Objective: To study whether knowledge of cervical length (CL) is useful in reducing the length of hospital stay in women admitted because of threatened preterm labor. Methods: We performed a single-center, parallel, randomized trial at the Hospital Clínic of Barcelona. Inclusion criteria were single pregnancy, gestational age (GA) between 24+0 and 35+6 weeks, Bishop score <6, no parturition within 24-48 h after admission, and no clinical signs of chorioamnionitis, vaginal bleeding, or nonreassuring fetal status. CL measurement was performed 24-48 h after admission. In the control group, the patient and the physician in charge were blinded. In the study group, this information was given; if CL was >25 mm, early discharge within 12-24 h from randomization was recommended. Length of hospital stay was the main outcome. Results: After randomization, 149 patients had complete follow-up (control group, n = 74; study group, n = 75). The mean (SD) length of stay was significantly shorter - 3.0 (2.2) vs. 4.0 (2.0) days (p = 0.004) - in the study group, with a higher proportion of women remaining hospitalized ≤3 days (relative risk [95% confidence interval] 0.43 [0.26-0.70]), with no differences in GA at delivery or preterm birth rate. Conclusions: Knowledge of CL in women admitted because of threatened preterm labor is useful in reducing length of stay, with no impact on GA at delivery or preterm birth rate.

ABSTRACTObjectiveThis study aimed to develop a model to adjust the increased β‐hCG levels observed in renal‐transplanted women, leading to increased false‐positive rates in Down syndrome screening.MethodsDetailed data from 11 renal‐transplanted and a nested‐cohort of 70 pregnant women, matched by age, parity and gestational age were retrieved from our hospital records. Patient's age, multiples of the median (MoM) values for freeβ‐hCG, pregnancy‐associated plasma protein‐A, nuchal translucency, and creatinine concentration and clearance were noted. Freeβ‐hCG levels were adjusted according to the deviation of serum creatinine concentration by means of three different methods (median, proportionality and regression). Subsequently, Down syndrome risk was estimated with the three resulting adjusted fβ‐hCG values.ResultsAfter adjustment, the median β‐hCG MoM decreased from 2.15 MoM to 1.00 MoM (median method), 1.61 MoM (proportionality method) or 1.16 MoM (regression method). The non‐adjusted 27% false‐positive rate dropped to 18% (median method) and 10% (proportionality or regression methods) after re‐estimation of the Down syndrome risk. In controls, the observed median for β‐hCG MoM was 1.12, and the false‐positive rate was 5.7%.ConclusionsIn first‐trimester Down syndrome screening, fβ‐hCG adjustment by the regression method appears to be the best to match with controls. © 2013 John Wiley & Sons, Ltd.

ABSTRACT Life for Africa is an international cooperation program that was developed by Matres Mundi International. It aims to improve the critical situation of maternal and infant health in Africa by improving the number and training of health professionals, particularly in the area of the maternal and infant health. The program, which is sponsored by the majority of the international societies of perinatal medicine (the International Academy of Perinatal Medicine, the World Association of Perinatal Medicine, etc.), consists of the creation of an International School of Perinatal Medicine for Africa and a Reference Hospital for Mothers and Children in Addis Abeba, capital of the African Union. This paper will discuss the reasons in favor of this project and will describe the details and the current situation. It will also provide information about the ‘exploratory mission’ that several members of Matres Mundi and the international societies made to Addis Abeba.

