Fetoplacental passage of 2',3'-dideoxyinosine.
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Adult↗
Biomedical subjects
E Papiernik
Publications and source records attributed to E Papiernik.
Vaginal infections, cervical ripening and preterm delivery.
A prospective study is presented which addresses the relative effect of cervicovaginal infection and precocious maturation of the uterine cervix on preterm delivery. From April 1981 through December 1983, a total of 5758 pregnant women were checked by means of a vaginal examination at every prenatal visit and a research for bacterial cervicovaginal infection whenever abnormal signs were observed. The study reveals that vaginal infection has no measurable effect when observed during the second trimester of pregnancy, and a small effect during the third trimester. This means that infection of the vagina or/and the cervix may be demonstrated as a risk factor only when the cervix is short before 28 weeks or open before 37 weeks.
Bacterial Infections↗
Trophoblast-like cells sorted from peripheral maternal blood using flow cytometry: a multiparametric study involving transmission electron microscopy and fetal DNA amplification.
Three monoclonal antibodies (MAbs) against trophoblast (GB17, GB21, and GB25) and flow cytometry were used to sort trophoblast-like cells (TLCs) from peripheral blood of pregnant women. Sorted TLCs were processed for electron microscopy and fetal DNA amplification of the Y-specific sequences from mothers carrying male fetuses. At the ultra-structural level, most of the nucleated cells had the morphology of leucocytes, suggesting maternal contaminants, and we did not find the characteristic features of the free intervillous trophoblast cells. Nevertheless, polymerase chain reaction (PCR) analysis showed an amplification of Y-specific sequences in two out of three samples of sorted TLCs. These results suggest that besides the maternal leucocytes, sufficient trophoblast nucleated fetal cells can be obtained using cell enrichment by sorting. This sensitive method holds promise for non-invasive prenatal diagnosis of fetal sex and if sufficient Y(positive) nuclei are found, for the diagnosis of selected numerical chromosome abnormalities.
Antibodies, Monoclonal↗
The costs of multiple pregnancy.
This paper reviews US vital statistics to describe the increase in multiple births in the United States between 1977 and 1987 and clarify the participation of differing maternal ethnic and age groups to this trend. The projected needs for NICU beds and costs of handicaps are estimated based on the distribution of low birthweights in multiple gestations. The potential methods of changing the distribution of low birthweight infants in multiple pregnancies are discussed.
Costs and Cost Analysis↗
Characterization of enzymes of catecholamine synthesis and metabolism in human fetal membranes at birth.
We looked for the presence of the enzymes monoamine oxidase, catechol-O-methyltransferase, and phenylethanolamine-N-methyltransferase in human fetal membranes at term. The activity of all three enzymes was detected via highly sensitive and selective radiometric enzyme assays. The most novel finding was the extremely high level of monoamine oxidase activity in the chorion compared with that in the amnion. The other enzyme of catecholamine metabolism, catechol-O-methyltransferase, did not show any difference in activity between the two layers. In addition, we observed that the enzyme phenylethanolamine-N-methyltransferase, which is primarily located in the adrenal medulla, was also present in appreciable levels in the two layers of fetal membranes. These results suggest that fetal membranes, like the placenta, possess the enzymatic machinery to metabolize catecholamines and have the capacity to synthesize epinephrine.
Amnion↗
HIV proteins absent from placentas of 75 HIV-1-positive women studied by immunohistochemistry.
Recent epidemiological and virological data suggest that the incidence of maternofetal transmission of HIV-1 infection is between 20 and 30%. The available evidence points to a possible role of peri- and postnatal contamination, but the isolation of HIV from fetuses shows that transplacental transmission also occurs. We attempted to detect, by means of an immunohistochemical method, HIV proteins in frozen placentas from 75 HIV-1-positive women (30 at term, 45 induced abortions). In addition, in situ hybridization using HIV-specific probes was performed in three cases. Neither HIV proteins nor nucleic acid sequences were detected, but CD4+ mononuclear cells were present in the chorion and villi, regardless of the clinical and biological status of the mother (particularly in the nine cases in which the infants were infected). There are several possible mechanisms involving the placenta in the maternofetal transmission of HIV, including active transport of the HIV-immunoglobulin G complex via Fc receptors on trophoblastic cells, passive transplacental passage of HIV during a viraemic episode, the passage of infected maternal cells, and infection of the placenta itself. The methods we used could not rule out the presence of HIV DNA provirus within the genome of placental cells. In any event, immunohistochemical detection of HIV proteins in the placenta is not a technique suitable for the prenatal diagnosis of HIV infection or for identifying newborns likely to develop HIV infection.
