Structural differences in the umbilical vein wall after full-term and pre-term delivery.

With the exception of its most proximal segment, the human umbilical cord lacks innervation. It might be expected, therefore, that a paracrine effect through the direct contact between the smooth muscle cells and the endothelium may be particularly important in the control of the fetoplacental circulation. In this study, electron microscopy and immunohistochemistry were applied to examine umbilical veins immediately after full-term and pre-term delivery. The smooth muscle cells in the upper layer of the tunica media exhibited long, foot-like processes with c-kit immunoreactivity. In the umbilical vein of full-term neonates more than 50% of these cell processes display a normal ultrastructure and they were closely associated with the lamina elastica interna. Whereas in pre-term infants more than 60% of these cell processes exhibit signs of severe shrinkage and detachedness from the lamina elastica interna. At the same time, the high level of immunoreactivity of the endothelial cells as regards the proapoptotic gene product Bax in pre-term infants is indicative of an enhanced apoptotic process in these cells.

Birth weight discordance in spontaneous versus induced twins: impact on perinatal outcome.

PURPOSE: To compare the rate of birth weight discordance and perinatal outcome of twin pregnancies after assisted reproduction with that of spontaneous twins. METHOD: A total of 12,920 deliveries were analyzed retrospectively. Seventy-five twin pregnancies after ART were compared to the 94 spontaneous counterparts. Birth weight discordance was defined as a difference of 20% or more. RESULTS: Discordance rate was elevated (25.3% vs. 17.0%) among ART twins. SGA was increased and NICU admission was more frequent in discordant group. Unlike-sexed twins were more prevalent (73.7% vs. 37.5%) among discordants after ART. CONCLUSIONS: ART can increase discordance rate which can elevate perinatal risk.

Dilemma of increased obstetric risk in pregnancies following IVF-ET.

PURPOSE: To determine the rates of pregnancy complications following in vitro fertilization in comparison with those in a matched control group. METHODS: A total of 13,543 deliveries at the Department of Obstetrics and Gynecology, University of Szeged, between January 1, 1995 and February 28, 2002 were subjected to retrospective analysis The 230 (1.7%) pregnancies following IVF-ET were evaluated and matched with spontaneous pregnancies concerning age, parity, gravidity, and previous obstetric outcome. Demographic and selected maternal characteristics, pregnancy and labor complications, and neonatal outcome were compared in the two groups RESULTS: The pregnancy complication rate was partly significantly higher among the singleton IVF-ET pregnancies. The obstetric risk was elevated, though not significantly concerning twin pregnancies. CONCLUSIONS: IVF-ET presents an additional obstetric risk. The neonatal outcome displays a significant difference only concerning an increased premature birth rate of singleton pregnancies. Triplet IVF-ET pregnancies involve a much higher risk of both pregnancy complications and neonatal outcome.

The incidence of major birth defects following in vitro fertilization.

PURPOSE: To evaluate the risk of congenital malformations in newborns delivered after IVF-ET in comparison with matched controls from spontaneous pregnancies. METHODS: A total of 12,920 deliveries were subjected to retrospective analysis. A total of 301 neonates were evaluated. The incidence of major birth defects was compared with controls matched with regard to age, gravidity, parity, and previous obstetric outcome after spontaneous pregnancies. RESULTS: The incidence of major congenital abnormalities was not significantly higher (p > 0.05) among the cases (1.90%) than among the controls (1.15%). CONCLUSION: The risk of major birth defects following IVF-ET is comparable with that of spontaneously conceived, matched pregnancies.

Perinatal outcome of induced and spontaneous pregnancies of primiparous women aged 35 or over.

OBJECTIVES: To compare the neonatal and maternal morbidity data associated with induced or naturally conceived pregnancies of primiparous women aged 35 years and older. METHODS: We recruited primiparous women aged 35 years and older, who delivered between January 1995 and December 2000. The outcomes of the induced (n=62) and naturally conceived (n=132) pregnancies were compared. The Fisher exact test was used for univariate analysis in order to compare the delivery and pregnancy characteristics in the two groups. RESULTS: Cesarean section featured with a 0.76 times lower prevalence among the induced pregnant women, than among the spontaneous ones, but the difference was not significant statistically. The induced pregnancies were not associated with a significantly higher rate of perinatal complications. CONCLUSIONS: Induced pregnancy does not involve a higher risk of maternal complications. The incidence of premature newborns and intrauterine growth retardation was high in both subgroups, but without a statistically significant difference.