Descripción de la efectividad del test combinado en gestaciones gemelares. Descripción del valor de los marcadores bioquímicos y de la medición de la translucencia nucal (TN) en gestaciones con fetos euploides y en gestaciones con algún feto afectado. Comparación de los marcadores en función de la corionicidad y del tipo de fecundación, espontánea o asistida. Estudio retrospectivo de 161 gestaciones gemelares. La determinación bioquímica (fracción beta libre de la gonadotropina coriónica humana [fß-hCG] y proteína plasmática A asociada al embarazo [PAPP-A]) se realizó entre las 8 y las 12 semanas y la medición de la TN entre las 11 y las 14 semanas. Con la aplicación del test combinado se calculó el riesgo de trisomía 21 para cada feto. En gestaciones monocoriales se calculó un único riesgo con la TN mayor. Se recomendó un procedimiento invasivo cuando el riesgo era ≥ 1/250 en uno o ambos fetos. El test combinado mostró una sensibilidad del 100% para la detección de trisomía 21 (3 gestaciones y 4 fetos) para una tasa de falsos positivos del 6,4% de las gestaciones y 3,5% de los fetos. Las mediana de la fß-hCG fue 1,72 MoM, la PAPP-A 2,01 MoM y la TN 1,05 MoM. En las gestaciones monocoriales la mediana de la fß-hCG y de la PAPP-A fue significativamente menor que en las gestaciones dicoriales y la PAPP-A fue significativamente menor en las gestaciones procedentes de reproducción asistida. No se observaron diferencias en la medición de la TN en función de la corionicidad ni del tipo de fecundación. El test combinado en la gestación gemelar muestra una sensibilidad y una especificidad elevadas. Se observan algunas diferencias en el valor de los marcadores bioquímicos en función de la corionicidad y del antecedente de reproducción asistida, pero estas diferencias deberían confirmarse con un número mayor de casos. To evaluate the effectiveness of the Combined Test for trisomy 21 screening in twin pregnancies. To assess the performance of biochemical markers and nuchal translucency (NT) measurement in pregnancies with euploid fetuses and in twin pregnancies with one or two affected fetuses. To compare the value of markers according to chorionicity and the mode of conception. Retrospective study including 161 twin pregnancies. Maternal serum fß-hCG and PAPP-A were determined at 8 to 12 weeks and fetal NT was measured at 11 to 14 weeks. The individual risk of trisomy 21 was calculated in each fetus using the Combined Test. In monochorionic pregnancies, the single risk for the pregnancy was obtained with the largest NT. An invasive diagnostic procedure was offered when the risk was 1:250 or more in one or both of the fetuses. All trisomy 21 pregnancies were identified (three pregnancies and four fetuses) by the combined testfor a false-positive rate of 6.4% of pregnancies and 3.5% of fetuses. The median fß-hCG level, expressed in MoM, was 1.72 and the median PAPP-A level was 2.01. The median NT was 1.05 MoM. Both fß-hCG and PAPP-A levels were significantly decreased in monochorionic pregnancies and PAPP-A was significantly decreased in pregnancies resulting from assisted reproduction. No significant differences were observed in NT measurement between monochorionic and dichorionic fetuses or between those conceived naturally or by assisted reproduction. The combined test shows high sensitivity and specificity in screening for trisomy 21 in twin pregnancies. The differences obtained in the biochemical markers according to chorionicity or the mode of conception require confirmation in further studies with a larger number or cases.

Objective: To evaluate pregnancy outcome and the role of the amount of amniotic fluid (AF) in the prognosis of extremely preterm (<24 weeks) premature rupture of membranes (EPPROM).Study design: Women with EPPROM and on-going pregnancy after 1 week of expectant management were included. Exclusion criteria: fetal anomalies, termination of pregnancy and spontaneous recovery of AF within the first week. The effect of the large vertical pocket (LVP) on pregnancy outcome was assessed by a Cox regression model which included three covariates: LVP measurements from rupture to 24 weeks, gestational age at rupture of membranes and sealing procedure.Results: Thirty-seven women were included in the study. The overall survival rate after the neonatal period was 40.5% (15/37) which increased to 62.5% (15/24) in neonates born alive after 24 weeks of gestation. Mean and S.D. of gestational age at rupture of membranes were 19.0 (+/- 3.8) weeks. From rupture to 24 weeks, the pooled mean and standard deviation of LVP were 20.5 (+/- 15.4) mm.Multivariate analysis showed that the likelihood for neonate survival increased by 2.7 (95% CI 1.45-4.65) for each 5 mm of LVP during the follow-up from rupture to 24 weeks. After controlling for AF amount, neither the gestational age at rupture nor the sealing procedure showed any significant effect on pregnancy outcome.Conclusion: Although the prognosis of EPPROM is poor overall, survival improves as the amount of AF before 24 weeks increases. (C) 2007 Elsevier Ireland Ltd. All rights reserved.

BACKGROUND AND OBJECTIVE:This was a preliminary study on the prevalence of the HbS gene, associated with sickle cell disease, other hemoglobinopathies and G6PD deficiency of immigrant and non-immigrant population of Catalonia.PATIENTS AND METHOD:A total of 3,189 blood samples from the Catalan Neonatal Screening Program for Metabolic Diseases (CNSPMD) including 1,620 from immigrant population were screened for haemoglobinopathies and G6PD deficiency. For screening of hemoglobinopathies the high performance liquid chromatography (HPLC) method was used and for the screening of G6PD deficiency, we used the fluorescent spot test as described by ICSH.RESULTS:1. Hemoglobinopathies: in 47 samples from immigrant population 2 cases of sickle cell anemia (phenotypes FS and FSC) were detected as well as 45 cases of heterozygote carriers of different pathological hemoglobins (HbS, HbC, HbD and HbE). 2. G6PD deficiency: in 29 samples, 3 cases of G6PD deficiency belonging to local (non-immigrant) population of G6PD were detected.CONCLUSIONS:The incidence of sickle cell disease in the risk population of Catalonia is 1 case out of 810 samples. This value is significantly higher than that reported for any of the metabolic diseases included in the CNSPMD. Despite it is a preliminary study, the results obtained give further support to the convenience of incorporating a neonatal screening of hemoglobinopathies, at least in the risk population, to the official programs of newborn screening. Due to its feasibility and low cost, a similar criterion might be adopted for the neonatal screening of G6PD deficiency.

