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C Romanini

Publications and source records attributed to C Romanini.

At least 19 recordsLinked to original sources
PubMed2000

Relation between decreased anandamide hydrolase concentrations in human lymphocytes and miscarriage.

BACKGROUND: Endocannabinoids such as anandamide are thought to have adverse effects on pregnancy and embryonic development. The activity of the degradative enzyme anandamide hydrolase may therefore be crucial for prevention of excessive concentrations of anandamide in the uterus, and thus prevention of pregnancy failure or female infertility. We tested this hypothesis in a preliminary study, and then used the results to find out whether anandamide hydrolase activity could predict miscarriage in a group of pregnant women. METHODS: We assessed anandamide hydrolase activity in peripheral lymphocytes from 50 healthy, pregnant women at weeks 6-11 of gestation by a specific radiochromatographic method. The expression of the enzyme at the protein level was measured by ELISA with specific polyclonal antibodies. In a further study, we measured anandamide hydrolase concentration in 120 women who were 7-8 weeks pregnant and compared these findings with subsequent pregnancy outcome. FINDINGS: In the first study, seven of the 50 women had a miscarriage. Anandamide hydrolase activity was lower in the seven women who miscarried than in the 43 who did not (60.43 pmol/min per mg protein [SD 29.34] vs 169.60 pmol/min per mg protein [30.20]; difference 109.17 pmol/min per mg protein [95% CI 26.64-191.70]; p<0.0001 by the Mann-Whitney test). Enzyme activity correlated with enzyme concentration, and a threshold concentration represented by an optical density (after ELISA) of 0.15 absorbance units at 450 nm separated the women who had miscarriages from those who did not. In the second study, 15 women had anandamide hydrolase concentrations below the threshold, and 105 had concentrations at or above the threshold. All 15 women in the low anandamide hydrolase group had miscarriages, compared with one of the 105 women with high concentrations (p<0.0001 by Fisher's exact test). INTERPRETATION: Decreased anandamide hydrolase activity and expression in peripheral lymphocytes is an early (<8 weeks of gestation) marker of spontaneous abortion, and may prove useful as a diagnostic tool for large-scale, routine monitoring of gestation. Our results also suggest that endocannabinoids might be critical in regulating the lymphocyte-dependent cytokine network associated with human fertility and successful pregnancy.

Abortion, Habitual↗
PubMed2000

Estroprogestin vs. gonadotrophin agonists plus estroprogestin in the treatment of endometriosis-related pelvic pain: a randomized trial. Gruppo Italiano per lo Studio dell'Endometriosi.

OBJECTIVE: This is a randomized clinical trial comparing estroprogestin (E/P) pill given for 12 months vs. gonadotrophin releasing hormone agonist (GNRHa) given for 4 months followed by E/P pill treatment for 8 months in the relief of endometriosis-related pelvic pain. METHODS: Eligible for the study were women with laparoscopically confirmed endometriosis and pelvic pain lasting 3-12 months after diagnosis. Eligible women were randomly assigned to treatment with E/P pill (gestroden 0.75 mg and ethynlestradiol 0.03 mg) for 12 months (47 patients) vs. tryptorelin 3.75 mg slow release every 28 days for 4 months followed by E/P pill for 8 months (55 patients). RESULTS: At baseline, dysmenorrhea was reported in 46 women allocated to E/P pill only (97.9%), and in all the 55 women allocated to GNRHa+E/P pill. The corresponding value at the 12 months follow-up visit was 14 subjects (35.9%) and 16 subjects (34.8%). The baseline median values of the multidimensional and analog scale were for dysmenorrhea 4 and 6 in the EP only and 3 and 6 in the GNRHa+E/P group. The corresponding value at the 12 months follow-up visit were 2 and 6 and 0 and 5. Non-menstrual pain was reported, respectively, at baseline and 12 month visit by 46 (97.9%) and 15 (38.5%) subjects in the E/P pill group and 49 (89.1%) and 17 (37.0%) of the GNRHa+E/P pill one. The baseline median values of the multidimensional and analog scale were for non-menstrual pain 3 and 5 in the E/P only and 2 and 6 in the GNRHa+E/P group. The corresponding values at the 12 month follow-up visit were 0 and 4 and 0 and 4. These differences between the two groups were not statistically significant. CONCLUSIONS: 1 year after randomization, the two treatment schedules show similar relief of pelvic pain in women with endometriosis.

