Angiogenic factors measured in aspirated placental tissue between the 10+6 and 18+3 weeks of gestation

This study was designed to determine the level of vascular endothelial growth factor-A (VEGF-A), basic fibroblast growth factor (bFGF) and endothelial nitric oxide synthase (eNOS) in chorionic villi during in first and second trimester, and their association with nuchal translucency (NT) measured by ultrasound. Seventy-five singleton healthy pregnancies with no detected congenital malformation were collected for NT measurements and chorionic villus sampling (CVS). Concentrations of angiogenic factors were assayed in chorionic villi sampled between 10 + 6 and 18 + 3 weeks of gestation. ENOS level was steady during this gestational period, while the concentrations of VEGF-A and bFGF significantly decreased. Placental concentrations of VEGF-A and bFGF correlated positively with each other (semi-partial correlation in multivariable linear regression (r): 0.90) and both correlated negatively with the eNOS level (r: -0.64 and r: -0.83, respectively). NT was positively correlated with eNOS concentration and negatively correlated with bFGF levels (r: 0.85 and r: -0.78, respectively). Inverse correlation was found between gestational age and VEGF-A and bFGF concentrations (r: -0.57 and r: 0.73, respectively). Alterations of angiogenic factors in chorionic villi might be an adjunct modality to NT and foetal growth as sonographic markers

Szegedi egyetemi hallgatók ismeretei a megbízható fogamzásgátlásról és a szexuális úton terjedő betegségekről

Absztrakt Bevezetés: A promiszkuitás és a megbízható fogamzásgátlás hiánya növeli a szexuális úton átvihető betegségek előfordulási valószínűségét, amely a felmérés szerint az egyetemi hallgatók körében gyakoribb. Célkitűzés: A vizsgálat célja az volt, hogy felmérjék az egyetemisták megbízható fogamzásgátlásra és nemi úton terjedő betegségekre vonatkozó ismereteit, valamint a középiskolai szexuális egészségnevelés hatékonyságát, kiemelt tekintettel a kortárs segítők által végzett oktatásra. Módszer: A fogamzásgátlási szokásokra és a nemi betegségekkel kapcsolatos ismeretekre irányuló önkitöltéses, anonim kérdőíves felmérést végeztek 2009 és 2011 között a Szegedi Tudományegyetem hallgatóinak randomizált mintáján (n = 472, 298 nő és 174 férfi, átlagéletkoruk 21 év). Eredmények: A kortárs segítők által tartott iskolai reproduktív egészségnevelő órákat a válaszadók 62,1%-a tartotta megbízható és hiteles információforrásnak, 12,3%-uk ítélte kevésbé megbízhatónak, és 25,6%-uk nevezte meg az iskolai felvilágosítást irreleváns információforrásnak. Azok körében, akik megbízhatónak tartották a kortárs segítők általi egészségfejlesztést, szignifikánsan több a nő (69,3% vs. 46,6%, p = 0,001), szignifikánsan kevesebben laknak városban (83,6% vs. 94,8%, p = 0,025) és szignifikánsan többen tudták, hogy a Candida-fertőzés átvihető szexuális érintkezés útján (79,5%, illetve 63,9%, p = 0,02). A válaszadók túlnyomó többsége a szexuális kérdésekkel kapcsolatban a médiából szerezte ismereteit. Következtetések: Azok a fiatalok, akik a kortárs segítők előadásait megbízhatónak tartják, a Candida betegségről szignifikánsan tájékozottabbak. Orv. Hetil., 2016, 157(14), 539–546

Perinatal outcome of induced and spontaneous pregnancies of primiparous women aged 35 or over

To compare the neonatal and maternal morbidity data associated with induced or naturally conceived pregnancies of primiparous women aged 35 years and older. Methods: We recruited primiparous women aged 35 years and older, who delivered between January 1995 and December 2000. The outcomes of the induced (n = 62) and naturally conceived (n = 132) pregnancies were compared. The Fisher exact test was used for univariate analysis in order to compare the delivery and pregnancy characteristics in the two groups. Results: Cesarean section featured with a 0.76 times lower prevalence among the induced pregnant women, than among the spontaneous ones, but the difference was not significant statistically. The induced pregnancies were not associated with a significantly higher rate of perinatal complications. Conclusions: Induced pregnancy does not involve a higher risk of maternal complications. The incidence of premature newborns and intrauterine growth retardation was high in both subgroups, but without a statistically significant difference. (C) 2002 International Federation of Gynecology and Obstetrics. All rights reserved

