gestacional según criterios de pesquisa / Maternal and perinatal health in women with gestational diabetes research results according to criteria

OBJETIVO: Conocer los resultados maternos y perinatales de mujeres con diabetes gestacional diagnosticada según los Criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo y la Asociación Latinoamericana de Diabetes. MÉTODOS: Se estudiaron ciento veintidós embarazadas con diagnóstico de diabetes gestacional, aplicando los criterios Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo y Asociación Latinoamericana de Diabetes. Se compararon datos socio-demográficos, factores de riesgo para diabetes gestacional, parámetros clínicos y metabólicos durante el embarazo y la pesquisa posparto de diabetes en ambos grupos. Las determinaciones de glucemias de las pruebas de tolerancia oral a la glucosa se realizaron mediante el método enzimático. Se utilizó Chi cuadrado y t de Student para la asociación de variables. Se consideró significativo un valor de P < 0,05. RESULTADOS: Al usar los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo, el número de pacientes con diabetes gestacional aumentó 22,95 %. No hubo diferencias en cuanto a factores de riesgo para diabetes gestacional, resultados maternos y perinatales entre los dos grupos. En el grupo según los criterios Asociación Latinoamericana de Diabetes, las glucemias 2 horas poscarga en el posparto eran más altas (P< 0,02) y resultaron casos de prediabetes. CONCLUSIONES: Se incrementó la proporción de casos con diabetes gestacional, al emplear los criterios de la Asociación Internacional de Grupos de Estudio de Diabetes y Embarazo y se detectaron más alteraciones glucémicas maternas en el posparto con los criterios Asociación Latinoamericana de Diabetes. Se requieren investigaciones ulteriores, cuyos resultados puedan contribuir a las decisiones institucionales sobre los criterios para la pesquisa de diabetes gestacional.

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Posible transmisión vertical de virus de papiloma humano en niños cuyas madres presentan antecedentes de infección viral

Objetivo: Detección y tipificación de virus de papiloma humano en muestras de niños cuyas madres tienen historia asociada al virus. Métodos: Estudio transversal y descriptivo. Se procesaron 66 hisopados perianales de niños con un promedio de edad de 18 meses atendidos en el Servicio de Dermatología del Hospital Universitario de Caracas. La detección viral se realizó mediante PCR con iniciadores genéricos MY11 y MY09; la tipificación de las muestras positivas en la detección se llevó a cabo mediante PCR múltiple. Resultados: Se obtuvo un porcentaje de positividad de 54,5 % y se identificó VPH de bajo riesgo oncogénico en 47,2 %, ADN viral de alto riesgo en 13,88 % e infecciones mixtas con tipos de alto y bajo riesgo oncogénico en 5,55 % de las muestras positivas. El 33,33 % de estas muestras no pudo ser tipificado con la metodología utilizada. Conclusiones: Aunque no se tienen datos del tipo viral en las madres para hacer comparaciones con los tipos identificados en los niños, estos resultados ponen en evidencia la posible transmisión vertical del VPH, considerando los antecedentes maternos, la corta edad de los niños y que la condición de abuso sexual fue descartada. Es recomendable hacer el seguimiento de la población estudiada con la incorporación de la evaluación de muestras obtenidas de los padres.

Objective: Detection and typing of Human Papillomavirus in samples of children whose mothers have a history associated with the virus. Methods: Transversal and descriptive study. Perianal swabs of 66 children with an average age of 18 months treated in the Service of Dermatology, University Hospital of Caracas, were processed. Viral detection was performed by PCR with MY11 and MY09 generic primers; typing of positive samples was performed by multiplex PCR. Results: A positive percentage of 54.5 % was obtained and low oncogenic risk HPV identified in 47.2 %, high-risk viral DNA in 13.88 % and mixed infections with types of high and low oncogenic risk in 5.55 % of the positive samples. 33.33 % of these samples could not be typed with the used methodology. Conclusions: Although the viral type is unknown in mothers to make comparisons with the types identified in children, these results highlight the possible vertical transmission of HPV, considering maternal history, the young age of the children and that the condition of sexual abuse was ruled out. It is recommended to monitor the studied population including the evaluation of samples obtained from the parents.