Gender-related physiologic differences in human neonates and the greater vulnerability of males to developmental brain disorders.

OBJECTIVE: To examine whether gender-specific physiologic differences are present at birth and can be a basis for gender-specific vulnerability to developmental disorders in males. We report on three studies of male-female physiologic and structural differences in neonates and their relevance to observed differences in the incidence of developmental disorders in males. METHODS: Study I: 56 neonates were examined for cardiac reactivity to the Moro reflex. Study II: 863 neonates' basic anthropometric data were examined to demonstrate gender-specific differences in body proportions as a possible basis for psychophysiologic differences. Study III: Developmental data on 1000 one- to 26-week-old infants were analyzed for gender-specific developmental differences in rhythmic patterns of sleeping and eating. RESULTS: Study I: There were gender-related differences in heart rate reactivity (male > female). Study II: Male newborns had significantly larger head/chest proportions, suggesting that they may have a greater metabolic demand, related to brain size. Study III: Mothers reported that infant males' sleeping rhythm developed significantly later than females', and that they slept for shorter periods at night. CONCLUSIONS: Gender-related vulnerability in brain development is proposed, based on physiologic differences during a specific early sensitive period in development. This hypothesis may help to explain the overrepresentation of males reported for most developmental disorders.

Breastfeeding duration and previous breastfeeding experience.

UNLABELLED: The aim of this study was to examine the effect of duration of earlier breastfeeding on the duration of breastfeeding with subsequent births. Medical records of 327 women who had had at least two deliveries were analysed; 89 of these women had had three deliveries. The average duration of breastfeeding increased from 6.01 mo to 6.85 mo with the second baby, but did not increase significantly with the third. A significant negative correlation was found between duration of first breastfeeding and change of breastfeeding duration at the second breastfeeding. Mothers who breastfed their first child for 0-7 mo significantly increased the duration of breastfeeding with the second child, whereas mothers who breastfed their firstborn for 8 mo or longer significantly reduced breastfeeding with the second baby. CONCLUSION: Results support earlier studies showing that duration of breastfeeding of the second child is significantly related to previous breastfeeding experience. Results also suggest that previous breastfeeding experience may lead mothers to regulate duration of subsequent breastfeeding toward a level that is optimal for them. The results are interpreted with respect to societal changes in breastfeeding patterns, as well as the role of maternal learning in breastfeeding behaviour.

Blood glutathione redox status in gestational hypertension.

Gestational hypertension during the third trimester reflects an exaggerated maternal inflammatory response to pregnancy. We hypothesized that oxidative stress present even in normal pregnancy becomes uncompensated in hypertensive patients. A glucose-6-phosphate dehydrogenase (G6PD) activity sufficient to meet the increased reductive equivalent need of the cells is indispensable for defense against oxidative stress. The erythrocyte glutathione redox system was studied, where G6PD is the only NADPH source. The glutathione (GSH) redox status was measured both in vivo and after an in vitro oxidative challenge in pregnant women with gestational hypertension (n = 19) vs. normotensive pregnant subjects (n = 18) and controls (n = 20). An erythrocyte GSH depletion with an increase in the oxidized form (GSSG) resulted in an elevated ratio GSSG/GSH (0.305 +/- 0.057; mean +/- SD) in hypertensive pregnant women vs. normotensive pregnant or control subjects (0.154 +/- 0.025; 0.168 +/- 0.073; p <.001). In hypertensive pregnant patients, a "GSH stability" decrease after an in vitro oxidative challenge suggested a reduced GSH recycling capacity resulting from an insufficient NADPH supply. The erythrocyte GSSG/GSH ratio may serve as an early and sensitive parameter of the oxidative imbalance and a relevant target for future clinical trials to control the effects of antioxidant treatment in women at increased risk of the pre-eclampsia syndrome.