Realizar un estudio preliminar sobre la prevalencia de la hemoglobina (Hb) S, asociada a la anemia falciforme o drepanocitosis, otras hemoglobinopatías y el déficit de glucosa-6-fosfato deshidrogenasa (G6PD) en neonatos de población autóctona de Cataluña e inmigrada. Se ha analizado 3.189 muestras de sangre procedentes del Programa de Cribado Neonatal de Cataluña (autóctona: 1.569; inmigrada: 1.620). El estudio de hemoglobinas se ha realizado mediante cromatografía líquida de alta resolución (HPLC) y el de déficit de G6PD, mediante la técnica de la mancha fluorescente (ICSH). En 47 muestras, todas ellas pertenecientes a población inmigrada, se ha detectado 2 casos de anemia falciforme (fenotipos FS y FSC) y 45 hemoglobinopatías en estado heterocigoto (HbS, HbC, HbD y HbE). En 29 muestras, 3 de ellas pertenecientes a población autóctona se ha detectado un déficit del G6PD. La prevalencia de la anemia falciforme en población de riesgo es 1 por cada 810 muestras analizadas, valor sensiblemente superior al observado para otras enfermedades incluidas en el programa oficial de cribado neonatal. Los resultados de este estudio preliminar confirman la conveniencia de incorporar el cribado de hemoglobinopatías, en la población de riesgo, al programa de cribado neonatal ya existente. Por su gran simplicidad técnica y bajo coste, un criterio parecido podría adoptarse para el cribado neonatal universal del déficit de G6PD. This was a preliminary study on the prevalence of the HbS gene, associated with sickle cell disease, other hemoglobinopathies and G6PD deficiency of immigrant and non-immigrant population of Catalonia. A total of 3,189 blood samples from the Catalan Neonatal Screening Program for Metabolic Diseases (CNSPMD) including 1,620 from immigrant population were screened for haemoglobinopathies and G6PD deficiency. For screening of hemoglobinopathies the high performance liquid chromatography (HPLC) method was used and for the screening of G6PD deficiency, we used the fluorescent spot test as described by ICSH. 1. Hemoglobinopathies: in 47 samples from immigrant population 2 cases of sickle cell anemia (phenotypes FS and FSC) were detected as well as 45 cases of heterozygote carriers of different pathological hemoglobins (HbS, HbC, HbD and HbE). 2. G6PD deficiency: in 29 samples, 3 cases of G6PD deficiency belonging to local (non-immigrant) population of G6PD were detected. The incidence of sickle cell disease in the risk population of Catalonia is 1 case out of 810 samples. This value is significantly higher than that reported for any of the metabolic diseases included in the CNSPMD. Despite it is a preliminary study, the results obtained give further support to the convenience of incorporating a neonatal screening of hemoglobinopathies, at least in the risk population, to the official programs of newborn screening. Due to its feasibility and low cost, a similar criterion might be adopted for the neonatal screening of G6PD deficiency.

OBJECTIVES:To compare the efficacy of nifedipine and ritodrine in prolonging pregnancy beyond 48 h, 1 week and 36.0 weeks and to evaluate maternal side effects and adverse perinatal outcome.STUDY DESIGN:Non-blinded, randomized controlled trial. Eighty patients with singleton pregnancies admitted for preterm labor with intact membranes between 22 and 35 weeks of gestation were included in the study. Preterm labor was defined as the persistence of at least two symptomatic uterine contractions within a 10 min period during 60 min after admission and despite bed rest.RESULTS:Forty women received oral nifedipine and forty intravenous ritodrine. Two patients, one from each group, were excluded because of loss to follow-up after discharge. Therefore, 39 women in the nifedipine and the ritodrine groups, respectively, were evaluable for the final analysis. Baseline characteristics were comparable in both groups. The percentage of initial response, the speed of onset of action and the rate of successful treatment within 48 h were significantly better in the ritodrine group. However, prolongation of pregnancy beyond 7 days and 36 weeks of pregnancy was similar with a significantly lower rate of side effects in the nifedipine group.CONCLUSIONS:In this small trial, ritodrine provided more effective tocolysis within the first 48 h than nifedipine at the doses used in this study, although with a significantly higher rate of side effects.

