Appropriate citation of placenta cell lines 3A(tPA-30-1) and 3A-sub E [post crisis of 3A(tPA-30-1)] in medical literature.

INTRODUCTION: To determine how often placenta cell lines 3A (tPA-30-1) and 3A-sub E [post crisis of 3A (tPA-30-1)] are appropriately cited, or identified, as "term"-gestation placental cell lines in medical literature. METHODS: We performed a literature search on two databases, PubMed and One Search, using the terms "3A (tPA-30-1)," "3Asub-E," "3AsubE," "tPA-30-1," "tPA30-1," and "3A AND (placenta OR placental OR trophoblast OR trophoblastic) AND (cell OR line OR cell line)." Of the 218 citations retrieved, 181 were excluded due to duplication, article content irrelevance or lack of access to a full manuscript. The remaining 37 citations were thoroughly reviewed for 1)the presence of a full citation as designated by the supplier, and 2)the identification of the placental lines as "term." RESULTS: Of the 37 eligible citations included in the study, five demonstrated complete identifications of the placental cell lines of interest, while 32 demonstrated partial identifications that failed to match the designations provided by the manufacturer. Furthermore, of the 37 citations, eight accurately identified the cell lines as "term," while 27 lacked any description of gestational age, and two incorrectly identified them as "first trimester" cell lines. Overall, only three citations contained both a full citation and correct identification as a "term" placenta cell line. DISCUSSION: Only 5 of the 37 (13.5%) publications demonstrated a complete citation and only 8 publications accurately identified the gestational age of the placenta cell line as "term". Such findings confirm the need for a representative set of standards for the documentation of cell lines to improve the quality of publications in the scientific community.

Cervical varices: An unusual source of first-trimester hemorrhage.

Endocervical varices are a rare cause of obstetrical hemorrhage. Usually presenting in the second and third trimesters, bleeding varices often require pregnancy termination or indicated preterm birth via cesarean delivery. Our patient experienced variceal hemorrhage at 12 weeks' gestation in a dichorionic twin pregnancy conceived through in vitro fertilization. A low-lying placenta resolved at 19 weeks followed by variceal regression at 22 weeks' gestation. Endocervical varices causing first-trimester hemorrhage may regress with resolution of a coexisting low placental implantation, permitting planned vaginal delivery, despite progressive hemodynamic changes of pregnancy. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46:218-221, 2018.

Clinical pitfalls in misoprostol-based medical management of first-trimester induced and presumed spontaneous abortion.

When administered inappropriately, first-trimester misoprostol management of induced or spontaneous abortion can result in loss or damage of a continuing pregnancy. Despite these serious consequences, such misoprostol exposures continue to occur. Unfortunately, contributing factors and preventive measures receive little attention. We describe the cases of 4 women in whom misoprostol was inappropriately administered during management of induced and presumed spontaneous abortion. In each case, careful adherence to published clinical guidance could have avoided the exposures.

First-trimester chorionic bump--Association with fetal aneuploidy in a high-risk population.

PURPOSE: To determine the relationship between the first-trimester chorionic bump and fetal aneuploidy. METHODS: This retrospective cohort study included all singleton pregnancies with chromosomal analysis and sonographic examination performed between 5 0/7 and 13 6/7 weeks from January 1, 2010 through August 15, 2015. Interobserver and intraobserver agreement for identifying a chorionic bump was evaluated by the Kappa statistic. Pregnancies with and without a chorionic bump were compared regarding patient characteristics and fetal karyotypes. RESULTS: Six hundred ninety subjects were included, 16 (2.3%) having a bump. The kappa coefficients for interobserver agreement were 0.88 (95% confidence interval [CI]: 0.71-1.00) and 0.94 (95% CI: 0.82-1.00); those for intraobserver agreement were 0.81 (95% CI: 0.61-1.00) and perfect agreement. One hundred seventeen fetuses (16.9%) were aneuploid, of which five (4.3%) had a bump. The odds of aneuploidy in the presence of a chorionic bump were higher than those in the absence of a chorionic bump, although this difference was not statistically significant (odds ratio [OR] 2.3, 95% CI: 0.8-6.7). In subgroup analyses, odds of aneuploidy were four times higher in the bump group than in the no bump group among those with a sonographically isolated bump (OR 4.5, 95% CI: 1.5-13.5) and 15 times higher among those with an isolated bump and increased first-trimester aneuploidy risk (OR 15.0, 95% CI 2.4-93.3). CONCLUSIONS: Agreement in identifying chorionic bumps is near-perfect. A sonographically nonisolated chorionic bump is not associated with significant additional aneuploidy risk, whereas a sonographically isolated chorionic bump confers a significantly increased likelihood of aneuploidy in high-risk fetuses. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:3-7, 2017.

