Neonatal outcomes of pregnancy complicated by idiopathic thrombocytopenic purpura.

OBJECTIVE: The aim of this study was to determine the factors associated with the prognosis of newborns born to mothers with idiopathic thrombocytopenic purpura (ITP), and to compare the infants with/without thrombocytopenia in terms of maternal and neonatal characteristics. STUDY DESIGN: We reviewed the charts of 29 parturients with ITP and their newborns who were born between January 1998 and December 2008. RESULT: A total of 16 (55%) gravidas had been diagnosed with ITP before pregnancy and 13 (45%) were diagnosed during pregnancy. Thrombocytopenia was observed in 21 gravidas. In total, 17 (58%) gravidas received treatment to increase the platelet count. The majority of deliveries (72.5%) were vaginal. The infant platelet counts at birth ranged from 20 to 336 x 10(9) per liter. None of the neonates had complications attributable to the mode of delivery. Normal platelet counts were determined in 15 newborns, whereas 14 infants had thrombocytopenia at birth. Three (10.3%) neonates had mild, four neonates (13.7%) had moderate and seven neonates (24.1%) had severe thrombocytopenia. The age of the mothers having infants with thrombocytopenia was significantly higher (30+/-5.3 vs 25.3+/-3.8 years), most of the infants (10/14 (71%)) were males (P<0.05). CONCLUSION: Pregnancy complicated with ITP generally has a good outcome. Although ITP in pregnancy carries a low risk, careful observation is required for the newborn of gravidas with ITP even when the infant has no bleeding complications at delivery, and infants may require treatment for thrombocytopenia.

Cytogenetic results of amniocentesis materials: incidence of abnormal karyotypes in the Turkish collaborative study.

The experience on prenatal chromosome diagnosis of four Turkish centers participating in a collaborative study on 6041 genetic amniocentesis performed during a 4-8 years period were reviewed. 5887 (97.5%) patients had strong clinical indications for prenatal chromosome studies and 154 (2.5%) were referred because of maternal anxiety and a bad history of previous gestations. The main indication groups were: advanced maternal age (3197 cases), positive serum screening (2011 cases), ultrasound-identified anomaly (492 cases), previous fetus/child with chromosomal aberrations (103 cases), a history of a previous abnormal and/or mentally handicapped child (70 cases) and a parental chromosome rearrangement (14 cases). The average maternal age was 33.9 years and average gestational age was 18 weeks. A total of 179 affected fetuses were detected in this collaborative study (3%) of which 133 were unbalanced (74.3%). Among the 124 (69%) numerical aberrations, 102 (82.3%) were autosomal aneuploidies, 20 (16.1%) were gonosomal aneuploidies and 2 (1.6%) were poliploidies. Among the 55 (31%) structural aberrations, balanced translocation was the most common (63.6%) and 11 cases of inversion, four cases of unbalanced translocation, two cases of marker chromosome and three cases of other abnormalities were found. The overall culture success rate was 99.7%. Pregnancy termination that is permitted by legal authorities was accepted by 94.7% (126/133) with parents at unbalanced cytogenetic result announcement.

Successful labor in the course of chronic lymphocytic leukemia (CLL) and management of CLL during pregnancy with leukapheresis.

We describe the successful management of a 30-year-old woman in the second trimester of her pregnancy with chronic lymphocytic leukemia (CLL) in stage IV by using only leukapheresis. We applied three sessions (courses) of leukapheresis throughout the pregnancy. The procedure did not have any significant adverse effect on the patient and the fetus. The patient gave birth vaginally to a healthy boy, weighing 3100 g, at 39 weeks of gestation. Seven months after delivery, Richter's syndrome developed in the patient. We conclude that leukapheresis may provide an alternative for palliative treatment to chemotherapy in pregnant patients with CLL. To our knowledge, this is the fourth reported case of CLL in pregnancy, and the first management of CLL during pregnancy with leukapheresis.

Idiopathic thrombocytopenic purpura in pregnancy: a single institutional experience with maternal and neonatal outcomes.

