NSIDRC Journal Article Alert — August 6, 2010
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.
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Sudden Infant Death
1. Courts C, Madea B
Genetics of the sudden infant death syndrome
Forensic Sci Int. 2010 Jul 29. [Epub ahead of print]
Institute of Forensic Medicine, University of Bonn, Bonn, Germany.
The sudden infant death syndrome (SIDS) is currently defined as "the sudden unexpected death of an infant less than 1 year of age with onset of the fatal episode apparently occurring during sleep, that remains unexplained after a thorough investigation". SIDS, whose etiology remains rather vague, is still the major cause of death among infants between 1 month and 1 year of age in industrialized countries with varying incidences in different populations. Herein, after touching on definitory approaches and several current hypotheses concerning SIDS etiology, we focus on the triple risk model of SIDS and discuss two large classes of genetic factors potentially contributing to or predisposing for the generation of a vulnerable infant that, when encountering an environmental trigger, may succumb to SIDS. We conclude by acknowledging that for the integration of the vast and complex genetic evidence concerning SIDS, a lot more research will be required and we briefly discuss the potential use of recently presented animal models for functional studies of SIDS pathology. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
2. Franco P, Kato I, Richardson HL, Yang JS, Montemitro E,
Horne RS
Arousal from sleep mechanisms in infants
Sleep Med. 2010 Aug;11(7):603-14. Epub 2010 Jul 13
Pediatric Sleep Unit, HFME & INSERM U 628, University Lyon 1, Lyon, France. pfranco@univ-lyon1.fr
Arousals from sleep allow sleep to continue in the face of stimuli that normally elicit responses during wakefulness and also permit awakening. Such an adaptive mechanism implies that any malfunction may have clinical importance. Inadequate control of arousal in infants and children is associated with a variety of sleep-related problems. An excessive propensity to arouse from sleep favors the development of repeated sleep disruptions and insomnia, with impairment of daytime alertness and performance. A lack of an adequate arousal response to a noxious nocturnal stimulus reduces an infant's chances of autoresuscitation, and thus survival, increasing the risk for Sudden Infant Death Syndrome (SIDS). The study of arousability is complicated by many factors including the definition of an arousal; the scoring methodology; the techniques used (spontaneous arousability versus arousal responses to endogenous or exogenous stimuli); and the confounding factors that complicate the determination of arousal thresholds by changing the sleeper's responses to a given stimulus such as prenatal drug, alcohol, or cigarette use. Infant age and previous sleep deprivation also modify thresholds. Other confounding factors include time of night, sleep stages, the sleeper's body position, and sleeping conditions. In this paper, we will review these different aspects for the study of arousals in infants and also report the importance of these studies for the understanding of the pathophysiology of some clinical conditions, particularly SIDS. Copyright 2010 Elsevier B.V. All rights reserved.
3. Sleep Med. 2010 Aug;11(7):615-21. Epub 2010 Jul 6.
Cardiovascular control during sleep in infants: Implications
for Sudden Infant Death Syndrome
Horne RS, Witcombe NB, Yiallourou SR, Scaillet S, Thiriez G,
Franco P
Ritchie Centre for Baby Health Research, Monash Institute of Medical Research, Monash University, Melbourne, Australia. rosemary.horne@med.monash.edu.au
In infants the cardiorespiratory system undergoes significant functional maturation after birth and these changes are sleep-state dependent. Given the immaturity of these systems it is not surprising that infants are at risk of cardiorespiratory instability, especially during sleep. A failure of cardiovascular control mechanisms in particular is believed to play a role in the final event of Sudden Infant Death Syndrome (SIDS). The "triple risk model" describes SIDS as an event that results from the intersection of three overlapping factors: (1) a vulnerable infant, (2) a critical development period in homeostatic control, and (3) an exogenous stressor. This review summarises normal development of cardiovascular control during sleep in infants and describes the association of impaired cardiovascular control with the three overlapping factors proposed to be involved in SIDS pathogenesis. Crown Copyright 2010. Published by Elsevier B.V. All rights reserved.