Patrón clínico en gestantes con síndrome antifosfolipídico (SAF) / Clinical pattern in pregnant women with antiphospholipid syndrome (APS)

Objetivo: Describir las características epidemiológicas, clínicas y analíticas de gestantes portadoras del síndrome antifosfolipídico que fueron tratadas en la consulta de medicina interna durante el período 2001-2012. Métodos: Estudio de campo, descriptivo, longitudinal. La población que se estudió fue de 157 pacientes portadoras del síndrome antifosfolipídico, sin tomar en cuenta el criterio del intervalo de al menos 12 semanas para el diagnóstico definitivo. Resultados: Se identificaron como síndrome antifosfolipídico primario 143 pacientes, mientras que como secundario 14 pacientes. Ochenta y seis pacientes solo tuvieron títulos positivos de anticuerpos anticardiolipina, seguido de 62 pacientes con títulos positivos para anticuerpos anticardiolipinas y beta- 2glicoproteína-1, 4 con anticuerpos anticardiolipinas, beta-2glicoproteína-1 y anticoagulante lúpico positivos, 3 solo anticoagulante lúpico positivo y 2 solo beta-2glicoproteína-1 positivo. El tratamiento anticoagulante triple con heparina de bajo peso molecular más ácido acetilsalicílico y prednisona a bajas dosis fue el más frecuentemente utilizado en 99 pacientes. Conclusión: Además de un tratamiento adecuado, el control prenatal y la vigilancia materno-fetal estrecha fue la clave para obtener un resultado favorable en cuanto al bienestar y salud materno-fetal.

Objective: Describe characteristics epidemiological, clinical and analytical for pregnant carrying the antiphospholipid syndrome that were treated in internal medicine, period 2001-2012. Methods: Descriptive, longitudinal, non-experimental and field study. The population that was studied in 157 patients carrying the antiphospholipid syndrome, was not taken into account the criterion interval of at least 12 weeks for definitive diagnosis. Results: We identified 143 patients as primary antiphospholipid syndrome, secondary antiphosphilipid syndrome while as 14 patients. Eighty-six patients had only positive titers of anticardiolipin antibodies, followed 62 patients with positive titers for anticardiolipin antibodies and beta 2 glycoprotein 1, 4 with anticardiolipin antibodies and lupus anticoagulant, beta 2 glycoprotein 1 positive, 3 only lupus anticoagulant positive and 2 beta 2 glycoprotein 1 only positive. The triple anticoagulant therapy with low molecular weight heparin plus acetylsalicylic acid and low-dose prednisone was the most frequently used in 99 patients. Conclusion: In addition to proper treatment, prenatal and maternal-fetal monitoring closely a favorable result was obtained for the welfare and maternal and fetal health.

Comportamiento de anticardiolipinas en gestantes / Anticardiolipins behavior in pregnant

Objetivo: Evaluar los niveles de anticuerpos anticardiolipina en gestantes portadoras del síndrome antifosfolipídico que fueron tratadas en la consulta de medicina interna durante el período 2001-2012. Métodos: Estudio de campo, descriptivo, longitudinal. La población que se estudió fue de 86 pacientes portadoras del síndrome antifosfolipídico. No se tomó en cuenta el criterio del intervalo de al menos 12 semanas para el diagnóstico definitivo. Resultados: En relación con los niveles de IgM e IgG de anticuerpos anticardiolipinas el promedio más alto (30,98) y (19,62) predominó en el primer trimestre del embarazo. El nivel mayor de IgM que se evidenció fue 198, mientras que el menor fue 0,6 durante toda la gestación. Los anticuerpos IgM en el tercer trimestre disminuyeron en 55,81 % con respecto al primer trimestre. Conclusiones: A pesar de que los niveles de anticuerpos son impredecibles, en las últimas etapas de la gestación los anticuerpos anticardiolipinas IgM disminuyeron con respecto a las primeras etapas.

