NSIDRC Journal Article Alert — November 13, 2009

Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University.

These articles have been selected from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources.

Availability of full-text journal articles is often limited to subscribers or through inter-library loan. Please see your local library for copies of these articles, or view PubMed's How to Get the Journal Article for more details.

Past issues of Resource Center Journal Alerts

Sudden Infant Death

1. Fracasso T, Karger B, Vennemann M, Bajanowski T, Golla-Schindler UM, Pfeiffer H
Amniotic fluid aspiration in cases of SIDS
Int J Legal Med. 2009 Nov 11. [Epub ahead of print]

Institut für Rechtsmedizin, Universitätsklinikum Münster, Roentgenstr. 23, 48149, Muenster, Germany, Tony.Fracasso@ukmuenster.de.

The scope of this study was to evaluate the incidence and the eventual consequences of amniotic fluid aspiration (AFA) in cases of sudden infant death. Cases of sudden infant death syndrome (SIDS; n = 113: 39 females, 74 males; mean age 4.6 months) were compared to a control group of 39 cases of explained death (14 females, 25 males; mean age 5.6 months). In each case, sections of the lung stained with hematoxylin and eosin and with the immunohistochemical reaction 34BE12 specific for cytokeratins were available. The microscope slides were observed at x200 magnification and semi-quantitatively classified into four categories(-, +, ++, and +++). In both groups, rests of amniotic fluid could be observed up to the fourth month of life. The comparison between the two groups did not show any significant difference. In the SIDS group, immunohistochemical reactions with the antibodies CD68, MRP8, MRP14, 27E10, 25F9, CD3, CD20Cy, and CD45R0 were available for the lungs. Twelve cases with AFA were compared to a group of SIDS cases without AFA with similar age and pathological distribution to evaluate whether the presence of amniotic remnants induced inflammatory changes in the lungs. No differences emerged. This study shows that AFA is not a rare event. Even moderate to severe AFA does not necessary cause death. A correlation between AFA and SIDS could not be shown.

2. Li L, Zhang Y, Zielke RH, Ping Y, Fowler DR
Observations on Increased Accidental Asphyxia Deaths in Infancy While Cosleeping in the State of Maryland
Am J Forensic Med Pathol. 2009 Nov 6. [Epub ahead of print]

From the *Key Laboratory of Evidence Science (L.L., D.R.F.), China University of Political Science and Law, Beijing, China, and the Office of the Chief Medical Examiner (L.L., D.R.F.), State of Maryland, Baltimore, Md; daggerCollege of Chemical and Life Sciences (Y.Z.), University of Maryland, College Park, Md; double daggerDepartment of Pediatrics (L.L., R.H.Z., D.R.F.), University of Maryland School of Medicine, Baltimore, Md; and section signthe Department of Forensic Medicine, (L.L., Y.P.), Wuhan University, China.

The Office of the Chief Medical Examiner (OCME) has recorded a significant increase of accidental asphyxia deaths in infancy associated with cosleeping in the state of Maryland in 2003. A total of 102 infants died suddenly and unexpectedly during 2003 in the state of Maryland. Of the 102 infants, 46 (45%) were found cosleeping. The frequency of cosleeping among these 102 infants was 28% (29/102) for black infants and 15% (15/102) for white infants. Ten of the 46 cosleeping infant deaths (20%) were determined to be the result of accidental asphyxia, and 28 cosleeping infant deaths (59%) were classified as "undetermined" because the possibility of asphyxia due to overlay while cosleeping could not be ruled out. Only 21 cases were determined to be Sudden Infant Death Syndrome (SIDS), which is consistent with the continuous decline of SIDS death in Maryland since 1994. The age of asphyxiated cosleeping infants ranged from 15 days to 9 months. Nine out of the 10 asphyxia deaths were black infants. The most common sleeping location of the asphyxia infants was on a couch/sofa, followed by an adult bed.Crib availability was documented in all of the cosleeping cases. A majority (61%) of the cosleeping infants (28/46) had an available crib or bassinet at home and 9 out of 10 asphyxiated cosleeping infants had a crib at home at the time of the incident.This report focuses on the detailed scene investigation findings of infant victims who died of asphyxia while cosleeping. The shift of diagnosis in sudden infant death investigation is also addressed.