Adult↗
Preterm birth prevention: an evaluation of programs in the United States.
During the last decade several programs were established to prevent the onset of preterm labor and facilitate its early identification and treatment. Although these prevention programs shared a similar goal, they varied in their primary outcome focus, target populations, study designs, and specific intervention components. Their initial reports were promising; however, subsequent evaluations of efforts in the United States produced mixed results. The current literature is suggestive of the benefits of programs to prevent preterm labor and delivery, but methodologic differences among them and deficiencies in the reported evaluations have rendered a final verdict equivocal. Many studies using historical or geographic controls found positive results, whereas randomized, controlled trials did not find a significant impact. Positive results were found in studies using low-risk populations, but investigations of high-risk patients noted little effect. Together with continued research on the factors that underlie the onset of labor, additional assessment of these programs and their individual intervention components appears to be necessary.
Bed Rest↗
Multiple pregnancy and very early preterm births in a referral center.
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Female↗
[System of decision support in obstetrics. The computerization of prenatal consultations].
The aim of this study was to realize a prototype of a computer-aided decision support for prenatal visits. He has been developped on a microcomputer. We used procedural programming to represent the medical knowledge. This prototype has several interfaced units: a computerized prenatal record, the computing of quantitative variables (term, fetal biometry, uterine height) and the two computer-aided units (preterm births and modelization of weight gain during pregnancy). The next step will be the medical evaluation of this computer-aided decision support in obstetrics.
Anthropometry↗
[Risk factors of ectopic pregnancy. A case-control study at 7 maternity units in the Paris area].
A case-control study was conducted in seven maternity hospitals in the Paris area in 1988 to evaluate the role of several risk factors in ectopic pregnancy (EP). A total of 279 cases and 307 controls were compared for sociodemographic characteristics, cigarette smoking, sexual reproductive and surgical histories and for the conditions under which conception occurred. Many factors were found to be associated with an increased risk of EP: cigarette smoking related to the number smoked at the time of conception (Odds Radio (OR) 1.26 to 2.72), appendicectomy (OR 1.25, 95% CI = 1.02-1.56), prior tubal surgery (OR = 2.42, 95% CI = 1.37-4.22), prior use of intrauterine devices (OR = 1.34, 95% CI = 1.02-1.80), induced ovulation cycle (OR = 1.66, 95% CI = 1.01-2.74) and prior EP (OR = 3.90, 95% CI = 2.27-6.75). Chlamydia trachomatis seropositivity was associated with an increased risk of EP (OR = 1.50, 95% CI = 1.04-2.13), but clinically reported pelvic inflammatory disease was not. Maternal age, parity, previous induced abortion and previous spontaneous abortion were not associated with EP. Use of an intrauterine device, progestagen micro-pill or the combined oestrogen/progestagen pill at the time of conception were associated with a lower risk of intrauterine pregnancy than of EP. These findings confirm the importance of several of the previously reported risk factors for EP; STD's, previous EP and cigarette smoking. They also identify new risk factors: appendicectomy, induced ovulation cycle, and showed that the combined oestrogen/progestagen pill does not prevent ectopic pregnancy as effectively as it prevents intrauterine pregnancy.
Case-Control Studies↗
[Fast determination of pulmonary surfactant in amniotic fluid using fluorescent polarization (FLM test Abbott)].
A study of 60 amniotic fluids obtained by amniocentesis shows that the measurement of total surfactant phospholipids by the TDX Fetal Lung Maturity assay makes it possible to predict accurately fetal lung maturity. A sensitivity of 100% is similar to that of other tests currently used but with a higher specificity (93% instead of 65% for the L/S ratio and 55% for the phosphatidylglycerol). The phospholipid/albumin ratio is carried out automatically by means of a fluorescence polarization method with the TDX Abbott apparatus. A cut off value of 50 mg/g should be considered as a good fetal lung maturity indicator. The population studied was composed of women with an arterial hypertension (n = 6), diabetes (n = 9) preterm premature rupture of the membranes (n = 8), gemellary pregnancy (n = 5) or with a risk of premature outcome (n = 10). In all cases delivery occurred within 24 hours after the amniocentesis. The average gestational age was 36 weeks. Seven newborns (11%) presented hyaline membrane disease. In conclusion, this simple and rapid test seems to be adequate to evaluate with accuracy the fetal lung maturity in abnormal pregnancies. It must however, be associated with the determination of phosphatidylglycerol, when the fluid is contaminated by blood or meconium.