Nuchal translucency (NT) is defined as the accumulation of subcutaneous fluid in the nuchal region of the fetus at 11–14 weeks. Its measurement in order to modify the previous background risk has been proved to be able to detect around 70% of trisomy 21 pregnancies (for a 5% fixed positive rate). When affected fetuses dying before 20 weeks are excluded, detection rate may decrease to 60%. Given that appropriate training of sonographers and adherence to a standard technique for the measurement of NT is of paramount importance to reduce variability, the Fetal Medicine Foundation has established a certification process. Fetal nuchal edema displayed at 15–20 weeks was described as enlarged nuchal skinfold, and is a less sensitive but more specific marker than nuchal translucency. Webbing of the neck in infants with trisomy 21 may be envisaged as the remainder of nuchal distension.

Abdel-Fattah, S.A. 341 Abe, A. 459 Abe, K. 459 Acolet, D. 241 Adama van Scheltema, P.N. 186 Adzick, N.S. 74, 316 Aizenstein, O. 235 Aka, N. 410 Akçakuş , M. 171 Akhlaghpoor, S. 116 Akoury, H. 306 Akyol, O. 450 Al, A. 249 Albig, M. 70 Alessandri, J.L. 301 Amit, A. 465 Andersson, A. 182 André, M. 285 Annane, K. 442 Antsaklis, A. 431, 540 Api, O. 91 Aran, J.M. 485 Arsan, S. 549 Aslan, H. 244 Atasay, B. 549 Audibert, F. 48 Ayhan, A. 249

The objective was to evaluate the associations between arterial, venous and intracardiac parameters and adverse perinatal outcome in growth restricted fetuses. Fetuses beyond the 26th week of gestation with an abdominal circumference below the 5th percentile were included in this prospective study. The last Doppler measurement of the umbilical artery, middle cerebral artery, ductus venosus, outflow tract waveforms, atrioventricular flow and ventricular shortening fraction before delivery and adverse perinatal outcome were used for univariate (Fisher's exact test) and multivariate (stepwise logistic regression) statistical analysis. Adverse perinatal outcome was defined as the following: umbilical artery pH < 7.1, significant neonatal morbidity, need for admission to the neonatal intensive care unit, need for intubation at birth and perinatal mortality. A total of 108 fetuses met the inclusion criteria. The univariate analysis showed that presence of arterial redistribution; the absence or reversion of the umbilical artery end-diastolic flow; an abnormal aortic peak velocity, left shortening fraction, right shortening fraction, right atrioventricular E/A ratio and a pulsatile ductus venosus flow are associated with adverse perinatal outcome. The multivariate analysis showed that apart from arterial redistribution, absent or reversed end-diastolic umbilical artery flow and abnormal ductus venosus waveform, no other tested variable added significantly to the prediction of adverse perinatal outcome. It was concluded that fetal cardiac function indices are associated with adverse perinatal outcome. Nevertheless, no benefit was found from using them, in terms of prediction, when arterial and venous Doppler are used.

International Journal of Gynecology & ObstetricsVolume 70, Issue S1 p. A5-A5 Invited presentations Tratamiento conservador en el sindrome hellp V. Cararach, V. CararachSearch for more papers by this authorG. Casals, G. CasalsSearch for more papers by this authorS. Martínez, S. MartínezSearch for more papers by this authorO. Coll, O. CollSearch for more papers by this authorJ. Figueras, J. FiguerasSearch for more papers by this author V. Cararach, V. CararachSearch for more papers by this authorG. Casals, G. CasalsSearch for more papers by this authorS. Martínez, S. MartínezSearch for more papers by this authorO. Coll, O. CollSearch for more papers by this authorJ. Figueras, J. FiguerasSearch for more papers by this author First published: 10 December 2003 https://doi.org/10.1016/S0020-7292(00)81944-XAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS12000Pages A5-A5 RelatedInformation

The present study aimed to evaluate the prevalence of bacterial vaginosis, and the correlation of clinical Amsel criteria with Gram Nugent criteria for the diagnosis of bacterial vaginosis in a low risk population of pregnant women. Pregnant women under 28 weeks of gestation who were followed in the low risk clinics at two centers were evaluated for the presence of bacterial vaginosis using the Amsel clinical criteria, and underwent vaginal samples for Gram staining. Gram smears were examined for the diagnosis of bacterial vaginosis on the basis of Nugent's criteria. A total of 492 women were included in the study. Bacterial vaginosis was diagnosed in 1.6% (8/492) women on the basis of clinical criteria, and in 4.5% (22/492) according to Gram stain. The sensitivity and specificity of Amsel criteria compared with Gram stain were 35% and 99%, respectively. In accordance with other recent reports, the prevalence of bacterial vaginosis appears to be much lower in certain areas than figures previously suggested. In these populations, the correlation of composite clinical criteria defined in groups with high prevalence of bacterial vaginosis appears to be also poor.