Increased nuchal translucency and congenital heart defects in euploid fetuses: the Szeged experience

Objective: To determine the utility of the first-trimester fetal nuchal translucency (NT) thickness in the prediction of fetal cardiac malformations. Design: Retrospective study. Setting: Department of Obstetrics and Gynecology and Medical Genetics, University of Szeged. Methods: The pre- and postnatal course and outcome. and the relationship between the first-trimester fetal NT thickness and fetal congenital heart defects (CHDs) in 4309 pregnancies ended up with birth or therapeutic abortion between January 1998 and June 2000 were registered. Prenatal care included first- and second-trimester fetal sonography at weeks 10-13 and 18-20, respectively. Results: 4251 births and 58 first- and second-trimester therapeutic abortions due to lethal congenital malformations or chromosomal abnormalities were recorded. Altogether 209 (4.9%) congenital malformations were detected, 39 (18.7%) of which were heart defects with normal karyotype. At birth, 151 congenital malformations were diagnosed. 34 of them were known prenatally. The prevalence of CHDs was 9 per 1000 pregnancies. The measurement of fetal NT thickness was available in 35 of the 39 fetuses with heart defects: it was greater than or equal to3 nim in 18 (51.4%) and <3 mm in 17 (48.6%). A sensitivity of 51.4% was found at a cutoff of 3 mm. Conclusions: An increased NT thickness in chromosomally normal fetuses was found to be highly associated with CHDs and identified in more than half of the affected cases. Furthermore. an increased NT of greater than or equal to3 mm can be regarded a selection criterion for early second-trimester targeted fetal echocardiography and for increased fetal and neonatal surveillance. (C) 2002 Elsevier Science Ireland Ltd. All rights reserved

Birth weight discordance in spontaneous versus induced twins: impact on perinatal outcome

Purpose: To compare the rate of birth weight discordance and perinatal outcome of twin pregnancies after assisted reproduction with that of spontaneous twins. Method: A total of 12,920 deliveries were analyzed retrospectively. Seventy-five twin pregnancies after ART were compared to the 94 spontaneous counterparts. Birth weight discordance was defined as a difference of 20% or more. Results: Discordance rate was elevated (25.3% vs. 17.0%) among ART twins. SGA was increased and NICU admission was more frequent in discordant group. Unlike-sexed twins were more prevalent (73.7% vs. 37.5%) among discordants after ART. Conclusions: ART can increase discordance rate which can elevate perinatal risk

Milyen az összefüggés a lepényi perfúzió vizsgálata során a teljes placenta vizsgálata és a szonobiopsziás módszer között? [Correlation between placental perfusion measured in the entire placenta versus assessed by sonobiopsy]

