Antiphosphatidylserine/prothrombin antibodies (aPS/PT) as potential diagnostic markers and risk predictors of venous thrombosis and obstetric complications in antiphospholipid syndrome.

BACKGROUND: The aim of the study was to determine the prevalence and clinical associations of antiphosphatidylserine/prothrombin antibodies (aPS/PT) with thrombosis and pregnancy loss in Chinese patients with antiphospholipid syndrome (APS) and seronegative APS (SNAPS). METHODS: One hundred and eighty six Chinese patients with APS (67 primary, 119 secondary), 48 with SNAPS, 176 disease controls (79 systemic lupus erythematosus [SLE], 29 Sjogren's syndrome [SS], 30 ankylosing spondylitis [AS], 38 rheumatoid arthritis [RA]) and 90 healthy donors were examined. IgG and IgM aPS/PT, IgG/IgM/IgA anticardiolipin (aCL) and IgG/IgM/IgA anti-ß2-glycoprotein I (anti-ß2GPI) antibodies were tested by ELISA. RESULTS: One hundred and sixty (86.0%) of APS patients were positive for at least one aPS/PT isotype. One hundred and thirty five (72.6%) were positive for IgG aPS/PT, 124/186 (66.7%) positive for IgM aPS/PT and 99 (53.2%) positive for both. Approximately half of the SNAPS patients were positive for IgG and/or IgM aPS/PT. Highly significant associations between IgG aPS/PT and venous thrombotic events (odds ratio [OR]=6.72) and IgG/IgM aPS/PT and pregnancy loss (OR=9.44) were found. Levels of IgM aPS/PT were significantly different in APS patients with thrombotic manifestations and those with fetal loss (p=0.014). The association between IgG/IgM aPS/PT and lupus anticoagulant (LAC) was highly significant (p<0.001). When both were positive, the OR for APS was 101.6. Notably, 91.95% (80/87) of LAC-positive specimens were positive for IgG and/or IgM aPS/PT, suggesting aPS/PT is an effective option when LAC testing is not available. CONCLUSIONS: Anti-PS/PT antibody assays demonstrated high diagnostic performance for Chinese patients with APS, detected some APS patients negative for criteria markers and may serve as potential risk predictors for venous thrombosis and obstetric complications.

Inflammation and Epidural-Related Maternal Fever: Proposed Mechanisms.

Intrapartum fever is associated with excessive maternal interventions as well as higher neonatal morbidity. Epidural-related maternal fever (ERMF) contributes to the development of intrapartum fever. The mechanism(s) for ERMF has remained elusive. Here, we consider how inflammatory mechanisms may be modulated by local anesthetic agents and their relevance to ERMF. We also critically reappraise the clinical data with regard to emerging concepts that explain how anesthetic drug-induced metabolic dysfunction, with or without activation of the inflammasome, might trigger the release of nonpathogenic, inflammatory molecules (danger-associated molecular patterns) likely to underlie ERMF.

Psychiatric disorders and changes in immune response in labor and postpartum.

Women may present with psychiatric disorders during pregnancy, normal labor, following delivery by caesarean section, or in the postpartum period. The accumulating evidence suggests that these disorders may be due to changes in immune responses. During pregnancy complications such as the prolongation of cervical ripening or descent, placental abruption, premature labor, and preeclampsia increase the risk of postpartum psychiatric disorders. Women may exhibit depression and postpartum psychosis following either normal birth or caesarean section. Since psychiatric disorders like schizophrenia, major depression, and bipolar disorder are associated with both alterations in the immune response and changes in immune cell subpopulations, in this study we have chosen to examine whether the psychiatric disorders in women during labor or postpartum also lead to aberrant immune responses.

Anaphylaxis to cefazolin during labor secondary to prophylaxis for group B Streptococcus: a case report.

BACKGROUND: Anaphylaxis is an uncommon event during pregnancy, but if it does arise, it can lead to serious fetal consequences even if there are no serious long-term maternal complications. CASE: A parturient developed anaphylaxis in the labor unit shortly after intravenous cefazolin chemoprophylaxis had begun for perinatal group B streptococcal disease. Prompt treatment for anaphylaxis commenced, involving the administration of epinephrine and glucocorticoids, and an emergency cesarean section spared the mother serious morbidity, with a favorable perinatal outcome for the fetus. CONCLUSION: To the best of our knowledge, this case is the first reported one of anaphylaxis to cefazolin in pregnancy secondary to prophylaxis against for B Streptococcus. The case demonstrates that a life-threatening anaphylactic reaction can occur at any time during pregnancy and that all staff in a maternal unit should be familiar with the management of perinatal anaphylaxis.

Prolonged gestation does not extend survival of uterine natural killer lymphocytes in mice deleted in the receptor for prostaglandin F2alpha.