Ultrasound Measurement of the Fetal Adrenal Gland as a Predictor of Spontaneous Preterm Birth.

OBJECTIVE: To estimate whether ultrasound measurement of the fetal adrenal gland remote from delivery in asymptomatic women can accurately predict spontaneous preterm birth. METHODS: We conducted a prospective multicenter observational nested cohort study of asymptomatic nulliparous women with a singleton pregnancy to study adverse pregnancy outcomes. Between 22 0/7 and 30 6/7 weeks of gestation, credentialed ultrasonographers measured the width (width), length (length), and, when able, depth (depth) of the "fetal zone" of the fetal adrenal gland as well as the width (Width), length (Length), and depth (Depth) of the total gland. We used the ratios of each measurement (width/Width, length/Length, and depth/Depth) to control for variation in adrenal size by gestational age. The accuracy of each ratio measurement in predicting spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation was assessed by receiver operating characteristic curves using area under the curve. RESULTS: Pregnancy outcomes were available for 1,697 women with one or more fetal adrenal gland measurements. Spontaneous preterm birth at less than 37 0/7 weeks of gestation and spontaneous preterm birth at less than 34 0/7 weeks of gestation occurred in 82 (4.8%) and six women (0.4%), respectively. None of the fetal adrenal gland measurements distinguished spontaneous preterm birth from term birth. The areas under the curve (95% confidence intervals) for spontaneous preterm birth at less than 37 0/7 weeks of gestation were 0.51 (0.45-0.58), 0.50 (0.44-0.56), and 0.52 (0.41-0.63) for width/Width, length/Length, and depth/Depth ratios, respectively. The areas under the curve for spontaneous preterm birth at less than 34 0/7 weeks of gestation were 0.52 (0.25-0.79) and 0.55 (0.31-0.79) for width/Width and length/Length ratios, respectively. Additionally, none of the means of the gland measurements were statistically different between those delivering at term and spontaneous at preterm (P>.05). CONCLUSION: Fetal adrenal size, as measured by ultrasonography between 22 0/7 and 30 6/7 weeks of gestation, is not predictive of spontaneous preterm birth in asymptomatic nulliparous women.

Positive cell-free fetal DNA testing for trisomy 13 reveals confined placental mosaicism.

PURPOSE: We report on a case in which cell-free fetal DNA was positive for trisomy 13 most likely due to confined placental mosaicism. Cell-free fetal DNA testing analyzes DNA derived from placental trophoblast cells and can lead to incorrect results that are not representative of the fetus. METHODS: We sought to confirm commercial cell-free fetal DNA testing results by chorionic villus sampling and amniocentesis. These results were followed up by postnatal chromosome analysis of cord blood and placental tissue. RESULTS: First-trimester cell-free fetal DNA test results were positive for trisomy 13. Cytogenetic analysis of chorionic villus sampling yielded a mosaic karyotype of 47,XY,+13[10]/46,XY[12]. G-banded analysis of amniotic fluid was normal, 46,XY. Postnatal cytogenetic analysis of cord blood was normal. Karyotyping of tissues from four quadrants of the placenta demonstrated mosaicism for trisomy 13 in two of the quadrants and a normal karyotype in the other two. CONCLUSION: Our case illustrates several important aspects of this new testing methodology: that cell-free fetal DNA may not be representative of the fetal karyotype; that follow-up with diagnostic testing of chorionic villus sampling and/or amniotic fluid for abnormal test results should be performed; and that pretest counseling regarding the full benefits, limitations, and possible testing outcomes of cell-free fetal DNA screening is important.

Genomic loss of imprinting in first-trimester human placenta.