We observed 13 pregnant women of 70 females with idiopathic thrombocytopenic purpura (ITP) from January 1992 through September 2002. Thirteen mothers with ITP gave birth to twelve babies and two fetuses died. One of the pregnancies produced twins. Seven of the cases were diagnosed with ITP before pregnancy and six during pregnancy. One of the thirteen pregnancies was complicated by preeclampsia, one by ablatio placentae, and one by intrauterine death. Seven mothers received corticosteroid treatment, four high-dose immunoglobulin therapies, and one underwent splenectomy in the second trimester of gestation. At the time of delivery six mothers had normal platelet counts and seven had low platelet counts. Nine deliveries were by vaginal route and four were by cesarean section. Eleven infants were born with normal platelet counts and one was thrombocytopenic at the time of delivery. No infant showed any clinical signs of hemorrhage and there were no neonatal complications. Two fetuses died; one of them because of ablatio placentae and the other was intrauterine dead. In conclusion, ITP in pregnancy requires the management of two patients, the mother and her baby; hence, the close collaboration of a multidisciplinary group composed of a hematologist, obstetrician, anesthesiologist, and neonatologist is essential.

Acute Effects of Maternal Smoking on the Uterine and Umbilical Artery Blood Velocity Waveforms

> Objective: The acute effects of smoking during pregnancy on the uterine and umbilical blood flow velocity waveform were assessed. Methods: Twenty-two chronic women smokers at a mean gestational age of 194.17 +/- 58.02 days and 21 women non-smokers at a mean gestational age of 193.24 +/- 34.71 days were studied. Systolic-diastolic (S/D) ratio, resistance index, and pulsatility index of uterine and umbilical arteries were measured in the control group and before and after smoking a single standard 100-mm filtered cigarette in the study group. Results: There was no significant change in the uterine artery and umbilical artery blood velocity waveform indices that could be attributed to the acute effect of smoking in the study group, but all of the uterine artery indices and S/D ratio in the umbilical artery were statistically higher in the study group in comparison with the control group both before and after smoking. Conclusion: Our results suggest that smoking causes an increase in vascular resistance of the placenta and umbilical cord when used chronically.

Plasma interleukin-1alpha, interleukin-1beta and interleukin-1 receptor antagonist levels in pre-eclampsia.

The values of plasma interleukin-1alpha (IL-1alpha), interleukin-1beta (IL-1beta) and interleukin-1 receptor antagonist (IL-1ra) levels were evaluated as the markers of pre-eclampsia in 35 serial plasma samples from ten pregnant women who subsequently developed pre-eclampsia and in 74 plasma samples from 20 uncomplicated pregnancies, retrospectively. No correlation was found between plasma IL-1alpha, IL-1beta and IL-1ra levels, liver and renal function tests, thrombocyte and white blood cell counts, proteinuria, systolic and diastolic blood pressures and gestational weeks. Almost equal levels of IL-1alpha and IL-1beta were measured in all corresponding groups, but these were too few in number to statistically analyze. IL-1ra values were higher in the pre-eclampsia group than in the uncomplicated pregnancy group, at 20-25 and 31-35 gestational weeks significantly and 26-30 gestational weeks insignificantly and showed an increase during labor in both groups. It was found to have 58% positive predictivity, 100% negative predictivity, 50% specificity and 100% sensitivity at gestational weeks 20-25. According to these results, IL-1ra seems to be considered for its high negative predictivity in the exclusion of the probability of pre-eclampsia development during antenatal visits, but its plasma level is not correlated with the severity of the disease.

Laparoscopic treatment of benign adnexial cysts.

The results of laparoscopic adnexial cyst excision operations performed within the last 2.5 years in our clinic are reported. Thirty-three adnexial masses thought to be benign after gynaecological examination and ultrasonographic findings were treated. Laparoscopy was done in 32 cases but laparotomy had to be performed in one case of stage IV endometriosis. The mean duration of the operations was 72.78 +/- 34.09 minutes and no major complication occurred. Pathologic examinations of the specimens were reported as benign in all cases. According to these results, laparoscopy should be the preferred method in the treatment of benign adnexial cysts.

