Gene Variants Determine Placental Transfer of Perfluoroalkyl Substances (PFAS), Mercury (Hg) and Lead (Pb), and Birth Outcome: Findings From the UmMuKi Bratislava-Vienna Study.

Prenatal exposure to perfluoroalkyl substances (PFAS), bisphenol A (BPA), lead (Pb), total mercury (THg), and methylmercury (MeHg) can affect fetal development. Factors influencing placental transfer rate of these toxins are poorly investigated. Whether prenatal exposure to pollutants has an effect on birth weight is incompletely understood. We therefore aimed (1) to determine placental transfer rates of PFAS, BPA, Pb, THg, and MeHg, (2) to analyze relationships between fetal exposure and birth outcome and (3) to analyze gene variants as mediators of placental transfer rates and birth outcome. Two hundred healthy pregnant women and their newborns participated in the study. BPA, 16 PFAS, THg, MeHg, and Pb were determined using HPLCMS/MS (BPA, PFAS), HPLC-CV-ICPMS (MeHg), CV-AFS (THg), and GF-AAS (Pb). Questionnaires and medical records were used to survey exposure sources and birth outcome. 20 single nucleotide polymorphisms and two deletion polymorphisms were determined by real-time PCR from both maternal and newborn blood. Genotype-phenotype associations were analyzed by categorical regression and logistic regression analysis. Specific gene variants were associated with altered placental transfer of PFAS (ALAD Lys59Asn, ABCG2 Gln141Lys), THg (UGT Tyr85Asp, GSTT1del, ABCC1 rs246221) and Pb (GSTP1 Ala114Val). A certain combination of three gene polymorphisms (ABCC1 rs246221, GCLM rs41303970, HFE His63Asp) was over-represented in newborns small for gestational age. 36% of Austrian and 75% of Slovakian mothers had levels exceeding the HBM guidance value I (2 µg/L) of the German HBM Commission for PFOA. 13% of newborns and 39% of women had Ery-Pb levels above 24 µg/kg, an approximation for the BMDL01 of 12 µg/L set by the European Food Safety Authority (EFSA). Our findings point to the need to minimize perinatal exposures to protect fetal health, especially those genetically predisposed to increased transplacental exposure.

Successful ablation of acardiac twin with Histoacryl.

OBJECTIVE: Acardiac twin occurs in 1:35,000 pregnancies. Several techniques have been described to treat this condition. Some techniques have been suggested as golden standard; however, new are still being tried. CASE REPORT: This is a case of a 32-year-old patient who had successful ablation of the acardiac twin with Histoacryl. The diagnosis of the acardiac twin was made in the 11 weeks + 3 weeks of pregnancy. Due to the development of myocardial hypertrophy and pericardial transudate of the pumping fetus, we had performed ablation of the acardiac twin with Histoacryl in the 21 weeks' +5 weeks' gestation. The procedure was uneventful, and the healthy fetus had no signs of distress. In the 33 weeks' +5 weeks' gestation, she had Cesarean section due to distress of the healthy fetus. The female baby was healthy, weighing 2380 g, Apgar score 9/10. The mummified mass of acardiac fetus weighted 300 g. Nine months later, the child is doing well. CONCLUSION: Histoacryl is suitable for the ablation of an acardiac twin. Further studies are needed to prove the efficacy of this technique.

[Pelvic venous congestion syndrome - diagnosis and management. Guidelines of the angiology section of slovak medical chamber (2015)]. / Syndróm vénovej panvovej kongescie - diagnóza a manazment Odporúcanie Angiologickej sekcie Slovenskej lekárskej komory (2015).

Pelvic congestion syndrome: chronic symptoms, which may include pelvic pain, perineal heaviness, urgency of micturition, and post-coital pain, caused by ovarian and/or pelvic vein reflux and/or obstruction, and which may be associated with vulvar, perineal, and/or lower extremity varices. The VEIN-TERM consensus document was developed by a transatlantic interdisciplinary faculty of experts under the auspices of the American Venous Forum (AVF), the European Venous Forum (EVF), the International Union of Phlebology (IUP), the American College of Phlebology (ACP), and the International Union of Angiology (IUA). It provides recommendations for fundamental venous terminology. Project Vessels of AS SMC.