Miscarriage/Stillbirth/Prenatal Issues

1. Tang AW, Alfirevic Z, Turner MA, Drury J, Quenby S
Prednisolone Trial: Study protocol for a randomised controlled trial of prednisolone for women with idiopathic recurrent miscarriage and raised levels of uterine natural killer (uNK) cells in the endometrium
Trials. 2009 Nov 10;10(1):102. [Epub ahead of print]

ABSTRACT: BACKGROUND: Idiopathic recurrent miscarriage is defined as 3 consecutive pregnancy losses with no contributing features found on investigations. At present there are no treatments of proven efficacy for idiopathic recurrent miscarriage. Uterine natural killer (uNK) cells, the most predominant leucocyte in the endometrium are adjacent to foetal trophoblast cells and thought to be involved in implantation. The exact mechanisms of how uNK cells affect implantation are not clear but are probably through the regulation of angiogenesis. Multiple studies have shown an association between high density of uterine natural killer cells and recurrent miscarriage. We have shown that prednisolone reduces the number of uNK cells in the endometrium. The question remains as to whether reducing the number of uNK cells improves pregnancy outcome. METHODS: We propose a randomised, double-blind, placebo controlled trial of prednisolone with a pilot phase to assess feasibility of recruitment, integrity of trial procedures, and to generate data to base future power calculations. The primary aim is to investigate whether prednisolone therapy during the first trimester of pregnancy is able to improve live birth rates in patients with idiopathic recurrent miscarriage and raised uNK cells in the endometrium. Secondary outcomes include conception rate, karyotype of miscarriage, miscarriages (first and second trimester), stillbirths, pregnancy complications, gestational age at delivery, congenital abnormality and side effects of steroids. The trial has 2 stages: i) screening of non-pregnant women and ii) randomisation of the pregnant cohort. All patients who fit the inclusion criteria (<40 years old, [greater than or equal to]3 consecutive miscarriages with no cause found and no contraindications to prednisolone therapy) will be asked to consent to an endometrial biopsy in the mid-luteal phase to assess their levels of uNK cells. Women with high levels of uNK cells ([greater than or equal to]5%), will be randomised to either prednisolone or placebo when a pregnancy is confirmed. Follow-up includes 2 weekly ultrasound scans in the first trimester, an anomaly scan at 20 weeks gestation, growth scans at 28 and 34 weeks gestation and a postnatal follow-up at 6 weeks. Trial Registration: Current Controlled Trials ISRCTN28090716.

2. Nielsen HS, Mortensen LH, Nygaard U, Schnor O, Christiansen OB, Andersen AM
Sex of Prior Children and Risk of Stillbirth in Subsequent Pregnancies
Epidemiology. 2009 Nov 5. [Epub ahead of print]

From the aThe National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; bThe Fertility Clinic, and cDepartment of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; and dDivision of Epidemiology, University of Southern Denmark, Odense, Denmark.

BACKGROUND:: Delivery of a boy has been reported to increase a woman's risk of recurrent miscarriage in subsequent pregnancies. We explored whether delivery of boys similarly increases the risk of a subsequent stillbirth. METHODS:: We identified all Danish women delivering their first child (singleton) between 1980 and 1998 (n = 499,731) using the Danish Birth Registry. These women had subsequent singleton births through 2004 (n = 558,314). We assessed the risk of stillbirth conditional on sex of prior children. RESULTS:: The risk of stillbirth was increased by 12% after deliver of boys compared with girls (relative risk = 1.12 [95% confidence interval = 1.02-1.23]). This association did not appear to be explained by maternal confounders. CONCLUSION:: Stillbirth risk appears to be slightly higher among the pregnancies of women who have previously delivered a boy. One possible mechanism is maternal immune response to male-specific minor histocompatibility antigens initiated during pregnancies with boys.

