Monochorionic-diamniotic twin pregnancy complicated by spontaneous septostomy and cord entanglement. a systematic review, evaluation of complication rates and presentation of an additional case

Background: Our purpose is to describe the ultrasound findings, both with bi-dimensional and three-dimensional imaging, suggestive of spontaneous septostomy in monochorionic-diamniotic twin pregnancies. Methods: PubMed, Medline and reference lists were searched using “Spontaneous septostomy and twin pregnancy” as keywords. Seventeen articles reporting a total of 25 cases, adding our own, were included in the systematic review. Only English full text articles, the main purpose of which was to describe spontaneous septostomy in twin pregnancies, were included. Results: In our sample the major ultrasound sign arousing suspicion of spontaneous septostomy was found to be an absent or disrupted inter-twin membrane (79% of cases). Twins close to each-other were described in 33% of cases, while cord entanglement was suspected only in 27% of cases. We reported a lower antenatal detection of entanglement when compared with intrapartum evaluation (27% vs 59%). Adverse fetal outcomes occurred in 12% of cases, while 88% of cases were born alive. Conclusions: Spontaneous septostomy represents a diagnostic and clinical challenge for obstetrics providers. Clinicians must focus on ultrasound findings to close surveil fetal wellness and reduce both fetal and neonatal impairment

Current Status on Canine Foetal Fluid and Adnexa Derived Mesenchymal Stem Cells

Effective standards of care treatment guidelines have been developed for many canine diseases. However, a subpopulation of patients is partially or completely refractory to these protocols, so their owners seek novel therapies such as treatments with MSCs. Although in dogs, as with human medicine, the most studied MSCs sources have been bone marrow and adipose tissue, in recent years, many researchers have drawn attention towards alternative sources, such as foetal adnexa and fluid, since they possess many advantages over bone marrow and adipose tissue. Foetal adnexa and fluid could be considered as discarded material; therefore, sampling is non-invasive, inexpensive and free from ethical considerations. Furthermore, MSCs derived from foetal adnexa and fluid preserve some of the characteristics of the primitive embryonic layers from which they originate and seem to present immune-modulatory properties that make them a good candidate for allo- and xenotransplantation. The aim of the present review is to offer an update on the state of the art on canine MSCs derived from foetal adnexa and fluid focusing on the findings in their clinical setting

Cervical ectopic pregnancy treated with systemic methotrexate and following successful term pregnancy: case report

Very few cases of successful term pregnancy obtained after a cervical pregnancy are reported in literature, due to the condition of subfertility of many patients who developed cervical pregnancy after ART and the few studies describing the incidence of following pregnancies. This case supports the hypothesis that the use of MTX does not have negative effects on their subsequent fertility treatment

Biological characteristics and metabolic profile of canine mesenchymal stem cells isolated from adipose tissue and umbilical cord matrix.

Despite the increasing demand of cellular therapies for dogs, little is known on the differences between adult and fetal adnexa canine mesenchymal stem cells (MSCs), and data on their metabolic features are lacking. The present study aimed at comparing the characteristics of canine adipose tissue (AT) and umbilical cord matrix (UC) MSCs. Moreover, for the first time in the dog, the cellular bioenergetics were investigated by evaluating the two main metabolic pathways (oxidative phosphorylation and glycolysis) of ATP production. Frozen-thawed samples were used for this study. No differences in mean cell proliferation were found (P>0.05). However, while AT-MSCs showed a progressive increase in doubling time over passages, UC-MSCs showed an initial post freezing-thawing latency. No differences in migration, spheroid formation ability, and differentiation potential were found (P>0.05). RT-PCR analysis confirmed the expression of CD90 and CD44, the lack of CD14 and weak expression of CD34, mostly by AT-MSCs. DLA-DRA1 and DLA-DQA1 were weakly expressed only at passage 0 by UC-MSCs, while they were expressed at different passages for AT-MSCs. There was no difference (P>0.05) in total ATP production between cell cultures, but the ratio between the "mitochondrial ATP Production Rate" and the "glycolytic ATP Production Rate" was higher (P<0.05) in AT- than in UC-MSCs. However, in both MSCs types the mitochondrial respiration was the main pathway of ATP production. Mitochondrial respiration and ATP turnover in UC-MSCs were higher (P<0.05) than in AT-MSCs, but both had a 100% coupling efficiency. These features and the possibility of increasing the oxygen consumption by a spare respiratory capacity of four (AT-MSCSs) and two (UC-MSCs) order of magnitude greater than basal respiration, can be taken as indicative of the cell propensity to differentiate. The findings may efficiently contribute to select the most appropriate MSCs, culture and experimental conditions for transplantation experiments in mesenchymal stem cell therapy for companion animals

Peptide Mediated Adhesion to Beta-Lactam Ring of Equine Mesenchymal Stem Cells: A Pilot Study