Objective: Evaluate the levels of anticardiolipin antibodies for pregnant carrying the antiphospholipid syndrome that were treated in internal medicine, period 2001-2012. Methods: A descriptive, longitudinal non-experimental and field study. The population studied was 86 patients carrying the SAF, did not take into account the criteria in the interval of at least 12 weeks for definitive diagnosis. Results: In relation to the levels of IgM and IgG anticardiolipin antibodies the highest average (30.98) and (19.62) prevailed in the first trimester of pregnancy. The higher level of IgM was 198, while the lowest was 0.6 during the entire pregnancy. IgM anticardiolipin antibodies in the third quarter decreased by 55.81 % over the first quarter. Conclusions: Although antibody levels are unpredictable, in the latter stages of gestation IgM anticardiolipin antibodies decreased with respect to the early stages.

Perdas fetais espontâneas e voluntárias no Brasil em 1999-2000: um estudo de fatores associados / Spontaneous and voluntary fetal losses in Brazil in 1999-2000: a study of associated factors

Apesar de ilegal no Brasil, cerca de 31% das gestações terminam em aborto. A maioria dos abortamentos provocados é realizada por pessoas não capacitadas, e em condições inseguras, resultando em aumento da mortalidade feminina. O presente estudo utilizou dados de uma amostra representativa de 3.047 puérperas, de 1999-2000, de corte transversal, parte de estudo multicêntrico nacional sobre soroprevalência de sífilis no Brasil. Destas, foram analisadas 1.838 puérperas com pelo menos uma gravidez anterior à gravidez de referência. Os desfechos estudados foram perdas fetais prévias (voluntária e espontânea) e ausência de perda fetal prévia. A análise foi conduzida por meio de regressão logística multinomial. Os resultados indicaram alto número de perdas fetais por mulher (até seis) e 31% das perdas foram voluntárias. A ausência de pré-natal, a história de DST na gravidez de referência e a ausência de filhos vivos aumentaram a ocorrência de perdas fetais. Para as perdas voluntárias, a raça/cor não branca, mais de um parceiro no ano anterior e idade precoce à primeira relação sexual também concorreram para o aumento da ocorrência. Características de vulnerabilidade destas mulheres devem ser consideradas em programas de planejamento familiar e de aconselhamento de mulheres, focalizando aquelas que já tiveram abortos, para a redução do número e consequências deste procedimento.

Despite its illegality in Brazil, about 31% of all pregnancies end in abortion. Most abortions are performed by unskilled personnel and under unsafe conditions, resulting in increased female mortality. This study used data from a cross-sectional representative sample of 3,047 puerperal women, in 1999-2000, part of a national multicenter study on the prevalence of syphilis in Brazil. Of these, 1,838 women with at least one previous pregnancy before the reference pregnancy were included in the analysis. The outcomes studied were voluntary prior fetal loss, spontaneous prior fetal loss, and no prior fetal loss. The analysis was carried out using multinomial logistic regression. The results indicated a high number of fetal losses per woman (up to six); and 31% of the losses were voluntary. The absence of prenatal care, history of STD in the reference pregnancy, and absence of living children were factors that increased the odds of fetal loss. For voluntary fetal loss, being non-white, having more than one partner in the previous year, and an early age at first sexual intercourse also increased the odds of fetal loss. These data confirm the public health relevance of abortion in Brazil. Characteristics related to women´s vulnerability should be considered in family planning programs in order to reduce the number of abortions and their consequences. Counseling must also be provided, targeting women with a previous abortion.

Fetal Loss Rate after Mid-trimester Amniocentesis

PURPOSE: The aim of this study was to asses the fetal loss rate after mid-trimester amniocentesis. MATERIALS AND METHODS: This was a retrospective cohort study including singleton pregnant women who underwent mid-trimester amniocentesis at Cheil General Hospital from January 2008 through December 2010. The procedure-related fetal loss was defined as miscarriage within 2 weeks after amniocentesis. We evaluated the fetal loss rate within 2 weeks after amniocentesis and fetal loss rate before 24 gestational weeks. RESULTS: During the study period, a total of 4,356 singleton pregnant women underwent mid-trimester amniocentesis. A total of Five hundred ninety six women were excluded owing to follow up loss and termination of pregnancy due to abnormal karyotype or major anomaly. At our institute, the fetal loss rate within 2 weeks was 0.1% and before 24 gestational weeks was 0.3% after amniocentesis. CONCLUSION: The fetal loss rate after mid-trimester amniocentesis in our study is lower than previously reported rate. We suggest that amniocentesis is a safe procedure.