3. Silingardi E, Santunione AL, Rivasi F, Gasser B, Zago S, Garagnani L
Unexpected Intrauterine Fetal Death in Parvovirus B19 Fetal Infection
Am J Forensic Med Pathol. 2009 Nov 6. [Epub ahead of print]

From the *Department of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy; daggerThe Department of Pathological Anatomy, University of Modena and Reggio Emilia, Modena, Italy; double daggerService of Pathologic Anatomy, E. Muller Hospital, Mulhouse, France; and section signService of Pathological Anatomy, Ravenna Hospital, Ravenna, Italy.

Parvovirus B19 infection during pregnancy can be transmitted to the fetus through the placenta. The consequences for the health of the fetus are very variable and can be very serious. They include intrauterine fetal death (IUFD) and miscarriage, which can lead to medico-forensic questions. For the most part, cases of IUFD take place during the second trimester of gestation and present an anatomopathologic picture characteristic of fetal infection with hydrops, placental edema, serous effusion, and erythroblastosis with nuclear inclusions. Endocardial fibroelastosis, medullar and thymic hypoplasia, and hepatic hemosiderosis are frequently present. In the third trimester, the cases are less frequent, not accompanied by hydrops, and can depend more on placental compromise than on direct infection of the fetus. We present 5 cases of IUFD resulting from parvovirus B19 and we discuss the pathogenetic and anatomopathologic aspects and obstetric liability. In 4 cases, the IUFD took place suddenly, in the absence of symptoms, in women who had not previously shown any symptom of the viral infection. In one case, the patient was hospitalized following an ultrasound diagnosis of fetal hydrops and IUFD took place 5 days after admission. Of these cases 3 were verified in the second trimester and 2 in the third trimester. Only the cases of the second trimester and one of the 2 cases of the third trimester presented the characteristic aspects of fetal infection. The other case of third trimester was characterized by placental involvement.

4. Zhang BY, Wei YS, Niu JM, Li Y, Miao ZL, Wang ZN
Risk factors for unexplained recurrent spontaneous abortion in a population from southern China
Int J Gynaecol Obstet. 2009 Nov 6. [Epub ahead of print]

Obstetrics and Gynecology Department of Women and Children's Care Hospital of Guangdong Province, Guangzhou City, China.

OBJECTIVE: To determine risk factors for recurrent spontaneous abortion (RSA) in women from southern China. METHOD: We looked for associations between RSA and body mass index (BMI), family history of spontaneous abortion, smoking, exposure to environmental tobacco smoke (ETS [also known as passive smoking]), and alcohol and coffee consumption using an unconditional logistic regression model involving 326 patients with RSA and 400 controls. RESULTS: Whereas smoking, alcohol consumption, and coffee consumption were not associated with increased risk of RSA, both short (<1hour/day) and long (>/=1hour/day) periods of ETS were associated (adjusted odds ratio [OR], 2.30; 95% confidence interval [CI], 1.50-3.52 and adjusted OR, 4.75; 95% CI, 3.23-6.99, respectively). The increased risk of RSA was significant for participants with a BMI of 24.0 or greater (adjusted OR, 1.54; 95% CI, 1.12-2.14) and those with a family history of miscarriage (adjusted OR, 2.12; 95% CI, 1.28-3.49). CONCLUSION: We found ETS, a higher BMI, and a family history of RSA to be independent risk factors for RSA in our population.

5. Kazerooni T, Asadi N, Jadid L, Kazerooni M, Ghanadi A, Ghaffarpasand F, Kazerooni Y, Zolghadr J
Evaluation of sperm's chromatin quality with acridine orange test, chromomycin A3 and aniline blue staining in couples with unexplained recurrent abortion
J Assist Reprod Genet. 2009 Nov 6. [Epub ahead of print]

Shiraz University of Medical Sciences, Shiraz, Iran.