Amniotic Fluid↗
The very tiny baby, multiple births, and other questions about preterm deliveries.
The progressive change of the limit of viability accepted for very preterm babies has resulted in a progressive improvement of survival, but also in costs for days spent in intensive care and for numbers of severely handicapped babies. Multiple births, including twins but especially triplets and quadruplets, result in severely premature births, high death rates, high costs, and severe risk of handicap. As most supermultiple pregnancies are the result of ovulation-inducing drugs, this rise has to be limited. More than acute care, prevention is the only good solution, from both an ethical and an economical standpoint.
Female↗
Anamnestic pregnancy risk assessment.
Based on data obtained from the 1984-1985 Guadeloupean Perinatal Audit, a pregnancy risk scoring system was developed using maternal demographic, socioeconomic, obstetric history and risk characteristics recorded at the first prenatal visit. Various combinations of risk factors were identified for four distinct pregnancy outcomes (perinatal mortality, low birth weight, preterm delivery and intra-uterine growth retardation). The findings emphasize the importance of developing risk assessments for discrete pregnancy outcomes within specific populations.
Adult↗
Advanced combined intra-uterine and ovarian gestations: case report.
Combined intra-uterine and ectopic gestations are uncommon. Heterotopic gestations in which the ectopic pregnancy is located in the ovary are exceptional. We are reporting a 22 week heterotopic gestation with two live fetuses, one fetus was developing in the uterus and one in the ovary. Surgical excision of the ovarian pregnancy was conducted without disturbing the intra-uterine live fetus who was ultimately delivered uneventfully at term.
Adult↗
Racial differences in pregnancy duration and its implications for perinatal care.
The average length of gestation is about 5 days shorter in black populations than in white populations. Although some of this difference is accounted for by higher preterm delivery rates in blacks, the most common gestational week of delivery at term is the 39th in black populations, the 40th in white. Black gestational age specific neonatal mortality is lower than that of whites until the 37th week of gestation, but higher thereafter. These observations suggest the hypothesis that complications of postmaturity occur sooner in black fetuses. If this hypothesis is confirmed, antepartum surveillance for signs of fetal compromise should be initiated earlier in gestation in black parturients, perhaps by setting the estimated date of confinement at 275 days after the LMP, rather than the conventional 280 days.
Black People↗
The cost effectiveness of preventing preterm delivery in twin pregnancies.
As an extension of previous work on the risk of prematurity in singletons and on the social cost of twin births, an analysis has been carried out into the cost effectiveness of preventing premature delivery in twin pregnancies. The cost of prevention is assessed in terms of early diagnosis through ultrasound screening and of an extra 11 weeks of work leave to expectant mothers. When this cost is compared to the social cost involved in the transfer of newborns to neonatal intensity care units and in supporting handicapped children, it is concluded that the total cost of prevention corresponds to one-third of the long-term costs associated to lack of prevention.
Cost-Benefit Analysis↗
Transfusion syndrome in a triplet pregnancy.
A case is reported of a transfusion syndrome in a triplet pregnancy with intrauterine death of two of the fetuses. This is an exceptional occurrence in a triplet pregnancy and raises the problem of the management of multiple pregnancies associated with the death of one or more of the fetuses. The problem of the method of delivery and the complications arising in triplet dizygotic pregnancies is discussed.
Adult↗
Social acceptability of HIV screening among pregnant women.
The paper presents the results of a survey about risk perception, knowledge, and attitudes towards HIV infection among 397 pregnant women in France. The survey was carried out between December 1987 and March 1988 in two Paris-region maternity hospitals where HIV testing is routinely proposed during the first prenatal visit. Uptake of HIV prenatal testing has been rapid in France: before coming to the maternity hospitals, 26.5% of women had already been tested. Social acceptability of testing is high, 68.8% of the sample even supporting mandatory prenatal HIV screening. Such acceptability appears to be based less on an in-depth knowledge about the risks of transmission from mother-to-fetus than on the general French context of free-of-charge mandatory prenatal care and on the potentially reassuring effect of a true negative test. Consensus about abortion for HIV-infected pregnant women is strong (80.1%) and is not influenced by religious beliefs, in contrast to attitudes toward abortion in the case of fetal handicaps. This social environment creates special difficulties for the management of the complex dilemmas regarding pregnancy and childbearing for HIV-infected women.
AIDS Serodiagnosis↗