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Biomedical subjects

A Antsaklis

Publications and source records attributed to A Antsaklis.

At least 37 records · Page 2Linked to original sources
PubMed2004

Assessment of ovarian tumors using transvaginal color Doppler ultrasonography.

In our study we used transvaginal color Doppler ultrasonography in a token of 127 women presenting with unilateral ovarian tumor. The characteristics of the tumors were analyzed, the presence of vascularization was checked and the resistance index (RI) was calculated. Consequently, based on a concrete scoring system, we attempted to discriminate these tumors as benign or malignant. It was proven that 24 of 127 ovarian tumors were malignant. Transvaginal color Doppler correctly identified 21 of the 24 malignant tumors, as well as 94 of the 103 benign tumors. In nine other cases we had false-positive results. The sensitivity and the specificity of the method was 87.5% and 91.2%, while the positive and negative predictive values were 70% and 96.9%, respectively.

Adolescent↗
PubMed2003

Fetal blood sampling in twin pregnancies.

OBJECTIVE: To evaluate the role of fetal blood sampling for prenatal diagnosis in twin pregnancies. METHODS: This was a retrospective study of 84 twin pregnancies that had undergone fetal blood sampling between the years 1977 and 2000. These results were compared with those from a similar study on amniocentesis and chorionic villus sampling. RESULTS: Miscarriage occurred in 3.6% of cases after fetal blood sampling. The total fetal loss rate was 13.6% and the fetal loss that could be attributed to the procedure was 8.2%. The procedure-related fetal loss rate was dependent on the indication for fetal blood sampling. The rates of preterm delivery at </= 32 weeks, preterm delivery at </= 35 weeks, perinatal mortality at </= 28 weeks, perinatal mortality at > 28 weeks and neonatal mortality were 16.9%, 28.3%, 10.9%, 3.1% and 7.7%, respectively. CONCLUSION: Fetal blood sampling in twin pregnancies carries higher risks for the fetus than do amniocentesis and chorionic villus sampling. However, it remains useful in evaluating the fetal condition in special circumstances such as hydrops and infection.

Adult↗
PubMed2003

Intrapartum ultrasound for the examination of the fetal head position in normal and obstructed labor.

OBJECTIVE: To assess the feasibility of transabdominal ultrasound for determining fetal head position in laboring women and compare it to digital examination, and to study ultrasonographically the rotation of the fetal head in normal and obstructed labor. DESIGN: This was an observational prospective study of 148 women in active labor. Ultrasound examinations were performed longitudinally in the first and second stages of labor. RESULTS: Assessment of the fetal head position by digital examination was not possible in 60.7% (122/201) of cases in the first stage and 30.8% (41/133) in the second stage of labor. Difficulty in assessing the position was more likely if the occiput was posterior in comparison to anterior and in the maternal right in comparison to the left side. In the second stage, it was three times more likely for the assessment not to be possible digitally if the occiput was posterior. In the cases when assessment by vaginal examination was possible, the correlation with ultrasound was average in the first stage (kappa = 0.59) and good in the second stage (kappa = 0.77). Overall fetal head position assessment by digital examination was accurate in 31.28% of the cases in the first stage and 65.7% of the cases in the second stage of labor. Rotation of the fetal head is highly unlikely when labor begins in the occipital anterior position. Persistent occipital posterior position developed through failure to rotate from an initial occipital posterior or transverse position. Duration of the first stage of labor was independently related to parity and position of the fetal spine at presentation, and duration of the second stage of labor was independently related to parity, birth weight, position of the fetal head at the beginning of the second stage, rotation and position of the head at delivery. CONCLUSION: Ultrasound assessment of the fetal head position in labor is feasible in a busy labor ward. Digital examination is less accurate than ultrasound, in particular in cases of obstructed labor when medical intervention is more likely to be needed. Ultrasound assessment may prove useful in the prediction and diagnosis of difficult and prolonged labor.

Adolescent↗
PubMed2002

Second-trimester amniocentesis vs. chorionic villus sampling for prenatal diagnosis in multiple gestations.

OBJECTIVE: To study the impact of invasive procedures for prenatal diagnosis on multiple pregnancies and compare first-trimester chorionic villus sampling with second-trimester amniocentesis. DESIGN: Retrospective study of 347 second-trimester amniocenteses and 69 chorionic villus sampling procedures. RESULTS: Miscarriage occurred in 4.18% of women after amniocentesis and 4.54% of women after chorionic villus sampling. In the amniocentesis group the risk of miscarriage was higher in the cases with transplacental entry (4.54%) than in those with transamniotic entry (2.08%). The rates of preterm delivery < or = 32 weeks and preterm delivery < or = 35 weeks in the amniocentesis group were 11.8% and 32.4% and in the chorionic villus sampling group 16.66% and 23.8%, respectively. Total fetal loss rate was similar in the amniocentesis group (8.8%) and the chorionic villus sampling group (10.22%). In the 21 cases where selective feticide was carried out the total fetal loss rate was lower in the chorionic villus sampling group (8.3%) than in the amniocentesis group (11.1%), although the difference did not reach statistical significance. CONCLUSION: Chorionic villus sampling appears to be a safe alternative to amniocentesis and should be considered as the method of choice particularly when there is a high risk of an affected fetus necessitating selective feticide.

