Increased nuchal translucency and decreased fetomaternal transfusion after chorionic villus sampling.

OBJECTIVE: To investigate the relationship between nuchal translucency (NT) and fetomaternal transfusion (FMT) after chorionic villus sampling (CVS). METHODS: The level of FMT was determined in 272 viable, singleton pregnancies in which 10-14-week ultrasound scanning, NT measurement and CVS for fetal karyotyping had been performed. The pre-CVS NT was measured transvaginally, and the women were divided into two groups, i.e. those with NT < 2.5 mm (Group 1) or >or= 2.5 mm (Group 2). The level of FMT was determined via the maternal serum alpha-fetoprotein levels before and after CVS. FMT was analyzed in relation to the pre-CVS NT. RESULTS: Of the 272 pregnancies, 213 were in Group 1 and 59 in Group 2. The mean levels of FMT after CVS were 23.3 +/- 12.2 and 5.4 +/- 2.9 micro L in Groups 1 and 2, respectively (P < 0.01). An FMT > 100 micro L was found in 19 cases in Group 1, whereas the maximum in Group 2 was 67.2 micro L. Aneuploidies were diagnosed in 17 cases, 15 (88.2%) of them in Group 2. When the pregnancies with adverse outcome were excluded from the two groups, a higher level of FMT was observed in Subgroup 1 than in Subgroup 2 (P < 0.01). CONCLUSIONS: The mean level of FMT after CVS was significantly lower in pregnancies with an increased pre-CVS NT, a relationship observed in euploid pregnancies also. An increased pre-CVS NT seems to be inversely correlated with the FMT increase after CVS. Further studies are planned to investigate the background to this phenomenon.

Fetomaternal transfusion and pregnancy outcome after cordocentesis.

OBJECTIVE: To study the extent of fetomaternal transfusion and the outcome of pregnancy after cordocentesis. MATERIAL AND METHODS: 268 women underwent percutaneous fetal umbilical cord blood sampling for fetal karyotyping between 15 and 26 gestations of weeks. Complete follow-up was available in 221 (82.5%) of the cases. Cordocentesis was performed under continuous real-time ultrasound guidance. The duration of the procedure and the post-procedural bleeding time was counted in seconds. Fetomaternal transfusion was calculated by using the measurements of the maternal serum levels of alpha-fetoprotein before and after the procedure. The data were analyzed by Student's t and multiple regression tests. RESULTS: The maximum and mean amounts of fetomaternal transfusion were 1.067 and 0.061 ml, respectively. Twenty percent or more alpha-fetoprotein elevation was in 35.4% of the cases. Positive correlation was found between bleeding time after cordocentesis and fetomaternal transfusion (r = 0.174, p < 0.0129) as well as between the duration of the procedure (r = 0.165, p < 0.0171) and the amount of fetomaternal transfusion. Comparing the cordocentesis at the placental insertion site and at the free cord loop, a smaller amount of fetomaternal transfusion was observed (p < 0.0123) in the latter. Transplacental passage was associated with a higher amount of fetomaternal transfusion (p < 0.0067). No association was found between the extent of fetomaternal transfusion and the outcome of pregnancy. The fetal loss related to the cordocentesis was 0.50%. CONCLUSIONS: The extent of fetomaternal transfusion was influenced by the subsequent four parameters: procedural time, bleeding time, puncture site and transplacental penetration. The lack of the association between the degree of fetomaternal transfusion and the outcome of pregnancy, along with the low (0.50%) post-procedural fetal loss rate, suggest that cordocentesis is clinically a safe procedure.

[Prenatal diagnosis of sirenomelia]. / Pränatale Diagnose einer Sirenomelie.

OBJECTIVE: What kind of diagnostical methods are usual to detect fetal sirenomelia? MATERIAL AND METHODS: The prenatal diagnosis of fetal sirenomelia combined with bilateral renal agenesis, oligohydramnios and single umbilical artery in a 24-year-old woman, gravida 2, para 1, at a gestational age of 18 + 3 weeks is described in this case report. RESULTS: This fetal malformation was an accidental sonographic found, and caused after confirming diagnosis by amnoinfusion and amniocentesis, the termination of pregnancy. Genetic examination revealed tetrasomia 13. CONCLUSIONS: The sonographic finding of oligohydramnios should cause an exactly sonographical examination with amnioinfusion. In case of sirenomelia genetical examination is necessary.

[Feto-maternal transfusion following cordocentesis]. / Foetomaternalis transzfúzió cordocentesis kapcsán.