Antiphospholipid syndrome in dermatology: An update.

Antiphospholipid syndrome (APS) is characterized by the presence of antiphospholipid antibodies, recurrent thrombosis, and fetal loss. Antiphospholipid antibodies are a family of autoantibodies that recognize various combinations of phospholipids, phospholipid-binding proteins, or both. APS can occur in the absence of underlying or associated disease (primary APS) or in combination with other diseases (secondary APS). The exact pathogenic mechanism by which these antibodies cause thrombosis is not known; however, several hypotheses, such as activation of platelet and endothelial cells and interference with the coagulation system, have been proposed. Diagnosis is based on the presence of at least one clinical and laboratory criterion each, according to International Consensus Statement on preliminary classification criteria. However, APS can be diagnosed in individuals even in the absence of some of the classification criteria. Clinical manifestations involve different organs and systems such as the blood vessels, central nervous system, skin, kidneys, gastrointestinal tract, heart, and placenta. The unifying mechanism of all these manifestations is thrombosis, either arterial or venous. Skin manifestations are varied and although not included in the diagnostic criteria, may be the presenting feature of this syndrome. Therefore all dermatologists should investigate the possibility of APS when cutaneous findings are related to venous or arterial thrombosis. The risk of thrombosis cannot be predicted, and therefore treatment is not initiated until a thrombotic event occurs. Indefinite anticoagulation is prescribed once a thrombotic event occurs. Prognosis depends on the severity of the clinical manifestations and so, knowledge of the presentation of this disease is important for early detection and prompt treatment to prevent life-threatening consequences of this catastrophic disease process.

Evaluation of antiphospholipid antibodies testing for the diagnosis of antiphospholipid syndrome / Avaliação da pesquisa de anticorpos antifosfolipídios para o diagnóstico da síndrome antifosfolípide

OBJETIVO: Determinar a prevalência de anticoagulante lúpico (LAC) e dos isótipos de anticardiolipina (ACL) e suas eventuais associações clínicas. PACIENTES E MÉTODOS: Estudo retrospectivo que avaliou manifestações clínicas e laboratoriais em indivíduos que apresentaram positividade para anticorpos antifosfolipídios no Hospital Edmundo Vasconcelos entre março de 2005 e junho de 2006. RESULTADOS: Cento e seis indivíduos (média de idade 42,2 ± 14,1 anos, 84 por cento do sexo feminino) foram incluídos no estudo. A prevalência de trombose foi de 17,9 por cento (19/106) e de morbidade gestacional foi de 12,3 por cento (13/106). O diagnóstico de Síndrome Antifosfolípide (SAF) foi feito em 23,6 por cento (25/106), sendo primária em 68 por cento (17/25) e secundária em 32 por cento (8/25). A prevalência de ACL foi de 97,1 por cento (103/106) e de LAC foi de 11,4 por cento (5/44 dos exames realizados). ACL isótipos IgM, IgG e IgA foram encontrados em 100 por cento, 23,3 por cento e 4,9 por cento dos 103 soros ACL positivos, respectivamente. Para o diagnóstico de SAF, a ACL IgM apresentou sensibilidade de 92 por cento e especificidade de 1,2 por cento, enquanto a ACL IgG teve sensibilidade de 40 por cento e especificidade de 82,5 por cento. A ausência de ACL IgG teve alto valor preditivo negativo (81,4 por cento) para SAF. O LAC apresentou sensibilidade de 18,7 por cento e especificidade de 92,8 por cento. A curva Receiver Operating Characteristic (ROC) demonstrou maior área abaixo da curva para ACL IgG e LAC. CONCLUSÃO: Em amostra aleatória de indivíduos com anticorpos antifosfolipídios positivos, ACL IgG e LAC apresentaram maior especificidade para o diagnóstico de SAF, que se caracterizou pela maior prevalência de trombose.