Pregnancy after uterine artery embolization for the treatment of myomas: a case series.

PURPOSE: Uterine artery embolization (UAE) has become an alternative therapy for the treatment of symptomatic myomas. The questions of fertility and pregnancy outcome after uterine artery embolization are still not answered. The study presents the results of pregnancies after UAE. The main goal was to evaluate the course of these pregnancies and concentrate on possible complications. METHODS: This was a prospective study from June 2009 till October 2011. Patients with symptomatic uterine myomas were included. The evaluation of the symptoms was done by quality of life questionnaire and bleeding charts. UAE was performed by superselective microcatheterization technique. Women still planning pregnancy were included in the study after signing detailed informed consent. Pregnant women after UAE were followed as high-risk pregnancies. RESULTS: A total of 98 patients underwent uterine artery embolization for symptomatic myomas; 21 expressed their wish to become pregnant, out of which 6 had successful spontaneous conception (23.08 %) and 1 patient was pregnant twice, and altogether there were seven pregnancies. During gestation and delivery, there was no serious complication. There was one missed abortion and one placental retention. Myomas did not show growth pattern during pregnancy. CONCLUSIONS: Data from further prospective, randomized trials comparing fertility and pregnancies after UAE with other treatment modalities are needed. UAE, with the new techniques of superselective microcatheterization, could be, in the future, a possible approach even in women with future maternity plans.

Amniopatch - possibility of successful treatment of spontaneous previable rupture of membranes in the second trimester of pregnancy by transabdominal intraamiotic application of platelets and cryoprecipitate.

OBJECTIVE: To outline possibility of successful treatment of spontaneous previable rupture of membranes in the second trimester of pregnancy. INTRODUCTION: Spontaneous previable rupture of membranes (SPROM) in the second trimester of pregnancy is one of the most alarming problems in current obstetrics. Perinatal mortality is about 60 %, one third of which represents intrauterine fetal demise. Surviving neonates suffer from various complications. There are different clinical approaches regarding treatment of SPROM. MATERIAL AND METHODS: We present a case of a 30 year old secundigravida with a history of SPROM at 19+1 weeks gestation. Ultrasonographic examination revealed anhydramnios. Genital cultures and laboratory studies ruled out infectious etiology of SPROM. Due to expected poor neonatal outcome, decision to attempt amniopatch as an experimental therapeutic alternative was made at 21+1 weeks gestation (two weeks after SPROM had occurred). Autologous concentrated platelets followed by autologous cryoprecipitate were administered into the amniotic cavity transabdominally under ultrasound guidance. After 3 days sonographic examination showed normal volume of amniotic fluid. On 22 postoperative day, patient notice some leaking of fluid vaginally. Fetal growth was appropriate, amniotic fluid volume was decreased, however, oligohydramnios never progressed to anhydramnios. Pregnancy ended with primary cesarean delivery at 33+1 weeks gestation. Live born male infant with 1750 g birth weight was delivered. Postnatal development was within normal limits. CONCLUSION: Intraamniotic application of "amniopatch" may represent a possibly successful treatment of spontaneous previable rupture of membranes. This case reports the longest stop of the leaking of amniotic fluid and total prolongation of pregnancy with favorable perinatal outcome after "amniopatch" treatment of spontaneous previable rupture of membranes in the second trimester so far published in available literature.

An alternative management for growth retarded fetus with absent end-diastolic velocity in umbilical artery and normal cardiotocography.