OBJECTIVE:To evaluate the serum levels of interleukin-4, interleukin-10, and granulocyte-macrophage colony-stimulating factor at the moment of diagnosis and in early second-trimester serum from women with preeclampsia and from gestational age-matched controls. METHODS:Serum from 14 women with preeclampsia at the moment of diagnosis and 14 gestational age-matched controls was analyzed. In 10 cases and 10 controls, second-trimester serum also was studied. Cytokines were measured by specific enzyme-linked immunosorbent assay. RESULTS:Serum levels of granulocyte-macrophage colony-stimulating factor at the moment of diagnosis were detected less frequently (21 compared with 71%, P < .01) and in lower concentrations (0 pg/mL [range 0-56] compared with 55.5 pg/mL [range 0-105], P = .01) in women with preeclampsia as compared with controls. In second-trimester serum, granulocyte-macrophage colony-stimulating factor detection rates (20 and 70% respectively, P = .06) and concentrations (0 pg/mL [range 0-32] and 2.5 pg/mL [range 0-37], respectively, P = .08) were lower in the group of preeclampsia, but the differences do not reach statistical significance. Measurements regarding interleukin-4 and interleukin-10 were similar between both study groups. CONCLUSION:Differences in granulocyte-macrophage colony-stimulating factor support the concept of the existence of an immunologic imbalance as part of the etiologic mechanisms leading to preeclampsia.

Objectives. To evaluate the levels of serum lipids (cholesterol and triglycerides) in pregnant women with different types of hypertension, at the first, second and third trimesters of pregnancy. Methods. Cholesterol and triglyceride levels at the first, second and third trimesters of gestation were recorded for 115 women with hypertension during pregnancy, and 115 healthy pregnant women matched for age and body mass index. Cases were classified as having mild gestational hypertension (25), severe gestational hypertension (15), mild preeclampsia (20), severe preeclampsia (20), chronic hypertension (20), and superimposed preeclampsia (15). Results. Cholesterol levels were not statistically different between cases and controls in any form of hypertension. At 20 and 34 weeks' gestation, triglyceride levels were significantly higher than controls in women with severe gestational hypertension, mild and severe preeclampsia, and superimposed preeclampsia, but not in mild gestational hypertension or chronic hypertension. The significant elevation in triglycerides was already present at 10 weeks in mild and severe preeclampsia. Conclusions. The data suggest that the alterations in lipid metabolism observed in preeclampsia are already present at the first trimester of pregnancy. Women with severe gestational hypertension presented a pattern of triglycerides similar to that of preeclamptic women, but mild gestational hypertension resembled chronic hypertension in this respect. This supports the concept that, although in many cases gestational hypertension represents latent essential hypertension, some of these women, probably the most severe cases, present with true pregnancy-induced hypertension, or nonproteinuric preeclampsia.

Objectives. To evaluate the incidence of toxic hepatitis associated with the use of ritodrine in pregnancy. Design. A prospective study. Setting. A large teaching hospital in Barcelona. Spain. Patients: One hundred and twenty-three consecutive pregnant women, 101 singleton and 22 multiple pregnancies, receiving intravenous ritodrine with normal transaminase levels prior to the initiation of therapy. Measurements. Serum glutamic pyruvic transaminase (SGPT) and glutamic oxaloacetic transaminase (SGOT). gamma-glutamyl transpeptidase (GGT). alkaline phosphatase (PA), direct and total bilirubin. Results. In two (1.9%) of 101 singleton and two (9.1%) of 22 multiple pregnancies, elevation of SGOT and SGPT levels was detected. PA, GGT, and bilirubin were normal in all women studied. Other causes of hepatitis were ruled out, and no other signs of liver impairment were found in these women. Transaminase levels recovered rapidly in all cases after discontinuation of therapv Conclusion. Elevation of liver enzymes is a rare complication of ritodrine. Discontinuation of therapy does not appear to be indicated as long as other signs of liver dysfunction are not present and tocolytic treatment is required.