Maternal-fetal prognosis in HELLP syndrome in a level 3 maternal-fetal care centre.

PURPOSE OF INVESTIGATION: The purpose of this study was to evaluate the maternal and perinatal outcome and prognosis in pregnant women with HELLP syndrome. MATERIALS AND METHODS: Medical records of eligible pregnant women with HELLP syndrome were reviewed retrospectively. Patients were evaluated in terms of maternal complication, as well as the types of delivery. Perinatal outcome were evaluated in terms ofApgar score, birth weight, respiratory distress syndrome, and neonatal intensive care unit admission. RESULTS: The leading maternal complications associated with HELLP syndrome were the following: severe preeclampsia, eclampsia, placental abruption, acute pulmonary edema, acute kidney failure, disseminated intravascular coagulation syndrome, and immediate maternal death. The most prominent neonatal outcomes associated with HELLP syndrome were: antenatal fetal death, intrauterine growth restriction, prematurity. CONCLUSION: The management and delivery of the patients with HELLP syndrome must take place in a tertiary referral maternal and fetal care centre.

[NK cells in the physiology of the fetomaternal relationships]. / Celulele NK în fiziologia relatiilor materno-fetale.

The NK cells are large granular lymphocytes that are found as approximately 2-15% of the global peripheral lymphocytes. As endometrial granulocytes, they represent 70% of the decidual leukocytes during the first trimester of pregnancy, with a progressive decreasing until term. The complex actions of these numerous and active cells, consist in: 1) placental regulation and control, based on the receptors for the HLA--G and HL--C antigens, that are trophoblast specific and act as universal inhibitors of the NK cells; 2) secretion of a large range of cytokines as IL-1, TNF alpha, IL-8, TGF, IFN gamma, GM-CSF, CSF1 which regulate the trophoblastic proliferation, differentiation and invasion; 3) removal of abnormal trophoblastic cells, which may appear in such a proliferating cell population; 4) infectious protection of the placental unit, due to their unspecific cytotoxic effect. In conclusion, the NK lymphocytes have important implications in the formation of the decidua, as the maternal side of the fetomaternal interface and they are deeply involved in the evolution of normal pregnancy concerning the nutritional, hormonal and immunologic aspects.

[The evolution of the natural-killer-dependent cytotoxic activity during normal pregnancy]. / Dinamica citotoxicitatii natural--killer (NK) dependente în evolutia sarcinii fiziologice.

The fetus was compared to an allograft because paternal antigens are also expressed. Even the analogy is not a real one, the main steps of the rejection phenomenon are relevant for the understanding of the complex materno-fetal interactions as the large granular lymphocytes are the first immune cells which invade the graft. Due to the important role of NK cells in the cell mediated immune response, the purpose of this paper was to assess the NK cell dependent cytotoxicity during normal pregnancy. The study was performed on a test group of 52 normal gravidas, in the Ist, IInd and IIIrd trimester and a control group of 20 healthy nonpregnant women with similar age and parity averages. The cytotoxic activity of the NK cells was measured in a 51Cr release assay against K 562 cell line. The results were expressed as the cytotoxicity index (%) and showed a statistically significant decrease for all gravidas compared to controls, mostly for the IInd trimester. The trend of the NK cytotoxic activity during normal pregnancy suggests the deep involvement of the NK cells in the mechanisms acting at the fetomaternal interface.

[Outbreak of Q fever in a municipal abattoir]. / Episod de febra Q într-un abator municipal.

The present paper reports on a Q fever outbreak of 149 cases in a municipal slaughter house focus. The diagnosis was established by clinical, epidemiological, radiologic and laboratory investigations. The route of transmission was air-borne from the sick animals (not detected at the veterinary control) to man. A closer cooperation is recommended between the human and veterinary health services, for early detection of the cases, their prevention and control. The authors suggest the need to immunize the personnel exposed to the risk of contamination (zoo technical units, slaughter house personnel, etc.).

[Clinico-epidemiological considerations on an outbreak of Q fever in the Arges region]. / Consideratii clinicoepidemiologice asupra unui episod de febra Q din judetul Arges.

The present paper reports on a Q fever episode, including 45 subjects (caretakers, technicians, workers building stables) in a zootechnical cooperative in the district of Arges. In the new unit milch and reproduction cows were brought from various parts of the district. None of the animals showed visible signs of the disease. No cases of Q fever had been reported in man or animals in the locality until then. The episode had an explosive character, the outbreak occurring during the calving season. The diagnosis was established clinically, epidemiologically, radiologically and serologically.