OBJECTIVE: To evaluate the sperm's chromatin quality in couples with spontaneous recurrent abortion. METHODS: Thirty couples with spontaneous recurrent abortion (case group) and 30 fertile couples (control group) referring to Zeinabieh Gynecology clinic of Shiraz were included. Semen samples were collected for each participant and were used for standard semen analysis and sperm nuclear maturity tests including Chromomycin A3 (CMA3), Aniline Blue (AB) staining and Acridine Orange (AO) test (by light microscopy). RESULT: Patients in case group had significantly higher percentage of CMA3 (p < 0.001) and AB (p < 0.001) positive spermatozoa compared to controls. However AO results did not differ significantly between groups (p = 0.656). Sperm morphology and progressive motility were negatively correlated with CMA3 (p = 0.001 and p = 0.043) and AB (p = 0.015 and p = 0.031) respectively. CONCLUSION: Evaluation of the sperm's quality via CMA3 and AB staining could be considered as one of the complementary tests of semen analysis for assessment of male factor in couples with spontaneous recurrent abortion.

6. Vigliani M
Chorioamnionitis and Intrauterine Fetal Death after Second-Trimester Amniocentesis
Fetal Diagn Ther. 2009 Nov 5. [Epub ahead of print]

Women and Infants' Hospital, Department of Obstetrics and Gynecology, Warren Alpert School of Medicine at Brown University, Providence, R.I., USA.

We report an intrauterine fetal death that occurred less than 24 h after transabdominal amniocentesis. Chorioamnionitis was confirmed by amniotic fluid culture which showed multiple enteric organisms and postmortem examination of the fetus that showed Clostridium perfringens. The patient was treated with intravenous broad-spectrum antibiotics and uterine evacuation and her condition rapidly improved. Intra-amniotic infection after amniocentesis requires a high index of suspicion and prompt aggressive treatment with broad spectrum antibiotics and uterine evacuation to prevent maternal sepsis-related morbidity and mortality. Copyright © 2009 S. Karger AG, Basel.

7. Parveen F, Faridi RM, Das V, Tripathi G, Agrawal S
Genetic Association of Phase I and Phase II Detoxification Genes with Recurrent Miscarriages among North Indian Women
Mol Hum Reprod. 2009 Nov 5. [Epub ahead of print]

Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow (UP) India.

Allelic variants of the detoxification genes that have impaired biotransformation functions may increase susceptibility to reproductive toxicity leading to endometriosis, recurrent miscarriage (RM) or poor pregnancy outcome. In the present study, we have investigated CYP1A1, CYP2D6, GSTT1, GSTP1 and GSTM1, which are involved in the phase I and phase II detoxification systems, in relation to their role in the etiology of unexplained recurrent miscarriages (RM). In a case control study, we have investigated 200 females with RM and 300 age and ethnically matched healthy controls with successful reproductive history from North India. The frequencies of phase I wild-type genotypes of CYP1A1 and CYP2D6 in RM cases were 0.56 and 0.60, whereas in controls these were 0.68 and 0.65 respectively (both p<0.05). The GSTM1 null-genotype frequencies were 0.66 and 0.84 among RM cases and controls respectively, the GSTT1 null- genotype frequencies were 0.52 and 0.45 (p<0.005) and the GSTP1 variant allele frequencies were 0.23 and 0.20 respectively. In conclusion, we observed significant protective effects of phase I wild-type genotypes and association of the GSTT1 null genotype with RM. Through combined analyses we have highlighted the importance of the balance of phase I/phase II detoxification systems, in the etiology of recurrent miscarriage.

Prepared by the
National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center
Georgetown University
2115 Wisconsin Avenue, N.W., Suite 601
Washington, DC 20007
(866) 866-7437 toll free
(202) 687-7466 local
(202) 784-9777 fax
info@sidscenter.org
http://www.sidscenter.org