4. McManus V, Abel S, McCreanor T, Tipene-Leach D
Narratives of deprivation: Women's life stories around Maori
sudden infant death syndrome
Soc Sci Med. 2010 Aug;71(3):643-9. Epub 2010 May 12
Whariki Research Group, Massey University, 90 Symonds St., Auckland, New Zealand. v.m.mcmanus@massey.ac.nz
Maori babies in Aotearoa/New Zealand die of Sudden Infant
Death Syndrome (SIDS) at over five times the rate of their
non-Maori peers. Research and health promotion around modifiable
risk factors has produced only a small improvement in this
situation since the mid-1990s. This paper reports on life story
interviews, conducted between 2002 and 2004, with nineteen
mothers of Maori infants who have died of SIDS. Potential participants
were identified and accessed with the support of the national
Maori SIDS Prevention Programme care-workers, in both urban
and rural locations throughout both main islands of New Zealand.
The paper articulates, in a thematic fashion, the bereaved
mothers' experiences of alienation, marginalisation and exclusion,
as a testimony of lives lived under conditions of serious deprivation
in an affluent society. Constructing these experiences as non-modifiable
risk factors hinders the development of policy and health promotion
interventions that could improve the conditions in which Maori
mothers live and raise their babies. It is argued that new
approaches that target those whose lives are described here
and build on the WHO Social Determinants of Health framework
are vital to the efforts of New Zealanders to attain health
equity and stem the tide of devastating and preventable loss
of Maori babies to SIDS. Copyright 2010. Published by Elsevier
Ltd.
Miscarriage/Stillbirth/Prenatal Issues
1. Stock SJ, Goldsmith L, Evans MJ, Laing IA
Interventions to improve rates of post-mortem examination after
stillbirth
Eur J Obstet Gynecol Reprod Biol. 2010 Jul 29. [Epub ahead
of print]
University of Edinburgh, Division of Reproductive and Developmental Sciences, Room S7129, Simpson Centre for Reproductive Health, 51 Little France Crescent, Edinburgh EH16 4SA, United Kingdom.
OBJECTIVE: Despite recognition of the value of post-mortem examination following stillbirth, worldwide rates have declined since the early 1990s. There is a paucity of published evidence relating to factors that can improve post-mortem uptake. The aim of this study was to assess post-mortem rates following stillbirth and identify trends in the past 18 years that may have affected acceptance of the investigation. STUDY DESIGN: Retrospective cohort study. RESULTS: Sharp declines in post-mortems coincided with publicity surrounding unlawful organ retention. Although nationally post-mortem rates have continued to fall, in our unit there was recovery in post-mortem rates. This increase was associated with implementation of policies to promote the uptake of perinatal post-mortem, including availability of specialist perinatal pathologists, education in the value of post-mortem, and senior staff involvement in counselling regarding the procedure. CONCLUSION: The need to improve uptake of post-mortem examination following stillbirth is internationally recognized. The results of this study suggest that increased local availability of specialist perinatal pathologists, who can support education in the value of post-mortem, along with senior staff obtaining consent, may help achieve this goal. Copyright © 2010. Published by Elsevier Ireland Ltd.
2. Tarui T, Khwaja OS, Estroff JA, Robinson JN, Grant PE
Fetal MR Imaging Evidence of Prolonged Apparent Diffusion Coefficient
Decrease in Fetal Death
AJNR Am J Neuroradiol. 2010 Jul 29. [Epub ahead of print]
Departments of Neurology and Radiology, Division of Fetal-Neonatal Neurology, Advanced Fetal Care Center, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts; Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Brigham and Women's Hospital, Newton Wellesley Hospital, Harvard Medical School, Boston, Massachusetts; and Center for Fetal-Neonatal Neuroimaging and Developmental Science, Division of Newborn Medicine, Department of Medicine, Division of Neuroradiology, Department of Radiology, Children's Hospital Boston, Harvard Medical School, Boston, Massachusetts.
SUMMARY: We report 2 fetal MR imaging cases at 22 wkGA with cerebral bright DWI and low ADC, 8 and 19 days after documented fetal death. These observations illustrate that decreased diffusion can be present weeks after injury onset, and its presence cannot be used to time injury onset within 1 week, which could significantly impact determination of the proximate cause of fetal brain injury in future cases.
3. Kelly J, Kohls E, Poovan P, Schiffer R, Redito A, Winter
H, Macarthur C
The role of a maternity waiting area (MWA) in reducing maternal
mortality and stillbirths in high-risk women in rural Ethiopia
BJOG. 2010 Jul 29. [Epub ahead of print]
Attat Hospital, Welkitay, Ethiopia Public Health, Epidemiology and Biostatistics, College of Medicine, University of Birmingham, Birmingham, UK.
