Implementing Preeclampsia Screening in Switzerland (IPSISS): First Results from a Multicentre Registry.

INTRODUCTION: The Fetal Medicine Foundation (FMF) London developed a first trimester combined screening algorithm for preterm preeclampsia (pPE) that allows a significantly higher detection of pregnancies at risk compared to conventional screening by maternal risk factors only. The aim of this trial is to validate this screening model in the Swiss population in order to implement this screening into routine first trimester ultrasound and to prescribe low-dose aspirin 150 mg (LDA) in patients at risk for pPE. Therefore, a multicentre registry study collecting and screening pregnancy outcome data was initiated in 2020; these are the preliminary results. METHODS: Between June 1, 2020, and May 31, 2021, we included all singleton pregnancies with pPE screening at the hospitals of Basel, Lucerne, and Bern. Multiple of medians of uterine artery pulsatility index (UtA-PI), mean arterial pressure (MAP), placental growth factor (PlGF), and pregnancy-associated plasma protein A (PAPP-A) as well as risks were analysed as calculated by each centre's software and recalculated on the FMF online calculator for comparative reasons. Statistical analyses were performed by GraphPad Version 9.1. RESULTS: During the study period, 1,027 patients with singleton pregnancies were included. 174 (16.9%) had a risk >1:100 at first trimester combined screening. Combining the background risk, MAP, UtA-PI, and PlGF only, the cut-off to obtain a screen positive rate (SPR) of 11% is ≥1:75. Outcomes were available for 968/1,027 (94.3%) of all patients; 951 resulted in live birth. Fifteen (1.58%) developed classical preeclampsia (PE), 23 (2.42%) developed PE according to the International Society for the Study of Hypertension in Pregnancy (ISSHP) definition. CONCLUSION: First trimester combined screening for PE and prevention with LDA results in a low prevalence of PE. The screening algorithm performs according to expectations; however, the cut-off of >1:100 results in a SPR above the accepted range and a cut-off of ≥1:75 should be considered for screening. More data are needed to evaluate, if these results are representative for the general Swiss population.

Acute ST-Elevation Myocardial Infarction During Labor Due to Amniotic Fluid Embolism.

BACKGROUND Amniotic fluid embolism (AFE) is an extremely rare, life-threatening complication of labor that leads to hyper-acute induction of inflammation and disseminated intravascular coagulation (DIC). Usually, acute pulmonary hypertension results in acute right ventricular failure, while DIC manifests by hemorrhagic and ischemic complications, ultimately leading to multi-organ failure and death. CASE REPORT A 30-year-old primigravida and primipara woman with no prior medical history was admitted for labor after intrauterine fetal death at 37 weeks of gestation. After medical birth induction, she had a convulsive seizure and cardiorespiratory arrest. Short mechanical resuscitation was performed before spontaneous circulation returned. Simultaneously occurring severe vaginal hemorrhage and an ST-elevation myocardial infarction (STEMI) triggered the diagnosis of AFE. Laboratory results fulfilled the criteria for DIC, and hemostatic resuscitation and mechanical hemostasis were performed. Transesophageal echocardiography revealed hypokinesia to akinesia of the inferior wall. Owing to the ongoing DIC, coronary angiography could not be performed. After the patient's transfer to the Intensive Care Unit, ST-segment elevations resolved and the myocardial infarct was managed medically. Cardiac magnetic resonance imaging performed 3 months later demonstrated myocardial scarring in 2 different areas. Referring to the coronary artery anatomy in a computed tomography scan of the chest, the infarcted areas correlated with 2 different coronary supply territories. CONCLUSIONS AFE should be considered in women with acute cardiorespiratory failure during labor. This is the first report of a STEMI triggered by an AFE. The 2 separate areas of infarction, corresponding to the 2 different coronary territories, suggest an AFE-related thrombotic/thromboembolic etiology.

