Inflammation and cardiovascular risk in women with preterm labor.

BACKGROUND: Women with a history of preterm delivery have about twice the normal risk of cardiovascular disease (CVD). Mechanisms underlying this association are not well understood. The aim of the present study was to evaluate the relationships between selected metabolic CVD risk factors and markers of both systemic inflammation and endothelial dysfunction in women with spontaneous preterm labor (sPL). METHODS: This was a case-control study in a university tertiary referral center. Forty pregnant women with sPL were compared to 50 controls during gestation. Maternal serum triglycerides, high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), total cholesterol, glycemia, insulinemia, homeostasis model assessment (HOMA), leptin, tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), soluble vascular cell adhesion molecule (sVCAM), soluble intercellular adhesion molecule (sICAM), selectin, and myeloperoxidase (MPO) were measured. RESULTS: Gestational age at study was similar in both groups (31.56±3.14 weeks of gestation vs. 31.27±2.14 weeks of gestation, p=0.62, for the control and the sPL groups, respectively). Body mass index (BMI) (21.72±2.99 vs. 23.56±3.80, p=0.01), all cholesterol fractions (HDL-C 53.44±18.22 vs. 68.32±18.38, p=0.0003; LDL-C 125.71±35.56 vs. 142.15±36.07, p=0.03, and total cholesterol 219.55±32.29 vs. 240.38±40.01, p=0.009) and MPO (3.07±0.63 vs. 3.48±0.32, p=0.0009) were significantly lower in women with sPL. Serum levels of IL-6 (0.61±0.46 vs. 0.33±0.46, p=0.007) and the ratio of total cholesterol/HDL-C (4.52±1.48 vs. 3.77±1.37, p=0.01) were significantly increased and correlated each other (r=0.21, p=0.04). Logistic regression showed that the best predictive model for sPL (R(2)=0.36, p=0.001) included BMI and total cholesterol. CONCLUSIONS: A combination of low maternal BMI, low cholesterol levels, and high total cholesterol/HDL-C ratio is present in women with sPL and is related to inflammation.

Cardiac biometry and function in euploid fetuses with intracardiac echogenic foci.

OBJECTIVE: To compare cardiac biometry and function between fetuses with and without intracardiac echogenic foci (ICEF). METHODS: One hundred and fifty-two fetuses with ICEF were compared with 104 controls. Diastolic ventricular transverse diameters, systolic aortic and pulmonary diameters and interventricular septum were measured. Doppler measurements included pulmonary artery and aortic maximum systolic velocities, time to peak, velocity time integral and atrioventricular E/A ratios. RESULTS: Only A wave in the mitral valve was slightly but significantly higher in the ICEF group (0.45 ± 0.07 m/s vs 0.43 ± 0.08 m/s, p = 0.03), but mitral E/A ratio was similar in both groups (0.61 ± 0.06 vs 0.60 ± 0.07, p = 0.22). There were no statistically significant differences in the rest of the studied variables between the two groups. CONCLUSION: Fetuses with ICEF do not have relevant abnormalities in either cardiac biometry or function. We suggest the presence of an isolated ICEF should not be an indication for fetal echocardiography as long as fetal morphology scan had been performed and revealed no other findings.

Diabetes pregestacional: resultados metabolicoperinatales según la terapia empleada / Pregestational diabetes: perinatal and metabolic results according to the therapy used

Objetivo. Evaluar el tratamiento de la diabetes pregestacional (DPG) y los resultados metabolicoperinatales en función del mismo. Marterial y métodos. Se analiza a 42 mujeres con DPG en tratamiento insulínico intensivo seguidas desde el primer trimestre de gestación. Resultados. La edad media fue de 30±5 años y el tiempo medio±desviación estándar de diabetes fue de 14,2±9,5 años. El índice de masa corporal (IMC) y los requerimientos de insulina pasaron de 26±4,85kg/m2 y 0,56±0,32 U/kg al inicio a 30±4,5kg/m2 y 0,70±0,28 U/kg al final. La hemoglobina glucosilada (HbA1c) previa era de 7,71±1,85% y la media gestacional de 6,81±1,33%. Se aplicaron 4 modalidades de insulina: NPH-lispro 26,2%, mezclas prefijadas 26,2%, glargina-lispro 21,4% e ISCI 26,2%. No hubo diferencias significativas entre el tipo de insulina y las variables analizadas. Conclusiones. El tipo de insulina no afecta a los resultados perinatales. Las HbA1c elevadas se relacionan con mayor circunferencia abdominal a las 32 semanas y más incidencia de partos pretérmino (AU)