Please cite this paper as: Kelly J, Kohls E, Poovan P, Schiffer R, Redito A, Winter H, MacArthur C. The role of a maternity waiting area (MWA) in reducing maternal mortality and stillbirths in high-risk women in rural Ethiopia. BJOG 2010; DOI: 10.1111/j.1471-0528.2010.02669.x. Objective To describe maternal mortality and stillbirth rates among women admitted via a maternity waiting area (MWA) and women admitted directly to the same hospital (non-MWA) over a 22-year period. Design Retrospective cohort study. Setting Hospital in rural Ethiopia, which provided comprehensive emergency obstetric care and has an established MWA. Population All women admitted for delivery between 1987 and 2008. Methods Data on maternal deaths, stillbirths, caesarean section and uterine rupture were ed from routine hospital records. Sociodemographic characteristics, antenatal care and other data were collected for 2008 only. Rates and 95% confidence intervals were calculated for maternal mortality and stillbirth. Main outcome measures Maternal mortality and stillbirth. Results There were 24 148 deliveries over the study period, 6805 admitted via MWA and 17 343 admitted directly. Maternal mortality was 89.9 per 100 000 live births (95% CI, 41.1-195.2) for MWA women and 1333.1 per 100 000 live births (95% CI, 1156.2-1536.7) for non-MWA women; stillbirth rates were 17.6 per 1000 births (95% CI, 14.8-21.0) and 191.2 per 1000 births (95% CI, 185.4-197.1), respectively; 38.5% of MWA women were delivered by caesarean section compared with 20.3% of non-MWA women, and none had uterine rupture, compared with 5.8% in the non-MWA group. For the 1714 women admitted in 2008, relatively small differences in sociodemographic characteristics, distance and antenatal care uptake were found between groups. Conclusions Maternal mortality and stillbirth rates were substantially lower in women admitted via MWA. It is likely that at least part of this difference is accounted for by the timely and appropriate obstetric management of women using this facility.
4. Matsubara S, Takahashi Y, Usui R, Nakata M, Kuwata T, Suzuki
M
Uterine artery pseudoaneurysm manifesting as postpartum hemorrhage
after uneventful second-trimester pregnancy termination
J Obstet Gynaecol Res. 2010 Aug;36(4):856-60
Department of Obstetrics and Gynecology, Jichi Medical University, Tochigi, Japan.
Uterine artery pseudoaneurysm is a rare complication mainly of abdominal or interventional delivery that can cause profuse postpartum hemorrhage if unrecognized or inadequately treated. There has been no report of this disorder accompanying uneventful second-trimester pregnancy termination. A primiparous Japanese woman underwent pregnancy termination at 24 weeks' gestation due to fetal death. Gradual dilatation of the cervix followed by administration of vaginal gemeprost led to an uneventful delivery without curettage. After 41 days, profuse vaginal bleeding occurred. Ultrasound revealed a mass within the uterine cavity and color Doppler indicated the presence of high-speed flow within the mass. Selective angiography revealed that the mass was connected to the right uterine artery, from which extravasation was observed. Uterine artery pseudoaneurysm was diagnosed, and we performed successful uterine artery embolization. This is the first report of uterine artery pseudoaneurysm after second-trimester pregnancy termination. Our experience indicates that even after uneventful pregnancy termination, clinicians must remain aware of the possibility of pseudoaneurysm, manifesting as postpartum/post-termination hemorrhage.
5. Caglayan AO, Ozyazgan I, Demiryilmaz F, Ozgun MT
Are heterochromatin polymorphisms associated with recurrent
miscarriage?
J Obstet Gynaecol Res. 2010 Aug;36(4):774-776
Medical Genetics, Kayseri Education and Research Hospital, Erciyes University, Kayseri, Turkey.