OBJECTIVE: To evaluate the prevalence of lupus anticoagulant (LAC) and isotypes of anticardiolipin (ACL) antibodies and its possible clinical associations. PATIENTS AND METHODS: A retrospective study analyzed clinical and laboratorial manifestations in individuals who showed positive antiphospholipid antibodies followed-up at Hospital Edmundo Vasconcelos from March 2005 to June 2006. RESULTS: 106 participants (mean age of 42.2 ± 14.1 years at inclusion and female gender in 84 percent of patients) were included in the study. The prevalence of thrombosis was 17.9 percent (19/106 patients) and pregnancy morbidity was 12.3 percent (13/106 patients). The antiphospholipid syndrome (APS) was confirmed in 23.6 percent (25/106 patients), and it was primary in 68 percent (17/25 patients) and secondary in 32 percent (8/25 patients). The ACL antibodies were found in 97.1 percent (103/106) and LAC in 11.4 percent (5/44 of the serum samples tested). IgM, IgG and IgA ACL isotypes were respectively found in 100 percent, 23.3 percent and in 4.9 percent of these ACL positive sera. For APS diagnosis the sensitivity of IgM ACL was 92 percent and its specificity was 1.2 percent, while IgG ACL had a sensitivity of 40 percent and specificity of 82.5 percent. The absence of IgG ACL had a high negative predictive value for APS diagnosis (81.4 percent).The analysis of the Receiver Operating Characteristic (ROC) curve showed larger area under the curve for ACL IgG and LAC. CONCLUSION: In a random sample of individuals with positive antiphospholipid antibodies, IgG ACL and LAC showed a larger specificity for APS diagnosis which had been characterized by a higher prevalence of thrombosis.

The association between adverse pregnancy outcomes and the serum inhibin A levels in mid-trimester of gestation / 대한산부인과학회지

OBJECTIVES: To investigate the association between abnormal inhibin-A level in Quad test during the 15 and 18 weeks of gestation and adverse pregnancy outcomes. METHODS: From January 2005 to March 2007, women who delivered their babies at our institute after Quad test in second trimester of gestation (N=140) were enrolled. We measured inhibin-A levels (MoM) and other serum markers of the Quad test. And we analyzed the incidence of adverse pregnancy outcomes such as preterm birth, fetal growth restriction, pregnancy induced hypertension, fetal loss, and intrauterine fetal death. RESULTS: When the pregnancy outcomes are hypertensive disorders and fetal losses, the inhibin-A levels are is more elevated with statistically significance. Inhibin-A and hCG levels are elevated with significantly at hypertensive disorders and fetal losses. But inhibin-A levels are more significantly associated with abnormal pregnancy outcomes than hCG. CONCLUSIONS: Measurement of inhibin-A levels may be the most useful among other serum markers of the Quad test in predicting adverse obstetric outcomes.

Fetal Loss Rate after Midtrimester Amniocentesis in Twin Pregnancies / 대한산부인과학회지

OBJECTIVE: To assess the fetal loss rate among dichorionic twin gestations undergoing genetic amniocentesis compared with singletons undergoing the procedure and untested twins. METHODS: From January 2002 through December 2004, total 132 pregnant women with dichorionic twin gestation with mid-trimester amniocentesis at Hospital were included in this study. In control group, 595 women with untested dichorionic twins during the same period and 402 women with singleton pregnancies with amniocentesis performed by the same physician at the same date of study group were selected. Excluded were fetuses with known structural anomalies, cases in which amniocentesis was done in only one fetus, and cases of which pregnancies were terminated due to fetal chromosomal abnormalities. Fetal loss was defined as the loss of both fetuses and subdivided into two categories: within 4 weeks after amniocentesis and before 28 gestational weeks. RESULTS: Up to 4 weeks after the procedure, one case (0.75%) in the tested twin group, two cases in post-procedure singleton group (0.49%, P=.729), and eight cases in the untested twin control group (1.34%, P=.581) were aborted spontaneously. Up to 28 gestational weeks, four fetal losses occurred in post-amniocentesis twins (3.03%), sixteen cases in untested twins (2.69%, P=.83), and two cases in the singleton pregnancies with amniocentesis (0.49%, P=.017). CONCLUSION: The risk of fetal loss in twin underwent mid-trimester amniocentesis appears to be higher than that of tested singletons in this study. However, there was no significant difference in the fetal loss rates between amniocentesis twin group and untested twin group.

