Reduced antioxidant capacity in second-trimester pregnancies with pathological uterine perfusion

OBJECTIVES

To examine whether pathological perfusion in the second trimester is characterized by an altered plasma antioxidant capacity and to investigate whether the total antioxidant capacity in maternal plasma is related to the clinical outcome of these high-risk pregnancies.

METHODS

This was a prospective cohort study that included 25 pregnancies with normal and 25 pregnancies with pathological uterine perfusion. Doppler ultrasound measurement of uterine perfusion was performed between 18 and 23 weeks of gestation. Total antioxidant capacity in maternal plasma was measured using a specific photometric assay.

RESULTS

Plasma antioxidant capacity of pregnant women with pathological uterine perfusion (227.3 +/- 4.0 micro mol/L) was significantly lower compared with the group with normal uterine perfusion (275.2 +/- 10.5 micro mol/L; P < 0.05). There was a significant negative correlation between antioxidant capacity and mean pulsatility index of the uterine arteries (r = -0.363; P < 0.05). Patients with pathological perfusion and a normal course of pregnancy did not show significantly changed values compared with those patients with later pre-eclampsia or intrauterine growth restriction (235.0 +/- 4.9 micro mol/L vs. 218.6 +/- 6.7 micro mol/L).

CONCLUSIONS

Second-trimester pregnancies with pathological uterine perfusion are characterized by a decreased antioxidant capacity in maternal plasma. This reduction is related to the impaired uteroplacental blood flow, but does not reflect the changes characteristic of the oxidative status for diseases like pre-eclampsia since the reduction of the plasma antioxidant capacity is not related to the clinical outcome of these high-risk pregnancies.

Another case of autosomal dominant exstrophy of the bladder

OBJECTIVE

Exstrophy of the bladder is a rare malformation due to an anterior midline defect. Most cases of this condition with variable expression occur sporadically, but there are some cases indicative of a strong genetic component apart from environmental factors. This is a report about another rare mother-child pair with bladder exstrophy.

METHODS

We present the clinical data of a familial case of bladder exstrophy with an affected mother and her equally affected male fetus.

RESULTS

Prenatal diagnosis of bladder exstrophy in the fetus was assessed by ultrasound at the 19th gestational week and was confirmed after termination of pregnancy at the 21st gestational week.

CONCLUSION

The present case may be additional evidence for an autosomal dominant inherited variant of this malformation complex with implication for counselling of affected patients.

Congenital urethral cysts in boys with vesicoureteric reflux

Four cases of congenital urethral cysts are reported. Diagnosis was made by endoscopy. The coincidence of urethral cysts and vesicoureteric refluxes seemed incidental in three cases. Fetal infravesical obstruction was provable in the fourth infant.

CONCLUSION

Urethral cysts should be considered in boys with vesicoureteric reflux. For the vast majority of cases it seems improbable that urethral cysts play a role in the pathogenesis of congenital vesicoureteric reflux.

Perinatales Management und Ausgang von Drillingsschwangerschaften zwischen 1997 und 2001

BACKGROUND

Because of the trend for premature birth, multifetal pregnancies are at high risk for neonatal morbidity and mortality. This study presents our perinatal management scheme and the outcome of triplet pregnancies.

PATIENTS AND METHODS

From 1997 to 2001 we studied 31 triplet pregnancies. Their management consisted of cervical measurement at 20 weeks, admission from 25 weeks onwards, regular ultrasound examinations, intravenous tocolysis with preterm contractions or cervical shortening, promotion of fetal lung maturation, antibiotic therapy with evidence of vaginal infection, delivery by caesarean section ideally at 33 weeks.

RESULTS

In the studied group 4 triplet pregnancies were monochorionic, 6 dichorionic, and 21 (68 %) trichorionic. 2/31 triplet pregnancies finalized in late abortions. Furthermore, a single and a double intrauterine death occured in two triplet pregnancies. 6 (21 %) of triplet pregnancies were delivered before the 30th week and 23 (79 %) after the 30th week of gestation (median gestational age 31.5 weeks, median birth weight 1545g). Neonates of trichorionic pregnancies in comparison to those of mono- and dichorionic pregnancies were delivered two to three weeks later and presented with significantly higher birth weights (1660 g vs. 1245 g vs. 1240 g; p = 0.001 and 0.0009, respectively). 13/84 (15.5 %) of the neonates showed growth retardation. In 4/84 (4.1 %) children brochopulmonary dysplasia or cerebral haemorrhage was observed. Only one child developed enterocolitis. 19 % (16/84) of neonates showed evidence of retinopathy. No intrauterine death occured after 28 weeks and no child died after delivery.