Aim. To evaluate the treatment of pregestational diabetes mellitus (PDM) and the metabolicperinatal results according to the treatment used. Material and method. We reviewed 42 women with PDM with intensive insulin treatment under clinical supervision from the first three months of their pregnancy. Results. The average age was 30±5 years and the time for the average development of diabetes was14,2±9.5 years. The Body Mass Index and the need for insulin passed from 26±4.85kg/m2 and 0,56±0.32 U/kg at the beginning to 30±4.5kg/m2 and 0.70±0.28 U/kg at the end. Prior HbA1c was 7.71±1.85% and a gestational average HbA1c of 6.81±1.33%. Four types of insulin therapy were used: NPH-lispro 26.2%, pre-programmed mixtures 26.2%, glargina-lispro 21.4% and ISCI 26,2%. Significant differences were not found among the types of insulin and the variables analyzed. Conclusions. The type of insulin doesn’t affect perinatal results. High HbA1c are related to greater abdominal circumference at 32 weeks and with a greater (AU)

Heterotopic triplets: tubal ectopic and twin intrauterine pregnancy. A review of obstetric outcomes with a case report.

INTRODUCTION: Heterotopic triplets hardly take place, but nowadays the extended use of assisted reproductive technologies is increasing the ectopic pregnancies rate and subsequently the heterotopic pregnancies, leading to a potentially dangerous condition for the woman and the intrauterine pregnancy. MATERIAL AND METHODS: Fourteen cases previously reported in the literature of patients presenting an intrauterine twin pregnancy which became complicated by a tubal ectopic pregnancy have been reviewed. The case of a patient following a homologous intrauterine insemination treatment, resulting in live birth of both twins, is also described. CONCLUSION: Although the diagnosis of heterotopic triplets with tubal ectopic is challenging, a timely surgical treatment will preserve intrauterine gestation with a great chance of a successful obstetric outcome for both twins.

Second-trimester amniotic fluid proinflammatory cytokine levels in normal and overweight women.

OBJECTIVE: To estimate the relationship between different adipokines and proinflammatory mediators in amniotic fluid and maternal body mass index (BMI), calculated as weight (kg)/height (m)2. METHODS: Seventy pregnant women who underwent amniocentesis for clinical reasons at 15-20 weeks of gestation were divided into two groups according to their BMI: a control group with normal weight (BMI 20-24.9, n=35) and a case group (BMI 25 or higher, n=35). The two groups were further divided into two subgroups: overweight (BMI 25-29.9, n=22) or obese (BMI 30 or more, n=13). Comparisons of amniotic fluid cytokines (tumor necrosis factor [TNF]-alpha, interleukin [IL]-8, IL-10, monocyte chemoattractant protein-1, resistin, and leptin) and C-reactive protein (CRP) levels were performed. The relationships between variables and maternal BMI were also analyzed. RESULTS: There were significant differences in amniotic fluid CRP and TNF-alpha levels among the studied groups: CRP, 0.018 (+/-0.010), 0.019 (+/-0.013), and 0.035 (+/-0.028) mg/dL (P=.007); and TNF-alpha, 3.98 (+/-1.63), 3.53 (+/-1.38), and 5.46 (+/-1.69) pg/mL (P=.003), for lean, overweight, and obese women, respectively. Both proinflammatory mediators increased in women with obesity compared with both overweight and normal women (P=.01 and P=.008 for CRP; P=.003 and P=.01 for TNF-alpha, respectively). There were significant correlations between maternal BMI and amniotic fluid CRP (r=0.396; P=.001), TNF-alpha (r=0.357; P=.003) and resistin (r=0.353; P=.003). CONCLUSION: Amniotic fluid CRP and TNF-alpha levels are increased in obese women, and both are related to maternal BMI, which suggests in utero exposure to higher proinflammatory cytokines and mediators in fetuses of these women. LEVEL OF EVIDENCE: II.