Adult↗
PubMed2000

Is local anesthesia an affordable alternative to general anesthesia for minilaparoscopy?

STUDY OBJECTIVE: To determine if minilaparoscopy under local anesthesia is at least as reliable and affordable as that performed under general anesthesia. DESIGN: Prospective, randomized study (Canadian Task Force classification I). SETTING: University-affiliated hospital. PATIENTS: One hundred sixty-four consecutive women evaluated for infertility. INTERVENTION: Diagnostic minilaparoscopy performed after women were randomized to receive general or local anesthesia with conscious sedation. MEASUREMENTS AND MAIN RESULTS: Levels of postoperative pain measured by visual analog scale; volume of CO(2) used; length of procedure, complete pelvic evaluation, and hospitalization; complications; and pathologic diagnosis were evaluated. The groups were comparable in age, years of infertility, and symptoms. For women receiving local anesthesia, 5.5% required general anesthesia to complete the procedure. Women in both groups required postoperative analgesics. The groups had no statistically significant differences in pain level 1 hour after the procedure, number of complications, and pelvic pathology. Patients who had local anesthesia required a smaller volume of CO(2) (p <0.01) and their hospitalization was significantly shorter (p <0.01). However, in 15% of these women pelvic visualization was incomplete, compared with 7.2% in the general anesthesia group. CONCLUSION: Minilaparoscopy performed under local anesthesia was as reliable and affordable as when performed under general anesthesia.

Adult↗
PubMed2000

Blood flow velocity waveforms from fetal peripheral pulmonary arteries in pregnancies with preterm premature rupture of the membranes: relationship with pulmonary hypoplasia.

OBJECTIVES: To measure fetal peripheral pulmonary artery velocity waveforms by Doppler ultrasonography in pregnancies complicated by premature rupture of membranes under 24 weeks' gestation and to relate the Doppler indices to the development of fetal pulmonary hypoplasia. DESIGN: A prospective longitudinal study of fetal peripheral pulmonary artery velocity waveforms from premature rupture of membranes to delivery. SUBJECTS: Twenty pregnancies complicated by premature rupture of membranes before 24 weeks of gestation and delivering after 26 weeks. METHODS: Peripheral pulmonary artery velocity waveforms were recorded by Doppler technique at weekly intervals until delivery and Pulsatility Index (PI) calculated. Pregnancies were managed conservatively according to an institutional management protocol. Pulmonary hypoplasia was defined at autopsy by lung/body weight ratios and radial alveolar counts. Pulsatility Indices of fetuses developing pulmonary hypoplasia were compared with those with a normal lung development. RESULTS: After premature rupture of membranes PI values were higher than normal reference limits for gestation, but no differences were found between the six fetuses which developed pulmonary hypoplasia and the remaining 14 fetuses with normal lung development. In this latter group PI values progressively decreased with advancing gestation (ANOVA for repeated measurements F = 11.61; P < or = 0.001), while they increased in fetuses developing pulmonary hypoplasia (F = 8.44; P < or = 0.001). As a consequence of these opposite trends significant differences in PI values were present between the two groups of fetuses from 2 weeks after the premature rupture of membranes. Two weeks after the premature rupture of membranes a PI value from the peripheral pulmonary arteries above the 95th centile had a sensitivity of 62.5%, specificity of 94.6%, positive predictive value of 83.3%, negative predictive value of 78.5% and relative risk of 3.88 (95th confidence interval 1.34-11.28) for the prediction of pulmonary hypoplasia. CONCLUSION: The measurement of peripheral pulmonary velocity waveforms may help to establish the risk of developing pulmonary hypoplasia in pregnancies complicated by premature rupture of membranes.