CONCLUSION/DISCUSSION

With our well defined management of triplet pregnancies from 20 weeks onwards we reach similar gestational ages at delivery but remarkably lower neonatal complication rates compared to previous studies.

[Heart rate and blood pressure interaction in normotensive and chronic hypertensive pregnancy]

Pregnancy has impact on autonomic control. Since hypertensive pregnancy disorders are a major cause of maternal mortality we investigated the baroreflex sensitivity (BRS) in chronic hypertensive pregnant women (CH), normotensive pregnant (PRE) and non-pregnant (NPRE) women. In addition to the traditional 'sequence method' we used joint symbolic dynamics (JSD). BRS was significantly reduced in all pregnancies compared with NPRE (p < 0.00001) but there was no significant difference between CH and PRE. Contrary, the JSD measures revealed significant differences (p < 0.00001) in the heart rate and blood pressure interactions between PRE and CH. In conclusion, JSD measures uncovered a different gestation related adaptation of autonomic regulation in women with chronic.

Joint symbolic dynamic analysis of beat-to-beat interactions of heart rate and systolic blood pressure in normal pregnancy

Pregnancy induces important changes in the autonomic control. Measures of heart rate (HR) variability and systolic blood pressure (SP) variability are sensitive to those changes. The interactions between HR and SP are complex and strongly non-linear. Therefore they cannot be completely described by linear analysis techniques. A study of joint symbolic dynamics is presented as a new short-term non-linear analysis method to investigate the interactions between HR and SP. Continuous, non-invasive 30 min blood pressure recordings (Portapres) of 25 pregnant and 14 non-pregnant women were analysed. Time series of beat-to-beat HR and SP were extracted. Using the concept of joint symbolic dynamics, HR and SP changes were transformed into a bivariate symbol vector. Subsequently, this symbol vector was transformed into a word series (words consisting of three successive symbols), and the probability of occurrence of each word type was calculated and compared between both groups. Significant differences were found in five word types between pregnant and non-pregnant women: w0,4(0.021+/-0.011 against 0.008+/-0.006; p = 0.022), w4,6(0.020+/-0.010 against 0.007+/-0.003; p = 0.001), w3,2(0.004+/-0.003 against 0.007+/-0.003; p = 0.038), W6,5(0.009+/-0.007 against 0.023+/-0.008; p< 0.001) and w3,6(0.011+/-0.007 against 0.023+/-0.008; p = 0.001). Joint symbolic dynamics provides an efficient non-linear representation of HR and SP interactions that offers simple physiological interpretations.

Biochemical and crystallographic characterization of ferredoxin-NADP(+) reductase from nonphotosynthetic tissues

Distinct forms of ferredoxin-NADP(+) reductase are expressed in photosynthetic and nonphotosynthetic plant tissues. Both enzymes catalyze electron transfer between NADP(H) and ferredoxin; whereas in leaves the enzyme transfers reducing equivalents from photoreduced ferredoxin to NADP(+) in photosynthesis, in roots it has the opposite physiological role, reducing ferredoxin at the expense of NADPH mainly for use in nitrate assimilation. Here, structural and kinetic properties of a nonphotosynthetic isoform were analyzed to define characteristics that may be related to tissue-specific function. Compared with spinach leaf ferredoxin-NADP(+) reductase, the recombinant corn root isoform showed a slightly altered absorption spectrum, a higher pI, a >30-fold higher affinity for NADP(+), greater susceptibility to limited proteolysis, and an approximately 20 mV more positive redox potential. The 1.7 A resolution crystal structure is very similar to the structures of ferredoxin-NADP(+) reductases from photosynthetic tissues. Four distinct structural features of this root ferredoxin-NADP(+) reductases are an alternate conformation of the bound FAD molecule, an alternate path for the amino-terminal extension, a disulfide bond in the FAD-binding domain, and changes in the surface that binds ferredoxin.

PRL as a novel potent cofactor for platelet aggregation

Pregnancy (including puerperium) is a period of hypercoagulability and seems to be an independent major risk factor for venous thromboembolism (VTE). However, the basis of the increased risk of VTE in pregnancy and around delivery is unknown. We hypothesized that changes in PRL, which is a prominently increased hormone during pregnancy and lactation, might be involved in the activation of platelets. To investigate platelet functional abnormalities in pregnancy, we assessed the ADP-stimulated and nonstimulated P-selectin expression of platelets in 42 consecutive pregnant women, 22 normo- and hyperprolactinemic patients with pituitary tumors, and controls. In addition, the aggregation of platelets by human PRL in vitro was studied. We found a significant correlation between PRL values and ADP stimulation of platelets in pregnant women (r = 0.56; P < 0.0001) and patients with pituitary tumors (r = 0.57; P = 0.006). Hyperprolactinemic pregnant women or hyperprolactinemic patients with pituitary tumors revealed significantly higher ADP stimulation of platelets (P < 0.0001) than healthy controls or normoprolactinemic patients with pituitary tumors. These results were reconciled by increased in vitro stimulation and aggregation of platelets using human PRL. Our novel findings demonstrate that hyperprolactinemia causes increased platelet aggregation via ADP stimulation both in vitro and in vivo. Moreover, our data indicate that PRL may be a physiological cofactor of the delicate coagulation balance during pregnancy and puerperium that might explain the increased risk of VTE in pregnant women around delivery. Further studies of the interaction between PRL and platelets will clarify the clinical relevance of hyperprolactinemia as a potential risk factor for VTE.

