Reduced fetal growth velocity precedes antepartum fetal death.

OBJECTIVES: To determine whether decreased fetal growth velocity precedes antepartum fetal death and to evaluate whether fetal growth velocity is a better predictor of antepartum fetal death compared to a single fetal biometric measurement at the last available ultrasound scan prior to diagnosis of demise. METHODS: This was a retrospective, longitudinal study of 4285 singleton pregnancies in African-American women who underwent at least two fetal ultrasound examinations between 14 and 32 weeks of gestation and delivered a liveborn neonate (controls; n = 4262) or experienced antepartum fetal death (cases; n = 23). Fetal death was defined as death diagnosed at ≥ 20 weeks of gestation and confirmed by ultrasound examination. Exclusion criteria included congenital anomaly, birth at < 20 weeks of gestation, multiple gestation and intrapartum fetal death. The ultrasound examination performed at the time of fetal demise was not included in the analysis. Percentiles for estimated fetal weight (EFW) and individual biometric parameters were determined according to the Hadlock and Perinatology Research Branch/Eunice Kennedy Shriver National Institute of Child Health and Human Development (PRB/NICHD) fetal growth standards. Fetal growth velocity was defined as the slope of the regression line of the measurement percentiles as a function of gestational age based on two or more measurements in each pregnancy. RESULTS: Cases had significantly lower growth velocities of EFW (P < 0.001) and of fetal head circumference, biparietal diameter, abdominal circumference and femur length (all P < 0.05) compared to controls, according to the PRB/NICHD and Hadlock growth standards. Fetuses with EFW growth velocity < 10th percentile of the controls had a 9.4-fold and an 11.2-fold increased risk of antepartum death, based on the Hadlock and customized PRB/NICHD standards, respectively. At a 10% false-positive rate, the sensitivity of EFW growth velocity for predicting antepartum fetal death was 56.5%, compared to 26.1% for a single EFW percentile evaluation at the last available ultrasound examination, according to the customized PRB/NICHD standard. CONCLUSIONS: Given that 74% of antepartum fetal death cases were not diagnosed as small-for-gestational age (EFW < 10th percentile) at the last ultrasound examination when the fetuses were alive, alternative approaches are needed to improve detection of fetuses at risk of fetal death. Longitudinal sonographic evaluation to determine growth velocity doubles the sensitivity for prediction of antepartum fetal death compared to a single EFW measurement at the last available ultrasound examination, yet the performance is still suboptimal. © 2020 International Society of Ultrasound in Obstetrics and Gynecology.

Lactobacillus crispatus dominant vaginal microbita in pregnancy.

OBJECTIVE: To summarize current knowledge regarding Lactobacillus crispatus-dominated vaginal microbiota in pregnancy, as well as an association between the presence of Lactobacillus crispatus-dominated vaginal microbiota and pregnancy complications. DESIGN: Review. SETTING: Department of Obstetrics and Gynecology, University Hospital Hradec Kralove. MATERIAL AND METHODOLOGY: In this review, the results from literature available about the presence of L. crispatus-dominated microbiota in pregnancy are summarized. RESULTS: Pregnant women with Lactobacillus crispatus-dominated vaginal microbiota is very common in pregnancy and it is associated with a lower risk of preterm delivery. CONCLUSION: Lactobacillus crispatus-dominated vaginal microbiota represents an optimal vaginal microbiota in pregnancy.

[Ultrasound diagnosis of fetal inflammatory response syndrome in women with preterm premature rupture of membrane]. / Ultrazvuková diagnostika syndromu fetální zánetlivé odpovedi u zen s predcasným odtokem plodové vody.

OBJECTIVE: The aim of this review is to analyze the existing possibilities of using ultrasound in the diagnosis of the fetal inflammatory response. DESIGN: Review. SETTINGS: Gynekologicko-porodnická klinika, Fakultní nemocnice Ostrava. METHODS: Preterm delivery is defined as a delivery before completed 37 weeks of gestation. Approximately one-thirdof these cases is associated with preterm premature rupture of membranes. About forty percent of preterm premature rupture of membranes is complicated by the fetal inflammatory response syndrome, which is associated with the development of severe perinatal morbidity. Recent prenatal diagnosis of the fetal inflammatory response syndrome is based on the invasive methods (amniocentesis, cordocentesis), which are limited by several risk factors accompanying these procedures and technical difficulties. Therefore, there is an effort to replace them by non-invasive approach. The development of ultrasound, as a diagnostic method through the last decade, and knowledge of pathophysiological and morphological changes in fetal organs associated with the fetal inflammatory response may lead to more specific diagnosis in the future and improvement of neonatal outcome. CONCLUSION: Early identification of fetuses affected by FIRS in pregnancies with PPROM is necessary for right management of these pregnancy pathology. At this moment, ultrasonography examination of fetal lineal vein and fetal echocardiography, seems to be suitable for diagnosing FIRS.

