beta-globin DNA in maternal plasma as a molecular marker of pre-eclampsia.

OBJECTIVES: Levels of cell-free foetal DNA in maternal plasma are higher in the presence of clinical features of pre-eclampsia (PE). However, currently, this method is informative only in women bearing a male foetus, by amplification of Y-specific sequences. In the present study, we overcame this limitation by examining quantitative distribution of beta-globin, a foetal gender-independent DNA marker. METHODS: We quantified beta-globin concentrations in the plasma of 207 pregnant women: control group, 164 subjects; affected group, 43 women affected by PE (n = 43). beta-globin concentrations were converted into multiples of the median of the controls (MoM), in order to assess the possible different distribution of beta-globin MoM in cases and controls. RESULTS: Adjusted MoM values were as follows: controls, 1.00 +/- 0.71; affected group 4.03 +/- 3.77 (p-value < 0.001). Among the PE affected cases, MoM beta-globin values of cases with foetal growth restriction (FGR) were almost twice as great as those cases without FGR (p-value = 0.003). CONCLUSION: beta-globin levels are higher in the plasma of pregnant women with PE, especially in those cases complicated with FGR, and do not depend on foetal gender. Such a molecular marker can potentially be used in evaluating the pathophysiological severity of PE. Copyright (c) 2004 John Wiley & Sons, Ltd

Total cell-free DNA (beta-globin gene) distribution in maternal plasma at the second trimester: a new prospective for preeclampsia screening.

OBJECTIVES: Levels of cell-free foetal DNA (f-DNA) in maternal plasma are higher in those asymptomatic subjects who will eventually develop preeclampsia. f-DNA is, however, informative only for those women bearing a male foetus, by amplification of Y-specific sequences and represents a small fraction of total circulating DNA that can be dosed by using ubiquitous genes as well as beta-globin. In this study, we examined the quantitative distribution of total DNA by amplification of beta-globin gene, in asymptomatic women matched with controls to evaluate its possible role in predicting preeclampsia. METHODS: Forty-eight low-risk women (8 asymptomatic cases matched for gestational age at the second trimester with 40 controls) were enrolled in the present study. beta-globin concentrations were converted into multiples of the median of the controls (MoM), in order to assess the possible different distribution of beta-globin MoM in cases and controls. RESULTS: MoM values were as follows: controls, 1.00 +/- 0.59; asymptomatic cases, 1.99 +/- 1.95. After Gaussian conversion of data, at a false-positive rate (FPR) of 5%, the detection rate (DR) was 46%. CONCLUSION: beta-globin (total DNA) levels are higher in those patients who subsequently developed preeclampsia and can potentially be used in screening for early detection of the disease. These findings represent a step forward in the study of cell-free DNA in maternal blood as a screening variable, because it overcomes the gender limitations of foetal DNA screening. Copyright (c) 2004 John Wiley & Sons, Ltd

Velamentous cord insertion and atypical variable decelerations with no accelerations.

OBJECTIVES: To examine intrapartum fetal heart rate (FHR) patterns in the presence of velamentous cord insertion (VCI). METHODS: The site of cord insertion was determined in 1460 women on antenatal ultrasonographic and postnatal examinations. Each of 24 women with pregnancies complicated with VCI was matched at the onset of labor with 10 women who had a normal pregnancy, and FHR patterns were analyzed for both cases and controls. RESULTS: Compared with controls, cases of variable decelerations with no accelerations (VDNA) during the first and second stages of labor were more frequent in women with VCI (first stage: 25% vs. 5.1%, second stage: 65.0% vs. 21.7%, P < 0.001). The adjusted odds ratio associated with VDNA occurrence in women with VCI was 3.83 (95% confidence interval [CI]: 1.51-9.72, P = 0.005). The mean odds ratio associated with length of aberrant vessels in women with VCI plus VDNA was 1.38 (95% CI: 1.04-1.83, P = 0.026). Conclusion: Pregnancies complicated with VCI are associated with a higher rate of VDNA

Analysis of the ultrasonographic findings predictive of vasa previa.