Adult↗
PubMed1999

Expression of vascular endothelial growth factor related to 72-kilodalton metalloproteinase immunostaining in patients with serous ovarian tumors.

BACKGROUND: The aim of the current study was to investigate the expression of vascular endothelial growth factor (VEGF) by neoplastic cells in patients with serous ovarian tumors. The correlation between neoangiogenesis and 72-kilodalton metalloproteinase (MMP2) immunostaining also was evaluated. METHODS: Fifty-eight patients with serous ovarian tumors who were treated at the Institute of Gynecology and Obstetrics of Ancona University (Ancona, Italy) were used as the study population; 10 women had serous cystoadenoma, 16 women had a serous borderline tumor, and 32 women had invasive cystoadenocarcinoma. Expression of VEGF and MMP2 was evaluated immunohistochemically by polyclonal antibody anti-VEGF (dilution, 1:100) and affinity purified, rabbit anti-MMP2, formalin fixed, paraffin embedded tissue. Positive staining was expressed as a percentage of positive cells per 10(3) counted neoplastic cells. RESULTS: Compared with cystoadenomas and borderline tumors, the tessutal VEGF immunostaining was significantly higher in cystoadenocarcinomas, with the highest values detected in architectural International Federation of Gynecology and Obstetrics Grade 3 neoplasms (P2 < 0.001). A direct relation was observed between VEGF and MMP2 immunostaining (correlation coefficient, 0.44; P2 = 0.013). A relation was found between VEGF expression and disease free survival as evaluated by Cox hazards analysis (P2 = 0.03). CONCLUSIONS: Neoangiogenesis detected by VEGF immunostaining appears to be a promising indicator of aggressiveness in serous ovarian tumors. In cystoadenocarcinomas, VEGF expression appears to be related to MMP2 index.

Adult↗
PubMed1999

Cisplatin-based polychemotherapy reduces the natural cytotoxicity of peripheral blood mononuclear cells in patients with advanced ovarian carcinoma and their in vitro responsiveness to interleukin-12 incubation.

BACKGROUND: The aim of the current study was to evaluate the in vitro effect of IL-12 on the natural cytotoxicity of peripheral blood mononuclear cells (PBMCs) obtained from patients who underwent adjuvant-based cisplatin polychemotherapy for advanced ovarian carcinoma. The authors also investigated amifostine, a cytoprotective agent that appears to protect against chemotherapy damage to healthy tissues, to determine its effects on natural immune function. METHODS: Twenty-one women with advanced ovarian serous cystoadenocarcinoma who underwent adjuvant cisplatin-based polychemotherapy were included in the study, and 20 normal volunteer women matched for age served as controls. Six of the 21 women who underwent polychemotherapy received 1:3 amifostine pretreatment. Blood samples were obtained immediately before the first cycle of cisplatin-based polychemotherapy and within 24 hours after the completion of polychemotherapy infusion to evaluate the natural cytotoxic activity of PBMCs against the K562 cell line and the in vitro responsiveness of cytotoxic cells to interleukin-12 (IL-12). RESULTS: The in vivo administration of cisplatin-based polychemotherapy significantly reduced the natural killer cytotoxicity of PBMCs toward undetectable levels (2.2+/-3.1 vs. 9.2+/-7.0 lytic units, respectively, after and before cisplatin; P < 0.01), and the in vitro exposure to IL-12 did not increase the cytolytic activity of PBMCs (1.9+/-2.1 lytic units). PBMCs from the 6 patients who received random amifostine pretreatment were shown to have retained natural killer cytotoxicity after in vivo administration of cisplatin polychemotherapy (9.7+/-6.7 vs. 9.6+/-6.0 lytic units, respectively, after and before cisplatin; P = 0.9), and the incubation with IL-12 increased cytotoxic activity (13.4+/-6.9 lytic units) toward the levels observed in PBMCs of controls (14.0+/-4.6 lytic units). CONCLUSIONS: These data suggest that cisplatin-based polychemotherapy reduces the natural cytotoxicity of PBMCs in patients with advanced ovarian carcinoma as well as their in vitro responsiveness to IL-12 incubation. Amifostine demonstrated a protective effect on natural killer cell cytotoxicity and responsiveness to IL-12 in this small cohort of patients.