OBJECTIVE: The purpose of this study was to investigate imprinting patterns in first-trimester human placentas. STUDY DESIGN: Using samples of 17 first-trimester and 14 term placentas from uncomplicated pregnancies, we assessed loss of imprinting (LOI) at the RNA level in a panel of 14 genes that are known to be imprinted in the placenta with the use of a quantitative allele-specific reverse transcriptase polymerase chain reaction analysis of those genes that contained readout single nucleotide polymorphisms in their transcripts. RESULTS: There is significant LOI (ie, biallelic expression) in all 14 genes in first-trimester placentas. LOI was more variable and generally at lower levels at term. Although there is little difference in gene expression, the level of LOI is higher in the first-trimester placentas, compared with term placentas. CONCLUSION: Genomic imprinting appears to be a dynamic maturational process across gestation in human placenta. In contrast with prevailing theories, epigenetic imprints may continue to evolve past 12 weeks of gestation.

Noninvasive prenatal diagnosis: past, present, and future.

The presence of fetal cells in the maternal circulation was first noted by Georg Schmorl when he documented the presence of multinucleated syncytial giant cells of placental origin in the lung tissue of women who had died from complications of eclampsia. In the intervening century, advances in cellular and molecular biology further elucidated both the physiology and pathophysiology of communication within the fetomaternal unit. This concept is at the foundation of the rapidly expanding field of noninvasive prenatal diagnosis. However, the clinical utility of this phenomenon had been limited until the presence of cell-free fetal DNA circulating in the maternal plasma was reported in 1997 and fetal messenger RNA was demonstrated to circulate in the maternal plasma in 2000. These circulating nucleic acids are found free-floating in the maternal plasma, unencumbered by a surrounding fetal cell. The analysis of these 3 fetal markers (fetal cells, cell-free fetal DNA, and fetal messenger RNA) for diagnostic and screening purposes is now being developed. The scope of noninvasive prenatal diagnosis is not limited to only the diagnosis of fetal genetic traits and aneuploidies. Recently, researchers have focused their investigations on the role of cell-free fetal DNA and fetal messenger RNA in preeclampsia, intrauterine growth restriction, and preterm labor. These biomarkers, the result of inherent placental dysfunction or the byproducts of placental trophoblastic apoptosis, may allow for improvements in the diagnosis and management of high-risk pregnancies.

Chorionic villus sampling and the risk of adverse outcome in patients undergoing multifetal pregnancy reduction.

OBJECTIVE: The objective of the study was to determine whether patients undergoing chorionic villus sampling (CVS) prior to MPR are at increased risk for adverse outcome compared to those who did not. STUDY DESIGN: We retrospectively identified multifetal pregnancy reduction (MPR) patients from an established database. Maternal demographic data were collected. Outcomes including complete pregnancy loss prior to 24 weeks' gestation, gestational age at delivery, and birthweight were analyzed. RESULTS: There was no significant difference in pregnancy loss between the 2 groups (CVS [4%] vs no CVS [7%], P = .098). When stratified by finishing number, there was a significantly lower loss rate in the singleton CVS group (2% vs 9%, P = .025) and no significant difference in reduced twins. There was no significant difference in the average gestational age of delivery or birthweight. CONCLUSION: CVS prior to MPR does not increase the risk of pregnancy loss. Our data suggest that CVS prior to singleton reduction may decrease the risk of adverse outcome.

Successful management of a consecutive cervical pregnancy by sonographically guided transvaginal local injection: case report and review of the literature.

OBJECTIVE: The purpose of this study was to describe the successful management of a recurrent cervical pregnancy with local injection and to review similarly treated cases to determine adverse outcomes. METHODS: A case of a recurrent cervical pregnancy treated with transvaginal local injection was reported. A MEDLINE English language search identified 90 cases of cervical pregnancy treated with local therapy. This literature was analyzed with regard to the various demographic and outcome variables described. RESULTS: Successful use of the transvaginal local approach is described. A review of cases identified a mean maternal age of 33.6 years with a mean gestational age at diagnosis of 7.5 weeks. Bleeding was the most common presenting sign (79%). The mean beta-human chorionic gonadotropin level at the time of diagnosis was 27,798 IU with an average time to resolution of 7.5 weeks. The most common risk factor was a history of curettage (69%), followed by previous cesarean delivery (35%). An additional dose of methotrexate was needed in 6% of cases. Bleeding requiring alternate procedures was present in 5% of cases. There were no complications in 81% of cases. The need for transfusion and development of infection were seen in 3% of cases each. There was 1 case (1.1%) requiring hysterectomy, and no maternal deaths were reported. CONCLUSIONS: Conservative management of cervical pregnancy using local injection has been reported to have a low complication rate and a high efficacy for cure.