Saliva, hair, tears, and other biological materials obtained non-invasively for diagnosis in pregnancy: a literature review

As medical technology evolves, clinicians are increasingly choosing relatively painless non-invasive methods of patient diagnosis and treatment. There are two principles behind this: greater patient comfort and lower cost. Tears, hair, saliva, urine, and faeces can replace blood for diagnosis. The varied constituents in these biological materials can serve as biomarkers for the detection of both local and systemic diseases. In this paper, we review a range of diagnostic techniques — all using biological material obtained via non-invasive procedure — for detecting medical conditions in pregnant women. PubMed, Medline, Embase, and the Cochrane Library were searched from January 1996 until December 2018. Forty seven studies were included: thirty-five original articles, nine reviews and three meta-analysis. Analysis showed that saliva, hair, tears, and other biological material — obtained via non-invasive methods — may serve as clinically informative biomarkers. These biomarkers may be used for: toxicology, psychological studies, disease detection, biomonitoring, and drug abuse. The analysis of tears, hair, saliva, urine, and faeces is a safe, noninvasive and useful diagnostic tool within groups of pregnant women, but further investigation is necessary to fully realize the promise of these novel diagnostic tools

Twin pregnancy with a partial hydatidiform mole and a coexistent live fetus. Diagnostic and therapeutic dilemmas. A case report and the review of literature

Objectives: We report the case of a twin pregnancy with a partial hydatidiform mole and a coexistent live fetus diagnosedin a 28-year-old primipara at 15 weeks of gestation and discuss the problems associated with the ultrasound diagnosis,histopathological examination of molar tissue samples and treatment.Material and methods: A systematic research of the literature was conducted in PubMed database and Cochrane Library,including case reports and case series. A new case was also discussed. We collected data regarding the patient’s serumhuman chorionic gonadotropin (hCG) level, initial symptoms, diagnosis and treatment.Results: Most of the cases reported in the literature are those of a multiple pregnancy with complete hydatidiformmole (CHM) and a coexistent live fetus. The coexistence of a twin pregnancy with partial hydatidiform mole (PHM)and a live fetus in two separate amniotic sacs is extremely rare as a partial mole usually causes miscarriage of earlypregnancy. Ultrasound is an important diagnostic tool, but the correct diagnosis is made only in 68% of cases.With further histological assessment of molar specimens and biochemical assays, the rates of correct early diagnoses shouldincrease contributing to early therapeutic decisions and fewer adverse events.Conclusions: The diagnosis, management, and monitoring of this condition will remain challenging because of its rarity.Because of that, all cases of a suspected multiple pregnancy with a hydatidiform mole and a coexistent live fetus should bereferred to and managed at a tertiary center which specializes in the diagnosis and treatment of gestational trophoblasticdisease

The Polish women’s experience and level of knowledge about fertility and its disorders – a cross-sectional study

Objectives: To assess the experience and knowledge of Polish women up to 50 years of age about fertility and its disorders. Material and methods: A self-composed questionnaire consisting of 44 questions, divided into six sections, was available in social media from January until February 2020. The answers to 13 single-choice questions were analyzed to assess the level of knowledge. Statistical analysis was performed with the use of Statistica 13.0, with p value < 0.05 considered significant. Results: A total of 3,321 correctly filled out questionnaires were obtained. The average result was 8.88 out of 13 single-choice questions regarding the basics of the menstrual cycle and infertility (median 9, standard deviation [SD] 2.21). As many as 65.2% of respondents did not know which days in the cycle were fertile days. The women who had been and/or were pregnant at the time of survey, more often answered better than those, who had never given birth. They had a better mean score of 13 single-choice questions compared to those who had never been pregnant (9.02 vs 8.61, p < 0.001). Respondents who obtained information about infertility from doctors in 86.97% knew that regular intercourse meant 2–3 times per week in comparison to 79.7% of those who were not educated by medical practitioners (p < 0.0001). 69.8% respondents from the first group knew that the test of ovarian reserve existed in comparison to 55.63% of women from the second group (p < 0.0001). Conclusions: The research has shown that the knowledge about fertility and its disorders is not satisfying among Polish women

Clinical Study Adjunctive Pessary Therapy after Emergency Cervical Cerclage for Cervical Insufficiency with Protruding Fetal Membranes in the Second Trimester of Pregnancy: A Novel Modification of Treatment