Aim: Recurrent miscarriage is a multifactorial problem associated with genetic abnormalities reflected by inherited disorders. The aim of the present study was to investigate the contribution of chromosomal abnormalities and the frequency of a particular type of aberration in couples of Turkish origin with recurrent miscarriages compared with patients without miscarriages. Methods: A total of 336 patients with recurrent miscarriages and 427 patients without miscarriages were analyzed. Results: In the recurrent miscarriage group, a structural chromosomal abnormality was found in four patients (1%). Twelve patients had mosaic karyotype (3%) and the total rate of chromosomal abnormalities was 4% in this group. The karyotypes were composed of polymorphisms in 8% of patients with recurrent miscarriages compared with 4% in the control group (P < 0.05). Conclusion: The overall high incidence of chromosome polymorphisms in patients with recurrent miscarriages compared to the normal population needs to be confirmed with additional investigations including larger populations in order to delineate the role of 'harmless' chromosomal aberrations in the etiology of recurrent spontaneous abortions.
6. Korteweg FJ, Erwich JJ, Folkeringa N, Timmer A, Veeger
NJ, Ravisé JM, Holm JP, van der Meer J
Prevalence of parental thrombophilic defects after fetal death
and relation to cause
Obstet Gynecol. 2010 Aug;116(2 Pt 1):355-64
Department of Obstetrics, Division of Haemostasis, Trial Coordination Center, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. f.j.korteweg@og.umcg.nl
OBJECTIVE: To estimate whether parental thrombophilic defects after fetal death, either acquired or inherited, were more prevalent than in the normal population and to estimate associations between these thrombophilic defects and different fetal death causes. METHODS: In a multicenter, prospective cohort study of 750 fetal deaths, we tested couples for antithrombin, protein C, total and free protein S, and von Willebrand factor (vWF) plasma levels. Mothers' values were compared with reference values in gestational age-matched healthy pregnant women, and fathers were compared with healthy men. Prevalence of factor V Leiden, prothrombin G20210A mutation, and lupus anticoagulant were compared with the normal population. A panel classified death cause. RESULTS: More women with fetal death had decreased antithrombin (16.8%, P<.001) and protein C (4.0%, P=.03) and increased vWF (15.5%, P<.001) plasma levels than healthy pregnant women (2.5%). However, compared with normal ranges in the nonpregnant population, we only observed more women with increased vWF (12.4%, P<.001). More fathers had decreased free protein S (6.3%, P<.001) and elevated vWF (12.1%, P<.001) than healthy men (2.5%). Prevalence of inherited thrombophilias was not higher in couples with fetal death than in the population. Neither inherited nor acquired maternal or paternal thrombophilic defects were associated with the main cause of death. Of placental causes, abruption and infarction were associated with acquired maternal defects. CONCLUSION: Except for vWF and paternal free protein S, acquired and inherited thrombophilic defects were not more prevalent after fetal death. Routine thrombophilia testing after fetal death is not advised. LEVEL OF EVIDENCE: II.
7. Dudley DJ, Goldenberg R, Conway D, Silver RM, Saade GR,
Varner MW, Pinar H, Coustan D, Bukowski R, Stoll B, Koch MA,
Parker CB, Reddy UM; Stillbirth Research Collaborative Network
A new system for determining the causes of stillbirth
Obstet Gynecol. 2010 Aug;116(2 Pt 1):254-60
University of Texas Health Science Center at San Antonio, Texas 78229, USA. dudleyd@uthscsa.edu
OBJECTIVE: To describe the methods for assigning the cause of death for stillbirths enrolled in the Stillbirth Collaborative Research Network (SCRN). METHODS: A complete evaluation, including postmortem examination, placental pathology, medical record ion, and maternal interview was available on 512 stillbirths among 500 women. These 512 stillbirths were evaluated for cause of death using the definitions outlined in this report. Using the best available evidence, SCRN investigators developed a new methodology to assign the cause of death of stillbirths using clinical, postmortem, and placental pathology data. This new tool, designated the Initial Causes of Fetal Death, incorporates known causes of death and assigns them as possible or probable based on strict diagnostic criteria, derived from published references and pathophysiologic sequences that lead to stillbirth. RESULTS: Six broad categories of causes of death are accounted for, including maternal medical conditions; obstetric complications; maternal or fetal hematologic conditions; fetal genetic, structural, and karyotypic abnormalities; placental infection, fetal infection, or both; and placental pathologic findings. Isolated histologic chorioamnionitis and small for gestational age were not considered causes of death. CONCLUSION: A new system, Initial Causes of Fetal Death, to assign cause of death in stillbirths was developed by the SCRN investigators for use in this study but has broader applicability. Initial Causes of Fetal Death is a standardized method to assign probable and possible causes of death of stillbirths based on information routinely collected during prenatal care and the clinical evaluation of fetal death.
