ABSTRACT
CONTEXT: Preterm birth still remains a significant management problem, and a large number of markers of the disease have been investigated. OBJECTIVE: We measured plasma levels of urocortin, a neuropeptide expressed by gestational tissues, in women with threatened preterm labor (TPTL) to evaluate whether the measurement may predict preterm delivery (PTD). DESIGN: We studied patients as part of an open observational study. SETTING: The study was conducted at a tertiary referral center for obstetric care. PATIENTS: Eighty-five women with singleton pregnancies between 28 and 34 completed gestational weeks with TPTL participated in the study. INTERVENTIONS: Interventions included clinical examination and urocortin measurement. MAIN OUTCOME MEASURES: Pregnancy outcome and evaluation of sensitivity, specificity, and predictive values of urocortin as diagnostic test for PTD were measured. RESULTS: Thirty of 85 patients (35.3%) had PTD: 23 of 30 delivered within 7 d from admission (delivery time interval: 2.91 +/- 1.62 d; gestational weeks at delivery: 32.12 +/- 1.7); the remaining delivered later (delivery time interval: 11.71 +/- 4.27 d; gestational weeks at delivery: 33.5 +/- 2.18). Urocortin was significantly higher in women who delivered preterm (median 131.2 pg/ml, interquartile interval 115.1-139.4 pg/ml) than in those who progressed to term delivery [95.4 (69.9-101.3) pg/ml, P < 0.0001] and still higher in those delivering within 7 d from admission [137.7 (124.8-141.2) pg/ml]. Receiver operating characteristic curve analysis revealed that urocortin at the cutoff of 113.9 pg/ml had sensitivity of 80%, specificity of 100%, positive predictive value of 100%, and negative predictive value of 90% as a marker for PTD. CONCLUSIONS: Maternal plasma urocortin concentration is increased in patients with TPTL who have PTD, and its measurement may be a promising new biochemical marker of PTD.
Subject(s)
Obstetric Labor, Premature/blood , Urocortins/blood , Adult , Biomarkers , Black People , Female , Fetal Membranes, Premature Rupture/diagnosis , Humans , Predictive Value of Tests , Pregnancy , ROC Curve , White PeopleABSTRACT
The perimenopausal period, from 1 to 4 years, is characterised by vasomotor symptoms, or hot flushes, and other effects due a deficit of estrogens. Approximately 85% of women have hot flushes for 1 year and 25 - 50% continue for up to 5 years. The cause of hot flushes has been linked to dysfunction of the thermoregulatory centre caused by estrogen withdrawal. One proposal for the aetiology of hot flushes is that the thermoregulatory zone is shifted downward in patients who experience hot flushes. Estrogen withdrawal creates a change of the central opioid system and a thermoregulatory instability. Estrogen and/or progestin replacement is the treatment of choice for this distressing symptom. However, steroid replacement may be associated with risks and complications, and is limited in some subjects by well-known contraindications. Veralipride, a synthetic benzamide derivative with antidopaminergic action, is effective in reducing the frequency and severity of hot flushes associated with menopausal hypoestrogenism, gaining interest as a non-hormonal treatment for climacteric flushing. In recent years, extrapyramidal disorders associated with veralipride therapy have been reported and are often due to drug misuse. Adverse effects include acute dyskinesia or Parkinsonism, which may occur after many months of treatment. An association between adverse effects and mistake of administration has been described. This article discusses available data on the benefits and risks of veralipride therapy for menopausal symptoms.
Subject(s)
Basal Ganglia Diseases/chemically induced , Estrogens/deficiency , Parkinsonian Disorders/chemically induced , Sulpiride/analogs & derivatives , Adult , Aged , Dopamine D2 Receptor Antagonists , Female , Half-Life , Hot Flashes/drug therapy , Hot Flashes/metabolism , Humans , Middle Aged , Randomized Controlled Trials as Topic , Risk Assessment , Safety , Sulpiride/adverse effects , Sulpiride/pharmacokinetics , Sulpiride/therapeutic useABSTRACT
OBJECTIVE: Evaluation of combined test in pregnant women 35 years of age and over to detect fetal Down syndrome. MATERIALS AND METHODS: The study population included 408 pregnant women of 35 years and over, who requested the combined test (nuchal translucency, PAPP-A, free beta hCG, maternal age, cut-off 1:250) before deciding whether to undergo amniocentesis. RESULTS: The test was positive in 66 women who then requested amniocentesis for fetal karyotype determination; the other women had a negative test and declined amniocentesis. False-positives increased with maternal age from 6.6% at 35 years to about 50% at 40 to 41 and 100% in women over 41. Six cases of Down syndrome and two cases of trisomy 18 were detected. Not a single case of Down syndrome or trisomy 18 was missed, and other chromosome abnormalities were detected as well. CONCLUSIONS: The application of the combined test reduced the need for invasive testing to only 14% of the studied pregnant population, without missing any of the fetuses with trisomy 21 or 18.
Subject(s)
Down Syndrome/diagnosis , Prenatal Diagnosis , Adult , Chorionic Gonadotropin, beta Subunit, Human/blood , Chromosomes, Human, Pair 18 , Down Syndrome/blood , Down Syndrome/diagnostic imaging , Down Syndrome/epidemiology , Female , Humans , Italy/epidemiology , Maternal Age , Medical Records , Neck/diagnostic imaging , Neck/embryology , Predictive Value of Tests , Pregnancy , Pregnancy-Associated Plasma Protein-A/metabolism , Retrospective Studies , Risk Factors , Trisomy , UltrasonographyABSTRACT
Listeria monocytogenes is an alimentary infection which can be extremely dangerous for pregnant women. A 34-year-old pregnant woman was hospitalized with fetal cardiac rate alterations and influenza-like symptoms. A caesarean section due to fetal distress was performed. A maternal-fetal listeriosis diagnosis was possible only after the birth through bacteriological and histological examination on both the placenta and the newborn.