Invasive intrauterine diagnostic procedures may be followed by feto-maternal transfusion. The authors studied the feto-maternal transfusion after cordocentesis. 199 women underwent fetal umbilical cord blood sampling for fetal karyotyping in weeks 15-26. Maternal serum alpha-fetoprotein level was measured before and after the procedure. The data were statistically analysed by multiple regression analysis and the paired and unpaired Student's t-tests. Twenty percent of more maternal serum alpha-fetoprotein level increase was observed in 73 (36.7%) women. Maximum feto-maternal transfusion was 0.684 ml. The average feto-maternal transfusion was 0.045 ml. No fetal exsanguination was observed. Positive correlation was found between bleeding time after cordocentesis (p = 0.0171) and feto-maternal transfusion as well as the duration of the procedure (p = 0.0275) and feto-maternal transfusion. Negative correlation was found between the amount of fetal blood sample and feto-maternal transfusion (p = 0.0431). The puncture site also influenced feto-maternal transfusion. If the cordocentesis has been performed at the insertion of the cord the feto-maternal transfusion was less than at the free floating umbilical cord (p = 0.0293). Higher feto-maternal transfusion was seen more often after transplacental cordocentesis (p = 0.002). These data suggest that fetomaternal transfusion in the indicator of the difficulty of the procedure.

[Granulosa cell tumor: implantation metastasis to the abdominal wall]. / Granulosazelltumor: Implantationsmetastase in der Bauchdecke.

We report on the rare localization of a metastasis in the abdominal wall of an ovarian Granulosa Cell Tumor, manifested as a haematoma in the abdominal wall nine years after the primary operation of the Granulosa Cell Tumor. The therapy consisted of a wide excision of the tumor, hysterectomy with a partial excision of the remaining ovary and resection of the omentum majus. Our case report illustrates the clinical problems of these kind of tumors.

Prevention of congenital toxoplasmosis in Szeged, Hungary.

BACKGROUND: Toxoplasma gondii infection of the fetus can only be discovered or prevented by the appropriate serological screening and subsequent treatment of the mother and her offspring. In Hungary, there is no obligatory toxoplasma screening for pregnant women and both the reporting and follow-up of congenital toxoplasmosis cases is limited. In 1987 we started a systematic study in the Szeged region of Hungary, in which all pregnant women were screened and appropriate treatment given to all mothers and their offspring where congenital toxoplasmosis was suspected. METHODS: All pregnant women were routinely screened within the first 16 weeks of gestation for toxoplasma antibodies by complement fixation test (CFT). Seronegative cases were retested for possible seroconversion every second month. Patients with CFT titres > or = 1:256 were retested for anti-P30 immunoglobulin A (IgA), IgM and IgG antibodies by ELISA and/or SDS-PAGE-Western immunoblot in order to distinguish the acute and chronic phases of the infection. RESULTS: Up to the end of 1994, the sera of 17,735 gravidae were screened. Ten women were found to have seroconverted during pregnancy and 78 had high initial antibody levels accompanied by anti-P30 IgA antibodies at the very first screening. These two groups together were considered as definitely (10) or possibly (78) infected with Toxoplasma during pregnancy and were treated with Spiramycin. All of their offspring were also treated for one month and followed-up by systematic serological and clinical screening for 2 years. No congenital toxoplasmosis was found in any of the offspring. CONCLUSIONS: Antenatal, early diagnosis and treatment of toxoplasmosis in mothers, together with treatment and follow-up of their offspring, may considerably reduce the incidence of the disease in the offspring.

[Ovarian Leydig cell tumor]. / Ovarieller Leydig-Zell-Tumor.

A case report on a 73 year old woman with an Leydig cell tumor of the right ovary accidentally discovered after hysterectomy with bilateral salpingo-oophorectomy is given. Signs of virilization existed for many years, but no diagnostic investigations had been performed. Histologically a well-differentiated Leydig cell tumor was found as the reason of the androgenic changes which regressed after extirpation of the tumor.

[The value of plasma prolactin level determination in the diagnosis of postmenopausal osteoporosis]. / A plazma prolactinszint vizsgálatok jelentósége a postmenopausalis osteoporosis diagnosztikájában.

Anovulation condition (estrogen deficiency due to high prolactin level) is linked with premature loss of bone mass. Bone mineral density was measured in the femur neck and the lumbar spine (L2-L4) with DEXA and the bone density was given by Z-score, which makes comparison to adult women's bone mass (normal reference). The examinations were carried out in two different groups. Bone mineral density was measured in the first group in 14 cases with hyperprolactinemic anovulation (aged 28 to 36 years). The average value of Z-score was -1.148 +/- 0.68. In the second group 39 patients (51.9 +/- 2.3 years) took part in the investigation within one year after menopause and the measured Z-score was less than -1.0 (-1.98 +/- 0.4). In the control group there were 40 postmenopausal patients (52.2 +/- 2.4 years) and their Z-score was more than -1.0 (-0.21 +/- 0.14). Prolactin value was 416 +/- 98 mU/l in the investigated group, while in the control group it was 238 +/- 76 mU/l (p < or = 0.05). Our results suggest that continuation of the antiprolactinemic (bromocryptine) treatment following completion of child-bearing appears to be indicated in premenopausal women with increased levels of serum prolactin. During the perimenopause endangered group, whose risk is increasing for postmenopausal osteoporosis, can be stated by determining prolactin level.

