Angiogenic growth factors in maternal and fetal serum in pregnancies complicated with intrauterine growth restriction.

The aim of this paper was to study if soluble fms-like tyrosine kinase 1 (sFlt-1), free vascular endothelial growth factor (f-VEGF) and the f-VEGF/sFlt-1 quotient in singleton pregnancies complicated with intrauterine growth restriction (IUGR) are different from controls. This was a case-control study between 18 pregnancies with IUGR and 24 controls. Angiogenic growth factors were measured in maternal serum during pregnancy and in umbilical artery and vein at birth. Results showed that maternal plasma f-VEGF and s-Flt-1 were significantly higher in IUGR compared with controls (p = 0.01 and 0.001, respectively). f-VEGF/sFlt-1 quotient was significantly lower in the IUGR group compared with controls. When we analysed umbilical cord angiogenic factors, we found no significant differences in the artery or vein angiogenic growth factors between the IUGR group and controls. It was concluded that mothers of IUGR fetuses have a more anti-angiogenic environment compared to those of controls.

Clinical outcome, fertility and uterine artery Doppler scans in women with obstetric bilateral internal iliac artery ligation or embolisation.

The objective of our study was to report on the clinical outcome, fertility and uterine artery Doppler scans in patients with major postpartum haemorrhage, treated with bilateral internal iliac artery ligation or embolisation. We performed an observational analysis of successful bilateral internal iliac artery ligation or embolisation for postpartum haemorrhage in a tertiary hospital between 2001 and 2006. Clinical data and other medical/ surgical manoeuvres were recorded. Fertility data, menstrual cycle characteristics and uterine artery Doppler scans were assessed. Our success rate in bleeding control was 81%. Three patients got pregnant again 13, 16 and 23 months after the procedure. The one patient whose uterine artery was not identified in the Doppler scan was the only one who presented with secondary infertility. Three patients presented with secondary dysmenorrhoea. We concluded that internal iliac artery occlusion is an effective fertility-sparing procedure for postpartum haemorrhage. The absence of uterine revascularization could be a negative factor in future reproduction. Due to our limited sample size, larger studies are required to confirm these findings.