Amifostine↗
PubMed1999

Vascular endothelial growth factor expression as a prognostic index in serous ovarian cystoadenocarcinomas: relationship with MIB1 immunostaining.

OBJECTIVE: The aim of our study was to investigate the expression of vascular endothelial growth factor (VEGF) by neoplastic cells in serous ovarian cystoadenocarcinomas; the correlation between this marker of angiogenesis, histopathologic parameters, disease-free survival, and MIB1 immunostaining was also evaluated. MATERIALS AND METHODS: Thirty-two patients with serous ovarian cystoadenocarcinoma, treated at the Institute of Gynecology and Obstetrics, Ancona University (Italy), were used as study population; 10 women with serous cystoadenoma were also analyzed. The expression of VEGF was immunohistochemically evaluated by polyclonal antibody anti-VEGF (Santa Cruz, CA, dilution 1:100) on formalin-fixed paraffin-embedded tissue. RESULTS: Compared to cystoadenomas, the tissutal VEGF immunostaining was significantly higher in cystoadenocarcinomas, with the highest values in architectural grade 3 neoplasms (P < 0. 001). A direct relationship was observed between VEGF immunostaining and MIB1 index (r = 0.44, P = 0.013). A relationship was defined between VEGF expression and disease-free survival, evaluated by Cox hazards analysis (P < 0.001). CONCLUSIONS: Angiogenesis, evaluated by VEGF immunostaining, seems to be an interesting prognostic indicator in serous ovarian cystoadenocarcinoma, involved in neoplastic proliferation.

Adult↗
PubMed1999

Monitoring of hormone replacement therapy in postmenopausal women by transvaginal sonography and color flow doppler: study in different phases of sequential therapy.

OBJECTIVE: To assess uterine artery blood flow and endometrial thickness in postmenopausal patients receiving sequential hormone replacement therapy (HRT) at different phases of the treatment. DESIGN: Prospective controlled study. SETTING: Ultrasound and menopause units of the obstetrics and gynecology department of the University of Tor Vergata, Rome, Italy. PATIENT(S): Forty postmenopausal women were treated with cyclic sequential HRT (transdermal E2, 50 microg/d, days 1-21; and dydrogesterone, 10 mg/d, days 12-24). INTERVENTION(S): All patients underwent transvaginal color Doppler sonography in the estrogen (phase E) and progestogen (phase E/P) phases and after uterine bleeding when no hormone was administered (phase 0). MAIN OUTCOME MEASURE(S): Endometrial thickness; systolic, diastolic, and mean velocities; and pulsatility and resistance indices of the uterine arteries. RESULT(S): No statistically significant difference in endometrial thickness between phase E (6.5+/-1.6 mm) and phase E/P (6.0+/-1.7 mm) was observed. In phase 0, compared with phases E and E/P, a statistically significant decrease in endometrial thickness was found (4.1+/-1.2 mm). Doppler flow impedance parameters of uterine arteries during the different phases of the HRT cycle showed no differences between the phases considered. CONCLUSION(S): The decrease in endometrial thickness in phase 0 suggests a protective effect of our cyclic sequential regimen on the endometrium. Dydrogesterone does not interfere markedly with the vasodilatory effect of estrogen on uterine arteries.

Aged↗
PubMed1999

Pain mapping during minilaparoscopy in infertile patients without pathology.