[Serodiagnosis of toxoplasmosis]. / A toxoplasmosis szerodiagnosztikája.

Generally, toxoplasmosis has mild symptoms, or is asymptomatic, in patients with intact immune system. The infection, however, may have serious consequences in immunodeficient or immunosuppressed patients, as well as in the off-springs of pregnant women. If the mother has acute toxoplasmosis during the pregnancy, the passage of parasites through the placenta may result in the death of the fetus, or, in the severe damage of the fetus or neonate. All these consequences can be prevented by the early detection of the disease followed by the immediate therapy of the mother. Contrary to the most infectious diseases, however, the high specific IgM level has not proved to be a reliable marker of the acute infection in the case of toxoplasmosis. Therefore, in the case of infections discovered in the "plateau" period [i.e. with persistent IgM ("residual" IgM) and/or persistent high level of IgG antibody), the "acute" and the "chronic" phases can be distinguished more reliably by the detection with ELISA of the IgA antibody response to the so called P30 protein of Toxoplasma gondii. The anti-P30 IgA antibody response appears very early and generally disappears in 3-9 months. Thus, it is possible to discriminate the acute phase of the disease from the harmless chronic phase. Between 1987 and 1996, practically all pregnant women in Szeged and its region (altogether 21,952 women), underwent serologic toxoplasma screening. Among them, 124 pregnant women were found highly suspicious for having acute toxoplasmosis. Appropriate counselling, followed by spiramycin therapy during pregnancy and regular ultrasound examination were their antenatal management. No clinically manifested fetal or neonatal infection was observed. The screening and treatment schedule seems to be promising in the prevention of fetal and neonatal toxoplasmosis.

[Significance of hyper-echogenic yolk sac in first-trimester screening for chromosome aneuploidy]. / A hyperechogen szikhólyag jelentósége a kromoszóma aneuploidiák elsó trimeszterbeli ultrahangszúrésében.

Recently, the measurement of the thickness and extent of the first-trimester posterior simple embryonic hygroma by vaginal ultrasound has become the most efficient method in the antenatal screening for chromosomal aneuploidies. The sensitivity of the screening is only 75-90%, therefore, the search for other potential (sonographic) markers is needed in order to increase the efficiency. Ultrasound measurement of the echogenicity and the diameter of yolk sac and the thickness of dorso-posterior simple embryonic hygroma was carried out in 3620 first-trimester pregnancies between 9-11 weeks. A total of 105 embryos with simple hygroma of > or = 3 mm and 39 pregnancies with abnormal, hyperechogenic yolk sac of 1.8-4.0 mm in diameter were detected. Cytogenetic analysis through chorionic villi samples revealed chromosomal aneuploidies in 52 cases. In 19 of 3620 pregnancies both hyperechogenic yolk sac and first trimester simple hygroma were present. Each of these 19 pregnancies were chromosomally abnormal. Hyperechogenic yolk sac alone was present in another 20 pregnancies with otherwise normal fetal findings. The authors could not accomplish sonographic identification of the yolk sac in 42 pregnancies. In conclusion, combined presence of hyperechogenic yolk sac plus first-trimester simple hygroma of 3 mm or more in the same pregnancy is highly associated with chromosomal aneuploidy between the 9-11 gestational weeks.

[Ultrasonic diagnosis of exencephaly/anencephaly during the first trimester]. / Az exencephalia/anencephalia ultrahang diagnózisa az elsö trimeszterben.

The paper deals with first trimester diagnosis of exencephaly. In association with first trimester sonographic and cytogenetic screening of chromosomal anomalies in 1145 examined pregnancies 2 exencephalic fetuses with normal karyotype were diagnosed. Exencephaly was characterized with the absence of normal echoes of the exocranium, the lateral ventricles, the chorioid plexus, the cerebral falx, and with the presence of deformed shape of the head and irregular, lobulated cerebral material with increasing volume at follow-up examination. Anencephalic fetuses were diagnosed subsequent to therapeutic abortion, since the uterine and cervical wall contractions eroded the fragile brain tissue during fetal expulsion. However, fetal brain was identified in abortion material in both cases providing evidence that exencephaly is an embryologic precursor of anencephaly.

First-trimester ultrasound screening for fetal aneuploidies in women over 35 and under 35 years of age.