Gestational regulation of the gene expression of C-type natriuretic peptide in mouse reproductive and embryonic tissue

C-Type natriuretic peptide (CNP) is a vasoactive hormone and the endothelial component of the natriuretic peptide system. We examined the expression of CNP in mouse reproductive organs and embryos at different stages of gestation. Pregnant mice were killed and embryos were dissected on gestational days 9.5, 12.5, 15.5, 18.5 postconceptionem (pc) and at term. Nonpregnant mice were used as controls. Total RNA was isolated from placenta, ovaries, myometrium and from head and trunk of embryos and neonates. CNP-mRNA was quantified by ribonuclease-protection assay (RPA). Uterine CNP-mRNA concentrations increase during pregnancy up to the sevenfold concentration, whereas in the ovaries these levels decrease to 10% compared to nonpregnant controls. In the placenta, a peak of CNP expression has been observed around day 15.5 pc, whereby placenta showed the strongest CNP signals. CNP-mRNA concentrations in embryos are gestational age-dependent with a high level at day 9.5 pc in head and trunk. These results indicate that CNP has a regulatory function in pregnancy and embryonic development.

Detection of cervical immunoglobulin A in normal pregnancy

The aim of our study was to evaluate a feasible method to quantify the immunoglobulin A concentration in the cervical mucus of women with a normal singleton pregnancy. In 60 immunologic healthy pregnant women cervical mucus samples were taken at a random time in pregnancy using an absorbing cylindrical cotton-swab stick. In this cervical mucus immunoglobulin A concentration was measured by radial immunodiffusion. A vaginal bacterial swab was taken from each woman. Concentration of immunoglobulins in maternal serum was estimated. There was no statistically significant difference of cervical immunoglobulin A concentration between the investigated groups (p = 0.952): 18-24 gestational weeks (gw): 52.8 (6.6-258.4) mg/l; 25-29 gw: 89.3 (4.8-193.8) mg/l; 30-34 gw: 55 (1.4-326) mg/l; 35-40 gw: 59.2 (4-400.9) mg/l. Women with a normal vaginal flora showed a significantly higher cervical immunoglobulin A concentration than those with a pathological colonization: 92.2 (6.6-400.9) mg/l vs. 42.5 (1.4-326) mg/l (p < 0.05). The serum levels of immunoglobulins A, A1, A2, M and G do not correlate to cervical immunoglobulin A levels nor to gestational age. In normal pregnancy, cervical immunoglobulin A concentration does not change with advancing gestational age, but a pathological vaginal colonization seems to be associated with decreased immunoglobulin A levels.

Genauigkeit pränataler Diagnosen bei terminierten Schwangerschaften - eine retrospektive Analyse der Ergebnisse und Einflussfaktoren1

OBJECTIVE

The aim of the study was to analyse the accuracy of prenatal sonography in terminated pregnancies and the influence of factors like personnel and standard of technique and organisation on the quality of prenatal sonography for the detection of fetal anomalies.

MATERIAL AND METHODS

The retrospective study includes 64 cases with termination of pregnancy from 1989 to 1997. We analyse prenatal sonographic and postnatal pathological findings of fetus, placenta and umbilical cord. Furthermore we compare two time periods (1989-93 and 1994-97) with different ultrasound conditions.

RESULTS

In 36 cases (56%) the prenatal diagnosis was exact. In 7 cases (11%) autopsy could not confirm all findings (false positive), whereas autopsy detected additional anomalies in 18 cases (28%) (false negative). The diagnosis was not correct in 3 cases (5%), whereby 2 pregnancies were terminated without proved somatic and chromosomal anomalies. Compared to 1989-93 the rate of false-positive (12 vs. 5) as well as false-negative (9 vs. 3) diagnoses decreased significantly (p < 0.002) in cases with major anomalies (heart, central nervous system).

CONCLUSION

We conclude that the improvement of the level of organisation, personnel and technical equipment has relevant impact on the accuracy of prenatal sonography. Autopsy as a method of quality control is absolutely necessary.