STUDY OBJECTIVE: To draw a map of pelvic pain and quantify the level of provoked pain during minilaparoscopy under local anesthesia and conscious sedation. DESIGN: Observational study (Canadian Task Force classification II-2). SETTING: University hospital. PATIENTS: Twenty infertile women. INTERVENTIONS: Minilaparoscopy was performed under local anesthesia and conscious sedation, and cognitive performance was evaluated with the Rey auditory verbal learning task. MEASUREMENTS AND MAIN RESULTS: The diagnostic procedure was performed with one 2-mm micrograsper and one 2-mm microprobe to evaluate the pelvis. In particular we grasped utero-ovarian ligaments; we touched, grasped, and distended fallopian tubes with blue dye; we moved the uterus with a manipulator inserted at the cervix; and we touched and grasped bowel and omentum. Level of pain was recorded on a visual analog scale. Patients had no pathologic findings, including minimal endometriosis and pelvic adhesions. The highest level of pain was recorded when we distended the tubes. No pain was elicited when we touched and grasped ovary, omentum, and bowel. In 10% of women when we stretched the tubo-ovarian ligament we provoked a minimal vagal reaction. CONCLUSION: Minilaparoscopy under conscious sedation for pelvic pain mapping in women without pain or pathology revealed consistently negative findings, validating the value of this measurement. (J Am Assoc Gynecol Laparosc 6(1):51-54, 1999)

Adult↗
PubMed1999

24-hour ambulatory blood pressure monitoring: a comparison between transdermal glyceryl-trinitrate and oral nifedipine.

The objective of the present study is to compare the effectiveness of transdermal glyceryl-trinitrate versus oral nifedipine in lowering blood pressure in patients affected by pregnancy-induced hypertension (PIH). Thirty-six consecutive pregnant women have been evaluated at different gestational ages after the diagnosis of PIH or preeclampsia (PE). After a 24-h ambulatory blood pressure monitoring, patients were allocated to three groups: those receiving oral nifedipine and those receiving transdermal glyceryl-trinitrate in a continuous (24 h/day) or intermittent (16 h/day) administration. A second blood pressure monitoring was performed after 2 weeks of treatment. Systolic and diastolic blood pressure were compared by using the Cosinor method looking at mesor, amplitude, and acrophase. Baseline systolic and diastolic blood pressure was similar among the three groups. Neither the transdermal glyceryl-trinitrate administered for 24 or 16 h nor oral nifedipine affected systolic and diastolic blood pressure. Analysis of variance showed that the posttreatment values were similar among the groups. Further studies are needed to verify the possible use of transdermal glyceryl-trinitrate as an antihypertensive drug during pregnancy.

Administration, Cutaneous↗
PubMed1998

The role of human papillomavirus DNAs in cervical carcinoma and risk of lymph node metastasis: association with 72-kilodalton metalloproteinase immunostaining.

BACKGROUND: The role of human papillomavirus (HPV) as a prognostic factor in cervical carcinoma is not understood completely and little is known regarding the intrinsic mechanisms involved in the metastatic process of HPV positive carcinoma. The authors evaluated HPV status with respect to clinical features in early stage cervical carcinoma, with special emphasis on lymph node spread. The authors also analyzed the relation between HPV, lymph node involvement, and 72-kilodalton (kDa) metalloproteinase immunostaining, an enzyme that cleaves Type IV collagen and may play a role in tumor metastasis. METHODS: Thirty-two patients with International Federation of Gynecology and Obstetrics Stage I and IIA squamous cell cervical carcinoma treated by primary radical surgery were reviewed. Histologic grade of differentiation, tumor size, fractional depth of invasion, and lymph node spread were evaluated with respect to HPV status and 72-kDa metalloproteinase immunostaining. HPV DNA was detected by polymerase chain reaction and the primers potentially recognized at least the following HPV subtypes: 6, 11, 16, 18, 31, 33, 34, 35, 42, 51, 56, and 58. Immunohistochemical staining was performed using the avidin-biotin complex technique. Affinity-purified rabbit anti-72-kDa metalloproteinase antibody was used. RESULTS: HPV DNA was detected in a total of 69% of cases, and HPV-16 was the most frequent type detected. HPV positive carcinomas showed a significantly higher rate of lymph node metastases than HPV negative carcinomas (45% vs. 10%; P = 0.03); similarly, 72-kDa metalloproteinase index was significantly higher (P = 0.001). CONCLUSIONS: These findings suggest a relation between HPV and risk of lymph node metastasis, which may be mediated by an increased production of 72-kDa metalloproteinase.