Four years experience of first-trimester nuchal translucency screening for fetal aneuploidies with increasing regional availability.

BACKGROUND: A prospective screening study was carried out at the regional genetic and perinatal center in South Hungary in order to determine the efficiency of first-trimester nuchal translucency screening for fetal aneuploidies, following augmentation of the availability of nuchal translucency screening in the region by the inclusion of newly-trained hospital sonographers. METHODS: Nuchal translucency thickness was measured by transvaginal sonography in 7,044 women with singleton or multiple pregnancies at weeks 10-12. Fetal karyotyping was performed when the nuchal translucency was . or = 2.5 mm, and in women with fetuses at high cytogenetic risk. RESULTS: Follow-up was performed in 6,841 of the 7,044 screened women. An abnormal karyotype was found in 33 cases (0.48%). The level of increased nuchal translucency was 4.5% at a cutoff of > or = 2.5 mm, and 2.8% at a cutoff of > or = 3 mm. Seventeen cases of trisomy 21, eight of trisomy 18, four of trisomy 13, one of 45,X, one of triploidy and two cases with other chromosomal abnormalities were detected. In the 33 fetuses with a chromosomal abnormality, the nuchal translucency thickness was <2.5 mm in a case of trisomy 18, > or = 2.5 mm in 32 cases and > or = 3 mm in 28 cases. With cutoffs of 2.5 mm and 3 mm, the sensitivity was 96.97% and 84.85%, respectively. CONCLUSIONS: Application of a nuchal translucency thickness cutoff of 2.5 mm is highly efficient for the screening of fetal aneuploidies at 10-12 weeks. This efficiency can be maintained by increasing the regional availability of nuchal translucency screening through the inclusion of newly-trained hospital sonographers.

Ferroxidases and xanthine oxidase in plasma of healthy newborn infants.

In the neonatal period, there is a high iron load, while both the level and molar oxidase activity of ceruloplasmin are low. On the other hand, the neonatal xanthine oxidase (XO) activity is higher than later in life and XO has a significant iron-oxidizing capacity. We therefore studied the physiological contribution of XO to the ferroxidase activity of the plasma in 20 full-term newborn infants. Ferroxidase activity was measured spectrophotometrically, with Fe++ as substrate. The uric acid formed by XO was assayed by means of HPLC, with electrochemical detection. The total ferroxidase activity in the plasma was about one-fourth of the adult level and rapidly increased doubling within 3 days after birth. About 90% of the plasma ferroxidase activity was due to ceruloplasmin, the remainder being accounted for by ferroxidase II. The XO activity underwent a 30% (statistically non-significant) elevation at 24 h, though ferroxidase activity attributable to XO was not detected at any time. Accordingly, XO does not seem to add substantially to the total iron-oxidizing capacity of the plasma in the neonatal period. The high molar ferroxidase activity is probably of importance at the endothelial cell surface.

Gender-related heart rate differences in human neonates.

The aim of the present study was to examine gender-related differences in heart rate of human neonates controlled for their behavior. Previous studies could not find any difference in male and female fetuses and newborns, although this gender-dependent difference clearly exists in children and adults. The heart rate of 99 newborns (47 girls and 52 boys) was measured with simultaneous video recording of their behavior. Results proved that alert newborns showed the same difference as adults: boys had a significantly lower baseline heart rate than girls. This suggests that heart rate is gender-dependent from birth onward.

Is adolescent pregnancy associated with adverse perinatal outcome?

