Prenatal sonographic evaluation and postnatal outcome of renal anomalies.

OBJECTIVE: To determine the prognosis of antenatally detected renal anomalies by sonographic evaluation. MATERIALS AND METHODS: This was a follow-up study of all antenatally detected renal anomalies from January 2008 to Dec 2009 referred to fetal medicine clinic. Prenatal evaluation was done and cases were divided into four groups depending upon their prenatal sonographic findings. Post natal follow-up was done up to one year in cases of live babies. Autopsy was carried out in still born fetus after consent. RESULTS: The renal anomaly was detected in 55 cases, which were fully followed. The prognosis was said to be poor for group I cases with gross extra renal anomaly along with the renal anomaly, and for group II in which there was organic renal pathology with loss of renal function suggested by non-visualization of bladder and almost absent liquor. Prognosis was guarded and depended upon the gestational age of presentation in group III, which had obstructive uropathy; prognosis was good in group IV cases, which were mild, unilateral or which presented late. CONCLUSION: Prenatal sonographic evaluation gives reasonably accurate picture of the prognosis and can be very helpful in counseling the parents regarding prognosis and help in deciding the timing and route of delivery.

Fetal vascular adaptation before and after treatment of severe maternal anemia in pregnancy.

OBJECTIVES: To use color Doppler ultrasonography indices to study the effects on fetal circulation of treating severe maternal anemia. METHODS: A prospective cohort study enrolled patients who were at 30-34weeks of pregnancy and had hemoglobin levels below 70g/L between November 1, 2011 and March 31, 2013 at a hospital in New Delhi, India. A control group consisting of patients with the same duration of pregnancy and with hemoglobin levels above 110g/L was included. Umbilical artery and middle cerebral artery velocimetry were performed using color Doppler ultrasonography at admission and after 4weeks and 6weeks of treatment. RESULTS: The maternal anemia cohort demonstrated a significantly lower middle cerebral artery resistance index and middle cerebral/umbilical artery resistance ratio (P<0.001) at admission. Following 4weeks of treatment for maternal anemia, significant increases in these parameters were observed (P<0.001). CONCLUSION: Fetuses of individuals with severe maternal anemia demonstrated altered cerebral and umbilical artery flows. Normal flows were restored following treatment of maternal anemia.

Role of endothelin and inflammatory cytokines in pre-eclampsia - A pilot North Indian study.

PROBLEM: Pre-eclampsia is new onset hypertension during pregnancy with proteinuria. The initiating event in pre-eclampsia is postulated to involve reduced placental perfusion, which leads to widespread dysfunction of the maternal vascular endothelium. Cytokines also appear to contribute to the development of the pathological condition. The aim of this study was to evaluate the role of cytokines in pre-eclampsia and to study the relationship between endothelin-1 and cytokines with the severity of the disease. METHOD OF STUDY: This cross-sectional study included 300 women with pre-eclampsia and 200 healthy pregnant women. Their blood samples were analyzed for endothelin-1 and inflammatory cytokines. RESULTS: Increased endothelin-1 and cytokines [tumor necrosis factor-α, interleukin-2 (IL-2) and γ-interferon (IFN-γ)] levels were found in pre-eclampsia (P < 0.001). Significant positive correlation was seen between endothelin-1 and cytokine level (IL-2 and IFNγ) in the pre-eclamptic group (P = 0.001). CONCLUSION: We conclude that pre-eclampsia is associated with increased levels of both endothelin-1 and circulating inflammatory cytokines, which points toward the role of endothelial and inflammatory components.

Coagulation inhibitors and activated protein C resistance in recurrent pregnancy losses in Indian women.

BACKGROUND: Thrombophilias, both acquired and inherited, have been investigated in the etiopathogenesis of unexplained recurrent pregnancy loss. AIM: To study coagulation inhibitors and activated protein C resistance (APCR) in recurrent pregnancy losses (RPL) occurring in second and third trimesters. MATERIALS AND METHODS: A total of 30 pregnant women (group A) with two or more recurrent unexplained fetal loses were evaluated for APCR, protein C deficiency, protein S deficiency, antithrombin deficiency, and antiphospholipid antibodies (APLA). Thirty age-matched controls were taken (group B) comprising of pregnant women with at least one live issue. STATISTICAL ANALYSIS: Comparisons between two group frequencies and group means were made using Chi square test and Student's t test, respectively. RESULTS: Protein C and protein S levels were reduced in group A compared with group B and the difference was statistically significant (P=0.005 and P=0.032, respectively). The mean value of antithrombin was slightly reduced in group A compared with group B. APCR was observed in 16.6% cases and 3.3% controls. However, the difference was not statistically significant. APLA was observed in 20% cases and none of the controls. Of these, lupus anticoagulant was positive in 16.6% cases and anticardiolipin antibodies in 10% cases. Combined defects were seen in seven patients. CONCLUSION: There is a significant risk of RPL in pregnant women with thrombophilias. Therefore, screening for thrombophilias may be justified in pregnant women with unexplained recurrent fetal wastage, especially in second and third trimester.

Inducible nitric oxide synthase (iNOS) gene polymorphism in pre-eclampsia: a pilot study in North India.

BACKGROUND: Pre-eclampsia is one of the most frequent complications of pregnancy, however, little is known about its aetiology. AIMS: The objective of this study was to investigate the association between inducible nitric oxide synthase (iNOS) genotypes and pre-eclampsia. We also measured the concentrations of tumour necrosis factor-alpha (TNF-alpha), nitric oxide (NO) and superoxide dismutase (SOD) in patients with pre-eclampsia to evaluate their relations to the single nucleotide polymorphisms (SNPs) observed. METHODS: This cross-sectional study included 30 pregnant women with pre-eclampsia and 30 healthy pregnant women. They were screened at 28th, 36th weeks of gestation and just after delivery (within 48 h), and their blood samples were analysed for NO, SOD, TNF-alpha and iNOS gene polymorphism. RESULTS: Patients with pre-eclampsia at 36 weeks gestation showed significantly increased serum NO levels (P=0.007), whereas SOD activity was decreased significantly (P=0.004). A doublefold increase was observed in TNF-alpha levels at 36 weeks in patients with pre-eclampsia (P=0.003) which decreased significantly (P=0.001) after delivery. A total of four SNPs were observed, of which two (G300A exon 8 and G274T exon 16) showed statistically significant association with pre-eclampsia. When compared, G274T exon 16 SNP also showed association with TNF-alpha levels and SOD activity in pre-eclamptic patients. CONCLUSION: As pre-eclampsia is a disease of multifactorial aetiopathology, NO, TNF-alpha, SOD activity and NOS2A polymorphism might play an intermingled role in its development.