Amino Acid Sequence↗
PubMed1998

A two-stage screening test for pregnancy-induced hypertension and preeclampsia.

OBJECTIVE: To assess the benefit of uterine artery Doppler ultrasound examination with ambulatory 24-hour blood pressure (BP) monitoring as a two-stage screening test for women at risk for pregnancy-induced hypertension, preeclampsia, or fetal growth restriction (FGR). METHODS: Uterine artery Doppler ultrasound was performed at 20-22 weeks' gestation on women at risk for pregnancy-induced hypertension, preeclampsia or FGR who were referred to our antenatal clinics. Abnormal findings were rechecked at 24 weeks' gestation. We selected 180 subjects (90 with abnormal uterine Doppler and 90 with normal uterine Doppler) for 24-hour BP monitoring with a portable automated device, immediately after recruitment, and the midline estimating statistics of rhythm of systolic and diastolic BPs were calculated. RESULTS: The highest incidence of pregnancy-induced hypertension and preeclampsia, with or without FGR, occurred in patients with abnormal uterine Doppler and a systolic midline estimating statistic of rhythm of at least 111 mmHg or a diastolic midline estimating statistic of rhythm of at least 68 mmHg. The specificity and positive predictive value of abnormal uterine Doppler ultrasound alone were low (55 and 27%, respectively), whereas the association of abnormal Doppler ultrasound with both systolic and diastolic midline estimating statistics of rhythm equal or above the selected cutoff values increased the specificity and positive predictive value to 93 and 63%, respectively. CONCLUSION: In clinical practice, a first-stage test with uterine artery Doppler ultrasound at 20-24 weeks' gestation, followed by a second-stage test with ambulatory 24-hour BP monitoring in patients with abnormal uterine Doppler, might indicate women at risk of developing pregnancy-induced hypertension or preeclampsia.

Adult↗
PubMed1998

Outpatient diagnostic hysteroscopy.

STUDY OBJECTIVE: To evaluate the feasibility, validity, indications, and results of a large series of diagnostic hysteroscopies performed without anesthesia. DESIGN: Retrospective analysis of hysteroscopy charts performed between 1989 and 1996 (Canadian Task Force classification II-2). SETTING: University-affiliated endoscopy unit. PATIENTS: Four thousand consecutive women referred for different indications. INTERVENTIONS: Diagnostic hysteroscopy was performed in 91% of patients without premedication or anesthetics. In some women premedication or general or local anesthesia was required to access the uterine cavity. MEASUREMENTS AND MAIN RESULTS: The success rate, validity indication, complication rate, and number of biopsies were critically evaluated and assessed in relation to increased experience of operators. In 91% of women we accessed the uterine cavity at the first attempt without premedication, whereas 207 (5. 1%) patients required local anesthesia and 99 (2.4%) premedication. Only 1.6% required general anesthesia. In 52% intrauterine pathology was diagnosed and in 21% further surgical treatment was suggested. CONCLUSION: Hysteroscopy was feasible when performed in an outpatient setting without general or local anesthesia in more than 90% of women. The operator's experience seems a key factor both for accurate endometrial evaluation and to reduce failure and endometrial biopsy rates. The low frequency of further surgical treatment justifies performing the procedure in the office.

Adolescent↗
PubMed1998

The value of transvaginal ultrasonographic examination of the uterine cervix in predicting preterm delivery in patients with preterm premature rupture of membranes.