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	Center Resources Bereavement Support Bibliographies Child Care and SIDS Definitions En Español First Responders For Families Infant Mortality Journal Alerts MCH Alert Multimedia Pregnancy Loss Professional Resources Safe Sleep Environment Statistics Training Toolkit Partner SIDS/ID Centers National SIDS & Infant Death Program Support Center / First Candle National SIDS & Infant Death Project IMPACT National Center for Cultural Competence SIDS/ID Project For more information on maternal and child health topics, visit the MCH Library	NSIDRC Journal Article Alert — November 13, 2009 Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center at Georgetown University. More about PubMed Copyright and Disclaimers These articles have been selected from PubMed, a service of the National Library of Medicine that includes over 19 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources. Availability of full-text journal articles is often limited to subscribers or through inter-library loan. Please see your local library for copies of these articles, or view PubMed's How to Get the Journal Article for more details. Past issues of Resource Center Journal Alerts Sudden Infant Death 1. Fracasso T, Karger B, Vennemann M, Bajanowski T, Golla-Schindler UM, Pfeiffer H Amniotic fluid aspiration in cases of SIDS Int J Legal Med. 2009 Nov 11. [Epub ahead of print] Institut für Rechtsmedizin, Universitätsklinikum Münster, Roentgenstr. 23, 48149, Muenster, Germany, Tony.Fracasso@ukmuenster.de. The scope of this study was to evaluate the incidence and the eventual consequences of amniotic fluid aspiration (AFA) in cases of sudden infant death. Cases of sudden infant death syndrome (SIDS; n = 113: 39 females, 74 males; mean age 4.6 months) were compared to a control group of 39 cases of explained death (14 females, 25 males; mean age 5.6 months). In each case, sections of the lung stained with hematoxylin and eosin and with the immunohistochemical reaction 34BE12 specific for cytokeratins were available. The microscope slides were observed at x200 magnification and semi-quantitatively classified into four categories(-, +, ++, and +++). In both groups, rests of amniotic fluid could be observed up to the fourth month of life. The comparison between the two groups did not show any significant difference. In the SIDS group, immunohistochemical reactions with the antibodies CD68, MRP8, MRP14, 27E10, 25F9, CD3, CD20Cy, and CD45R0 were available for the lungs. Twelve cases with AFA were compared to a group of SIDS cases without AFA with similar age and pathological distribution to evaluate whether the presence of amniotic remnants induced inflammatory changes in the lungs. No differences emerged. This study shows that AFA is not a rare event. Even moderate to severe AFA does not necessary cause death. A correlation between AFA and SIDS could not be shown. 2. Li L, Zhang Y, Zielke RH, Ping Y, Fowler DR Observations on Increased Accidental Asphyxia Deaths in Infancy While Cosleeping in the State of Maryland Am J Forensic Med Pathol. 2009 Nov 6. [Epub ahead of print] From the Key Laboratory of Evidence Science (L.L., D.R.F.), China University of Political Science and Law, Beijing, China, and the Office of the Chief Medical Examiner (L.L., D.R.F.), State of Maryland, Baltimore, Md; daggerCollege of Chemical and Life Sciences (Y.Z.), University of Maryland, College Park, Md; double daggerDepartment of Pediatrics (L.L., R.H.Z., D.R.F.), University of Maryland School of Medicine, Baltimore, Md; and section signthe Department of Forensic Medicine, (L.L., Y.P.), Wuhan University, China. The Office of the Chief Medical Examiner (OCME) has recorded a significant increase of accidental asphyxia deaths in infancy associated with cosleeping in the state of Maryland in 2003. A total of 102 infants died suddenly and unexpectedly during 2003 in the state of Maryland. Of the 102 infants, 46 (45%) were found cosleeping. The frequency of cosleeping among these 102 infants was 28% (29/102) for black infants and 15% (15/102) for white infants. Ten of the 46 cosleeping infant deaths (20%) were determined to be the result of accidental asphyxia, and 28 cosleeping infant deaths (59%) were classified as "undetermined" because the possibility of asphyxia due to overlay while