Regenerative medicine applied to skin lesions is a field in constant improvement. The use of biomaterials with integrin agonists could promote cell adhesion increasing tissue repair processes. The aim of this pilot study was to analyze the effect of an &alpha;4&beta;1 integrin agonist on cell adhesion of equine adipose tissue (AT) and Wharton&rsquo;s jelly (WJ) derived MSCs and to investigate their adhesion ability to GM18 incorporated poly L-lactic acid (PLLA) scaffolds. Adhesion assays were performed after culturing AT- and WJ-MSCs with GM18 coating or soluble GM18. Cell adhesion on GM18 containing PLLA scaffolds after 20 min co-incubation was assessed by HCS. Soluble GM18 affects the adhesion of equine AT- and WJ-MSCs, even if its effect is variable between donors. Adhesion to PLLA scaffolds containing GM18 is not significantly influenced by GM18 for AT-MSCs after 20 min or 24 h of culture and for WJ-MSCs after 20 min, but increased cell adhesion by 15% GM18 after 24 h. In conclusion, the &alpha;4&beta;1 integrin agonist GM18 affects equine AT- and WJ-MSCs adhesion ability with a donor-related variability. These preliminary results represent a first step in the study of equine MSCs adhesion to PLLA scaffolds containing GM18, suggesting that WJ-MSCs might be more suitable than AT-MSCs. However, the results need to be confirmed by increasing the number of samples before drawing definite conclusions

Pregnancy in advanced (≥ 40) and very advanced (≥ 45) reproductive age: Maternal and fetal risks

Aim of the study. The aim of our study is to evaluate the pregnancy complications, mode of delivery and neonatal outcome in women of advanced reproductive age (≥ 40 years) and very advanced reproductive age (≥ 45 years). Methods and materials. We selected 343 patients aged ≥ 40 years who subsequently gave birth at the Department of Obstetrics- Gynecology at the Policlinico Umberto I in Rome, between 2010 and 2011. We selected a control group of 527 patients aged between 25 and 35 who gave birth in the same period. After excluding twin pregnancies and intrauterine deaths, the study sample is made up of 312 patients, subdivided into two subgroups according to age: 40-44 years (group A: 274 patients) and age ≥ 45 years (group B: 38 patients), while the control group includes 510 patients. For each group we evaluated the pregnancy outcomes (chronic maternal diseases, gestational maternal diseases, obstetric complications), delivery (mode of delivery, gestational age at birth) and neonatal outcome (birth weight and Apgar). Obstetric history (parity and previous cesarean section), mode of onset of pregnancy (spontaneous or assisted reproductive technology) and duration of the hospital stay were reported. Results. We found in women over 40 compared to the control group a significant increase in the frequency of both chronic and gestational maternal diseases: diabetes mellitus (2.6% vs 0.4%), chronic hypertension (6.1% vs 2%), gestational diabetes (9% vs 2.5%), gestational hypertension (8.7% vs 2%); and of obstetric complications: oligohydramnios (7.4% vs 3.7%), intrauterine growth restricion-IUGR (6.7% vs 2.5 %); an increase of cesarean section (70.2% vs 48.2 %) and an increased risk of neonatal complications such as prematurity (20.8% vs 7.5%), low birth weight (17.3% vs 10.6%) and Apgar score less than 7 at the first minute (7.4% vs 1.6%) were evidenced in the study group. We found no significant differences in the frequency of preeclampsia, placental disorders (placenta previa, placental abruption), instrumental delivery. Considering only the group over 40, the comparison between group A (40-44 years) and group B (≥ 45 years) showed a significantly increased frequency of preeclampsia (1.5% vs 13.2%), gestational hypertension (5.8% vs 28.9%), cesarean section (67.2% vs 92.1%), low birth weight (15% vs 34.2%), prematurity (19.3% vs 31.6%) and Apgar score less than 7 at the first minute (5.8% vs 18.4%) in the patients ≥ 45 years. No significant differences emerged for maternal chronic diseases (hypertension, diabetes), for gestational diabetes, obstetric complications (oligohydramnios, IUGR, placental disorders) and instrumental delivery. Conclusions. The pregnancy in age ≥ 40 is associated with an increased risk for the majority of the maternal-fetal complications, but it is mostly over 45 years that the increase of frequency of gestational diseases involving the cardiovascular system becomes highly prevalent (gestational hypertension and preeclampsia); fetal complications such as low birth weight and prematurity are increased. © Copyright 2014, CIC Edizioni Internazionali, Roma

Immigration and adverse pregnancy outcomes in an Italian free care hospital

Introduction: The ever-increasing wave of immigration in Italy has posed demanding challenges in the management of the new multiethnic obstetric population. The aim of this study was to compare pregnancy and perinatal outcomes between immigrants and the native population in an Italian public hospital. Materials and Methods: Singleton pregnant women (≥ 24 weeks of gestation) who delivered during a 3-year period in an Italian free care hospital were included. Long-term (≥ 2 years of residence) immigrant patients were divided into 4 groups according to their ethnic origin: Europeans, Asians, Latin Americans, and Africans. Perinatal indicators of obstetric outcomes were collected and compared between immigrants and Italians. Results: Of the 3556 patients included, 1092 were immigrants and 2464 Italians. The immigrant cohort experienced a higher rate of macrosomia (1.8% vs 0.6%; p = 0.001), very low birth weight (1.3% vs 0.6%; p = 0.048), very early preterm delivery (1.4% vs 0.4%; p = 0.048), and gestational diabetes mellitus (1.8% vs 0.5%; p = 003) compared with the native population. The overall rate of cesarean sections was greater among Italians (56% vs 45.8%; p &lt; 0.001). Among ethnic groups, Europeans and Latin Americans reported a higher rate of preterm delivery (20.2% and 19%, respectively; p &lt; 0.001). Latin Americans carried also a greater risk of fetal macrosomia (3.6%; p &lt; 0.008), while the rate of very low birth weight was higher among Europeans and Africans (2% and 1.8%, respectively; p &lt; 0.04). Conclusion: Obstetricians should pay special attention to the potential disparities in pregnancy outcomes between immigrants and the native population. Future efforts should focus on reducing preterm delivery and glucose dysmetabolism among pregnant immigrants