ABSTRACT
OBJECTIVE: To assess the relation between sonographic fetal thymus size and the components of fetal inflammatory response syndrome (FIRS) in women with preterm prelabour rupture of membranes (PPROM). DESIGN: Prospective cohort study. SETTING: University hospital from January through October 2006. POPULATION: Fifty-six women with PPROM. METHODS: In these women, fetal thymus perimeter was measured sonographically. At birth, cord venous plasma interleukin-6 (IL-6) level estimation and histopathological examination of the placentas and umbilical cords were performed. MAIN OUTCOME MEASURES: Small thymus size (< 5th percentile for gestational age) and its association with FIRS. RESULTS: From the 56 women with PPROM, 54% had chorioamnionitis (CA), 23% had funisitis. IL-6 level was > 11 pg/ml in 52% of women and > 18 pg/ml in 41%. A small thymus was more associated with male fetuses, shorter preterm prelabour rupture of membranes delivery interval, higher IL-6 level, higher frequency of funisitis and CA. When data were regressed for confounding, only IL-6 level and funisitis remained significant independent factors that influence the thymus size. In the subset of women (n = 19) who delivered within 1 week of first measurements, a small thymus had sensitivity and positive predictive value of 93%, specificity and negative predictive value of 75% and accuracy of 89% in the identification of FIRS (IL-6 >18 pg/ml and/or funisitis). CONCLUSIONS: An association exists between fetal thymic involution and components of FIRS in women with PPROM. Small fetal thymus size may be considered a reliable sonographic marker of fetal involvement in the inflammatory response.
Subject(s)
Fetal Development/immunology , Fetal Diseases/pathology , Fetal Membranes, Premature Rupture/pathology , Systemic Inflammatory Response Syndrome/pathology , Thymus Gland/embryology , Adult , Chorioamnionitis/etiology , Chorioamnionitis/immunology , Cohort Studies , Female , Fetal Diseases/immunology , Fetal Membranes, Premature Rupture/etiology , Fetal Membranes, Premature Rupture/immunology , Humans , Infant, Newborn , Interleukin-6/metabolism , Male , Organ Size , Pregnancy , Pregnancy Outcome , Pregnancy Trimester, Second , Pregnancy Trimester, Third , Regression Analysis , Systemic Inflammatory Response Syndrome/immunology , Thymus Gland/diagnostic imaging , Thymus Gland/pathology , UltrasonographyABSTRACT
OBJECTIVE: To assess plasmapheresis with low dose prednisone on obstetric and neonatal outcomes among unsuccessfully treated pregnant women with documented antiphospholipid syndrome (APS). METHODS: Eighteen pregnant women received prednisone (10 mg/day) and plasmapheresis at 7.08+/-0.6 weeks of gestation, for 3 sessions per week, until lupus anticoagulant activity suppressed and IgG anticardiolipin lowered. Serial pulsatility indexes (PI) of umbilical and uterine arteries were performed. RESULTS: The live birth rate was 100%; mild pre-eclampsia 5.5%; preterm deliveries 22.22%; intrauterine growth restriction 11.11%; thrombocytopenia 5.5%; oligohydramnios and fetal distress 16.6%. There were no perinatal deaths, thrombotic events or lupus flare. Uterine artery PI was reduced and umbilical artery PI was >95th percentile. CONCLUSION: Plasmapheresis and low dose prednisone were associated with a low rate of obstetric and neonatal complications. Plasmapheresis may be used to treat pregnant women with documented APS when first lines (aspirin and/or heparin) fail to prevent pregnancy loss.