cosleeping could not be ruled out. Only 21 cases were determined to be Sudden Infant Death Syndrome (SIDS), which is consistent with the continuous decline of SIDS death in Maryland since 1994. The age of asphyxiated cosleeping infants ranged from 15 days to 9 months. Nine out of the 10 asphyxia deaths were black infants. The most common sleeping location of the asphyxia infants was on a couch/sofa, followed by an adult bed.Crib availability was documented in all of the cosleeping cases. A majority (61%) of the cosleeping infants (28/46) had an available crib or bassinet at home and 9 out of 10 asphyxiated cosleeping infants had a crib at home at the time of the incident.This report focuses on the detailed scene investigation findings of infant victims who died of asphyxia while cosleeping. The shift of diagnosis in sudden infant death investigation is also addressed. Miscarriage/Stillbirth/Prenatal Issues* 1. Tang AW, Alfirevic Z, Turner MA, Drury J, Quenby S Prednisolone Trial: Study protocol for a randomised controlled trial of prednisolone for women with idiopathic recurrent miscarriage and raised levels of uterine natural killer (uNK) cells in the endometrium Trials. 2009 Nov 10;10(1):102. [Epub ahead of print] ABSTRACT: BACKGROUND: Idiopathic recurrent miscarriage is defined as 3 consecutive pregnancy losses with no contributing features found on investigations. At present there are no treatments of proven efficacy for idiopathic recurrent miscarriage. Uterine natural killer (uNK) cells, the most predominant leucocyte in the endometrium are adjacent to foetal trophoblast cells and thought to be involved in implantation. The exact mechanisms of how uNK cells affect implantation are not clear but are probably through the regulation of angiogenesis. Multiple studies have shown an association between high density of uterine natural killer cells and recurrent miscarriage. We have shown that prednisolone reduces the number of uNK cells in the endometrium. The question remains as to whether reducing the number of uNK cells improves pregnancy outcome. METHODS: We propose a randomised, double-blind, placebo controlled trial of prednisolone with a pilot phase to assess feasibility of recruitment, integrity of trial procedures, and to generate data to base future power calculations. The primary aim is to investigate whether prednisolone therapy during the first trimester of pregnancy is able to improve live birth rates in patients with idiopathic recurrent miscarriage and raised uNK cells in the endometrium. Secondary outcomes include conception rate, karyotype of miscarriage, miscarriages (first and second trimester), stillbirths, pregnancy complications, gestational age at delivery, congenital abnormality and side effects of steroids. The trial has 2 stages: i) screening of non-pregnant women and ii) randomisation of the pregnant cohort. All patients who fit the inclusion criteria (<40 years old, [greater than or equal to]3 consecutive miscarriages with no cause found and no contraindications to prednisolone therapy) will be asked to consent to an endometrial biopsy in the mid-luteal phase to assess their levels of uNK cells. Women with high levels of uNK cells ([greater than or equal to]5%), will be randomised to either prednisolone or placebo when a pregnancy is confirmed. Follow-up includes 2 weekly ultrasound scans in the first trimester, an anomaly scan at 20 weeks gestation, growth scans at 28 and 34 weeks gestation and a postnatal follow-up at 6 weeks. Trial Registration: Current Controlled Trials ISRCTN28090716. 2. Nielsen HS, Mortensen LH, Nygaard U, Schnor O, Christiansen OB, Andersen AM Sex of Prior Children and Risk of Stillbirth in Subsequent Pregnancies Epidemiology. 