Can first trimester pregnancy-associated plasma protein-A predict the surfactant needs of preterm neonates?

BACKGROUND: Low values of pregnancy associated plasma protein A (PAPP-A), have been shown to be associated with some poor gestational outcomes, especially those related to placental deficiency such as pre-eclampsia and fetal growth restriction as well as preterm labor. The aim of this study was to compare first trimester PAPP-A MoM values with the surfactant needs of newborns of pregnant women who had a preterm delivery. METHODS: This study included 216 pregnant women who had a preterm delivery, who were found to be in the low-risk group based on their aneuploidy screening. The women were separated into two groups based on the surfactant receipts of their newborns. A record was made of the obstetric history, birth characteristics of the preterm infants, and whether or not there was a need for surfactant. RESULTS: A comparison of the PAPP-A values of the two groups revealed that the group that received surfactant had statistically significantly lower PAPP-A values (t(-3.97) = 0.203, p < 0.001). When the cut-off value of PAPP-A was taken as 1 MoM and the gestational age was analyzed together with the birth weight, PAPP-A alone was found to be a significant independent variable for the prediction of respiratory distress syndrome (RDS) (p = 0.031; OR:8.2 (1.2-55.6)). CONCLUSIONS: The result of this study demonstrated that PAPP-A MoM values may be significant in predicting the need for surfactant in RDS, which is a frequently seen condition in the neonatal period.

Protective effect of intravenous lipid emulsion treatment on malathion-induced ovarian toxicity in female rats.

OBJECTIVE: Malathion (MLT) is an organophosphate (OP) pesticide widely used in agriculture and for domestic purposes for several years. Intravenous lipid emulsion (ILE) has been reported to reduce toxicity caused by some lipid soluble agents. The aim of this study was to investigate the possible protective effects of ILE treatment on acute malathion toxicity in ovarian tissue of female rats. MATERIALS AND METHODS: Twenty-one adult female Wistar rats (weighted 200-250 g) were divided into three groups; control (corn oil, gavage), MLT (one administration of 100 mg/kg/ by gavage), 20% ILE (one intravenous administration of 3 ml/kg) plus the MLT group. Blood samples were collected for biochemical tests. The ovaries were removed and fixed for histopathological and immunohistochemical analyses. Malondialdehyde (MDA), superoxide dismutase (SOD), and glutathione peroxidase (GSH-Px) were investigated in ovarian tissues. Histopathological and immunohistochemical evaluations were performed through scoring ovarian tissue damage and bax/caspase-3 immunoreactivity, respectively. RESULTS: SOD activity decreased in MLT group compared to the control group in tissue samples (p = 0.012). ILE treatment significantly increased SOD activity in MLT+ILE group compared to MLT group in tissue samples (p = 0.017). MLT treatment increased significantly caspase-3 and bax immunoreactivity while ILE decreased bax and caspase-3 immunoreactivity. However, no significant difference was found for MDA levels and GSH-Px activity in both blood and tissue samples and for histopathological results. CONCLUSIONS: The present study revealed that acute oral MLT administration increased oxidative stress and apoptosis in the rats. ILE treatment partially decreased deleterious effects of MLT. Further controlled animal studies are required to define the role of ILE in acute OP poisonings.

Obstetric outcomes in pregnancies with normal nuchal translucency and abnormal ductus venosus Doppler in the first trimester ultrasonography.

In the present case-control study, we evaluated obstetric outcomes of pregnancies with normal nuchal translucency (NT) and abnormal ductus venosus (DV) Doppler findings in the first trimester combined screening test for chromosomal abnormalities. All study patients underwent DV Doppler examination, concurrent with the combined screening test. DV Doppler revealed pathologic findings in 14 pregnant women despite normal NT after the elimination of lost to follow-up and foetal anomaly. Obstetric outcomes of the case patients were compared with a control group that were matched for mean gestational age, and Crown-rump length with normal NT and DV Doppler measurements was selected comprising 88 pregnant women. Regarding maternal outcomes, women with abnormal DV Doppler findings had a higher rate of placental abruption, delivered at an earlier mean gestational age (preterm delivery). Interestingly, a higher rate of spontaneous vaginal delivery rate was observed in these patients. From the foetal perspective, pregnancies with abnormal DV Doppler had lower birth weight and received lower Apgar scores. In conclusion, an abnormal DV Doppler test in the first trimester was associated with poor maternal and foetal obstetric outcomes. These findings should be elucidated in future studies.

The predictive value of lactate levels in vaginal fluid on the latent period in pregnant women with preterm premature rupture of membranes.

The aim of the present study was to investigate the relationship between lactate level in vaginal fluid and the latent phase of labour in pregnancies complicated by preterm premature rupture of membranes (PPROM). Seventy pregnant women with PPROM during 28-34 weeks' gestation were selected for this prospective observational study. All subjects underwent a pelvic examination involving the insertion of a vaginal speculum, and lactate levels were measured in vaginal fluid samples. The relationship between the lactate levels in the vaginal fluid and the latent phase of the labour was analysed using a logistic regression test. Of the patients, 48 (68.6%) had a latent period of 48 h or less, and 22 patients (31.4%) had a latent period longer than 48 h. The median lactate level was 3.81 mmol/L in patients with a latent period ≤ 48 h, and 3.36 mmol/L in patients with a latent period > 48 h. The lactate level in vaginal fluid was not found to be distinctive in the differentiation of patients according to the duration of the latent phase (receiver operating characteristic or ROC: 0.509; 95% confidence interval or CI: 0.361-0.657; p = 0.904). There was no significant correlation between the lactate level in the vaginal fluid and the transition from the latent phase to the active phase of labour in pregnancies complicated by PPROM.

Is lateral localisation of placenta a risk factor for adverse perinatal outcomes?

The aim of this study was to evaluate the relationship between placental localisation and perinatal outcomes. This study was performed in a tertiary centre hospital by retrospectively analysing the medical records of patients who were followed up and underwent delivery in the same hospital. The patients were divided into two groups according to the placental locations (central and lateral) in their routine sonographic findings between the 18 and 24 weeks' gestation. Out of 1,057 patients, 87.4% (n = 919) had centrally located placentas and 12.6% (n = 133) had laterally located placentas. Preeclampsia was found to be significantly higher in the lateral placental location group (4.5% vs. 1.6%; p = 0.027). There was a significant correlation with foetal growth restriction (FGR), preterm birth rates, low Apgar scores and need for neonatal intensive care unit in the lateral placental location group (p < 0.05). The pregnant women with laterally located placentas should be followed up promptly with special care for the risk of preeclampsia and FGR, and poor neonatal outcomes.

Isolated polycystic morphology: Does it affect the IVF treatment outcomes?

The aim of the current study was to compare women who have normal ovarian ultrasonographic findings and women with ovulatory polycystic ovary (PCO), in terms of IVF treatment outcome. The study was conducted at a tertiary referral hospital and included 906 women who underwent IVF treatment. Of these, 224 of the women had PCO (24.7%) and 682 of the women had normal ovarian morphology (75.3%) at the time of ultrasonographic examination prior to IVF. The treatment outcomes were compared between the two groups. In the PCO group, the number of oocytes at the size of > 16 mm, the overall number of collected oocytes and the number of fertilised oocytes were found to be significantly higher. Furthermore, the rates of implantation, biochemical pregnancy and clinical pregnancy were significantly higher in the PCO group (p < 0.05). The detection of PCO morphology on baseline ultrasonography in IVF candidates may be associated with higher treatment success.