8. Adolfsson A, Larsson PG
Applicability of general grief theory to Swedish women's experience
after early miscarriage, with factor analysis of Bonanno's
taxonomy, using the Perinatal Grief Scale
Ups J Med Sci. 2010 Aug;115(3):201-9
School of Life Sciences, University of Skövde, Skövde, Sweden. annsofie.adolfsson@his.se
BACKGROUND: Grief is a normal phenomenon but showing great variation depending on cultural and personal features. Bonanno and Kaltman have nonetheless proposed five aspects of normal grief. The aim of this study was to investigate if women with miscarriage experience normal grief. MATERIAL AND METHODS: Content analyses of 25 transcribed conversations with women 4 weeks after their early miscarriages were classified depending on the meaning-bearing units according to Bonanno and Kaltman's categories. In the factor analyses, these categories were compared with the Perinatal Grief Scale and women's age, number of children and number of miscarriages, and gestational weeks. RESULTS: Women with miscarriage fulfill the criteria for having normal grief according to Bonanno and Kaltman. All of the 25 women had meaning-bearing units that were classified as cognitive disorganization, dysphoria, and health deficits, whereas disrupted social and occupational functioning and positive aspects of bereavement were represented in 22 of 25 women. From the factor analysis, there are no differences in the expression of the intensity of the grief, irrespective of whether or not the women were primiparous, younger, or had suffered a first miscarriage. CONCLUSION: Women's experience of grief after miscarriage is similar to general grief after death. After her loss, the woman must have the possibility of expressing and working through her grief before she can finish her pregnancy emotionally. The care-giver must facilitate this process and accept that the intensity of the grief is not dependent on the woman's age, or her number of earlier miscarriages.
9. Hirst JE, Arbuckle SM, Do TM, Ha LT, Jeffery HE
Epidemiology of stillbirth and strategies for its prevention
in Vietnam
Int J Gynaecol Obstet. 2010 Aug;110(2):109-13
Department of Obstetrics and Gynaecology, University of Sydney, Sydney, Australia. jhirst@med.usyd.edu.au
OBJECTIVE: To describe major epidemiologic and placental findings regarding stillbirth in Vietnam. METHODS: A cross-sectional study of all stillbirths in a tertiary referral facility in Ho Chi Minh City, Vietnam, was performed. Detailed examination of each infant, placental pathology, and semi-structured maternal interviews were conducted according to the Perinatal Society of Australia and New Zealand Perinatal Death Classification guidelines. Maternal, fetal, and placental characteristics were examined. RESULTS: Between December 8, 2008, and January 9, 2009, there were 4694 live births and 122 stillbirths at the facility. In total, 107 (87.7%) cases were included in the study. Low education level was associated with a lack of prenatal care; induced abortion accounted for 34.6% of fetal deaths (gender selection was not the reason); 35.5% of infants were born at 22-28 weeks of gestation; 31.8% of stillbirths were small for gestational age; histologic evidence of chorioamnionitis was present in 40.2% of cases. Calcium supplements were less likely to have been taken in cases in which death from hypertension occurred. alpha-Thalassemia was the main cause of fetal hydrops (6.2%). CONCLUSION: Improving access to prenatal care and prenatal calcium and iron supplementation, and screening for congenital abnormalities and alpha-thalassemia may help to reduce rates of perinatal death in Vietnam. Crown Copyright 2010. Published by Elsevier Ireland Ltd. All rights reserved.
10. Woods-Giscombé CL, Lobel M, Crandell JL
The impact of miscarriage and parity on patterns of maternal
distress in pregnancy
Res Nurs Health. 2010 Aug;33(4):316-28
School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7460, USA.
The purpose of the current study was to examine patterns of state anxiety and pregnancy-specific distress across pregnancy in a diverse sample of women with (n = 113) and without (n = 250) prior miscarriage. For both groups, state anxiety and pregnancy-specific distress were highest in the first trimester and decreased significantly over the course of pregnancy. Compared to women without prior miscarriage, women with prior miscarriage experienced greater state anxiety in the second and third trimesters. Having a living child did not buffer state anxiety in women with a prior miscarriage. Attention to patterns of distress can contribute to delivery of appropriate support resources to women experiencing pregnancy after miscarriage and may help reduce risk for stress-related outcomes. 2010 Wiley Periodicals, Inc.