Transformed alpha-fetoprotein (t-AFP) levels in women with threatened preterm labor.

BACKGROUND/AIMS: To evaluate maternal serum transformed alpha-fetoprotein (MSt-AFP) levels, a new molecular conformation of AFP was used in cases of threatened preterm labor (TPL). METHODS: Prospective case-control study. Maternal serum levels of classical AFP and transformed AFP (t-AFP) were compared between 2 groups matched by gestational age: 25 women with TPL and 25 healthy pregnant women as controls. RESULTS: There was no significant difference in classical maternal serum AFP (MSAFP) levels between the 2 groups. In contrast, MSt-AFP levels were significantly lower in cases of TPL than in the control group [7.64 (1.78-29.06) vs. 33.38 (13.80-190.50) ng/ml; p = 0.006]. Similarly, the t-AFP:AFP ratio was also decreased in the TPL group [0.04 (0.004-0.12) vs. 0.16 (0.05-0.80); p = 0.008]. There was no significant correlation between MSAFP and MSt-AFP levels. CONCLUSIONS: MSt-AFP levels are decreased in women with TPL.

Three-dimensional power Doppler analysis of cerebral circulation in normal and growth-restricted fetuses.

The objective of the present study was to evaluate fetal cerebral circulation by using three-dimensional (3D) power Doppler ultrasound in normal and growth-restricted fetuses. A total of 100 normal grown fetuses were compared with other 25 with growth restriction (FGR). Three-dimensional power Doppler ultrasound was used to assess fetal cerebral 3D vascular indices: vascularization index, flow index (FI), and vascularization flow index (VFI). Both FI and VFI correlated positively with gestational age. On average, all the 3D vascular indices were increased in fetuses with FGR. The proportion of fetuses detected as having hemodynamic redistribution was higher when using 3D power Doppler indices than by means of the middle cerebral artery pulsatility index (52% versus 20%, P=0.002). In conclusion, two of the three indices increased during gestation. All the fetal cerebral 3D vascular indices are increased in fetuses with FGR. In these fetuses, there were more cases suggesting hemodynamic redistribution than expected by conventional Doppler studies.

Maternal and fetal serum transformed alpha-fetoprotein levels in normal pregnancy.

AIM: To evaluate transformed alpha-fetoprotein (t-AFP) (a new molecular conformation of alpha-fetoprotein) levels in maternal serum and fetal serum in normal pregnancy. METHODS: Prospective longitudinal study. Fifty pregnant women were studied in two groups: 25 were evaluated in each trimester of pregnancy and near term (12, 20, 32 and 36 weeks) and the other 25 were evaluated at the time of planned cesarean section at term. In the first group, maternal serum t-AFP was measured and in the second group, maternal and fetal serum t-AFP were analyzed. RESULTS: Maternal serum t-AFP levels (medians) were 14.73 ng/mL in the first trimester, 28.29 ng/mL in the second trimester, 30.45 ng/mL in the early third trimester and 8.06 ng/mL in late pregnancy. t-AFP levels were significantly higher in maternal than in fetal serum (P < 0.001). There were no significant correlations between AFP and t-AFP levels in maternal versus fetal serum. CONCLUSIONS: t-AFP increases during pregnancy until the early third trimester and then falls before delivery. t-AFP levels are higher in maternal than in fetal serum which suggests that native AFP is transformed to t-AFP either in the mother or in the placenta.

Chondrosarcoma of the uterus: case report and literature review.

BACKGROUND: Pure heterologous sarcomas of the uterine corpus are extremely rare, accounting for 4% of all uterine sarcomas. Primary chondrosarcoma, which is characterized by the absence of epithelial or other heterologous mesenchymal elements, is included in this group. To this date, only 17 cases, including the presenting case, have been reported. CASE: A 55-year-old female presenting with post-menopausal bleeding was diagnosed with chondrosarcoma of the uterus, after abdominal hysterectomy and bilateral salpingoophorectomy. After 8 months of surgery, there is no evidence of recurrence after receiving external radiotherapy and brachytherapy. CONCLUSION: Primary chondrosarcoma of the uterus is an extremely rare uterine tumour most frequently diagnosed by the pathologist. They are usually aggressive malignant tumours with an early relapse and metastases.

