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

Ophthalmological and obstetric management in pregnant women with retinal disorders

Objectives: To analyze the clinical significance of ophthalmological assessment in pregnant women affected with degenerative retinal lesions, and the lesions’ clinical relevance in determining the obstetric management and delivery method.  Material and methods: 69 pregnant women affected with retinal degenerative lesions were included in our study. In each patient, the risk of ophthalmological complications during vaginal delivery was evaluated. After the woman’s delivery, alignment between the ophthalmological recommendations and the obstetric management were analyzed. Each case where the management plan differed from the clinical proceedings was thoroughly investigated to determine the cause.  Results: In 69 pregnant women the risk of ophthalmological complications was evaluated, and in 24 cases (35%) assessed as low, as medium in 37 cases (54%) and as high in 8 cases (11%). Among the 69 patients, 42 of women delivered vaginally and the remaining 27 underwent caesarean section. In the high-risk group, the rate of caesarean section was 87%, while in both the low- and medium-risk groups the rate of vaginal births was 75%. Two years of postnatal ophthalmological follow-up did not reveal any complications that could have been associated with the delivery.  Conclusions: Every pregnant woman should undergo ophtalmological examination to assess peripartum risk of complications and determine the method of delivery.

Is there a future for cell-free fetal dna tests in screening for preeclampsia?

CffDNA screening is a powerful diagnostic tool in the prenatal diagnosis algorithm for chromosomal abnormalities. With detailed ultrasound examination as the mainstay of first-trimester risk assessment, cffDNA has been shown to be superior to first-trimester combined screening (FTCS) in false-positive rates for trisomy 21 detection. In light of the growing interest in cffDNA testing and the possibility of it replacing first-trimester biochemistry, we decided to investigate the usefulness of cffDNA tests in early-pregnancy risk assessment for preeclampsia (PE). The aim of this review paper was to evaluate clinical application of first-trimester cfDNA in predicting PE, as well as to investigate its possible use in first-trimester PE screening enhancement, also in cases where biochemistry is not performed.

Epidemiology, prevention and management of early postpartum hemorrhage — a systematic review

Early Postpartum Hemorrhage (EPH) is one of the leading causes of postpartum mortality. It is defined as blood loss of atleast 500 mL after vaginal or 1000 mL following cesarean delivery within 24 hours postpartum. The following paper includesliterature review aimed to estimate the incidence and predictors of early postpartum hemorrhage (EPH). Available preventionand treatment methods were also assessed. The inclusion criteria for the study were met by 52 studies.The exact frequency of EPH in different populations varies from 1.2% to 12.5%. Maternal, pregnancy-associated, laborcorrelatedand sociodemographic risk factors seem to be important predictors of EPH. In these cases appropriate prophylaxisshould be considered. However, EPH may occur without previous risk factors. The main reason for EPH is uterine atonywhich contributes to up to 80% of cases of postpartum hemorrhage (PPH). Other common reasons for PPH include genitaltract injuries, placenta accreta or coagulopathies. Interestingly, the majority of uterotonics seem to have a similar effect.However, carbetocin seems to be the most effective in certain situations.Appropriate diagnosis of EPH is the most important issue. The treatment should be causative. The first-line treatment shouldinclude uterotonics. Surgical interventions, if required, should be performed without delay, although preoperative uterinetamponade should be considered due to its high effectiveness.Medical staff training in medical simulation centers is an important factor that improves the outcomes of EPH treatment.It provides adaptation to hospital protocols, team work improvement, self-confidence building, more accurate blood lossevaluation and reduced perception of stress. The implementation of systematic trainings provides better outcomes in the future

The practical use of acetylsalicylic acid in the era of the ASPRE trial. Update and literature review

It is now well established that acetylsalicylic acid — one of the most widely prescribed drugs today — has brought a new era in maternal-fetal medicine. The History of medicine mentions several antecedents. Extracts made from willow contained in clay tablets are reported in both ancient Sumer and Egypt. In 400 BC, Hippocrates referred to the use of salicylic tea to reduce fevers. In the 1950s, acetylsalicylic acid entered the Guinness Book of Records as the highest selling painkiller. There is little doubt that acetylsalicylic acid — one of the first drugs to enter common usage — remains one of the most researched drugs in the world

Clinicopathological factors of pelvic lymph nodes involvement in advanced serous ovarian cancer

Objectives: Retroperitoneal lymph nodes metastases occur frequently in patients with ovarian cancer. Lymphadenectomyincreases risk of perioperative complications. In clinical practice to reduce rate of complications aortocaval lymphadenectomyis omitted and solely resection of pelvic lymph nodes is performed. To establish factors affecting metastases to pelviclymph nodes in advanced ovarian cancer.Material and methods: A retrospective study among patients with serous advanced ovarian cancer (FIGO IIIB–IVB) wasconducted at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw and Department of GynecologicOncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw. All patients underwentsurgical treatment including pelvic lymphadenectomy between 2014 and 2017. Data including age, body mass index(BMI), pretreatment CA125 serum level, tumor volume, grading, one-/both-sided tumor, menopausal status, ascites wereanalysed as possible factors influencing the pelvic lymph nodes involvement. The statistical analysis was performed withPython software.Results: 87 consecutive patients were eligible for the study. Metastases to pelvic lymph nodes were found in 29 (33.33%)patients. Pretreatment serum CA-125 concentration (652 U/mL vs 360.9 U/mL, p < 0.05) and high grade histology correspondedwith pelvic nodal involvement.Conclusions: The knowledge of factors influencing metastases to pelvic lymph nodes may help clinicians in proper counsellingand tailoring of therapy

Contemporary management of prenatally diagnosed spina bifida aperta — an update

Spina bifida aperta is a relatively common congenital defect that occurs in the general population. Once the disorder hasbeen diagnosed, a discussion, that can be emotionally-charged, ensues about whether to treat it prenatally or to only offer surgery postnatally. Given that there are good arguments for and against both options, it is of paramount importance to gain a good understanding of the major advantages and disadvantages of the various surgical approaches. The aim of our paper is to summarize current knowledge about spina bifida and the potential benefits of prenatal surgery

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