Abortion, Induced↗
PubMed2001

Use of misoprostol for the termination of second trimester pregnancies.

Surgical termination of pregnancy is of high risk for the woman's health and safe medical ways are required. The use of prostaglandins may substantially reduce this risk. The efficacy and safety of misoprostol as a medication for the termination of the second trimester pregnancies were studied. During a 15-month period ninety-eight healthy pregnant women (13-24 weeks) wishing to terminate their pregnancy due to medical reasons participated voluntarily in this study. Misoprostol was administered 400 microg per os and 400 microg vaginally. Dose was repeated every 6 hours until adequate contractions and cervical ripening were achieved. Outcome measures included successful termination rates, mean expulsion time and side effects of the medication. The efficacy of the method was as high as 91.8% (90/98 cases 95%, CI 86-97%). Mean expulsion time was 10.2 h (range 3-23.4 h) for primigravida and 9.2 h (range 2.5-22.2 h) for multigravida. In 9 cases (9.2%) placenta remnants and in 8 (8.2%) placenta retention were found. Most common side effect was shivering in 17.3% of cases, vomiting and nausea (10.2%), headache and dizziness (7.1%), abdominal pain (79.6%), while diarrhea was noticed in 4.1%. The high efficacy and low incidence of side effects make misoprostol a useful alternative method for medical termination of second trimester pregnancies.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

Use of annexin V antibody to identify apoptotic cells during pregnancy.

In a previous study, we demonstrated that apoptosis increased according to gestational age, accounting partly for the presence of free fetal DNA in maternal plasma and serum. Using simultaneous TUNEL assay and FISH analysis, we identified the fetal origin of part of the apoptotic cell population, but very few TUNEL-positive cells showed hybridization signals since they were in a late apoptosis stage and nuclei were destroyed. In the present study, the apoptotic cell population was identified immunocytochemically using Annexin V, a marker of cells in an early stage of apoptosis. The mean apoptosis rate in mononuclear cells isolated from the peripheral blood of 20 pregnant women in the 16th to 19th week of pregnancy with Annexin V was 6.8 +/- 0.5% (range: 4.2-8.1%) compared to 6.14 +/- 0.5% (range: 3.7-6.9%) obtained with ethidium bromide staining. FISH using X and Y chromosome-specific probes was applied in 11 cases known to be carrying male fetuses. Eighty percent of Annexin V+ cells showed hybridization signals, while the proportion of apoptotic cells showing X/Y signals was 7.8% (range: 5-12%). Although our results are still preliminary, it seems that use of Annexin V antibody to detect the apoptotic cell population improves FISH analysis and allows a more accurate estimate of the proportion of fetal cells among the apoptotic cell population.

Annexin A5↗
PubMed2001

Detection of fetal NRBCs in maternal blood of pregnant carriers of beta-thalassemia using anti-gamma and anti-epsilon monoclonal antibodies.

Fetal nucleated red blood cells (NRBCs) entering maternal circulation during pregnancy constitute a potential source of material for safe and reliable noninvasive prenatal diagnosis. The increased prevalence of beta-thalassemia mutations in countries like Greece may create a problem, making it difficult to distinguish between NRBCs of fetal or maternal origin. Use of Ab against embryonic hemoglobin epsilon may increase specificity for fetal NRBC detection. In the present study, Ab against embryonic hemoglobin epsilon was used in the first and second trimesters of pregnancy in order to determine if specificity for fetal NRBC detection could be increased.

Antibodies, Monoclonal↗
PubMed2001

First trimester transabdominal embryo fetoscopy.