11. Bohlmann MK, von Wolff M, Luedders DW, Beuter-Winkler
P, Diedrich K, Hornemann A, Strowitzki T
Hysteroscopic findings in women with two and with more than
two first-trimester miscarriages are not significantly different
Reprod Biomed Online. 2010 Aug;21(2):230-236. Epub 2010 Apr
24
Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
The purpose of this study was to analyse hysteroscopic results in patients with recurrent miscarriages and to compare the frequency of uterine anomalies in women with a history of exactly two and with more than two consecutive miscarriages. A retrospective analysis of 206 patients undergoing hysteroscopy for repeated early pregnancy losses was performed at two university centres. Late miscarriages were excluded, terminations of pregnancy were not counted. Eighty-seven patients had suffered from exactly two early miscarriages and 119 from more than two. Both groups were comparable with respect to age at admission (32.95+/-4.46 versus 34.06+/-5.02years) and at first miscarriage (30.43+/-4.24 versus 29.08+/-5.38years). The prevalence of acquired (adhesions, polyps, fibroids) and congenital uterine anomalies (septate or bicornuate uterus, etc.) did not differ significantly (acquired: 28.7 versus 27.7%; congenital: 9.2 versus 16.8%). The rates of uterine anomalies did not differ significantly overall (36.8 versus 42.9%). In conclusion, uterine anomalies are frequently found in patients with two and with more than two early miscarriages. Due to the high rate of anomalies, their risk for adverse pregnancy outcome and a possible therapeutic approach, hysteroscopy might be a diagnostic option even after two early miscarriages. Copyright © 2010 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.
12. Turner MJ, Fattah C, O'Connor N, Farah N, Kennelly M,
Stuart B
Body Mass Index and spontaneous miscarriage
Eur J Obstet Gynecol Reprod Biol. 2010 Aug;151(2):168-70. Epub
2010 May 21
UCD Centre for Human Reproduction, Coombe Women and Infants University Hospital, Dublin 8, Ireland. michael.turner@ucd.ie
OBJECTIVE: We compared the incidence of spontaneous miscarriage in women categorised as obese, based on a Body Mass Index (BMI) >29.9 kg/m(2), with women in other BMI categories. STUDY DESIGN: In a prospective observational study conducted in a university teaching hospital, women were enrolled at their convenience in the first trimester after a sonogram confirmed an ongoing singleton pregnancy with fetal heart activity present. Maternal height and weight were measured digitally and BMI calculated. Maternal body composition was measured by advanced bioelectrical impedance analysis. RESULTS: In 1200 women, the overall miscarriage rate was 2.8% (n=33). The mean gestational age at enrolment was 9.9 weeks. In the obese category (n=217), the miscarriage rate was 2.3% compared with 3.3% in the overweight category (n=329), and 2.3% in the normal BMI group (n=621). There was no difference in the mean body composition parameters, particularly fat mass parameters, between those women who miscarried and those who did not. CONCLUSIONS: In women with sonographic evidence of fetal heart activity in the first trimester, the rate of spontaneous miscarriage is low and is not increased in women with BMI>29.9 kg/m(2) compared to women in the normal BMI category. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.
13. Kheshtchin N, Gharagozloo M, Andalib A, Ghahiri A, Maracy
MR, Rezaei A
The expression of Th1- and Th2-related chemokine receptors
in women with recurrent miscarriage: the impact of lymphocyte
immunotherapy
Am J Reprod Immunol. 2010 Aug 1;64(2):104-12. Epub 2010 Mar
22
Department of Immunology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.
