The significance of fetal inflammatory response syndrome in early and later adaptation of premature infants.

PURPOSE: Intrauterine infection may induce the fetal inflammatory response syndrome (FIRS) and may cause cerebral palsy and bronchopulmonary dysplasia in newborns. The aim of the study was to evaluate the importance of FIRS for the early and later adaptation of preterms. METHODS: Hundred and fifty-eight preterm infants, born at 22-34 weeks of gestation, were investigated at Vilnius University Children hospital in 2007-2009. The data were evaluated at the first week after birth and at 36-37 weeks of post conceptual age. The levels of IL-6, tTNF-α (total), tVEGF-A (total), aTNF-α (active) and aVEGF-A (active) were determined. RESULTS: Correlation between IL-6 and tTNF-α from umbilical blood and the degree of respiratory distress syndrome (RDS) was found (p < 0.001). The concentration of tTNF-α >345 pg/ml and IL-6 >12.7 pg/ml was determined allowing to predict the lethal outcome. CONCLUSIONS: The correlation between the concentration of the inflammatory markers IL-6 and tTNF-α in umbilical cord blood at 22-34 weeks of gestation and acute RDS, and the death of preterms was determined. Significant values of umbilical cord blood IL-6 and tTNF-α concentration for predicting the lethal outcome in the later adaptation of preterms were determined.

Physiological Uterine Involution in Primiparous and Multiparous Women: Ultrasound Study.

PURPOSE: To examine the uterine involution period after uncomplicated delivery in primiparous and multiparous women. METHODS: Longitudinal prospective study. Repeated parameters were measured and endometrial contents and diastolic notch were observed. Measurements of primiparous and multiparous women were carried out after labour on the 1st, 3rd, 10th, 30th, 42nd, and 60th postpartum days. The analysis was performed using SPSS version 21. RESULTS: The median uterus parameters are bigger in multiparous group in physiological puerperium, but the decreasing trend is the same. The endometrial cavity on the 10th day was significantly wider in multiparous women and mainly echo-negative view of the uterine cavity was observed. The evaluation of the uterine angle deviation changes from an extremely retroverted position to a more anteverted position. RI of the uterine artery in both groups was low immediately after labour and significantly increased one month postpartum. Notching of the uterine artery undergoes changes, but diastolic notch does not appear in all postpartum women even after two months following labour. CONCLUSIONS: The puerperium period after normal vaginal delivery depends on parity. The trend of involution in primiparous and multiparous women follows a similar pattern, yet, it lasts longer in the multiparous women. Ultrasound of uterine is certainly a useful tool after labour and may be important in facilitating an early detection of postpartum uterine complications.