Impact of 3D ultrasound on fetal CNS examination.

OBJECTIVE: An overview of current knowledge about the use of 3D ultrasound examinations for the examination of fetal CNS. DESIGN: A review article. SETTING: Department of Gynecology and Obstetrics, Faculty of Medicine and Dentistry, Palacký University and Faculty Hospital Olomouc. METHODS: Literary sources related to the subject were used, especially articles indexed by Pubmed-Medline. CONCLUSION: 3D ultrasound is currently used for examination of fetal CNS structures that can be only very difficult displayed by conventional 2D ultrasound. The best for technique for visualisation of midline fetal CNS structures, respectively corpus callosum cerebellar vermis, appears to be 3D volume acquisition in a sagittal plane through the sagittal suture or large fontanel with further post-processing in multiplanar mode, OVIX (Samsung), TUI (GE Healthcare) etc.

Immunological and biochemical markers in preeclampsia.

A basic precondition for the development of preeclampsia is the presence of placental trophoblast cells in the maternal blood circulation. On the other hand, while trophoblast cells are present in the blood of all pregnant women, preeclampsia occurs in only 2-5% of them. Evidently, other factors play a crucial role. The aim of this study was to compare a set of selected immunological factors (anti-cardiolipin autoantibodies, trophoblast-induced cell-mediated immunity, C3 and C4 complement components) and biochemical factors (serum immunoglobulins IgA, IgG, IgM) among three groups of women with uncomplicated pregnancy, gestational hypertension, or preeclampsia. Blood samples were taken 2-12h before delivery. In the preeclampsia group, there was a significantly higher number of women positive for anti-cardiolipin autoantibodies, trophoblast-induced cell-mediated immunity was elevated, serum IgG was elevated and C4 complement component was reduced. We conclude that both elevated autoimmune reactivity and the higher immune reactivity to trophoblast may contribute to the onset of preeclampsia.

First-trimester maternal serum tumor necrosis factor receptor-1 and pre-eclampsia.

OBJECTIVES: To examine whether the maternal serum concentration of the soluble receptor-1 of tumor necrosis factor-alpha (TNF-R1) at 11-13 weeks of gestation in pregnancies that subsequently develop pre-eclampsia is different from that in women without this complication. METHODS: The concentration of TNF-R1 at 11 + 0 to 13 + 6 weeks was measured in samples from 128 cases that subsequently developed pre-eclampsia and 569 controls with no pregnancy complications. TNF-R1 and uterine artery pulsatility index (UtA-PI) values were expressed as multiples of the median (MoM) adjusted for maternal factors. The distributions of log TNF-R1 MoM and log UtA-PI MoM in the control and pre-eclampsia groups were compared. Logistic regression analysis was used to determine whether a significant contribution is provided by maternal factors, TNF-R1 and UtA-PI in predicting pre-eclampsia. The performance of screening was determined by analysis of receiver-operating characteristics curves. RESULTS: Median TNF-R1 and UtA-PI were significantly higher in the pre-eclampsia group (TNF-R1, 1.062 MoM; UtA-PI, 1.301 MoM) than in the control group (TNF-R1, 0.996 MoM; UtA-PI, 1.037 MoM). There was no significant association between TNF-R1 and gestational age at delivery, birth weight percentile or UtA-PI. Logistic regression analysis demonstrated significant contributions to the detection of pre-eclampsia from maternal factors and UtA-PI but not from TNF-R1. CONCLUSIONS: In pregnancies developing pre-eclampsia the maternal serum TNF-R1 concentration at 11-13 weeks of gestation is increased, but the level of TNF-R1 is not associated with the degree of impairment in placental perfusion or the severity of pre-eclampsia. Measurement of serum TNF-R1 does not improve the prediction of pre-eclampsia provided by screening based on a combination of maternal factors and UtA-PI.

Dose dependency between cigarette consumption and reduced maternal serum PAPP-A levels at 11-13+6 weeks of gestation.

OBJECTIVE: To examine whether in smokers there is a significant dose dependency between the number of cigarettes per day and levels of free ss-hCG and pregnancy-associated plasma protein A (PAPP-A) at 11-13(+6) weeks of gestation. METHODS: This was a retrospective analysis of the maternal serum free ss-hCG and PAPP-A levels in relation to the maternal smoking status in 109 263 chromosomally normal singleton pregnancies that had undergone first-trimester screening for Down syndrome by a combination of fetal nuchal translucency thickness and maternal serum biochemistry. RESULTS: There were 95 287 nonsmokers and 13 976 cigarette smokers. The overall median PAPP-A MoM among cigarette smokers was 0.827, which was 19.6% lower than the value of 1.029 in nonsmokers (p < 0.0001 for log(10) MoM). The respective values for beta-hCG MoM were 1.003 for smokers and 1.035 for nonsmokers (p < 0.0001 for log(10) MoM) which corresponds to a reduction of 3.1%. There was a significant inverse relationship between the number of cigarettes per day and the level of PAPP-A MoM (r = 0.989, p < 0.0001) but not the level of free beta-hCG MoM (r = 0.733; p = 0.098). Using a statistical modeling approach we found that the screen-positive rate when correcting the PAPP-A MoM by an all or nil smoking factor was reduced by only 0.1% (3.75 vs 3.85%) when compared to correcting with a factor related to the smoking dose per day. CONCLUSION: In first-trimester screening for Down syndrome by maternal serum PAPP-A and free beta-hCG the impact of correcting for the dose dependant rather than the all or nil effect of smoking is marginal. However, a dose dependent correction improves the accuracy of the individual patient-specific risk.

Markers of inflammation in preeclampsia.

Advanced oxidation protein products (AOPP) represent terminal products of proteins exposure to free radicals. The aim of this study was to estimate the serum AOPP levels in preeclamptic patients together with ultrasensitive C-reactive protein and anticardiolipin antibodies (ACA) IgG and IgM. 21 women in the third trimester of pregnancy were included in the study--10 women with preeclampsia and 11 women with normal outcome of pregnancy. AOPP levels in preeclampsia were higher than those in normal pregnant women in the third trimester, but not statistically significantly. The comparison with AOPP levels in non-pregnant women has shown a significant increase (P<0.0001). CRP in preeclampsia was significantly increased in comparison with third trimester levels in normal pregnancy (P<0.001) as well as with non-pregnant women (P<0.0001). In preeclampsia, the ACA IgG levels were even significantly lower than in normal pregnant women in the same gestation age, but significantly higher than in non-pregnant women (P<0.001). No difference was found in ACA IgM in preeclampsia and normal third trimester pregnancy and non-pregnant women. A statistically significant negative correlation was found between AOPP and ACA IgG (r= - 0.708, P<0.05). The results indicate enhanced oxidative and inflammatory reaction of maternal organism to pregnancy, which is more pronounced in preeclampsia than in uncomplicated pregnancy.