Effects of antenatal betamethasone on human fetal branch pulmonary artery flow velocity waveforms.

OBJECTIVE: To evaluate the effect of antenatal betamethasone on fetal branch pulmonary artery flow velocity waveforms. METHODS: Betamethasone 12 mg i.m. in 2 injections 24 h apart was given to 25 pregnant women at risk of preterm delivery. Pulsatility (PI) and resistance (RI) indexes were measured at the proximal, middle and distal segments of the fetal pulmonary artery before and repeatedly 1, 2 and 7 days after the first dose. ANOVA for repeated measures and the general linear model were used to statistically analyze the results. RESULTS: Blood flow resistance decreased after betamethasone treatment at both the middle (p = 0.001 and p = 0.02 for RI and PI, respectively) and the proximal (p = 0.03 for RI) segments returning to basal values after 7 days. CONCLUSIONS: Antenatal betamethasone decreases fetal branch pulmonary artery vascular resistance.

Metabolic syndrome in normal and complicated pregnancies.

OBJECTIVE: To evaluate the prevalence of metabolic syndrome and its components in normal and complicated pregnancies. SETTING: university hospital, tertiary referral centre. SUBJECTS: 90 pregnant women in four groups: 20 women with preeclampsia, 20 women with gestational hypertension, 30 women with late-onset gestational diabetes and 20 healthy pregnant women as a control group. INTERVENTION: peripheral insulin resistance was measured by using the insulin tolerance test. Glucose, triglycerides, high-density lipoprotein cholesterol, blood pressure and body mass index were analysed. Comparisons were done by Chi-squared test, one-way analysis of variance and the Bonferroni's test. Prevalence of the metabolic syndrome was calculated by adapting both the WHO and the NCEP definitions of the metabolic syndrome to pregnancy. RESULTS: There were no cases of metabolic syndrome in the control group according to any of the adapted definitions. The prevalence of this syndrome was 3.3% and 10% in the late-onset gestational diabetes group, 35% and 20% in the gestational hypertension group and 30% and 30% in the preeclampsia group for the WHO and the NCEP definitions, respectively. CONCLUSIONS: Metabolic syndrome is present in about one-third of women with pregnancy-induced hypertension but only in 10% of women with late-onset gestational diabetes.

Ultrasound evaluation of visceral fat and metabolic risk factors during early pregnancy.

OBJECTIVE: The objective was to study the relationships between ultrasound estimated visceral fat and metabolic risk factors during early pregnancy. RESEARCH METHODS AND PROCEDURES: Thirty consecutive healthy pregnant women at 11 to 14 weeks of gestation were studied. Maximum subcutaneous fat thickness (SFT) and visceral fat thickness (VFT) were successfully measured by ultrasound. Fasting plasma glucose, insulin, triglycerides, total cholesterol, high-density lipoprotein cholesterol (HDL-C), and blood pressure were measured. Insulin resistance was calculated by using the homeostasis model assessment (HOMA). RESULTS: VFT significantly correlated with diastolic blood pressure (r = 0.37, p = 0.04), glycemia (r = 0.37, p = 0.04), insulinemia (r = 0.59, p = 0.001) insulin sensitivity (HOMA; r = 0.59, p = 0.001), triglycerides (r = 0.58, p = 0.03), HDL-C (r = -0.39, p = 0.03), and total cholesterol/HDL-C ratio (p = 0.002), whereas SFT was significantly correlated with only diastolic blood pressure (p = 0.03). VFT better significantly correlated with the metabolic risk factors than pre-gestational BMI [r = 0.39, p = 0.03 for insulinemia, r = 0.42, p = 0.02 for insulin sensitivity (HOMA), and r = 0.49, p = 0.01 for triglycerides and not significant for the rest]. DISCUSSION: Visceral fat thickness can be easily measured by ultrasound at early pregnancy and correlates better than BMI with metabolic risk factors.