During decidualization in mice and women, expansion of the Natural Killer (NK) cell lineage occurs within the uterus. In rodents, peak numbers of uterine (u)NK cells are reached at mid-gestation. The population then declines and residual cells are shed with the placenta. Decidualization, but not a fetus, is required to induce division and maturation of uNK cells. Mechanisms regulating the decline in uNK cells are unknown. To determine if the conceptus or its products have regulatory roles on uNK cell survival during normal gestation, a histological time course study was undertaken of implantation sites in mice ablated in the gene for the Prostaglandin F2alpha receptor (PGF2alphaR). These females experience normal gestation but fail to initiate labour and delivery. Their pregnancies extend a further 4-7 days before onset of maternal compromise. Large numbers of uNK cells were present in PGF2alphaR null mice by gestational day (gd) 10 and numbers had begun to decline at gd 14. By gd 18, very few uNK cells remained and no uNK cells were found at day 22 of extended gestation. Thus, the population history of uNK cells in PGF2alphaR null mice resembles that of uNK cells in normal mice, suggesting that the placenta, its products, the fetus and PGF2alpha are not factors that influence the rate of uNK cell decline in late gestation.

Pathophysiology of the periparturient egg rise in sheep: the role of prolactin.

The involvement of prolactin in the periparturient rise in the faecal nematode egg count in sheep was investigated. Ostertagia circumcincta larvae (5000 third stage larvae three times weekly) were administered to adult immune ewes from three weeks before parturition to three weeks afterwards. Ten ewes were injected twice daily with 2-bromo-alpha-ergocryptine (bromocriptine), an antagonist of prolactin secretion, for two weeks starting two days after lambing while 10 ewes remained untreated. Bromocriptine treatment was initiated approximately two weeks pre partum in three other ewes. Plasma pepsinogen concentrations rose significantly by one week after the start of O circumcincta larval challenge in all the ewes but faecal egg counts remained negative until approximately one week post partum. Plasma prolactin concentration was reduced to a very low level in all bromocriptine treated ewes but this did not alter the dynamics of the periparturient rise in faecal egg counts. Neither cell-mediated nor humoral immunity of the ewes, as assessed by their sensitivity to BCG inoculation and by antibody titre raised against horse red blood cells, respectively, were impaired during the rise in faecal egg count, nor were these parameters altered by manipulation of plasma prolactin concentration. Lamb growth rate was not retarded by low plasma prolactin concentration in the bromocriptine treated ewes. These results are not consistent with the generally held hypothesis that elevated plasma prolactin concentration is directly associated with the periparturient rise.

Pre-partum leucocytic activity and retained placenta.

An investigation concerning the association of the leucocytecotyledon reaction and the expulsion of the placenta is described. The in vitro reaction does not appear to be individual-specific. It is thus possible to determine the activity of the leucocytes against a cotyledon before parturition. The leucocytes of cows which will develop a retained placenta have lowered activity against the chemotactic stimulus of a cotyledon; this reduced activity of the leucocytes can be observed some days before parturition.

Retained placenta and leucocytic activity.

In a study of 262 cows, the relationship between the activity of peripheral leucocytes and the expulsion of the placenta was investigated, bearing in mind that the post- partal placenta may be considered as a foreign tissue. The activity of the leucocytes against the cotyledon was examined by determining the presence of chemotaxis in a Boyden Chamber, and by estimating the number of leucocytes in the cotyledon at the time of parturition. It was shown that in the absence of leucocytic activity, retained placenta occurred in 100 per cent of cases. When chemotaxis is used as the sole criterion, positive chemotaxis resulted in an incidence of 2.6 per cent retained placenta and negative chemotaxis in 35.6 per cent.

Post-partum leucocytic activity and its relationship to caesarian section and retained placenta.

The activity of the leucocytes of 30 cows during 10 days after parturition is described. A comparison is made between the activity of leucocytes of 10 cows after normal parturition, 10 cows after caesarian section and 10 cows with retained placenta. When compared with normal parturition, caesarian section does not have a negative influence on the activity of the leucocytes during the puerperal period, during which time however the activity of leucocytes of cows with retained placenta is strongly decreased.

Influence of dilution on the chemotactic properties of cotyledon suspensions.

In this study the influence of dilution of cotyledon suspensions on the chemotactic stimulus was investigated. When the concentration of the chemotactic stimulus is reduced, the activity of the leucocytes is reduced as well. Dilutions of retained placenta cotyledon suspensions showed an increase in leucocyte activity. This may indicate the existence of a leucocyte inhibition factor in the retained placenta cotyledon.

Control of neonatal group B streptococcal infection.

Group B beta-haemolytic streptococcus (GBS) is the leading cause of life-threatening perinatal infection in developed countries. As immunization of women is not yet available, selective intrapartum chemoprophylaxis appears to be the best current strategy for preventing disease. All pregnant women should be screened for GBS at 26 to 28 weeks gestation. During labour, all colonized women with risk factors for invasive GBS neonatal infection should be treated with intravenous penicillin or ampicillin. Risk factors include preterm labour, premature rupture of membranes, intrapartum fever, multiple births, prolonged rupture of membranes, maternal diabetes, previous sibling with invasive GBS disease, and maternal GBS bacteriuria. The latter two categories warrant chemoprophylaxis regardless of maternal colonization status.

[Autoimmune hepatitis during pregnancy].

