Predictive value of amniotic fluid and fetal blood cultures in pregnancy outcome in preterm prelabour rupture of membranes

We carried out a comprehensive prospective study of 26 pregnancies complicated by preterm rupture of the membranes. Microbiological assessment included cultures for aerobic and anaerobic bacteria, Mycoplasmas, Chlamydia, Trichomonas and fungi from: high vaginal and cervical swabs, maternal blood and urine, amniotic fluid and fetal blood on admission and finally, placenta and umbilical cord after delivery. The group with positive cultures (n = 16), was compared with the group with negative cultures (n = 10) in terms of gestational age at labour, latent phase after membrane rupture and fetal and neonatal morbidity and mortality. All patients with positive cultures delivered before 32 weeks and their neonates had evidence of infection. Three intrauterine deaths occurred in this group and 12/13 (86%) of the live neonates were admitted to the neonatal intensive care unit. The 10 (38%) patients of the group with negative cultures delivered after 32 weeks, had no perinatal deaths, and only two were admitted to neonatal intensive care. The median latent phase differed between these two groups (4.5 vs. 53.5 days, P < 0.01), as did the median gestational age at labour (28 vs. 36 ± 4 weeks, P < 0.01). A positive amniotic fluid or fetal blood culture in the clinical setting of preterm rupture of the membranes indicates labour onset within a few days. Intrauterine infection with fetal sepsis is accompanied by high neonatal infectious morbidity (100%) and mortality (30%)

Diagnostic Yield of Non-Invasive Testing in Patients with Anomalous Aortic Origin of Coronary Arteries: A Multicentric Experience

Background: Anomalous aortic origin of a coronary artery (AAOCA) is a congenital heart disease with a 0.3%-0.5% prevalence. Diagnosis is challenging due to nonspecific clinical presentation. Risk stratification and treatment are currently based on expert consensus and single-center case series. Methods: Demographical and clinical data of AAOCA patients from 17 tertiary-care centers were analyzed. Diagnostic imaging studies (Bidimensional echocardiography, coronary computed tomography angiography [CCTA] were collected. Clinical correlations with anomalous coronary course and origin were evaluated. Results: Data from 239 patients (42% males, mean age 15 y) affected by AAOCA were collected; 154 had AAOCA involving the right coronary artery (AAORCA), 62 the left (AAOLCA), 23 other anomalies. 211 (88%) presented with an inter-arterial course. Basal electrocardiogram (ECG) was abnormal in 37 (16%). AAOCA was detected by transthoracic echocardiography and CCTA in 53% and 92% of patients, respectively. Half of the patients reported cardiac symptoms (119/239; 50%), mostly during exercise in 121/178 (68%). An ischemic response was demonstrated in 37/106 (35%) and 16/31 (52%) of patients undergoing ECG stress test and stress-rest single positron emission cardiac tomography. Compared with AAORCA, patients with AAOLCA presented more frequently with syncope (18% vs. 5%, P = 0.002), in particular when associated with inter-arterial course (22% vs. 5%, P < 0.001). Conclusion: Diagnosis of AAOCA is a clinical challenge due to nonspecific clinical presentations and low sensitivity of first-line cardiac screening exams. Syncope seems to be strictly correlated to AAOLCA with inter-arterial course