NSIDRC Journal Article Alert — September 7, 2007

Past issues of NSDIRC journal alerts are available at: http://www.sidscenter.org


Hattori Y, Nakanishi T, Ozaki Y, Nozawa K, Sato T, Sugiura-Ogasawara M.
Uterine cervical inflammatory cytokines, interleukin-6 and -8, as predictors of miscarriage in recurrent cases.
Am J Reprod Immunol. 2007 Oct; 58(4):350-7.

Problem Inflammatory changes frequently occur in cases of second trimester miscarriage or pre-term delivery, but little attention has been paid to this association with recurrent miscarriage. As interleukin-6 and interleukin-8 are inflammatory cytokines reported to be associated with bacterial vaginosis, intrauterine infections, and pre-term delivery, we here investigated whether they might have predictive value for spontaneous abortion in recurrent cases. Method of study Cervical mucus and sera were collected at 4-5 weeks' gestation from a total of 59 patients with a history of two or more unexplained consecutive first trimester miscarriages, and examined by enzyme-linked immunosorbent assay. Patients then were followed up without medication and their pregnancy outcomes were compared with the test results. Results Of a total of 59 patients, 13 (22%) miscarried subsequently. Both IL-6 and IL-8 in cervical mucus were significantly higher in patients who miscarried subsequently than in those who had a live birth. In addition, there was no correlation between cervical mucus and serum concentrations of IL-6 and IL-8 take at the same time, and there was no relation with serum IL-6 and IL-8 levels between the two groups. Conclusion Cervical IL-6 and IL-8 might have predictive value for cases of recurrent miscarriage.

Full-text available at: www.blackwell-synergy.com/

Kano T, Mori T, Furudono M, Ishikawa H, Watanabe H, Kikkawa E, Warita T, Onizuka M, Takahashi M, Maeda Y, Naruse T, Inoko H, Kimura A.
Human leukocyte antigen may predict outcome of primary recurrent spontaneous abortion treated with paternal lymphocyte alloimmunization therapy.
Am J Reprod Immunol. 2007 Oct; 58(4):383-7.

Problem Recurrent spontaneous abortion (RSA) is defined by at least three consecutive abortions in otherwise healthy couples. Paternal lymphocyte alloimmunization therapy (PLAT) is an effective therapy for RSA in some cases, but there are no predictive markers about the effectiveness of PLAT. Method of study Forty-two consecutive cases with primary RSA treated by PLAT and 23 controls were the subjects. Polymorphisms of human leukocyte antigen (HLA)-E, HLA-G, HLA-A, HLA-B, HLA-C and HLA-DRB1 were investigated by sequenced based typing. Promoter polymorphism and a 14 bp ins/del polymorphism in exon 8 were also investigated for HLA-G. Results Thirty-eight RSA wives became pregnant within 1 year after PLAT. Among them, 27 obtained babies (succeeded PLAT cases), while 11 again aborted with no detectable chromosomal abnormalities in the aborted fetuses (aborted PLAT cases). The frequencies of HLA-G*010401, A*2402, B*5201, and DRB1*1502 were significantly increased in the aborted cases than those in the succeeded cases or controls. Of note, HLA-G*010401 was found in all aborted cases whereas it was found in 51.9% of succeeded cases (odds ratio = 21.4, P = 0.006, P(c) = 0.03), and the presence of HLA-G*010401 could predict the abortion after PLAT with sensitivity and specificity of 100% and 48.1%, respectively. Conclusion Human leukocyte antigen testing may be useful for predicting effectiveness of PLAT in RSA.

Full-text available at: www.blackwell-synergy.com

Kobler K, Limbo R, Kavanaugh K.
Meaningful moments: The use of ritual in perinatal and pediatric death.
MCN Am J Matern Child Nurs. 2007 September/October; 32(5):288-295.

Rituals provide meaning and order to transitions, and symbolically connect people and events. Despite the prevalence of perinatal loss (miscarriage, stillbirth, and newborn death) and pediatric deaths, little has been written about the use of rituals surrounding these losses. The purpose of this article is to define the dimensions of a ritual as each pertains to perinatal and pediatric death, and provide concrete applications for use in clinical practice. Intention, participation, and meaning-making are the key dimensions of rituals that arise from clinical encounters. Initiating the discussion about ritual and the timing of the ritual itself are critical elements for the nurse who is caring for a bereaved family. Because of the paucity of research on using rituals in perinatal and pediatric death, nurse researchers should design studies that explore the outcomes of using rituals, both in the short- and long-term, following the death.