When diamniotic twins suddenly become monoamniotic twins: spontaneous septostomy of the dividing membrane.

In twin pregnancies, amnionicity and chorionicity are crucial as they strongly determine prenatal and perinatal management. First trimester ultrasound allows a highly reliable diagnosis of amnionicity and chorionicity, making it an internationally accepted standard in antenatal care. However, in rare cases, amnionicity can change from diamniotic to monoamniotic throughout pregnancy, substantially impacting perinatal management. We report the case of a confirmed monochorionic diamniotic twin pregnancy with a diagnosis of spontaneous septostomy of the dividing membrane (SSDM) at 28 weeks of gestation, resulting in a pseudomonoamniotic pregnancy. Even though SSDM is a rare condition and its sonographic diagnosis might be challenging, it should be considered if, in a known diamniotic pregnancy, there is a sudden failure to visualise the intertwin membrane truly separating both twins.

What obstetricians should be aware of: serious side effects of antibiotic toxoplasmosis treatment in pregnancy.

Infection with Toxoplasma gondii is usually an asymptomatic or oligosymptomatic, self-limiting disease in immunocompetent individuals. However, during the pregnancy, primary infection can lead to transplacental vertical transmission resulting in congenital toxoplasmosis with possible severe sequelae. The efficacy of systematic screening remains controversial and the effect of antibiotic treatment is unclear. Although main side effects of antibiotic drugs used for toxoplasmosis are well known, mostly from malaria treatment, there is a lack of information about occurrence in pregnant woman treated for toxoplasmosis. We report a case of a healthy pregnant woman with primary toxoplasmosis infection in the second trimester, who developed a severe adverse reaction in form of hypersensitivity pneumonia after antibiotic treatment with pyrimethamine and sulfadiazine and discuss the literature.

[First Diagnosis of a Squamos Cell Carcinoma of the Cervix Uteri FIGO 1B1 in Pregnancy]. / Erstdiagnose eines Plattenepithelkarzinoms der Zervix uteri FIGO 1B1 in der Schwangerschaft.

First Diagnosis of a Squamos Cell Carcinoma of the Cervix Uteri FIGO 1B1 in Pregnancy Abstract. The squamous cell cancer of the cervix uteri is one of the most frequent detected cancers in pregnancy. As the tumor is in direct contact to the pregnancy, the treatment is challenging and has to be tackled individually. So far, standard concepts or studies are missing. Treatment should be focused on the oncological security of the mother like in non-pregnant women and should be according to current guidelines. Thanks to the existing therapy options during pregnancy, it is a reasonable option to maintain the pregnancy in compliance with oncological standards. An interdisciplinary approach is therefore necessary.

Utero-tubal sperm transport and its impairment in endometriosis and adenomyosis.

The uterus is composed of different smooth muscle layers that serve various functions. First, menstrual debris is expulsed at the time of the menses. Second, sperm is transported in the preovulatory phase to maximize fertility, and third, the human embryo is placed in an adequate setting during implantation. Endometriosis is a gynecologic disorder leading to severe pain symptoms such as severe pain during menstruation (dysmenorrhea), chronic pelvic pain, pain during sexual intercourse (dyspareunia), and abnormal uterine bleeding. Besides, endometriosis is often associated with female infertility and exhibits a massive impairment in the physiology of uterine contractility that can be documented by the in vivo examination method of hysterosalpingoscintigraphy (HSSG). In addition, endometriosis is associated in 80-90% of subjects with adenomyosis and our data clearly indicate that sperm transport is disturbed by hyperperistalsis when at least one focus of adenomyosis can be detected via magnetic resonance imaging (MRI) and turns into dysperistalsis (a complete failure in sperm transport capacity) when diffuse adenomyosis affecting all myometrial uterine muscle layers is detected. Hence, dysperistalsis is significantly associated with reduced spontaneous pregnancy rates. We therefore recommend MRI and HSSG in every sterility workup.