2009 Nov 5. [Epub ahead of print] From the aThe National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark; bThe Fertility Clinic, and cDepartment of Neonatology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; and dDivision of Epidemiology, University of Southern Denmark, Odense, Denmark. BACKGROUND:: Delivery of a boy has been reported to increase a woman's risk of recurrent miscarriage in subsequent pregnancies. We explored whether delivery of boys similarly increases the risk of a subsequent stillbirth. METHODS:: We identified all Danish women delivering their first child (singleton) between 1980 and 1998 (n = 499,731) using the Danish Birth Registry. These women had subsequent singleton births through 2004 (n = 558,314). We assessed the risk of stillbirth conditional on sex of prior children. RESULTS:: The risk of stillbirth was increased by 12% after deliver of boys compared with girls (relative risk = 1.12 [95% confidence interval = 1.02-1.23]). This association did not appear to be explained by maternal confounders. CONCLUSION:: Stillbirth risk appears to be slightly higher among the pregnancies of women who have previously delivered a boy. One possible mechanism is maternal immune response to male-specific minor histocompatibility antigens initiated during pregnancies with boys. 3. Silingardi E, Santunione AL, Rivasi F, Gasser B, Zago S, Garagnani L Unexpected Intrauterine Fetal Death in Parvovirus B19 Fetal Infection Am J Forensic Med Pathol. 2009 Nov 6. [Epub ahead of print] From the *Department of Legal Medicine, University of Modena and Reggio Emilia, Modena, Italy; daggerThe Department of Pathological Anatomy, University of Modena and Reggio Emilia, Modena, Italy; double daggerService of Pathologic Anatomy, E. Muller Hospital, Mulhouse, France; and section signService of Pathological Anatomy, Ravenna Hospital, Ravenna, Italy. Parvovirus B19 infection during pregnancy can be transmitted to the fetus through the placenta. The consequences for the health of the fetus are very variable and can be very serious. They include intrauterine fetal death (IUFD) and miscarriage, which can lead to medico-forensic questions. For the most part, cases of IUFD take place during the second trimester of gestation and present an anatomopathologic picture characteristic of fetal infection with hydrops, placental edema, serous effusion, and erythroblastosis with nuclear inclusions. Endocardial fibroelastosis, medullar and thymic hypoplasia, and hepatic hemosiderosis are frequently present. In the third trimester, the cases are less frequent, not accompanied by hydrops, and can depend more on placental compromise than on direct infection of the fetus. We present 5 cases of IUFD resulting from parvovirus B19 and we discuss the pathogenetic and anatomopathologic aspects and obstetric liability. In 4 cases, the IUFD took place suddenly, in the absence of symptoms, in women who had not previously shown any symptom of the viral infection. In one case, the patient was hospitalized following an ultrasound diagnosis of fetal hydrops and IUFD took place 5 days after admission. Of these cases 3 were verified in the second trimester and 2 in the third trimester. Only the cases of the second trimester and one of the 2 cases of the third trimester presented the characteristic aspects of fetal infection. The other case of third trimester was characterized by placental involvement. 4. Zhang BY, Wei YS, Niu JM, Li Y, Miao ZL, Wang ZN Risk factors for unexplained recurrent spontaneous abortion in a population from southern China Int J Gynaecol Obstet. 2009 Nov 6. [Epub ahead of print] Obstetrics and Gynecology Department of Women and Children's Care Hospital of Guangdong Province, Guangzhou City, China. OBJECTIVE: To determine risk factors for recurrent spontaneous abortion (RSA) in women from southern China. METHOD: We looked for associations between RSA and body mass index (BMI), family history of spontaneous abortion, smoking, exposure to environmental tobacco smoke (ETS [also known as passive smoking]), and alcohol and coffee consumption using an unconditional logistic regression model involving 326 patients with RSA and 400 controls. RESULTS: Whereas smoking, alcohol consumption, and coffee consumption were not associated with increased risk of RSA, both short (<1hour/day) and long (>/=1hour/day) periods of ETS were associated (adjusted odds ratio [OR], 2.30; 95% confidence interval [CI], 1.50-3.52 and adjusted OR, 4.75; 95% CI, 3.23-6.99, respectively). The increased risk of RSA was significant for participants with a BMI of 24.0 or greater (adjusted OR, 1.54; 95% CI, 1.12-2.14) and those with a family history of miscarriage (adjusted OR, 2.12; 95% CI, 1.28-3.49). CONCLUSION: We found ETS, a higher BMI, and a family history of RSA to be independent risk factors for RSA in our population. 