NSIDRC Journal Article Alert — April 17, 2009
Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.
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Sudden Infant Death
1. Leiter JC
Serotonin, gasping, autoresuscitation and SIDS - a contrarian view
J Appl Physiol. 2009 Apr 9. [Epub ahead of print]
Dartmouth Medical School.
Miscarriage/Stillbirth/Prenatal Issues
1. Denney JM, Culhane JF
Bacterial vaginosis: A problematic infection from both a perinatal and neonatal perspective
Semin Fetal Neonatal Med. 2009 Apr 9. [Epub ahead of print]
Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine, University of Utah, Salt Lake City, UT, USA.
Bacterial vaginosis (BV) infections are common in women of reproductive age and are easily diagnosed and treatable. Aside from being an annoyance when symptoms of discharge, odor, and pruritus occur in the gravid female, BV infections increase risk of late miscarriage, preterm labor, preterm premature rupture of membranes, and, consequently, preterm delivery. Antepartum and puerperal issues such as chorioamnionitis and endometritis are increased in the context of maternal BV. Moreover, the morbidities and mortality of preterm delivery are consequently increased as a result of BV during pregnancy. Although the pathology associated with BV appears to result from inflammation, more investigation is needed in terms of designing guidelines for appropriate screening and treatment for the prevention of adverse outcomes.
2. Homer H, Saridogan E
Uterine artery embolization for fibroids is associated with an increased risk of miscarriage
Fertil Steril. 2009 Apr 8. [Epub ahead of print]
Department of Obstetrics & Gynaecology, Institute for Women's Health, University College London Hospitals, London, United Kingdom.
OBJECTIVE: To investigate how uterine artery embolization (UAE) might alter the risk profile for pregnancies complicated by fibroids. DESIGN: Systematic literature review and meta-analysis of existing studies. SETTING: Academic reproductive medicine unit. PATIENT(S): Women with fibroids. INTERVENTION(S): A systematic literature review, raw data extraction, and data analysis. MAIN OUTCOME MEASURE(S): Rates of miscarriage, preterm delivery, malpresentation, intrauterine growth restriction (IUGR), cesarean delivery, and postpartum hemorrhage (PPH). RESULT(S): Two hundred twenty-seven completed pregnancies after UAE were identified. Miscarriage rates were higher in UAE pregnancies (35.2%) compared with fibroid-containing pregnancies matched for age and fibroid location (16.5%) (odds ratio [OR] 2.8; 95% confidence interval [CI] 2.0-3.8). The UAE pregnancies were more likely to be delivered by cesarean section (66% vs. 48.5%; OR 2.1; 95% CI 1.4-2.9) and to experience PPH (13.9% vs. 2.5%; OR 6.4; 95% CI 3.5-11.7). Rates of preterm delivery (14% vs. 16%; OR 0.9; 95% CI 0.5-1.5), IUGR (7.3% vs. 11.7%; OR 0.6; 95% CI 0.3-1.3), and malpresentation (10.4% vs. 13%; OR 0.8; 95% CI 0.4-1.5) were similar in UAE pregnancies and in control pregnancies with fibroids. CONCLUSION(S): The risk of miscarriage seems to be increased after UAE. In contrast, apart from an increased risk of abdominal delivery and PPH, critical adverse obstetric sequelae of IUGR and prematurity appear no more likely after UAE.