Objectives: To clarify the ultrasonographic findings indicative of prenatal vasa previa. Methods: The variables associated with placental and umbilical cord abnormalities were retrospectively analysed in cases with and without vasa previa. Results: Consecutive subjects were divided into those with vasa previa (10) and controls (4682). Abnormal placental forms and placenta previa/low-lying placenta were associated with vasa previa [odds ratio (OR) 21.9 and 28.0]. While the frequency of velamentous cord insertion was 1.6% in the controls, it was 90% in the cases with vasa previa (OR 552). In addition, low cord insertions in the uterus were observed in 90% of the patients with vasa previa and only in 0.4% of the controls (OR 2470). Descending cords were also frequently observed in patients with vasa previa (OR 89.8). Finally, a multivariable regression analysis demonstrated an OR of 65.1 (95% confidence interval (CI) 5.8-733) for velamentous cord insertion and an OR of 344.7 (95% CI 31-3838) for low cord insertion with regard to the risk of vasa previa. Conclusion: Our results suggest that confirmation of the placental cord insertion, including not only velamentous cord insertion but also the cords located on the lower uterine segment, is the best way to detect vasa previa. Copyright \ua9 2010 John Wiley & Sons, Ltd

The Tei index for evaluation of fetal myocardial performance in sick fetuses

OBJECTIVE: The Tei index is a useful, new, noninvasive Doppler index of combined systolic and diastolic function calculated by isovolumic relaxation time plus isovolumic contraction time divided by ejection time. Sick fetuses were evaluated with the Tei index. METHODS: The study group underwent two-dimensional/Doppler echocardiographic measurement of their Tei index and included 10 monochorionic diamniotic (MD) twin pairs with non-twin to twin transfusion syndrome (TTTS), 4 twin pairs with TTTS, 12 fetuses with intrauterine growth retardation (IUGR), 14 fetuses of diabetic mothers, 3 hydrops fetalis fetuses, 8 fetuses of mothers treated with a tocolytic agent, and 40 normal fetuses (control group). RESULTS: The Tei indices in the following groups were significantly higher than the control: recipient fetuses in TTTS, large for gestational age (LGA) fetuses of diabetic mothers, and fetuses with hydrops fetalis. CONCLUSION: The Tei index may be a useful tool for the assessment of fetal cardiac status in a variety of sick fetuses. Recipient fetuses in TTTS, LGA fetuses of diabetic mothers, and hydrops fetalis fetuses may have abnormal myocardial performance. The Tei index readily provides early detection of diminished myocardial function, particularly ventricular dysfunctio

Influenza in pregnancy

Objectives: This study was performed to determine whether multiparous pregnant women are prone to influenza. Methods: A questionnaire survey was conducted at 19 centres located throughout Japan, targeting all 6694 postpartum women within 7 days after birth before leaving the hospital. All women gave birth during the study period between March 1, 2015, and July 31, 2015. Data regarding vaccination and influenza infection in or after October 2014, age, previous experience of childbirth, and number and ages of cohabitants were collected. Results: Seventy-eight percent (n = 5,197) of women given questionnaires responded. Of these, 2,661 (51%) and 364 (7.0%) women reported having been vaccinated and having contracted influenza, respectively. Multiparous women had a higher risk of influenza regardless of vaccination status (8.9% [121/1,362] vs. 5.7% [74/1,299], relative risk [95% confidence interval], 1.80 [1.36 to 2.38] for vaccinated and 9.3% [112/1,198] vs. 4.3% [57/1,328], 2.18 [1.60 to 2.97] for unvaccinated women) compared to primiparous women. The risk of influenza increased with increasing number of cohabitants: 4.8% (100/2,089), 7.5%, (121/1,618), 9.0%, (71/785), and 10.4% (58/557) for women with 1, 2, 3, and ≥ 4 cohabitants, respectively. Conclusions: Family size is a risk factor for influenza infection in pregnancy