The influence of decoction with function of nourishing kidney and promoting blood flow to model rat of fetal loss induced by APA / 中华中医药杂志

Objective:To explore the influence ofDan Shou Tang to fetal loss induced by APA.Methods:One hundred of10-week pregnant SD rats were divided randomly into two groups, every group were divided randomly into nourishing kidney and promoting blood flow group A, nourishing kidney group B, promoting blood flow group C, group D-APS model group and group E--blank control group.From the first day ofpregnancy, the rats in group A were given Dan Shou Tang through intragastric administration;the rats in group B were given formula to nourish kidney and rats in group C were given formula to promote blood flow, while group D and group E, as the control were given the corresponding physiological brine through intragastric administration.Then on the eighth and the twelfth day ofpregnancy, all rats ofgroup A, B, C and D were given multi-site subcutaneous injecting ofpurified ACA-IgG or LA-IgG with a dosage of15mg/ml, fats ofgroup E were injected the corresponding physiological brine.On the 15th day ofpregnancy, the rats were killed for samples.Results:Compared with APS model group, fetal absorptivity, ACA and APTT level were dramatically decreased in group A, B and C(P

Chorionic Villus Sampling: Clinical and Cytogenetic Study of the First 1,058 Cases in YUMC from 1984 to 2004 years / 대한산부인과학회지

OBJECTIVE: This study was performed to evaluate the feasibility, accuracy and safety of Chorionic Villus Sampling (CVS). METHODS: We analyzed the outcome of 1,058 cases of CVS performed for prenatal genetic diagnosis between 7 and 12 weeks of gestation in the outpatient prenatal genetic clinic in Yonsei University Medical Center (1,030 cases by trans-cervical method and 28 cases by trans-abdominal). Fetal Karyotyping was obtained by direct or indirect culture methods using Gimsa and Gimsa-Banding. RESULTS: Advanced maternal age was the most common indication for CVS (34.7%). The overall sampling success rate was 98% (1040/ 1,058), representing 92.5% in 7 to 8 weeks, 98.0% in 9 to 10 weeks, and 98.9% in 11 to 12weeks of gestation. The majority of cases (94.6%) required one or two aspirations. Cytogenetic analysis routinely included direct overnight and long-term culture methods, which revealed 27 chromosomal abnormalities (2.6%). Of 1,040 cases in which CVS were successful, 989 delivered normal baby, 23 resulted in fetal loss, 25 had therapeutic termination (24 with chromosome abnormalities and 1 with normal chromosome with huge myoma), and 3 with chromosome abnormalities were loss to follow up. The overall fetal loss rate was 2.2% (23/1,058). No congenital anomalies were found to be related to CVS in these series. CONCLUSION: When performed by experienced operators and cytogeneticists beyond 9 weeks of gestation, CVS is a feasible, accurate and safe method for prenatal genetic diagnosis capable of replacing genetic amniocentesis.

Factors Affecting Complete Fetal Loss Following Multifetal Pregnancy Reduction / 대한불임학회지

OBJECTIVE: To identify the factors affecting the complete fetal loss following multifetal pregnancy reduction (MFPR). DESiGN: Retrospective clinical study. METHODS: A total of 256 consecutive treatments of MFPR in iVF-ET cycles performed between 1992 through 2000 in Samsung Cheil hospital were analyzed. MFPR was done around 8 weeks of gestation by transvaginal ultrasono-guided aspiration in multiple pregnancies and reduced to singleton or twins. Stepwise logistic regression was performed to identify the factors affecting the final outcome of pregnancy after MFPR. Dependent variable was complete fetal loss and the independent variables were maternal age, paternal age, initial number of gestational sac (iGSNO), initial number of fetal heart beat, the number of remaining live fetus after MFPR, and chorionicity. RESULTS: The total survival rate was 87.9%, and total fetal loss rate after MFPR was 12.1%. Total fetal loss occurred within four weeks from MFPR procedure was 1.95%. Total loss occurred after four weeks of procedure and before 24 gestational weeks was 8.2%. Seventy nine percent (202/256) of pregnancies delivered after 34 weeks of gestation. The survival rate of pregnancies reduced to singleton was significantly higher than that of pregnancies reduced to twins (93.5% vs. 86.7%, p<0.05). The mean (+/-SEM) gestational age at delivery was 36.2+/-1.0 and 34.1+/-0.5 weeks for pregnancies reduced to singletons and twins, respectively (p=0.065). Logistic regression analysis revealed that the maternal age, the number of initial gestational sac (iGSNO), and the number of remaining live fetus after MFPR significantly affected the rate of total fetal loss (Z = 0.174'age + 0.596'iGSNO + 1.324'remaining fetuses-12.07), (p<0.05). CONCLUSiONS: MFPR seems to be a relatively safe and efficient method to improve the obstetric outcome in high order multiple pregnancy. Because the maternal age, the number of initial gestational sac and the remaining live fetuses after MFPR affect the total fetal loss rate, restriction of the number of transferred embryos according to the age and MFPR to singleton fetus could be considered for the better obstetric outcome in iVF pregnancy.