3. Tempfer CB, Brunner A, Bentz EK, Langer M, Reinthaller A, Hefler LA
Intrauterine fetal death and delivery complications associated with coagulopathy: a retrospective analysis of 104 cases
J Womens Health (Larchmt). 2009 Apr;18(4):469-74
Department of Obstetrics and Gynecology, Medical University of Vienna, Vienna, Austria. clemens.tempfer@meduniwien.ac.at
OBJECTIVE: To assess the prevalence of delivery complications associated with coagulopathy in women with intrauterine fetal death (IUFD). METHODS: This is a retrospective cohort study of women with IUFD at >24 weeks gestation or a birth weight of >500 g between 1994 and 2007. Clinical data were assessed by chart review. RESULTS: One hundred four women were diagnosed with IUFD. The mean time between diagnosis of IUFD and delivery was 28.8 (+/-17.4) hours. Twelve of 104 (11.5%) women had a delivery complication associated with coagulopathy, defined as need for blood transfusion. In 8 of these 12 women, coagulopathy was associated with a preexisting preeclampsia/hemolysis, elevated liver enzymes, low platelet (HELLP) syndrome, uterine rupture after induction, or an acute clinical problem at presentation to the clinic. In 4 of 104 (4%) women, there was no attributable cause of coagulopathy other than IUFD. In these women, there was a statistically significant difference of laboratory parameters of coagulation at the time of diagnosis of IUFD compared with women who did not subsequently develop coagulopathy; platelet count 93.3 +/- 96.4 vs. 229.3 +/- 68.1 G/L, p < 0.001; prothrombin time (PT) 97.0 +/- 43.9 vs. 123.3 +/- 21.1 %, p = 0.02; activated partial thromboplastin time (aPTT) 42.9 +/- 34.0 vs. 31.5 +/- 4.3 sec, p = 0.01; thrombin time (TT) 22.8 +/- 16.5 vs. 14.1 +/- 13.3 sec, p = 0.02), plasma fibrinogen 219.0 +/- 117.5 vs. 472.9 +/- 122.8 mg/dL, p < 0.001), and antithrombin III 70.5 +/- 21.9 vs. 101.5 +/- 17.0 %, p = 0.01. CONCLUSIONS: Delivery complications associated with coagulopathy occur in 11% of women with IUFD and are associated with preexisting preeclampsia/HELLP, uterine rupture, or an acute clinical problem in most cases. In 4% of women with IUFD, coagulopathy develops without an apparent cause.
4. Mechery J, Shantha N, Polson D
Recurrent miscarriage and endometrial receptivity
J Obstet Gynaecol. 2009 Apr;29(3):257-8
Department of Obstetrics and Gynaecology, Hope Hospital, Salford, Manchester, UK. jmechery@nhs.net
5. Heazell AE, Martindale EA
Can post-mortem examination of the placenta help determine the cause of stillbirth?
J Obstet Gynaecol. 2009 Apr;29(3):225-8
Maternal and Fetal Health Research Group, University of Manchester, St Mary's Hospital, Manchester, UK. alex_heazell@talk21.com
Some cases of stillbirth are associated with placental abnormality; recent classification systems have included some features of placental pathology. This study aimed to determine whether placental investigations assist in determining the cause of stillbirth. A total of 71 consecutive cases of stillbirth were reviewed. Placental investigations were undertaken in 54% of cases. Women who had placental assessment were significantly less likely to have an unexplained stillbirth (OR = 0.17; 95% CI 0.04-0.70). In 47% of cases, the findings of placental investigation were included in the classification of stillbirth. In 16% of cases the classification was determined primarily by placental examination. Some placental abnormalities found were associated with clinical causes of stillbirth, such as placental infarction and IUGR or leukocyte infiltration and chorioamnionitis (p < 0.05). We conclude that assessment of the placenta can aid classification of stillbirth and recommend that histological analysis of placental tissue be offered in all cases of stillbirth, even when full infant post-mortem is declined.
6. Gloria-Bottini F, Magrini A, Amante A, Nicotra M, Bottini E
Haptoglobin phenotype and reproductive success in repeated spontaneous abortion
Eur J Obstet Gynecol Reprod Biol. 2009 Apr 6. [Epub ahead of print]
Division of Human Populations Biopathology and Environmental Pathology, Department of Biopathology and Imaging Diagnostics, University of Rome Tor Vergata, Via Montpellier, 1, 00133 Rome, Italy.
OBJECTIVE: To study the reproductive success of couples with a history of repeated spontaneous abortion (RSA) with respect to the haptoglobin (Hp) phenotypes of both the wife and husband. STUDY DESIGN: This study examined maternal and paternal Hp in 194 couples with primary and secondary RSA recruited from the Center for Reproductive Disorders of the Institute of Obstetrics and Gynaecology at the University of Rome, La Sapienza. Reproductive success was indicated by the presence of at least one live-born infant after more than 5 years of follow-up. RESULTS: The proportion of wives carrying Hp2/1 phenotype and with at least one live-born infant is significantly lower than that of wives without a live-born infant. Moreover, the proportion of couples in which both wife and husband possess the Hp2/1 phenotype is much lower in those with at least a live-born infant than in those without a live-born infant. Both maternal and paternal Hp contribute to reproductive success. However, the contribution of maternal Hp appears stronger than that of paternal Hp. CONCLUSIONS: Hp may play an important role in implantation and/or embryo survival. Couples in which both partners carry the Hp2/1 phenotype have a low probability of producing a live-born infant.
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