Comparison of Amniotic Fluid Cytokine Levels in Postterm and Term Pregnancy: a Prospective Study.

BACKGROUND: To evaluate amniotic fluid pro- and anti-inflammatory cytokine levels in women with postterm and term pregnancies in labor and not in labor. METHODS: The study involved three groups: postterm (Group 1, n = 29), term in labor (Group 2, n = 28), and control (Group 3, n = 30). All groups were compared with respect to age, gravidity, parity, obstetric history, gestation week, cervical dilatation and effacement, maternal serum C-reactive protein and white cell count, amniotic interleukin 4, 6, and 10 levels, birthweight, and cord blood pH. RESULTS: The amniotic fluid interleukin 10 level was 24.4 ± 8.8 pg/mL in the postterm group, 13.5 ± 5.1 pg/mL in the term in labor group, and 19.8 ± 5.4 pg/mL in the control group (p < 0.001). The amniotic fluid interleukin 4 level was 86.5 ± 57.7 pg/mL in the postterm group, 38.2 ± 29.2 pg/mL in the term in labor group, and 81.9 ± 68.4 pg/mL in the control group (p = 0.002). The amniotic fluid interleukin 6 level was 329 ± 135.1 pg/mL in the postterm group, 252.8 ± 138.7 pg/mL in the term in labor group, and 227.9 ± 114.4 pg/mL in the control group (p = 0.02). There was a positive correlation between gestational age and IL-10 levels (p < 0.05). CONCLUSIONS: Amniotic fluid IL-10 and IL-4 cytokine levels were increased in postterm pregnancy and they decreased with active labor.

Spontaneous labor onset: is it immunologically mediated?

OBJECTIVE: The investigators tested the hypothesis that maternal-fetal immune interactions could be important in initiating spontaneous labor onset by examining if labor was delayed when fetuses share maternal HLA antigen types. STUDY DESIGN: HLA antigen types A, B, and DR in 200 Danish mother-infant pairs delivering in 42-44 weeks (postterm) were compared with 195 mother-infant pairs delivering in 37-40 weeks (term). RESULTS: Sharing of HLA A and B antigens was more common than expected in postterm deliveries. Odds ratios were 1.54 (95% confidence interval [CI], 1.01-2.35) and 1.75 (95% CI, 0.87-3.52), respectively (risk per shared antigen: 1.40 [95% CI, 1.04-1.90] per unit increase). Adding stringent birth-length criteria for postmaturity (92 cases; 168 controls) strengthened risks associated with antigen sharing to 1.57 (95% CI, 0.90-2.74) and 2.60 (95% CI, 1.15-5.88), respectively (risk per shared antigen: 1.60 (95% CI, 1.10-2.32). CONCLUSION: Postterm-delivered infants had more HLA A and B antigens in common with their mothers, suggesting that recognition of HLA antigen differences by adaptive immunity may have a role in triggering labor onset.

[Study of immunological status in women with post-term pregnancy].

The aim of the work was to study immunological homeostasis by comparing the immune responses during physiological, post-term and prolonged pregnancy. 51 women were divided into 3 groups. In the first group there were 13 pregnant women with post-term pregnancy, in the second group--8 pregnant women with prolonged pregnancy and in the third group--30 pregnant women with term pregnancy. All of them were practically healthy pregnant women. We could not find reliable differences between full-term and prolonged pregnancies, but in latter cases there was a trend towards deficiency of immunologic factors. Post-term pregnancy was characterized as an immunophatologic condition. It may be concluded that post-term newborns must be included into the high-risk group and be permanently observed by pediatricians.

Modern concept on the role of phagocytes in the pathogenesis of complications during pregnancy.

Here we review modern concept of the role of phagocytes, the key cell component of natural immunity, in the course of pregnancy and in the pathogenesis of its complications. Phagocytes contribute to the development, maintenance, and favorable outcome of pregnancy. These cells play a role in the pathogenesis of various pregnancy complications, including fetal growth retardation, late gestosis, and intrauterine infections. The understanding of the pathophysiological mechanisms that occur in the mother-placenta-fetus system would allow us to improve diagnostic procedures, perform pathogenetically substantiated therapy, and decrease the incidence of obstetrical complications.

[Level of antifibrinogen antibodies in newborns and women during the postpartum period]. / Poziom przeciwcial antyfibrynogenowych u noworodków i kobiet po porodzie.

In newborns and women who have just delivered antifibrinogen antibodies level was measured by means of immunoenzymatic method (ELISA). It has been found significantly higher antibodies level in women than in newborns. All newborns had lower antibodies level than their mothers. It has been found significantly lowered antibodies level before 38 week of gestation. Especially high antibodies level was observed in women who gave birth after 42 week of gestation and in newborns born in the same time.

[Diaplacental transmission of varicella zoster virus antibodies after chickenpox at the time of birth]. / Diaplazentare Ubertragung von Varizella-Zoster Virus-Antikörpern nach Windpocken am Geburtstermin.

A pregnant woman with post-term birth developed a varicella rash on the day, when birth was to be initiated. The date was then postponed, until varicella zoster virus (VZV) IgG-antibodies could be proved in the mother, so as to allow the child to achieve an adequate diaplacental passive immunisation. Cesarean section was performed on the 7th day after the rash, but a comparison of the child's blood (from the umbilical cord) with the mother's blood showed, that the VZV antibodies developed by the mother during this time were only present in a tenfold reduced amount in the child. Antibodies to herpes simplex virus, already present in the mother's blood before the VZV infection, also increased because of the close relationship of the virus to VZV. Similar to the VZV antibodies, these antibodies did not increase in the baby as in the mother. Our results show that maternal antibodies are not transferred rapidly to the baby, and therefore it seems reasonable, that in the case of chickenpox at the time of delivery, the birth should be delayed, not only until seroconversion in the mother's blood, but - if possible - a few days longer.

[Circulating immune complexes in women with prolonged pregnancy]. / Tsirkulirashti imunni kompleksi pri zheni s prenosena bremennost.

The authors examined 90 pregnant women, divided into three groups: pregnant women at 39-40 weeks gestation, parturients and women with prolonged pregnancy. Circulating immune complexes were determined. Differences in the three groups were statistically significant. The lowest level of circulating immune complexes was found in women with prolonged pregnancy, but the highest--in parturients. Inferences are made for the significance of circulating immune complexes for the onset of delivery and development of postmaturity.

Evaluación del manejo del embarazo post-término

El embarazo post-término se ha asociado a una insuficiencia utero placentaria progresiva, resultando en hipoxia fetal, oligoamnios, meconio antiguo, bajo peso y en extremo muerte fetal. El riesgo e incremento de la mortalidad y morbilidad neonatal comienza después de las 42 semanas de gestación. Se estudiaron 100 pacientes con embarazos post-término. Se evaluan las pruebas de seguimiento tales como monitoría de no stress y stress, ecografía y estriol plasmático. Se encontró el 4 por ciento de recién nacidos con síndrome de post-madurez, 2 por ciento con hipoxia leve intraparto. Con base en los resultados se propone esquema de manejo de los pacientes post-término