Factors associated with fetal losses after mid-trimester amniocentesis / 대한산부인과학회잡지

OBJECTIVE: To evaluate factors associated with fetal losses following mid-trimester diagnostic amniocentesis. METHODS: 412 pregnancy outcomes following amniocentesis were analyzed for each variables(maternal age, gestational age, indication for the amniocentesis, placental penetration by aspiration needle, needle touch by the fetus, color of amniotic fluid) with statistical methods(student t-test, chi-square test and multiple logistic regression test). RESULTS: Mean maternal age was 31.8+/-4.9 years, fetal loss rate was increased slightly with the age of the mother. If the indications were abnormally high maternal serum alpha-fetoprotein level, the pregnancy courses after the procedure were worse than other indication groups. In cases of discolored amniotic fluid, the dark brown discoloration made the pregnancy outcome poor. Gestational age at the time of the procedure, penetration of the placenta by the aspirating needle, needle touch during the procedure by the fetus, did not influence the outcomes after the procedure. CONCLUSION: Maternal age, indication as neural tube defect in triple test and dark brown discoloration of amniotic fluid are associated with fetal losses following mid-trimester diagnostic amniocentesis.

Obstetric Outcomes in Patients with Systemic Lupus Erythematosus / 대한류마티스학회지

OBJECTIVE: To analyze the effect of clinical and serological variables of SLE on pregnancy outcome and to analyze the effects of pregnancy on the disease course of SLE. METHODS: We studied retrospectively about 91 pregnancies in 41 female patients with SLE, who had visted to Kangnam St Mary Hospital from January,1990 to May,1996. We divided the patients into two groups, who had been pregnant before SLE was established versus who were pregnant after SLE had been established. We considered the former as control group. We compared the fetal or maternal outcomes after divided the latter into subgroups according to our purposes such as cases with lupus flare versus without lupus flare, autoantibody (+) cases versus (-) cases, cases with renal disease versus without renal disease. RESULTS: The rate of fetal loss, prematurity was 19. 7%, 46. 9% respectively in 63 cases of 32 patients who were pregnant after SLE had been estabished. The number of pregnancy loss and premature delivery was higher in pregnancy after SLE was established than before SLE was established. Lupus flare was associated with the positivity of antibody to ds DNA and negativity of antibody to Ro. The frequency of fetal loss was higher in pregnancies of antiphospholipid (+) women than those of antiphospholipid (-) women. Pregnancy with renal involvement was associated with short duration of gestation and small body weight of neonate. CONCLUSION: Lupus pregnancy remains highly risky from a maternal standpoint in terms of increased lupus activity and from fetal outcome standpoint in terms of fetal loss and preterm birth, especially in the antiphosphospholid positive mother.

Chromosomal Abnormality In Cases Of Recurrent Abortions.

Couples (225) found negative for clinical, hormonal and biochemical problems as causes of recurrent abortion were studied for cytogenetic abnormalities. Nineteen per cent of the 450 individuals exhibited chromosomal anomalies. Eighty one per cent of the anomalies were structural, 18% numerical and 47% mosaics, the last being unexpectedly high. Forty seven per cent of the cases with anomalies carried translocations but in 21% of the cases, satellite association between D and G groups indicated an important role of satellite association in recurrent abortion and congenital defects. Some cases with even 10% of abnormal metaphases suffered recurrent abortion. Genetic diagnosis and counseling are, therefore, strongly advised in recurrent abortion.