BACKGROUND: Autoimmune hepatitis is a rare chronic disease that mainly affects young women and may influence fertility and pregnancy in these patients. OBJECTIVES: To describe pregnancy and labor in a patient suffering from autoimmune hepatitis and to review the relevant literature. METHODS: Computerized literature research. RESULTS: The disease of 9 years' duration did not relapse during pregnancy under continuous treatment with steroids, cytotoxic drugs, ursodeoxycholic acid and vitamins. Pregnancy was uneventful and ended with preterm vaginal delivery at 35 weeks, of a 2299 gram healthy neonate. The patient did well during the postpartum period and 6 months thereafter. Since there is no single diagnostic test for the disease, the diagnosis is based on the combination of clinical, laboratory, and histopathological findings and by exclusion of other causes of hepatitis. CONCLUSIONS: There is paucity of data in the literature on pregnancy in these patients but the treatment protocols seem to be effective for the mother and safe for the fetus. Maternal and fetal complications rates appear to be currently lower than in the past. Given that relapse cannot be predicted, close surveillance during pregnancy is warranted.

[Markers of hepatitis-viral infection in children born of mothers with hepatitis B]. / Markery gepatiti-virusnoi infektsii u detei, rodivshikhsia u materei, bol'nykh gepatitom B.

Sixty-two women suffering from hepatitis B (HB) and their newborn babies were examined by a highly sensitive radioimmunoassay (RIA). The fluorescent antibody technique was also used to examine autopsy specimens of livers of 7 fetuses, 1 stillborn, and 3 babies dying in the first days of life whose mothers during pregnancy or delivery had experienced HB. Frequent infection of babies (77.8%) was observed at high concentrations of HBsAg in mothers in labor with subsequent development of persisting HBs-antigenemia, and in half of the babies of chronic hepatitis. HBsAg was detected in the first days of life not only in the blood serum, but also in the liver tissue which may be explained by intrauterine infection. At low concentrations of HBsAg in mothers the babies were infected less frequently (26.1%) and half of them were shown to have anti-HBs in the umbilical blood and blood serum in the first days and months of life. Anti-HBc transmission from mothers was also demonstrated. In babies born to convalescents after HB in the absence of HBsAg, anti-HBs in combination with anti-HBc were determined.

[Effect of levamisole on the course of chronic cytomegalovirus infection in women]. / Vliianie levamizola na techenie khronicheskoi tsitomegalovirusnoi infektsii u zhenshchin.

The therapeutic effect of orally given levamisole in the treatment of women with chronic cytomegalovirus infection was studied. The patients were examined serologically, cytologically, virologically; the factors of cell-mediated immunity were also studied. Oral therapy with levamisole resulted in a definite increase of the cell-mediated immunity with a trend for decrease in antibody titres and reduced virus excretion. Evaluation of the clinical effect of levamisole therapy, however, revealed no distinct difference in the outcomes of pregnancy in the groups of women treated or not treated with levamisole.

[Changes in specific and nonspecific immune reactivity in women with a complicated obstetrico-gynecologic status]. / Promiana na spetsifichnata i nespetsifichnata imunna reaktivnost pri zheni s uslozhnen akushero-ginekologichen status.

The immunologic status of some groups of women from the obstetric practice was, studied by using some routine immunologic tests. BT test and C-reactive protein were used in parturients with complicated puerperium. Pregnant women with preserved amniotic sac at tenth lunar month were investigated as well as pregnant women with declared labour activity and ruptured amniotic sac and women with normal pos-partial period and parturients with inflammatory process (complicated puerperium). It was established a statistically significant lowering of active and total T-rosette forming cells and increased level of immunoglobulin G in women with declared labour activity and ruptured amniotic sac. There were lowered values of active T-lymphocytes in parturients with inflammatory complications. The performed studies on these women showed that the usage of BT test and determination of C-reactive protein were indicative methods presenting clear picture of the instant state of the infected organism.

[Hentaxan as an immunoregulator in purulent wounds in parturient women]. / Hentaksan iak imunorehuliator pry hniinykh ranakh u porodil'.

Hentaxan, a new silicon sorbent, is a complex drug preparation containing hentamycin sulfate and zinc-tryptophan, endowed with antioxidant and immunomodulating activities. We used it for treating suppurating wounds in those women in labour. As many as 65 parturient women were examined. The conclusion drawn from the obtained results is that the immunomodulating potential of hentaxan is not very high, for which reason we recommend that hentaxan be combined with laferon which effects the T-link of immunity. The proposed method is at present under study.

[The pathogenesis of generalized suppurative-septic complications in patients with eclampsia and massive blood loss of obstetrical origin]. / Patogenez generalizovannykh gnoino-septicheskikh oslozhnenii u bol'nykh s éklampsiei i massivnoi krovopoterei akusherskogo geneza.

Changes in immune status, central hemodynamics, oxygen regimen and endogenous intoxication indexes have been compared in patients with eclampsia combined with blood loss and in patients with isolated blood loss. It has been established that severe septic processes were 1.5 times and lethality was 4 times more frequent in the first group of patients than in patients with isolated blood loss. Generalized septic processes accompany marked secondary immune defects. The main reasons for the immune system damage are circulatory hypoxia and severe endogenous intoxication.