The aim of this study was the visualization of the embryo and blood sampling through transabdominal embryoscopy during the first 12 week of pregnancy. Twenty women attending Alexandra Maternity Hospital, Athens for pregnancy termination were invited to participate in this study. Informed consent was obtained before participation. The gestational age ranged between 9 and 12 weeks from LMP. We used a Karl Storz semirigid fiberoptic endoscope 20 cm in length, with a diameter of 1 mm and an angle of view of 70 degrees. Under local anesthesia the endoscope was introduced transabdominally into the amniotic sac, using continuous ultrasound guidance. Complete examination of the embryo including head, face, limbs ventral and dorsal walls, genitalia, placenta, umbilical cord and yolk sac were performed. A 0,6 mm diameter puncture needle was inserted into the blood vessels of the chorionic plate or umbilical cord through the side arm of the canulla to obtain a small amount of blood. The complete anatomical survey was possible in all cases (100%). Access to the embryonic circulation was attempted in 14 cases. A small quantity of blood was obtained in 10 cases (71,4%). The average length of the procedure was 15 min. No maternal complications were recorded. D & C were performed 24 hours after the embryoscopy. Embryoscopy represent a diagnostic tool to confirm a diagnosis suspected through noninvasive means. Gaining access to the embryonic circulation when embryos are immunologically naïve will allow perhaps gene or cell therapy. Finally embryoscopy may be helpful to study the biology of embryonic development.

Embryo, Mammalian↗
PubMed2000

The effect of gestational age and placental location on the prediction of pre-eclampsia by uterine artery Doppler velocimetry in low-risk nulliparous women.

OBJECTIVE: To assess how placental position and gestational age can influence the value of a diastolic notch of the uterine arteries as a screening test for pre-eclampsia, in a low-risk population of healthy nulliparous women. METHODS: Color Doppler ultrasound was used to examine both uterine arteries in 654 healthy nulliparas at 4-week intervals between 20 and 32 weeks. The only criterion for an abnormal result was the presence of an early diastolic notch. In each subject the placental position was also recorded. The major end points were pre-eclampsia and pre-eclampsia requiring delivery before the 34th week. RESULTS: Ninety-eight women (15%) had abnormal flow velocity waveforms at their first visit. Twenty-one out of 654 women developed pre-eclampsia (3.2%). The sensitivity of the test became lower as gestational age advanced and ranged from 81% at 20 weeks, to 71.4% at 32 weeks. In contrast, the specificity and positive predictive value increased significantly. Eleven out of 12 women who delivered before 34 weeks had abnormal waveforms at the 24th week. In women with a full lateral placenta, the predictive value of the test was extremely low, especially in cases with unilateral notches. CONCLUSION: Pre-eclampsia can be more accurately predicted if, along with the presence of a notch, both gestational age and placental position are taken into account. At week 24 the test maintains a high sensitivity (76.1%), but also has an improved specificity (95.1%) and positive predictive value (34%), which allow the clinician to intervene with a potential preventive treatment.

Arteries↗
PubMed2000

Genetic amniocentesis in women 20-34 years old: associated risks.

The aim of this retrospective controlled study is to evaluate the impact of predisposing factors on amniocentesis-related fetal loss. It comprises 3910 consecutive cases of women, aged 20-34 years, who had genetic amniocentesis during the years 1992-97 (study group). The control group comprised 5324 women under 35, at low risk for Down syndrome, during the same period. The fetal losses in both groups were analysed, in respect of: (a) maternal historical conditions; and/or (b) bleeding during current pregnancy. The leading indication for amniocentesis in women 20-34 years was maternal anxiety, mainly for marginal age (33-34 years), which accounted for a remarkable 34.4% of the study group. Total fetal loss rate up to the 28th week was 2.1% in the study group versus 1. 5% in controls. A history of previous spontaneous or induced abortions, as well as bleeding during the current pregnancy, was associated with a substantial rise of fetal loss in both groups. In cases with no predisposing factors, the added fetal loss rate was 0.03%. Previous abortions and bleeding during the current pregnancy are associated with the most fetal losses after amniocentesis. In the absence of these, the added fetal loss rate (0.03%) is non-significant.

Abortion, Spontaneous↗
PubMed1999

Pregnant women of 35 years of age or more: maternal serum markers or amniocentesis?

The aim of this prospective study was to compare triple test screening (alpha-fetoprotein, beta-chorionic gonadotrophin and unconjugated oestriol) with amniocentesis in the detection of fetuses with Down's syndrome in women of 35 years of age or more. Between 1992 and 1996, maternal serum markers were evaluated in 1406 women who had amniocentesis for prenatal diagnosis of chromosomal abnormalities related to a maternal age of 35 or more years. Sixteen fetuses with Down's syndrome were identified in the whole group by amniocentesis and karyotyping. The group with negative triple test screening consisted of 919 pregnancies and included two fetuses with trisomy-21 (false negatives). With triple test screening in the age group over 35, there was a detection rate of 87.5% for cut-off points ranging from 1:200 up to 1:350, with corresponding false positive rates ranging between 23% and 34%. In our population, if we had practiced the policy of offering amniocentesis only to women screening positive for the ages of 35 and 36 and to all pregnant women of 37 or more, we would have carried out 30% less amniocenteses. In this group of 1406 women, 33 abnormal karyotypes were detected with amniocentesis (16 Down's syndrome included) and equal number of elective abortions were carried out. Nevertheless, 19 healthy fetuses and neonates were lost after amniocentesis. Considering the high detection rates that can be achieved with triple test screening, the existing procedure related risk of amniocentesis (0.5-1.0%), and the facts that conception in women over 35 years of age is usually more difficult and the background loss usually higher than in younger women, we believe that in the future women over 35 should be offered a choice between non-invasive and invasive procedures after being thoroughly informed.