5. Kazerooni T, Asadi N, Jadid L, Kazerooni M, Ghanadi A, Ghaffarpasand F, Kazerooni Y, Zolghadr J Evaluation of sperm's chromatin quality with acridine orange test, chromomycin A3 and aniline blue staining in couples with unexplained recurrent abortion J Assist Reprod Genet. 2009 Nov 6. [Epub ahead of print] Shiraz University of Medical Sciences, Shiraz, Iran. OBJECTIVE: To evaluate the sperm's chromatin quality in couples with spontaneous recurrent abortion. METHODS: Thirty couples with spontaneous recurrent abortion (case group) and 30 fertile couples (control group) referring to Zeinabieh Gynecology clinic of Shiraz were included. Semen samples were collected for each participant and were used for standard semen analysis and sperm nuclear maturity tests including Chromomycin A3 (CMA3), Aniline Blue (AB) staining and Acridine Orange (AO) test (by light microscopy). RESULT: Patients in case group had significantly higher percentage of CMA3 (p < 0.001) and AB (p < 0.001) positive spermatozoa compared to controls. However AO results did not differ significantly between groups (p = 0.656). Sperm morphology and progressive motility were negatively correlated with CMA3 (p = 0.001 and p = 0.043) and AB (p = 0.015 and p = 0.031) respectively. CONCLUSION: Evaluation of the sperm's quality via CMA3 and AB staining could be considered as one of the complementary tests of semen analysis for assessment of male factor in couples with spontaneous recurrent abortion. 6. Vigliani M Chorioamnionitis and Intrauterine Fetal Death after Second-Trimester Amniocentesis Fetal Diagn Ther. 2009 Nov 5. [Epub ahead of print] Women and Infants' Hospital, Department of Obstetrics and Gynecology, Warren Alpert School of Medicine at Brown University, Providence, R.I., USA. We report an intrauterine fetal death that occurred less than 24 h after transabdominal amniocentesis. Chorioamnionitis was confirmed by amniotic fluid culture which showed multiple enteric organisms and postmortem examination of the fetus that showed Clostridium perfringens. The patient was treated with intravenous broad-spectrum antibiotics and uterine evacuation and her condition rapidly improved. Intra-amniotic infection after amniocentesis requires a high index of suspicion and prompt aggressive treatment with broad spectrum antibiotics and uterine evacuation to prevent maternal sepsis-related morbidity and mortality. Copyright © 2009 S. Karger AG, Basel. 7. Parveen F, Faridi RM, Das V, Tripathi G, Agrawal S Genetic Association of Phase I and Phase II Detoxification Genes with Recurrent Miscarriages among North Indian Women Mol Hum Reprod. 2009 Nov 5. [Epub ahead of print] Department of Medical Genetics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow (UP) India. Allelic variants of the detoxification genes that have impaired biotransformation functions may increase susceptibility to reproductive toxicity leading to endometriosis, recurrent miscarriage (RM) or poor pregnancy outcome. In the present study, we have investigated CYP1A1, CYP2D6, GSTT1, GSTP1 and GSTM1, which are involved in the phase I and phase II detoxification systems, in relation to their role in the etiology of unexplained recurrent miscarriages (RM). In a case control study, we have investigated 200 females with RM and 300 age and ethnically matched healthy controls with successful reproductive history from North India. The frequencies of phase I wild-type genotypes of CYP1A1 and CYP2D6 in RM cases were 0.56 and 0.60, whereas in controls these were 0.68 and 0.65 respectively (both p<0.05). The GSTM1 null-genotype frequencies were 0.66 and 0.84 among RM cases and controls respectively, the GSTT1 null- genotype frequencies were 0.52 and 0.45 (p<0.005) and the GSTP1 variant allele frequencies were 0.23 and 0.20 respectively. In conclusion, we observed significant protective effects of phase I wild-type genotypes and association of the GSTT1 null genotype with RM. Through combined analyses we have highlighted the importance of the balance of phase I/phase II detoxification systems, in the etiology of recurrent miscarriage. Prepared by the National Sudden and Unexpected Infant/Child Death and Pregnancy Loss Resource Center Georgetown University 2115 Wisconsin Avenue, N.W., Suite 601 Washington, DC 20007 (866) 866-7437 toll free (202) 687-7466 local (202) 784-9777 fax info@sidscenter.org http://www.sidscenter.org
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