Serum relaxin and cervical length for prediction of spontaneous preterm birth in second-trimester symptomatic women.

OBJECTIVE: To investigate whether serum relaxin level is associated with preterm birth in symptomatic women, either as a standalone test or in the context of a combined model of serum relaxin and cervical length (CL). METHODS: This was a case-control study of women with a singleton pregnancy who presented between 24 + 0 and 26 + 6 weeks' gestation with threatened preterm labor and intact membranes. CL, full blood count, C-reactive protein level and maternal demographics were recorded at presentation, and blood samples were taken for relaxin measurement. Parameters were compared between women who delivered preterm (before 37 weeks) (n = 46) and those delivering at term (n = 66). Logistic regression with receiver-operating characteristics (ROC) curve analysis was used to assess significant predictors for birth before 37 and before 34 weeks. RESULTS: Women delivering before 37 weeks had higher mean serum relaxin levels and lower mean CL than those delivering at term (P < 0.0001). Relaxin alone had 63% (95% CI, 49-75%) sensitivity for birth before 37 weeks and 61% (95% CI, 47-74%) for birth before 34 weeks, at a 10% false-positive rate (FPR). Serum relaxin levels did not correlate with CL; a combined model of the two predictors had an area under the ROC curve of 0.895 (95%CI, 0.835-0.954) for the prediction of birth before 37 weeks and 0.869 (95% CI, 0.802-0.937) for birth before 34 weeks (n = 44). Serum relaxin > 1010 pg/mL had 58% sensitivity for prediction of preterm birth in women with a CL > 15 mm, at a 10% FPR. CONCLUSIONS: High serum relaxin level is associated with an increased risk of preterm birth in second-trimester symptomatic women with intact membranes. A combination of serum relaxin and CL increases predictive accuracy for preterm birth. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.

Neonatal acute kidney injury following Valsartan exposure in utero: report of two cases.

BACKGROUND: Maternal sartan intake during pregnancy has been associated with several fetal/neonatal complications related to disturbed renal development. Description of cases: We present two cases of neonatal acute kidney injury (AKI) following valsartan administration during pregnancy and provide evidence for the use of novel AKI biomarkers in these neonates. The first case was a female neonate, delivered at 32+4 weeks of gestation after maternal valsartan intake from 24 to 32 gestational weeks. In the second case, ultrasound examination revealed a growth-restricted fetus with severe oligohydramnios following maternal valsartan intake during the first 29 gestational weeks. In the absence of any improvement in amniotic fluid, the neonate was born at 31+5 weeks. In both cases, AKI was documented after birth, but renal function progressively recovered. Urine cystatin-C and neutrophil gelatinase-associated lipocalin were found abnormally increased during the first week of life. CONCLUSION: Sartan use during pregnancy is associated with the development of neonatal AKI. Novel urine biomarkers may be used to document renal injury. Hippokratia 2016, 20(1): 73-75.

Effect of mode of delivery on vertical human papillomavirus transmission - A meta-analysis.

A systematic review of the literature has been conducted (last update March 2014) for clinical studies reporting the prevalence of human papillomavirus (HPV) in the offspring of HPV-infected women in association to their mode of delivery. A meta-analysis was carried out according to the identification of concordant neonatal to maternal HPV types. Overall eight studies were included in the meta-analysis. Our pooled results, showed that caesarean section is associated with significantly lower rates of HPV transmission than vaginal birth (14.9% vs. 28.2%, risk ratio or RR: 0.515, 95% confidence interval or CI: 0.34-0.78). The number of caesarean sections needed to prevent one case of perinatal infection (number needed to treat or NNT) would be 7.5. As a conclusion it should be noted that caesarean section decreases the risk for perinatal HPV transmission by approximately 46%. Perinatal transmission still occurs in approximately 15% of the children born by caesarean section.

Uterine inversion after controlled cord traction during caesarean section: a case report.

INTRODUCTION: Inversion of the uterus during caesarean section is a rare but life-threatening complication of the procedure that requires immediate treatment, which is reversion and awareness due to the very serious adverse effects that it may have. MATERIALS AND METHODS: The authors present a case of a 34-year-old para 1 woman of Greek ethnicity who underwent a scheduled caesarean section at 39 weeks of gestation. During the procedure, a uterine inversion occurred as a controlled cord traction was applied in order to achieve placental detachment, after the delivery of the baby. It was managed by immediate manual uterine reversion, which was performed after exteriorization of the uterus. There were no adverse effects. CONCLUSION: Uterine inversion during caesarean section is a serious complication, but fortunately very rare. However, the obstetrician should be aware that the complication should be quickly identified and act without hesitation because it is critical for the well being of the patient.

Struma ovarii. A case report.

BACKGROUND: Struma ovarii is the presence of thyroid tissue as a major cellular component in an ovarian teratoma. CASE REPORT: A 46-year-old old woman, with a palpable mass at the anatomical position of the right adnexa known for the preceding 3 years underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histology reported struma ovarii. CONCLUSION: Struma ovarii is a rare tumor of the ovaries and its clinical appearance may vary: it may be asymptomatic, mimic malignant ovarian tumor, or present with symptoms of hyperthyroidism and, in rare cases, it can even be a malignant tumor.