BACKGROUND: The number of teenage pregnancies has increased throughout the world and these pregnancies are reported in association with a higher rate of maternal and fetal complications. AIM OF THE STUDY: To evaluate the social surroundings; the results of ante-, intrapartum surveillance and perinatal outcome in adolescent pregnancies where mothers were below the age of 18. METHODS: Between 1st January, 1991 and 31st December, 1996 there were 13,131 births at our department. During this period, 209 newborns were born of 207 adolescent mothers. We compared the data of adolescent mothers with the data of all mothers who delivered in Hungary during the study period. RESULTS: 39 (18.6%) from 209 newborns were delivered before 37th week of gestation, and 34 (16.3%) newborns showed signs of intrauterine growth retardation (IUGR). The rate of primiparous adolescent mothers was 72.0%, 131 (63.3%) were primigravidae, and 136 (65.7%) received adequate prenatal care. Maternal complications (pregnancy induced hypertension, threatened preterm delivery, gestational diabetes and pre-eclampsia) and adverse perinatal outcome (higher rate of IUGR and perinatal mortality) were found more frequently in adolescent pregnancies. CONCLUSIONS: As young maternal age is associated with an increased risk of unfavourable fetal outcome, teenage mothers need improved prenatal care and increased observation during labour. In addition, improvement of the social environment of adolescents and the prevention of teenage pregnancies should be recommended.

Epidemiological study of Chlamydia trachomatis infection in pregnant women in Hungary.

A multicentre survey was carried out in order to determine the prevalence and risk factors of Chlamydia trachomatis infection in the pregnant population in Hungary. The nucleic acid hybridisation method (PACE 2 Gen-Probe) was applied for the examination of C trachomatis. The overall average prevalence of C trachomatis cases during an 18 month survey on 6161 pregnant women was 5.87%. There were significant differences in the proportions of chlamydial infection in the different survey centres, and also in the different age groups and the different family status groups. The perinatal mortality rate exhibited a significantly higher prevalence (8.52%) among C trachomatis positive than among negative patients (2.03%). In the anamnestic histories of C trachomatis infected patients, the frequency of premature uterine activity was 8.13%, in contrast with 5.18% in the non-infected group (p < 0.05). We suggest that all pregnant women be tested for C trachomatis infection.

Iatrogenic multiple pregnancy. Higher risk than a spontaneous one?

OBJECTIVE: To determine if spontaneous and induced multiple pregnancies have similar outcomes. STUDY DESIGN: We compared the results of antepartum and intrapartum surveillance and fetal outcome in spontaneous multiple gestations (group A) with induced multiple gestations (group B) at Albert Szent-Györgyi Medical University, Szeged, Hungary, in a six-year period. RESULTS: Between January 1, 1991, and December 31, 1996, there were 13,131 births; the number of multiple pregnancies was 307 (2.34%). There were 232 spontaneous and 48 induced twin pregnancies, 8 spontaneous and 16 induced triplet pregnancies, and 3 quadruplet pregnancies, all induced. Higher incidences of gestational diabetes and cervical insufficiency were found in group B. The incidences of prematurity in the induced and spontaneous groups were similar. The incidences of low birth weight and perinatal mortality were higher in induced triplet pregnancies than in spontaneous ones. Fetal outcome, with respect to Apgar score and umbilical cord blood pH, was much poorer in both induced groups. CONCLUSION: Iatrogenic multiple pregnancy following ovulation induction or assisted operative reproductive techniques may increase the incidence of pathologic events in the antepartum, intrapartum or postpartum period. Careful counseling before assisted reproductive techniques is of paramount importance.

[Recurrence of focal sclerosing glomerulonephritis in the kidney graft]. / Focalisan sclerotisáló glomerulonephritis recidívája vesetranszplantátumban.

This is the first report on the recurrence of a glomerular disease in renal transplant in Hungary. The primary disease of the girl died at the age of 13 was focal sclerosing glomerulonephritis with slight mesangial cell proliferation. The first symptoms appeared at the age of 6.5 and they progressed rapidly. Four years later, because of the severe nephrotic syndrome and chronic renal failure, renal transplantation was performed with the synchronous removal of the patient's own kidneys. In the latter an interesting immunohistological finding has been observed: beside the usual positivities, the basement membrane of the distal tubule at the opposite side of the macula densa showed a strong reaction with anti IgM and a somewhat weaker positivity with anti C3 sera. The primary disease recurred very soon. A mesangial cell proliferation, however did not develop, in contrary to the primary disease, which contradicts the theory that the mesangioproliferative form would be a distinct clinicopathological entity.