[Management of preterm prelabor rupture of membranes with respect to the inflammatory complications - our experiences]. / Management predcasného odtoku plodové vody s ohledem na zánetlivé komplikace - nase zkusenosti.

OBJECTIVE: Preterm prelabor rupture of membranes is responsible for approximately one third of all preterm deliveries. The most common complications associated with this pregnancy pathology are microbial invasion of the amniotic cavity, intraamniotic inflammation, intraamniotic infection and histological chorioamnionitis. This article explains these complicatioss and their relation to the optimal management of preterm prelabor rupture of membranes. DESIGN: Overview study. SETTING: Department of Obstetrics and Gynecology, Charles University in Prague, Faculty of Medicine and University Hospital Hradec Kralove. METHODS: To analyze current knowledge and our own experiences regarding inflammatory complications of preterm prelabor rupture of membranes. CONCLUSION: Inflammatory complications of preterm prelabor rupture of membranes are associated with risk of development of early onset sepsis. Nevertheless, gestational age is a main confounder affecting neonatal morbidity and mortality.

[Proteomics and biomarkers for detection of preterm labor: a systematic review]. / Proteomika a biomarkery predcasného porodu: systematický prehled literatury.

OBJECTIVE: To review the published articles about identification of biomarkers of spontaneous preterm birth using a proteomic approach and to create a list of potential biomarkers. DESIGN: Systematic review of literature. SETTING: Department of Obstetrics and Gynecology, Medical Faculty Charles University Hradec Kralove. METHODS: The following databases were accessed in search of relevant citation: MEDLINE, SCOPUS and PubMed. Totally 101 references were identified and relevant 37 abstracts were screened. As appropriated were pointed 16 studies. Finally, the data were extracted from five articles. CONCLUSION: The implementation of high-throughput technologies is necessary in the field of spontaneous preterm birth research. A compelling option is the use of proteomics in the area spontaneous preterm birth biomarkers identification in amniotic fluid, maternal serum/plasma, cervical-vaginal fluid and placental tissue. The data was extracted from published articles and a list of 72 proteins was created.

[Possible use of Doppler velocimetry in the detection of discordant growth of twins]. / Moznosti uzití dopplerovské flowmetrie v detekci diskordantního rustu dvojcat.

OBJECTIVE: To evaluate the clinical utility of Doppler velocimetry as a comprehensive test for the prediction of discordant twins. DESIGN: Prospective clinical study. SETTING: Department of Gynecology and Obstetrics, Charles University Hospital, Hradec Králové, Czech Republic. METHODS: Biometrical measurements and Doppler velocimetry of umbilical artery (UA) and middle cerebral artery (MCA) were performed in twins in third trimester. Intertwin differences in biometrical parametres delta BPD, delta AC, delta FL, delta EFW and in pulsality indexes of studied vessels delta UA a delta MCA were expressed. Discordance was identified by the birth weight difference from 20%. Studied parameters were evaluated using ROC analysis. RESULTS: Among the 63 sets of twins studied, 33 pars fulfilled the study criteria. 21 pars were bichorionic, 7 monochorionic and 5 with unknown chorionicity. Ten sets of twins were discordant (303%). The mean gestational age at delivery was 35.9 +/- 1.7 weeks. Overall the best discordancy predictor was delta EFW with sensitivity and specificity values of 100% and 95.7%, respectively, for the cut-off value delta EFW 17.9%. The more accurate one of doppler parameters was MCA, with sensitivity and specificity values of 85.7% and 77.9%, respectively, for the cut-off value delta MCA 25%. UA had senzitivity and specificity 70% and 47.8%, respectively, for most suitable cut-off value delta UA 16.7%. CONCLUSION: It is possible to predict the discordant twins birth using middle cerebral artery Doppler velocimetry, but the EFW assessment remains the most accurate method. Umbilical artery Doppler velocimetry did not appeared as effective.

[Prenatal detection of congenital mezoblastic nephroma]. / Prenatální záchyt kongenitálního mezoblastického nefromu.

TYPE OF STUDY: Case report. SETTING: Department of Gynecology and Obstetrics, Department of Radiology, Department of Pathology, Department of Medical Genetics, Charles University Hospital, Hradec Králové. METHODS: The autors report a case of renal tumor in a fetus at 33 weeks of gestation detected by means of ultrasonography and magnetic resonance imaging. The pregnancy course was complicated by polyhydramnios. The female infant was born vaginally at 37 weeks of gestation. Postnatal nephrectomy confirmed prenatal diagnostic presumption - congenital mezoblastic nephroma. At follow-up at 12 months of age, the infant had no evidence of the disease. CONCLUSION: Detection of renal tumor in a fetus is rare. Congenital mezoblastic nephroma with the favourable prognosis is most probable diagnosis. Prenatal detection enables the prevention of complications (prematurity prevention, detection of the developing cardial decompensation and fetal hydrops) with the planning of labour and postnatal management.