Full-text available at: http://metawkhealth.com/

McClure EM, Wright LL, Goldenberg RL, Goudar SS, Parida SN, Jehan I, Tshefu A, Chomba E, Althabe F, Garces A, Harris H, Derman RJ, Panigrahi P, Engmann C, Buekens P, Hambidge M, Carlo WA; NICHD FIRST BREATH Study Group.
Global network: a prospective study of stillbirths in developing countries.
Am J Obstet Gynecol. 2007 Sep;197(3):247.e1-5.

OBJECTIVE: Our goal was to determine stillbirth rates in a multisite population-based study in community settings in the developing world. STUDY DESIGN: Outcomes of all community deliveries in 5 resource-poor countries (Democratic Republic of Congo, Guatemala, India, Zambia, and Pakistan) and in 1 mid-level country (Argentina) were evaluated prospectively over an 18-month period. Births of > 1000 g with no signs of life were defined as stillbirth. RESULTS: Outcomes of 60,324 deliveries were included. Stillbirth rates ranged from 34 per 1000 in Pakistan to 9 per 1000 births in Argentina. Increased stillbirth rates were associated significantly with lower skilled providers, out-of-hospital births, and low cesarean section rates. Maceration was present in 17.2% of stillbirths. CONCLUSION: The stillbirth rates among births of > or = 1000 g in these developing countries were substantially higher than reported stillbirth rates in developed countries (3-5/1000 births). Because most developed countries define stillbirth as > or = 20 weeks of gestation or > or = 500 g and because almost one-half of all stillbirths are < 1000 g, the developing/developed country difference is actually larger than apparent from this study. Maceration was uncommon, which indicates that most of the deaths probably occurred during labor. The low rates of physician attendance, hospital delivery, and cesarean section deliveries suggest that stillbirth rates could be reduced by access to higher quality institutional deliveries.

Full-text available at: www.sciencedirect.com/

Jehan I, McClure EM, Salat S, Rizvi S, Pasha O, Harris H, Moss N, Goldenberg RL.
Stillbirths in an urban community in Pakistan. Aga Khan University, Karachi, Pakistan.
Am J Obstet Gynecol. 2007 Sep;197(3):257.e1-8.

OBJECTIVE: The purpose of this study was to determine stillbirth risk factors and gestational age at delivery in a prospective developing country birth cohort. STUDY DESIGN: At 20-26 weeks of gestation, 1369 Pakistani women were prospectively enrolled in the study; the gestational age was determined by ultrasound evaluation, and risk factors and pregnancy outcomes were assessed. RESULTS: The stillbirth rate was 33.6 of 1000 births, despite the fact that 96% of the women received prenatal care, 83% of the women were attended by skilled providers in the hospital, and a 20% of the women underwent cesarean delivery. Fifty-one percent of stillbirths occurred at > or = 37 weeks of gestation and 19% occurred from 34-36 weeks of gestation. Only 4% of the births had congenital anomalies. Hemoglobin of < 8 g/dL, vaginal bleeding, and preeclampsia were associated with increased stillbirth risk. CONCLUSION: In this developing country with reasonable technical resources defined by hospital delivery and a high cesarean delivery rate, stillbirth rates were much higher than rates in the United States. That most of the stillbirths were term and did not have congenital anomalies and that the death appeared to be recent suggests that many Pakistani stillbirths may be preventable with higher quality obstetric care.

Full-text available at: www.sciencedirect.com/

Altman RL, Forman S, Brand DA.
Ophthalmologic findings in infants after an apparent life-threatening event.
Eur J Ophthalmol. 2007 Jul-Aug;17(4):648-53.

PURPOSE. An apparent life-threatening event (ALTE) refers to the sudden occurrence in an infant of a breathing abnormality, color change, or alteration in muscle tone or mental status. The finding of retinal hemorrhage in an infant who has experienced an ALTE strongly suggests the possibility of shaken baby syndrome. Previous ALTE studies have reported the frequency of this specific ocular abnormality but have not reported other ocular findings and their possible diagnostic significance. METHODS. This study reviews ophthalmologic findings from a series of 120 patients with ALTE who underwent eye examinations as part of their inpatient evaluation. Details of the history, physical examination, diagnostic testing, and discharge diagnosis were abstracted from the medical record while the patient was in the hospital. RESULTS. Ten patients (8.3%) had positive findings, including retinal hemorrhages in four of the six patients with shaken baby syndrome, the only ophthalmologic finding that helped establish the cause of an ALTE. CONCLUSIONS. Since the funduscopic examination can help identify child abuse as the cause of an apparent life-threatening event, ophthalmologists play a critical role in the early evaluation of infants who have experienced such an event.

Full-text available at: http://www.eur-j-ophthalmol.com/ejo

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