Xenotransplantation of human ovarian tissue pieces in gonadotropin-stimulated SCID mice: the effect of ovariectomy.

The number of follicles were compared in different developmental stages after the cryopreservation of human ovarian tissue by open freezing system followed by xenotransplantation into severe combined immunodeficient (SCID)-mice under stimulation, with and without ovariectomy. Ovarian tissue, cryopreserved for fertility preservation was partly examined by LIVE/DEAD viability staining or was transplanted in the neck muscle of 32 SCID-mice. The development of follicles, estradiol production, vaginal cytology and uterus weight was assessed after 15 weeks under gonadotropin stimulation, with or without ovariectomy. Viable follicles were detected in all frozen/thawed specimens using the LIVE/DEAD assay. Ovariectomy caused a significant improvement of survival of follicles in the preantral and antral stages in the gonadotropin-stimulated animals (p < 0.001), whereas there was no significant effect on the primordial and primary follicle counts. In the non-ovariectomised group, only isolated primordial and primary follicles could be detected. The total follicle amount was significantly higher in the ovariectomised group (n=17, 9.2 +/- 7.8, mean +/-SD) than in the non-ovariectomized group (n=15, 0.3 +/- 1.0). This study demonstrates that ovariectomy of stimulated recipient SCID-mice is essential for the development of follicles after xenotransplantation of cryopreserved human ovarian grafts.

Significant loss of primordial follicles after prolonged gonadotropin stimulation in xenografts of cryopreserved human ovarian tissue in severe combined immunodeficient mice.

This study evaluated the effect of gonadotropin stimulation on the primordial follicle reserve of cryopreserved human ovarian tissue after transplantation in severe combined immunodeficient mice. We found that prolonged gonadotropin stimulation significantly reduces primordial follicles.

Uterine contractility and directed sperm transport assessed by hysterosalpingoscintigraphy (HSSG) and intrauterine pressure (IUP) measurement.

BACKGROUND: Uterine peristalsis sustains sperm transport and can be detected by hysterosalpingoscintigraphy (HSSG). This study is the first to be designed to investigate utero-tubal transport function by HSSG and uterine contractility by intrauterine pressure measurement (IUP) consecutively on the same day in the periovulatory phase. METHODS: Twenty-one female subjects (mean age 28.4 years) without a gynecologic history were examined sequentially by HSSG and IUP on the same day to evaluate uterine contractility in relation to the utero-tubal transport function. In HSSG, intact transport function was visualized by the rapid uptake of 99m-technetium-marked albumin aggregates through the female genital tract. In IUP, the frequency of uterine contractions (UC/min), amplitude of uterine contractions and basal pressure tone were detected via a intrauterine catheter. HSSG and IUP were embedded in cycle monitoring with measurement of LH and estradiol. RESULTS: In HSSG, a positive transport of inert particles was assessed in 20 of 21 subjects, in 76% to the side of the dominant follicle or on both sides of the oviduct, and in 19% a strict contralateral transport could be observed. In only one subject (5%), no transport was assessed. The mean value of uterine contractions was 3.4 UC/min (SD +/- 0.7), the mean amplitude was 12.0 mmHg (SD +/- 4.25 mmHg). Basal pressure tone was 70.7 mmHg. There was a statistically significant correlation with estradiol levels: none of the subjects with less than 3 UC/min showed an estradiol level higher than 100 pg/mL; nearly every patient (one exception) with more than 3 UC/min had an estradiol level higher than 100 pg/mL (p < 0.0001, Fisher's exact test). CONCLUSIONS: Intact periovulatory utero-tubal transport function can be documented by HSSG and is caused by directed uterine contractility, measured consecutively by IUP. Uterine contractility is influenced by rising estradiol levels. Directed uterine contractility and intact utero-tubal transport function are considered necessary for intact sperm transport, mainly to the side bearing the dominant follicle to maximize fertility.