PROBLEM: Recurrent miscarriage (RM) is defined as three or more consecutive pregnancy losses prior to the 20th week of gestation. The aim of this study was to investigate the expression of T helper (Th)1- and Th2-related chemokine receptors on CD4(+) T helper and CD8(+) T cytotoxic (Tc) cells in RM and control subjects. The effects of lymphocyte immunotherapy on the balance of Th1/Th2 and Tc1/Tc2 chemokine receptors were further evaluated in RM women. METHOD OF STUDY: The expression of Th1-related (CCR5 and CXCR3) and Th2-related (CCR3 and CCR4) chemokine receptors on CD4(+) or CD8(+) T cells from RM women were analyzed and compared with controls using flow cytometry. The expression of chemokine receptors in RM women was also compared before and after lymphocyte immunotherapy. RESULTS: The ratios of Th1/Th2 and Tc1/Tc2 chemokine receptors were higher in RM women compared to controls. The ratio of Th1/Th2 chemokine receptors was decreased in RM women after immunotherapy, while no significant change was identified in the Tc1/Tc2 after immunotherapy. CONCLUSION: This study indicates the Th1 dominant immune responses in circulation of RM women compared to controls. Moreover, lymphocyte immunotherapy might influence pregnancy outcome via a shift in the balance of the Th1/Th2 chemokine receptors.
14. Rådestad I, Hutti M, Säflund K, Onelöv E, Wredling R
Advice given by health-care professionals to mothers concerning
subsequent pregnancy after stillbirth
Acta Obstet Gynecol Scand. 2010 Aug;89(8):1084-6
School of Health, Care and Welfare, Mälardalen University, Eskilstuna, Sweden. Ingela.radestad@mdh.se
We studied the advice mothers with stillbirths were given concerning a suitable time to become pregnant. A questionnaire was sent in 2001 to mothers with a stillbirth at one of five hospitals in the Stockholm region in Sweden. At three months follow-up, 33 mothers participated and at 12 months 31. The advices varied from waiting one to 12 months. Eleven mothers were advised to trust their own feelings of readiness and six were advised to wait until they had dealt with their grief before becoming pregnant. At one year post-loss, most of the mothers felt that a suitable time for a subsequent pregnancy was as soon as the mother herself wanted. Mothers whose baby had died in utero were given radically different kinds of advice concerning a suitable time for a subsequent pregnancy. The best advice seems to be that the mother should wait until she, herself, feels ready.
15. Chaiworapongsa T, Romero R, Kusanovic JP, Savasan ZA,
Kim SK, Mazaki-Tovi S, Vaisbuch E, Ogge G, Madan I, Dong Z,
Yeo L, Mittal P, Hassan SS
Unexplained fetal death is associated with increased concentrations
of anti-angiogenic factors in amniotic fluid
J Matern Fetal Neonatal Med. 2010 Aug;23(8):794-805
Perinatology Research Branch, NICHD, NIH, DHHS, Detroit, MI 48201, USA.
OBJECTIVE: Angiogenesis is critical for successful pregnancy. An anti-angiogenic state has been implicated in preeclampsia, fetal growth restriction and fetal death. Increased maternal plasma concentrations of the anti-angiogenic factor, soluble vascular endothelial growth factor receptor (sVEGFR)-1, have been reported in women with preeclampsia and in those with fetal death. Recent observations indicate that an excess of sVEGFR-1 and soluble endoglin (sEng) is also present in the amniotic fluid of patients with preeclampsia. The aim of this study was to determine whether fetal death is associated with changes in amniotic fluid concentrations of sVEGFR-1 and sEng, two powerful anti-angiogenic factors. Study design. This cross-sectional study included patients with fetal death (n = 35) and controls (n = 129). Fetal death was subdivided according to clinical circumstances into: (1) unexplained (n = 25); (2) preeclampsia and/or placental abruption (n = 5); and (3) chromosomal/congenital anomalies (n = 5). The control group consisted of patients with preterm labor (PTL) who delivered at term (n = 92) and women at term not in labor (n = 37). AF concentrations of sVEGFR-1 and sEng were determined by ELISA. Non-parametric statistics and logistic regression analysis were applied. Results. (1) Patients with a fetal death had higher median amniotic fluid concentrations of sVEGFR-1 and sEng than women in the control group (p < 0.001 for each); (2) these results remained significant among different subgroups of stillbirth (p < 0.05 for each); and (3) amniotic fluid concentrations of sVEGFR-1 and those of sEng above the third quartile were associated with a significant risk of unexplained preterm fetal death (adjusted OR = 10.8; 95%CI 1.3-89.2 and adjusted OR 87; 95% CI 2.3-3323, respectively). Conclusion. Patients with an unexplained fetal death at diagnosis are characterized by an increase in the amniotic fluid concentrations of sVEGFR-1 and sEng. These observations indicate that an excess of anti-angiogenic factors in the amniotic cavity is associated with unexplained fetal death especially in preterm gestations.
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