Biomarkers in pre-eclampsia: a novel approach to early detection of the disease.

Pre-eclampsia is a unique disorder of human pregnancy with a great impact on maternal and perinatal morbidity and mortality worldwide and especially in developing countries. The aetiology is still unknown and the pathophysiology of the disease is the subject of extensive investigation. Recently, much of the interest of the investigators for the prediction of pre-eclampsia has been aimed at measurable manifestations of abnormal placentation, endothelial dysfunction and feto-maternal unit perfusion. Biomarkers constitute a novel approach to an early detection of the disease. Low maternal serum levels of PAPP-A and PP13 early in pregnancy are predictive for emerging pre-eclampsia. On the other hand, increased levels of homocysteine, ADMA, sEng, leptin and sFlt-1 in the 1st trimester, signal the onset of the disease later in pregnancy. After the onset of pre-eclampsia, increased serum levels of PAPP-A, ADMA, homocysteine and sFlt-1 are associated with the severity of the disease. The identification of biomarkers which can contribute to the early detection of pre-eclampsia is essential. It could then be possible to apply better surveillance and treatment protocols in such patients.

Neonatal outcomes of late preterm deliveries with pre-eclampsia.

AIM: The aim of the study was to examine the impact of pre-eclampsia on neonatal outcomes of late preterm deliveries. METHODS: A retrospective study was conducted, enrolling pregnancies delivered between 34 0/7 and 36 6/7 weeks of gestation during the period 2004-2007 in a large tertiary center. Pregnancies were divided in group 1, including those complicated with pre-eclampsia and group 2, including normotensive cases. Epidemiological characteristics, mode of delivery and complications contributing in late preterm delivery were initially studied. Neonatal morbidity parameters of our interest included mean Apgar score in the 1st and 5th minute, admission to Neonatal Intensive Care Unit (NICU) and need for emergency intubation. Intrauterine growth retardation (IUGR), low birth weight (LBW) and very LBW (VLBW), respiratory distress syndrome (RDS), hypoglycemia, NICU infection, abnormal cerebral ultrasonographic findings and duration of NICU residence were also compared between the two groups. RESULTS: Out of 363 late preterm pregnancies, 29 (8%) were delivered because of pre-eclampsia. Mean gestational week and birth weight were significantly lower in group 1. The rate of elective caesarean section was also significantly higher in this group. The same observation was made concerning rates of IUGR, LBW and VLBW neonates. Furthermore, incidence of NICU admission and hypoglycemia were significantly higher in the group of infants born by pre-eclamptic mothers. Incidence of RDS and cerebral echo pathology were also higher, but without significant difference when compared to group 2. CONCLUSION: Neonatal adverse outcomes were increased in late preterm infants of pre-eclamptic women in comparison with those of normotensive women.

Parity affects pregnancy outcomes in women 35 and older.

PURPOSE OF INVESTIGATION: The objective of the study was to examine the impact of parity on pregnancy outcomes in women 35 years and older. METHODS: The study was a retrospective cohort of singleton pregnancies of women aged > or = 35 years old during the period 2004-2008. Women were divided in two groups: group 1 included primigravidas and group 2 those with at least one past labor. Epidemiological characteristics, obstetric and neonatal outcomes were analyzed using the t test and chi-square test. RESULTS: 816 out of 5834 (14%) cases involved women aging > or = 35 years, 234 (28.7%) of which were nulliparous and 582 (61.3%) multiparous. Rate of cesarean section was 2.4 fold higher for primigravidas (p < .0001). Fetal distress, prolonged labor and Neonate Intensive Care Unity (NICU) admission were also significantly higher in group 1. CONCLUSION: Adverse pregnancy outcomes were increased in primigravidas of 35 years and older compared to multigravidas of the same age.

Epidemiological characteristics and trends of caesarean delivery in a University Hospital in Northern Greece.

BACKGROUND: Current obstetric practice is characterised by a continuous increase in caesarean section (CS) delivery rates. OBJECTIVE: Main purpose of our study was to estimate the overall and annual rates of CS in a University Hospital in Greece. METHODS: This was a retrospective chart review of all singleton pregnancies delivered by CS between 2004 and 2008 at a gestational age > 24 weeks. The overall and annual CS rates were calculated. The rate of elective (Group 1) and emergency CS (Group 2) , as well as the specific indications in the two groups of the study were also analyzed. RESULTS: Overall 5362 singleton pregnancies were delivered in the period of the study. The overall CS rate was 29.2% (n = 1564). The mean ±SD maternal age in years of the women delivered by CS was 29.65 ± 6.72 years, while it was 27.10 ±5.63 years for those who delivered vaginally (P<0.0001). The overall rates of elective and emergency CS were 18.2% and 11.0% respectively in the 5-year period of the study. The most common indication for an elective CS was a previous CS (63.1%), which remained almost stable during the period of the study. The main indication for emergency CS was foetal distress in the first three years of the study, while labour progress failure was the leading indication in the last two years. CONCLUSION: In this series, the overall CS rate was high. A previous caesarean delivery accounts for about one third of all cases and constitutes the leading indication for elective CS while foetal distress is the most common indication for an emergency caesarean section.

Previous cesarean section increases the risk for breech presentation at term pregnancy.

PURPOSE OF INVESTIGATION: The aim of the present study was to estimate the risk for breech presentation in women with singleton pregnancies at-term who had had at least one previous cesarean section (CS) versus at least one previous vaginal delivery. METHODS: Out of 4269 singleton pregnancies during the study period, 2008 met the inclusion criteria. The history, the number of previous CSs, as well as maternal age, parity, birth weight, gestational age, neonatal sex and placenta previa were used to estimate the risk for breech at term. RESULTS: The overall incidence of breech presentation was 3.2%, while 20% of the women had a history of at least one previous CS. The rate of breech presentation at term in singleton pregnancies after CS increased two-fold (5.3%) when compared to those with at least one previous vaginal delivery (2.6%), (p = 0.01) [OR 2.08 (95% CI, 1.23-3.52)], while the number of the previous CSs did not correlate with breech presentation (p = NS) [OR 0.86 (95% CI, 0.31-2.4)]. CONCLUSION: According to the present study, women with a history of at least one cesarean delivery have an increased risk for breech presentation in the subsequent singleton pregnancy at-term.

Operative vaginal delivery in singleton term pregnancies: short-term maternal and neonatal outcomes.

BACKGROUND: The rate of operative vaginal delivery has remained stable the last decade, however the rate of vacuum has increased against forceps application. Different maternal and neonatal outcomes have been proposed by many reports. The aim of the present study is to compare the short term maternal and neonatal outcomes between vacuum and forceps delivery. MATERIAL AND METHODS: We conducted a medical record review of live born singleton, vacuum and forceps-deliveries. Maternal and delivery characteristics were recorded. Maternal and neonatal outcomes were also assessed. Out of 7098 deliveries, 374 were instrument assisted, 324 were conducted by vacuum (86.7%) and 50 by forceps (13.3%). RESULTS: The incidence of 3rd degree lacerations and periurethral hematomas was similar between vacuum and forceps (3.4% vs. 2% and 0.3% vs 0% respectively), while perineal hematomas were more common in forceps compared with vacuum application (2% vs 0.3% respectively), albeit not significantly. The rate of neonates with Apgar scores