The objective of this study was to compare the value of ultrasonographic assessment of the uterine cervix and amniotic fluid tests in the prediction of the interval from admission to delivery in patients with preterm premature rupture of membranes. Ninety-two patients admitted to the hospital for preterm premature rupture of membranes between 24 and 32 weeks of gestation underwent both transabdominal amniocentesis and transvaginal ultrasonographic evaluation of the uterine cervix. Amniotic fluid analyses included cultures for aerobic and anaerobic bacteria, mycoplasmas and ureaplasmas, white blood cell count and glucose and interleukin-6 determinations. The ultrasonographic variables evaluated were cervical length, presence of funneling and cervical index ((funnel length + 1)/cervical length). The outcome measure was the interval from admission to delivery. The median interval from admission to delivery was 4.5 days (range 0-36). An abnormal uterine cervix was associated with a short time interval (cervical length < or = 20 mm, median 2 days, range 0-14 vs. median 6 days, range 0-36; p < or = 0.0001; presence of funneling, median 3 days, range 1-31 vs. median 8 days, range 0-36; p < or = 0.001; cervical index > 0.50, median 2 days, range 0-7 vs. median 8 days, range 1-36; p < or = 0.0001). However, interleukin-6 concentration in the amniotic fluid was the best predictor of the interval from admission to delivery when compared to the ultrasonographic indices and to all the amniotic variables considered. Moreover, when a multiple model was applied, the cervical index significantly and independently improved the performance of interleukin-6 in the prediction of the interval from admission to delivery. These data suggest that the combined use of the amniotic fluid interleukin-6 assay and the cervical index in patients with preterm premature rupture of membranes provides a good prediction of the interval from admission to delivery, thus identifying a subgroup of patients at high risk of imminent delivery.

Adult↗
PubMed1998

Ultrasonographic assessment of the uterine cervix and interleukin-8 concentrations in cervical secretions predict intrauterine infection in patients with preterm labor and intact membranes.

OBJECTIVE: Interleukin-8 concentrations in cervical secretions have been related to microbial invasion of the amniotic cavity and histological chorioamnionitis. Since a short uterine cervix may be a risk factor for intrauterine infection, we set out to determine the interrelationship between cervical-secretion interleukin-8 concentration, cervical length measured by transvaginal sonography and intrauterine infection in women with preterm labor and intact membranes. DESIGN: The study group comprised 144 pregnant women admitted to hospital for preterm labor and intact membranes. At admission, interleukin-8 in cervical secretions was assayed. The uterine cervix was evaluated by transvaginal sonography and the cervical index (funnel length + 1)/cervical length) was measured. In all cases, amniotic fluid was obtained by amniocentesis immediately after cervical examination and was cultured for aerobic and anaerobic bacteria including Ureaplasma ureolyticum and Mycoplasma hominis. Placentas were analyzed at delivery for the presence of histological chorioamnionitis. RESULTS: Forty-three per cent (62/144) of pregnancies delivered preterm and 12.5% (18/144) of the amniotic fluid cultures were positive. Placentas were available from 54 pregnancies which delivered preterm and histological chorioamnionitis was found in 59.2% (32/54) of the cases. Interleukin-8 concentrations in cervical secretions were significantly higher in the presence of microbial invasion of the amniotic cavity (median 1191.5 ng/ml, range 812-5234 ng/ml vs. median 109 ng/ml, range 12-2231 ng/ml; p < or = 0.0001) and histological chorioamnionitis (median 982.5 ng/ml, range 430-5234 ng/ml vs. median 435 ng/ml, range 40-1750 ng/ml; p < or = 0.0001). Similarly, higher values for cervical index were obtained in the presence of a positive amniotic fluid culture (median 1.23, range 0.35-5.88 vs. median 0.29, range 0.024-4.85; p < or = 0.0001) or histological chorioamnionitis (median 1.18, range 0.043-5.88 vs. median 0.562, range 0.040-2.48; p = 0.011). Multiple logistic regression analysis indicates significant independent associations with a positive amniotic fluid culture and histological chorioamnionitis for the cervical interleukin-8 concentrations (amniotic fluid culture positive > or = 850, histological chorioamnionitis > or = 450) and for the cervical index (amniotic fluid culture positive < or = 0.58, histological chorioamnionitis < or = 0.56). CONCLUSIONS: Intrauterine infection is associated with increased interleukin-8 concentrations in cervical secretions and a short cervix. Their combined analysis may reduce the indications for invasive procedures and improve the selection of women in preterm labor who may benefit from antimicrobial treatment.