Aim. To evaluate the effectiveness of adjunctive pessary therapy after emergency cervical cerclage (ECC) in improving perinatal outcome in cervical insufficiency with fetal membranes protruding into the vagina. Material and Methods. A retrospective analysis of patients treated at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2008 and 2013. The study group consisted of 15 women treated with ECC and a pessary and the control group consisted of 17 patients treated with cerclage only. Results. The mean gestational age at delivery was significantly higher in the study group (34.7 versus 29.7 weeks, = 0.03). The period between cerclage insertion and delivery was significantly longer in the study group (82.9 versus 52.1 days, = 0.045). The mean neonatal birthweight and neonatal "discharge alive" ratio were higher in the study group, although not statistically significant (2550 g versus 1883 g, = 0.14, and 93.3% versus 70.5%, = 0.18, resp.). NICU hospitalization rates were comparable (33.3% versus 35.3%, = 0.9). Conclusions. Adjunctive pessary therapy allows delaying delivery in women treated with ECC due to cervical insufficiency with protruding fetal membranes. It also seems to improve neonatal outcome, although the differences are not statistically significant. Further prospective study is required to prove these findings

Adjunctive Pessary Therapy after Emergency Cervical Cerclage for Cervical Insufficiency with Protruding Fetal Membranes in the Second Trimester of Pregnancy: A Novel Modification of Treatment

Aim. To evaluate the effectiveness of adjunctive pessary therapy after emergency cervical cerclage (ECC) in improving perinatal outcome in cervical insufficiency with fetal membranes protruding into the vagina. Material and Methods. A retrospective analysis of patients treated at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, between 2008 and 2013. The study group consisted of 15 women treated with ECC and a pessary and the control group consisted of 17 patients treated with cerclage only. Results. The mean gestational age at delivery was significantly higher in the study group (34.7 versus 29.7 weeks, p=0.03). The period between cerclage insertion and delivery was significantly longer in the study group (82.9 versus 52.1 days, p=0.045). The mean neonatal birthweight and neonatal “discharge alive” ratio were higher in the study group, although not statistically significant (2550 g versus 1883 g, p=0.14, and 93.3% versus 70.5%, p=0.18, resp.). NICU hospitalization rates were comparable (33.3% versus 35.3%, p=0.9). Conclusions. Adjunctive pessary therapy allows delaying delivery in women treated with ECC due to cervical insufficiency with protruding fetal membranes. It also seems to improve neonatal outcome, although the differences are not statistically significant. Further prospective study is required to prove these findings

Oxidative Stress Markers Differ in Two Placental Dysfunction Pathologies: Pregnancy-Induced Hypertension and Intrauterine Growth Restriction

Aim. Pregnancy-induced hypertension (PIH) and intrauterine growth restriction (IUGR) are both multisystemic disorders of pregnancy that cause perinatal morbidity and mortality. Recently, researchers focused on the role of oxidative stress (OS) as a pathophysiological mechanism in the development of these pathologies. The aim of this study was to compare OS in placental-related pathologies (PIH and IUGR) and uncomplicated pregnancies. We also investigated which salivary OS markers reflect systemic oxidative status and which only reflect the state of the oral cavity. Material and Methods. A total of 104 pregnant women (n=104; 27 with PIH, 30 with IUGR, and 47 controls) were evaluated. Malondialdehyde (MDA), total antioxidant capacity (ORAC), aldehyde dehydrogenase (ALDH), and activity of glutathione peroxidase (GPx) and glutathione transferase (GST) in plasma/whole blood and/or saliva were analysed. Dietary nutrient intake was calculated using a Semiquantitative Food Frequency Questionnaire (SFFQ). Oral health was assessed to eliminate patients with bleeding, severe periodontitis, and other dental pathologies. Results. In the IUGR group, increased concentration of ORAC was observed both in saliva and plasma. Also, lower plasma levels of MDA in IUGR compared to the control group was detected. No sign of oxidative stress was confirmed in the PIH group. The examined groups did not differ regarding diet and markers of inflammation. ORAC in saliva was correlated with its level in plasma. No such correlations for MDA were observed. In the IUGR group, there were no differences in OS markers in plasma, but there was a lower ALDH level in the blood compared to the control group. It confirms OS occurrence in IUGR. In IUGR, a higher activity of salivary ALDH was probably due to worse oral health. Conclusion. Oxidative stress differs between IUGR and PIH groups: the presence of oxidative stress was confirmed only in the IUGR group. Salivary ORAC can be used to estimate ORAC in plasma. The activity of salivary ALDH reflects the state of the oral cavity