In a prospective screening study, the utility of the thickness of first-trimester simple hygroma in sonographic screening for fetal chromosomal aberrations was examined. A total of 3380 women, 1280 of whom were 35 years or over, and 2100 of whom were under 35 years, were screened by ultrasound at 9-12 weeks of gestation. The thickness of fetal nuchal simple hygroma was measured. Women over 35 years of age underwent transabdominal chorionic villus sampling (CVS). In women under 35 years of age, CVS was offered only if the thickness of nuchal hygroma was at least 3 mm, or in cases of parental chromosomal abnormalities. A total of 46 chromosomal anomalies were detected, of which 43 (93.5%) showed simple hygroma. The incidence of first-trimester simple nuchal hygroma in pregnancies of women over 35 and under 35 years of age was 5.4% (69 cases) and 1.28% (27 cases), respectively, and the percentage of chromosomal abnormalities was 2.9% and 0.43%, respectively. The risks of trisomies and poor pregnancy outcome were increased at larger sizes of first-trimester simple hygroma. A sensitivity of 93.5% and a specificity of 98.4% of the method were found. Using a measurement of first-trimester simple hygroma of > or = 3 mm to identify pregnancies at risk for chromosomal anomalies at 9-12 weeks of pregnancy is a useful method for selection of women with high and low risk for aneuploidy.

Elastase given intracisternally opens blood-brain barrier in newborn piglets.

The effect of elastase on the blood-brain barrier (BBB) permeability was intravitally studied by fluorescence photomacroscope using the open cranial window technique in newborn piglets. Eleven animals (group 1) were given intracisternal injection of porcine elastase (1.0 micrograms), while 7 piglets served as controls (group 2). Elastase administration resulted in spotty sodium fluorescein (MW 376 daltons) extravasations in pial venules in all animals of group 1 78 +/- 4 min (mean +/- SEM) after the challenge, and in a 2-fold increase (p < 0.05) in brain sodium fluorescein uptake both in occipital cortex and white matter. The concentration of elastase-alpha 1-proteinase inhibitor complex increased significantly (p < 0.05) in cerebrospinal fluid samples in group 1, 2 and 4 h after the injection, while it did not change in sera. A significant pleocytosis and leukocytosis was also seen in group 1, while there was no change in laboratory data and BBB remained tight in group 2. BBB permeability changes during neonatal meningitis may be caused, at least partially, by elastase.

The feasibility of suppressing ovarian activity following the end of amenorrhoea by increasing the frequency of suckling.

OBJECTIVE: To determine the feasibility of suppressing ovarian activity by increasing the frequency of suckling episodes. METHOD: Prospective study was carried out with 19 exclusively breastfeeding volunteers. Ten subjects (experimental group) increased the suckling episodes by minimum 50% per day from the beginning of the first postpartum menses. Nine controls continued breastfeeding as before. Estradiol, progesterone, LH, FSH and prolactin were measured in blood samples, drawn twice a week up to the second postpartum menses or for 60 days, by RIA. Student's t-test was employed. RESULT: The higher suckling frequency prevented ovulation in 7 of 10 cases examined according to the plasma progesterone concentration (< 9.5 nmol/l). Significantly higher average prolactin value could also be found in the experimental group (1038 (527) munits/l vs. 518 (245) munits/l; P < 0.05). CONCLUSION: Results suggest that an earlier initiation of the increase in breastfeeding frequency may delay the resumption of ovulation. Frequent, full time lactation may reduce the risk of pregnancy.

[Changes in serum levels of lipid and lipoprotein fractions during breast feeding under the effect of hormonal contraceptives]. / A lipid és a lipoprotein frakciók szérum szintjének változása a szoptatás alatti hormonális fogamzásgátlás hatására.

During the first 3 months of the full-time lactation the level of the lipid and lipoprotein fractions does not change in the mother's blood. The levonorgestrel contraceptive pills taken during the lactation do not influence considerably the lipid-metabolism either. There is only one minute deviation in the levonorgestrel group, which is the decreasing though not significant change of the HDL level. The contraceptive pills containing levonorgestrel can be given during the lactation without any danger from the point of view of mother's lipid-metabolism, too.

[Prenatal diagnosis of measles infection by transabdominal puncture of the umbilical vein]. / Rubeola fertözés prenatális diagnózisa transabdominális köldökvéna punkció segítségével.

Prenatal diagnosis of fetal rubella infection was reported. Maternal infection took place at the 13th week of gestation. Percutaneous umbilical fetal blood sampling was performed at the 22nd week of gestation. 1:400 titre of rubella specific immunoglobulin in fetal sera confirmed the rubella infection. A normal baby was born by cesarean section at term and subsequent ophthalmologic, cardiologic, audiologic follow-up have not revealed any alteration in infant's development. Clinical management of fetal rubella infection was discussed.