Journal Article↗
PubMed1998

Fetal blood sampling--indication-related losses.

The aim of this study, was to determine the fetal loss rate after fetal blood sampling (FBS) in relation to the indication. In total, 1981 FBS procedures (1878 pregnancies) were included, of which 117 were performed for the detection of congenital infection (group 1), 1437 for the detection of haemoglobinopathy (group 2), 233 for prenatal diagnosis with normal ultrasound findings (group 3), 121 for rapid karyotyping in cases with abnormal sonographic findings (group 4) and 73 for severe growth retardation (group 5). All the procedures were performed with a free-hand technique under continuous ultrasound guidance. Pregnancy losses occurring within two weeks of FBS were considered procedure-related losses. 343 pregnancies were terminated. Of the remaining 1535 continuing pregnancies, 73 (4.8 per cent) were lost, of which 39 (2.5 per cent) were lost within two weeks of the procedure. The procedure-related losses were 3 in 103 (2.9 per cent), 17 in 1090 (1.6 per cent), 2 in 191 (1 per cent), 11 in 84 (13.1 per cent) and 6 in 67 (8.9 per cent) in groups 1, 2, 3, 4 and 5, respectively. The differences in procedural loss between the five groups were highly significant, suggesting that the method entails a much higher risk when the fetus is structurally abnormal, or severely growth retarded. Patients should therefore be counselled before the procedure accordingly.

Adolescent↗
PubMed1998

Factors affecting postoperative pregnancy rate after endoscopic management of large endometriomata.

OBJECTIVE: To identify factors influencing postoperative pregnancy rate in women with extensive endometriosis and large endometriomata as the only identified cause of infertility that were treated by laparoscopy. METHOD: Sixty-four infertile patients with endometriomata (> or = 3 cm) and no other apparent cause of infertility. The latter were removed by operative laparoscopy. Life table calculations, the Student's t-test and the chi2 test were used where appropriate. RESULT: Thirty-four patients (53%) became pregnant during the 2-year follow-up period. A significantly increased pregnancy rate was found for the first year compared to the second (76 vs. 24%). The existence of adhesions affected adversely the outcome of the operation only as far as early achievement of pregnancy is considered. The number and size of endometriomata and the existence of peritoneal implants have not been found to affect pregnancy rates. The severity of the disease did not affect pregnancy rate, but in the cases with moderate disease most of the pregnancies were achieved during the first postoperative year. The duration of infertility was significantly associated only at the 10% level with decreased pregnancy rates. CONCLUSION: Extensive endometriosis with large endometriomata can be safely and effectively treated with laparoscopy using the traditional laparoscopic tools providing the infertile patient with a high chance to conceive in a relatively short period of time postoperatively.

Adult↗
PubMed1998

Biotin plasma levels of the human fetus.

Biotin is an important vitamin for cellular function and growth and, therefore, essential for fetal development. The fetus is exclusively dependent on maternal biotin supply. Since biotin is not produced within the body, maternal biotin levels depend on dietary intake. In order to investigate the biotin status of the human fetus, we measured the plasma biotin levels in 15 pregnant women and their fetuses who underwent amniocentesis and fetal blood sampling at 18-24 weeks of gestation for prenatal diagnosis of thalassemia. Maternal biotin was found to be 131 +/- (SD) 102 ng/l and fetal biotin 784 +/- 327 ng/l (p < 0.0001). Our findings are indicative of an active transport mechanism of biotin through the placenta in favor of the fetus.

Biotin↗
PubMed1997

Thrombosis prophylaxis after treatment during pregnancy.

Deep vein thrombosis (DVT) is not a rare occurrence during pregnancy and puerperium due to changes in the coagulation mechanism. Eighteen cases with DVT during pregnancy are presented here. All of them received subcutaneous heparin for two weeks at a dose adjusted so as to prolong the activated partial thromboplastin time, or plasma recalcification time, to twice that of normal controls. Treatment continued with low molecular weight heparin (LMWH), once daily subcutaneously, for the duration of pregnancy and for one month postpartum. All women went into labor uneventfully, except for one who had a missed abortion during the 10th week. No side-effects were observed. LMWH has some advantages compared with standard heparin, which make it the treatment of choice for the prevention of thromboembolic events in pregnant women.

Adult↗