OBJECTIVES: Intrauterine growth retardation (IUGR) is associated with fetal adverse conditions. The most important cause of growth restriction and poor perinatal outcome is chronic fetal hypoxemia (CFH). Adaptation to CFH can be studied by Doppler velocity waveform on umbilical and fetal arteries and cardiotocography (CTG). METHODS: Preterm delivery, as an elimination of CFH, has to be confronted with the risks of prematurity. A special situation may occur when CTG is normal at the absence of end-diastolic velocity (AEDV). AEDV in the umbilical artery precedes the onset of abnormal CTG, whose duration differs considerably among the fetuses. The time after the onset of AEDV in pregnancy may be utilized for performing exact diagnosis by fetal blood analysis. CASE: Primigravida at 30 gestational weeks was referred because of IUGR. IUGR, AEDV, oligohydramnion, and normal fetal anatomy were revealed. CTG was normal. Indication for cordocentesis was to perform cord blood gases analysis and to obtain fetal caryotype. Cordocentesis revealed normal caryotype, values of pH, and fetal blood gases were considered satisfactory. Continuation of pregnancy was decided in spite of persistent AEDV. At 33 gestational weeks pathological CTG was an indication for induction of labor. Labor, delivery, umbilical blood gases, postpartal and neonatal outcome were normal. CONCLUSION: In the case of fetal monitoring controversy assessment of umbilical blood analysis may be crucial. This examination is significant and independent of the interval between cordocentesis and the onset of CTG pathology. This interval may be utilized for intrauterine treatment and for optimizing obstetric management.

Delivery as a "physiological stress" and its influence on some parameters of oxidative stress.

OBJECTIVES: In healthy term newborns (HTN) to determine on the 1st and 5th day of life the activity of total antioxidant capacity (TAS), malondialdehyde (MDA), superoxide dismutase (SOD) and glutathione peroxidase (GPX) and to compare the values with the group of asphyxiated term newborns (ATN). PATIENTS/METHODS: The series consisted of 15 HTN and 24 ATN. In both groups TAS, MDA, GPX and SOD were investigated. RESULTS: Reference values in HTN (1st/5th day of life) for TAS were 0.52+/-0.03/0.49+/-0.04 mmol/l, for MDA 0.72+/-0.07/1.08+/-0.09 micromol/l, for SOD 594.20+/-16.47/591.23+/-14.14 Ug/Hb and for GPX 25.48+/-1.32/25.98+/-1.20 Ug/Hb. In a group of ATN the obtained values were (1st/5th day of life): TAS 1.1+/-0.08/0.98+/-0.08 mmol/l, MDA 2.08+/-0.22/2.21+/-0.34 micromol/l, SOD 509.18+/-26.8/564.49+/-36.4 Ug/Hb and GPX 30.2+/-1.9/32.45+/-2.69 Ug/Hb. CONCLUSIONS: Statistically significant differences were found on the 1st and 5th day of life between the two groups investigated in values of MDA (**p<0.01) and TAS (**p<0.01). Increased values of MDA in the group of ATN on the 1st and 5th day of life confirmed the presence of lipoperoxidation. The obtained values of TAS on the 1st and 5th day of life in the group of ATN were surprisingly higher than in HTN. The increase of TAS in ATN could point to a certain ability of ATN to prevent the damage of balance between overproduction of MDA and antioxidants. The results of SOD and GPX activity were not statistically significant, yet they are indicative of the biochemical reaction of the organism of term newborns to asphyxia.

Delivery as "physiological stress" and its influence on liver enzymatic systems in asphyxial newborns.

A new aspect on delivery as "physiological stress" provides the possibility for assessing its influence in asphyxial newborns. Asphyxia is characterized by hypoxic ischemic damage of organs with subsequent damage due to reoxygenation and reperfusion. The aim of the study was to compare the activity of liver enzymatic systems of healthy newborns with asphyxial newborns. Reference values of the AST on the 1st day of life 0.80 +/- 0.12 microkat/l and on the 5th day of life 0.78 +/- 0.11 microkat/l, of the ALT on the 1st day of life 0.29 +/- 0.04 microkat/l and on the 5th day of life 0.54 +/- 0.21 microkat/l and of the quotient of DeRitis on the 1(st) day of life 3.35 +/- 0.6 and on the 5th day of life 2.14 +/- 0.22 were established. The quotient of DeRitis expresses better the influence of stress on healthy term newborns since isolated evaluation of liver enzymes and their dynamics, which is decreased on the 5th day of life shows stabilization of the baby and improvement of liver cell function in comparison with the 1st day of life. The authors found that delivery is considered to be a certain form of physiological stress.