Non-invasive fetal RHD and RHCE genotyping from maternal plasma in alloimmunized pregnancies.

BACKGROUND: In this prospective study, we assessed the feasibility of fetal RH genotyping by analysis of DNA extracted from maternal plasma samples of alloimmunized pregnant women using real-time PCR and primers and probes targeted toward RHD (exon 7 and exon 10) and RHCE (intron 2 and exon 5) genes. METHODS: We analysed 23 alloimmunized pregnant women (16 anti-D, 5 anti-D + C, 2 anti-E) at risk of haemolytic disease of the newborn (HDN) within 11th and 37th week of pregnancy and correlated the results with serological analysis of cord blood. RESULTS AND CONCLUSION: Detection of the presence of the RHD gene, the C and/or E alleles of the RHCE gene in maternal plasma samples is highly accurate and enables implementation in a clinical diagnostic algorithm for following pregnancies at risk for HDN. The absence of RHD gene, the C and/or E alleles of RHCE gene in the current pregnancy excludes the risk of HDN caused by anti-D, anti-C and/or anti-E alloantibodies and the performance of invasive fetal-blood sampling.

[Tissue damage in alternative types of hysterectomy: prospective study]. / Tkánové poskození u alternativních typu hysterektomií: prospektivní studie.

OBJECTIVE: To assess and compare tissue damage during alternative hysterectomies. DESIGN: Prospective clinical study. SETTING: Department of Gynaecology, Endoscopic Training Centre, Kladno Hospital. METHODS: Tissue damage and perioperative parameters were assessed using the enzymatic activity of creatine kinase (CK) and C-reactive protein (CRP). Serum levels of these markers were measured in 127 women who underwent laparoscopic, abdominal and vaginal hysterectomy. RESULTS: The rare of CK activity and CRP were significantly greater in 45 patients who underwent abdominal hysterectomy compared with that in the patients who underwent laparoscopic and vaginal hysterectomies (57 and 25 patients, respectively). CONCLUSION: Clinical experience and metabolic changes indicate that the tissue damage and perioperative stress in patients undergoing laparoscopic hysterectomy is lower than in patients where an abdominal approach is used. Large prospective studies are needed to evaluate the surgical trauma and metabolic changes induced by laparoscopic hysterectomy.

Evaluation of perioperative stress after laparoscopic and abdominal hysterectomy in premalignant and malignant disease of the uterine cervix and corpus.

OBJECTIVE: To compare the differences in laparoscopic and abdominal hysterectomy in surgery of premalignant and malignant uterine disease. DESIGN: Prospective study. SETTING: Baby Friendly Hospital, Kladno, Czech Republic. SUBJECT: A total 32 patients underwent hysterectomies for premalignant and malignant uterine conditions. INTERVENTIONS: Patients were assigned to either laparoscopic-assisted vaginal hysterectomy or total abdominal hysterectomy (LAVH), with bilateral salpingo-oophorectomy and lymph node dissection. MEASURES: Clinical data and value of total creatine kinase and C-reactive protein were measured. RESULTS: All 32 procedures were successfully completed. There were no major complications. Mean order of CRP concentrations was significantly lower (p = 0.001) in patients with LAHV. Mean order of total CK activities was also significantly lower in these patients (p = 0.003) and the median hospital stay was 4.1 days (p = 0.05). CONCLUSIONS: Laparoscopic procedures were followed by shorter hospital stays and the proposed evaluation of tissue damage using serum enzymes and proteins demonstrates that the laparoscopic approach to hysterectomy and accessory procedures has considerable importance in decreasing perioperative patient stress. The presented results are supported by clinical experience and should have a decisive impact on the chosen approach to the course and duration of convalescence in patients undergoing a hysterectomy in premalignant and malignant disease of the uterine cervix and corpus.