Bevezetés: A placenta perfúziója háromdimenziós power-Doppler (3DPD )-indexekkel értékelhető in vivo, szonobiopsziás úton vagy pedig a teljes placentában. Célkitűzés: A két mérési módszer közötti kapcsolat feltárása. Normál várandós nők körében prospektív kohorsz-ultrahangvizsgálat történt a 11–40. terhességi héten. Módszer: A placenta vascularisatióját a 3DPD-indexek (vascularisatiós index [VI]; áramlási index [FI]; vascularisatiós áramlási index [VFI]) segítségével értékeltük ki gömb alakú szonobiopszás eljárással vagy pedig a teljes méhlepényben. Eredmények: Összesen 150 nőt vizsgáltunk meg, átlagosan 20,8 ± 7,22 hetes terhességi korban. Megfigyeltük, hogy a szonobiopsziás gömbtechnikával mért 3DPD-indexek a terhességi korral előrehaladva csökkennek a 11. és a 40. hét között, míg a teljes méhlepény térfogatszkennelése stabil, nem csökkenő vascularisatiós mutatókat eredményezett a várandósság alatt. Az indexek a szkennelés módjától függetlenül legalább közepes mértékben korreláltak egymással (r≥0,30). Limitáló tényezők: A terhesség előrehaladtával egyre kevesebb rész jeleníthető meg a méhlepényből egyetlen ultrahangképen, a terhesség késői szakaszában a méhlepénynek csak egy kis része vizsgálható egyszerre. Következtetés: A placentából a köldökzsinór-eredési pontnál vett szonobiopsziás minta 3DPD-indexei jobban tükrözik a várandósság alatti exponenciálisan növekvő méhlepény csökkenő erezettségét. Ennélfogva a szonobiopsziás gömbtechnika hathatósabb szűrővizsgálati lehetőséget kínálhat patológiás terhességek esetén. Introduction: Placental perfusion can be evaluated using three-dimensional power-Doppler (3DPD) indices with sonobiopsy acquisition in a sphere or throughout the entire placenta. Objective: We aimed to explore the relation between these two measurement methods. Method: A prospective cohort study was conducted among normal pregnant women recruited at 11 to 40 gestational weeks. Placental vascularization was evaluated using the 3DPD indices (vascularization index [VI]; flow index [FI]; vascularization flow index [VFI]) with the application of the sphere ultrasound technique or scanned from the entire placenta. Results: A total of 150 women were recruited at a mean gestational age of 20.8 ± 7.22 weeks. We observed that scanned 3DPD indices using sphere technique decrease by gestational age between 11 and 40 weeks, whereas whole placental volume scanning yielded stable, non-decreasing indices during gestation. The indices were correlated to each other at least moderately, irrespectively of the method of scanning (r≥0.30). Limitations: As gestation advances, less and less placentas can be visualized in one sweep for a whole view and at late period of gestation only a minority of placentas can be visualized as a whole. Conclusion: 3DPD indices acquired in a sphere of the placenta at umbilical cord insertion may reflect more to the decreasing vascularity of the exponentially growing placenta during gestation. Hence, sphere technique may have a greater screening opportunity in pathological pregnancies

Risk factors for cesarean section of primiparous women aged over 35 years

Background. To determine the perinatal outcome of pregnancy in primiparous women over 35 years of age and to evaluate determinants predicting cesarean delivery in these women. Methods. Two hundred and seven mothers aged at least 35 years (1.8% of the total deliveries) delivered in the Department of Obstetrics and Gynecology between 1995 and 2000. These women were matched with women aged 20-29 years according to gravidity. Multiple logistic regression analysis was used to evaluate the risk of cesarean delivery, with controls for possible confounding factors. Results. Cesarean section was 2.09-fold more prevalent among the older than among the younger women; the difference being significant (odds ratio, OR=3.36, 95%CI 2.22-5.09; p<0.001). The advanced maternal age was associated with a significantly higher rate of assisted reproductive techniques involvement (OR 6.54; 95%CI 3.54-12.38; p<0.001). The difference between the rates of preeclampsia in the two groups did not reach the level of significance (OR 1.85; 95%CI 1.02-3.34; p=0.056). There were no significant differences in perinatal outcome between the two groups. The logistic regression model demonstrated an increased risk of cesarean section among the primiparous women aged over 35 years. Conclusions. The risk of cesarean section at this advanced age is 6.54-fold. The determinants are included in the pregnancy, delivery and neonatal outcome

Shortened cervix in the subsequent pregnancy after embolization for postpartum cervical hemorrhage

Introduction. Rupture of a branch of uterine artery during delivery often leads to a massive postpartum hemorrhage that can be successfully treated using uterine artery embolization. Case Report. A 33-year-old woman had a cesarean section at term followed by a secondary postpartum hemorrhage due to a ruptured cervicovaginal branch terminating in a large, partially thrombosed hematoma of the cervix. She was given selective uterine artery embolization, and she was discharged to home in stable condition on the third day after embolization. In the forthcoming pregnancy a shortened cervix was a risk of threatened premature delivery from 26 weeks of gestation onwards. Conclusion. Superselective unilateral embolization of a thrombosed hematoma in the cervix might prevent extensive iatrogenic trauma of the cervix, which allows preservation of reproductive function