Gestational herpes: 3 cases.

Three histologically proven gestational herpes cases were presented. All were complaining of itching and vesiculobullous skin lesions. The diagnosis was confirmed by skin biopsies and they all gave a complete response to 1 mg/kg-day oral prednisolone therapy. No neonatal morbidity was observed.

Antenatal ambroxol usage in the prevention of infant respiratory distress syndrome. Beneficial and adverse effects.

A bromhexine metabolite ambroxol, is a relatively new promoter of fetal lung maturation. The data on its efficacy and side effects in humans are not yet as many as those of corticosteroids. We found that in 24 premature labor patients ambroxol reduced the incidence of respiratory distress syndrome when compared with the control group, consisting of 58 patients. There was no concomitant disorder in any patient that would have contributed to the fetal lung maturation. We also observed septic morbidity to be less frequent in the ambroxol group. Thyroid hormone levels were within normal range both in maternal and fetal circulation. There were no side effects attributable to the drug. Maternal liver and renal function test results did not differ significantly throughout the treatment.

PIP: At the clinics of Uludag University Medical Faculty's Department of Obstetrics and Gynecology in Bursa, Turkey, clinicians compared data on 24 premature infants whose mothers had received oral ambroxol (1300 mg/day until delivery) with data on 58 premature infants whose mothers did not receive ambroxol to determine whether or not ambroxol reduced infant respiratory distress syndrome (RDS) by promoting fetal lung maturation. RDS occurred in 8% of the infants in the ambroxol group compared to 10% in the control group. The only RDS case to survive had received ambroxol. Sepsis was more common in the control group than the ambroxol group (13% vs. 4%). None of the infants had any concomitant disorder that would have contributed to fetal lung maturation. Ambroxol did not significantly change maternal liver and renal function results. In infant and maternal cases, the blood thyroid hormone levels were within the normal range. None of the mothers in either group developed a puerperal infection. Ambroxol did not cause any significant maternal or infant side effects. These findings suggest that ambroxol may prevent RDS and sepsis. Larger study groups and studies of groups with hypertension, diabetes, and multiple gestations are needed to determine whether ambroxol is a valuable alternative to steroids for prevention of RDS.

Effect of progestogens on estrogen-induced lipoprotein changes.

A study was performed to evaluate the role of progestogens, on estrogen-induced changes in lipoprotein levels. Sixty postmenopausal symptomatic women, aged 36-59, were included in the study. They were prospectively randomized to a sequential schedule (n = 20), 17 beta-estradiol transdermally 0.05 mg/day on days 1-24 and medroxyprogesterone acetate 10 mg/day orally on days 15-24 or a continuous schedule (n = 20), 17 beta-estradiol transdermally 0.05 mg/day and medroxyprogesterone acetate 2.5 mg/day orally on days 1-24. Patients who had total abdominal hysterectomy+bilateral salphingooopherectomy (n = 20) received only 17 beta-estradiol 0.05 mg/day continuously. Serum total cholesterol (TC), high density lipoprotein (HDL) cholesterol, low density lipoprotein (LDL) cholesterol and triglyceride (TG) levels were determined prior to and at the 3rd, 6th and 9th month of therapy in all groups. Mean TC, TG and LDL cholesterol levels did not change significantly during therapy (P > 0.05). Only the mean HDL cholesterol levels showed significant increases in all groups; from 42.30 +/- 9.97 mg/dl to 64.10 +/- 6.81 mg/dl in group I (P < 0.001), from 41.85 +/- 9.09 mg/dl to 60.65 +/- 7.41 mg/dl in group II (P < 0.001) and from 40.70 +/- 11.26 mg/dl to 58.80 +/- 7.74 mg/dl in group III (P < 0.001). It is concluded that medroxyprogesterone acetate, whether used continuously or sequentially, does not oppose the beneficial effects of transdermal 17 beta-estradiol on the lipoprotein profile.