Adult↗
PubMed1998

The efficacy and fetal-maternal cardiovascular effects of transdermal glyceryl trinitrate in the prophylaxis of pre-eclampsia and its complications: a randomized double-blind placebo-controlled trial.

OBJECTIVES: Pre-eclampsia continues to be a major cause of maternal and perinatal mortality. A disorder of the nitric oxide system is implicated in the pathogenesis of this condition and preliminary studies have suggested a possible therapeutic role for nitric oxide donors in women with established pre-eclampsia. The aim of this study was to determine whether pre-eclampsia and its complications could be prevented by the long-term use of nitric oxide donors in a group of women identified to be at risk on the basis of abnormal uterine artery Doppler measurements. STUDY DESIGN: We enrolled 40 healthy normotensive women at high risk of pre-eclampsia selected on the basis of abnormal uterine artery Doppler waveforms at 24-26 weeks of gestation. Women were randomly allocated to receive transdermal glyceryl trinitrate 5 mg-patches or equivalent placebo patches in a double-blind randomized study. The primary outcome measures were pre-eclampsia, fetal growth restriction, preterm delivery or small for gestational age/fetal growth restriction rates. Patches were worn daily from recruitment for 10 weeks or until delivery. RESULTS: The primary outcomes were not significantly different in the placebo compared to the glyceryl trinitrate group. However, survival analysis of adverse events with gestation in both groups showed a significantly reduced risk of an adverse event in the glyceryl trinitrate group (p = 0.004), equating to a 73% reduction in hazard. There was no difference in maternal systolic and diastolic blood pressure, mean uterine artery resistance index and fetal umbilical and middle cerebral artery pulsatility indices between the groups. CONCLUSIONS: Low-dose prophylactic transdermal glyceryl trinitrate commenced late in the second trimester did not reduce the incidence of pre-eclampsia, preterm delivery or fetal growth restriction, but may increase the likelihood of a complication-free pregnancy. Transdermal glyceryl trinitrate (5 mg/day) did not affect maternal cardiovascular, uterine artery or fetal arterial Doppler parameters.

Administration, Cutaneous↗
PubMed1998

Interleukin-6 concentrations in cervical secretions in the prediction of intrauterine infection in preterm premature rupture of the membranes.

The objective of this study was to determine the value of interleukin-6 (IL-6) in cervical secretion to diagnose microbial invasion of the amniotic cavity in patients with premature rupture of the membranes. Cervical secretions were sampled immediately before amniocentesis in 124 patients with singleton pregnancies and preterm premature rupture of the membranes. Gestational age ranged between 24 and 32 weeks. Amniotic fluid was cultured and IL-6 measured in amniotic fluid and cervical secretions. A total of 33.8% (21/124) of the amniotic fluid cultures had positive results. In cervical secretions the median concentration of IL-6 was 672 pg/ml (range 5-1,250) in the presence of intra-amniotic infection in contrast to 95.5 pg/ml (range 12-640) in women with negative amniotic fluid culture (p </=0.001). There were no differences between IL-6 concentrations in the cervical secretions of patients with or without obvious leakage of amniotic fluid. A significant relationship was found between IL-6 levels in amniotic fluid and in cervical secretions (rho = 0.74, p </=0.001). An IL-6 level in cervical secretions >200 pg/ml had a sensitivity of 78.5%, a specificity of 73.1% and a relative risk of 4.6 for intra-amniotic infection. Receiver-operator characteristics curve analysis showed that IL-6 assay in cervical secretions is comparable to IL-6 assay in amniotic fluid in predicting intra-amniotic infection (p = 0.468). In conclusion, intra-amniotic infection is associated with increased levels of IL-6 and concentrations in cervical secretions are related to amniotic levels. The measurement of IL-6 in cervical secretions may help to noninvasively identify intra-amniotic infection among pregnancies with preterm premature rupture of membranes.

Adult↗