First trimester screening for Down syndrome in rhesus negative women.

OBJECTIVES: To explore the effect of maternal rhesus status on first-trimester screening markers for Down syndrome. METHODS: We accessed a database of singleton pregnancies undergoing first-trimester genetic screen with maternal Rh status documented and pregnancy outcome information available. Excluded were cases of fetal chromosomal or structural abnormalities, or maternal systemic disease. Results of maternal serum pregnancy-associated plasma protein A (PAPP-A) and beta-human chorionic gonadotrophin (beta-hCG) adjusted for gestational age were compared between Rh-negative and Rh-positive women with p < 0.05 considered significant. RESULTS: Two thousand two hundred and two pregnancies fulfilled the study criteria, and 160 of them (7%) were Rh negative. Only free beta-hCG corrected multiples of the median (MoM) values were statistically increased in Rh-negative women (p < 0.009). Using a cut-off of 1:300, screen-positive rates of maternal serum biochemistry were not significantly different between Rh-negative and Rh-positive women (12.5 vs 10.4%, p = 0.41). CONCLUSION: The present study focused on measurements of beta-hCG and PAPP-A in the sera of women with Rh-negative blood group. Women with Rh-negative blood type have similar first-trimester serum PAPP-A MoM values as Rh-positive women, but significantly higher beta-hCG MoM values. However, there was no significant difference in the screen-positive rate for Down syndrome between the two groups.

Pregnancy outcome following second-trimester amniocentesis: a case-control study.

The purpose of this study was to investigate whether second-trimester amniocentesis increases fetal loss rate. Two thousand sixty-eight women with singleton gestations who underwent mid-trimester amniocentesis at 15 to 22 weeks gestation and 2068 controls matched one-to-one for maternal age, parity, and the number of prior spontaneous abortions were studied prospectively in a case-control study design. The fetal loss rates and other adverse pregnancy outcomes were compared between the study and control groups using the Pearson chi2 test or Fisher exact test when appropriate. In the amniocentesis group, eight (0.4%) fetal losses occurred within 30 days of the procedure, and in the control group, six (0.3%) losses occurred within 30 days of the inclusion in the study; the difference was not statistically significant ( p = 0.59; OR, 1.34; 95% CI, 0.46 to 3.85). The total fetal loss rates including spontaneous abortions and intrauterine fetal deaths/stillbirths were 2.3 and 2% in the study and control groups, respectively, and the difference was not significant ( p = 0.59; OR, 1.12; 95% CI, 0.74 to 1.71). Amniotic fluid leakage occurred in only two (0.1%) of 2068 study patients. Transplacental needle passage was not associated with an increased risk of pregnancy loss compared with nontransplacental amniocentesis ( p = 0.92; OR, 0.96; 95% CI, 0.47 to 1.95). There was no statistically significant difference in fetal loss rate between women requiring two needle insertions to obtain amniotic fluid and those having only one insertion ( p = 1.00; OR, 0.75; 95% CI, 0.10 to 5.53). The rates of preterm deliveries, small for gestational age infants, preeclampsia/eclampsia, placental abruptions, and cesarean deliveries were also not significantly different between two groups (each p > 0.05). We conclude that second-trimester amniocentesis for prenatal diagnosis is a safe procedure that does not appear to increase fetal loss rate.

The effect of hormone therapy on plasma homocysteine levels: a randomized clinical trial.

OBJECTIVE: An elevated plasma homocysteine level is a risk factor for cardiovascular diseases. Hormone therapy (HT) may reduce fasting plasma homocysteine levels. We studied 80 postmenopausal women to determine the effect of medroxyprogesterone acetate (MPA) combined with conjugated equine estrogens (CEE) on fasting plasma homocysteine levels. DESIGN: In a randomized, double blind, prospective, placebo-controlled study, we randomly assigned 80 healthy postmenopausal women between CEE 0.625 mg/d combined with MPA 2.5 mg/d (n = 20), CEE 0.625 mg/d combined with MPA 5 mg/d (n = 20), unopposed CEE 0.625 mg/d (n = 20), and placebo (n = 20) all given for a duration of 6 months. Fasting plasma homocysteine levels were measured before and at the end of the treatment. RESULTS: Before treatment, plasma homocysteine concentrations were similar in all groups. After 6 months of unopposed CEE, the mean fasting plasma homocysteine levels decreased by 19.02% when compared with baseline levels (P < 0.05). The mean fasting plasma homocysteine concentrations decreased by 17.63% and 19.56% from baseline in both the CEE plus MPA 2.5 mg/d and CEE plus MPA 5 mg/d groups, respectively (P < 0.05 for each group). In contrast, plasma homocysteine levels increased by 11.66% in the placebo group. The homocysteine lowering effect did not differ significantly among the three groups of women receiving unopposed CEE alone and CEE plus MPA at two different doses. CONCLUSION: Six months of estrogen therapy (ET) and combined estrogen-progestogen therapy (EPT) significantly lower fasting plasma homocysteine levels in healthy postmenopausal women with equal efficacy.