OBJECTIVES: To prospectively validate the diagnostic performance of a non-invasive point-of-care tool (Rapid IAI System), including vaginal alpha-fetoprotein and interleukin-6, to predict the occurrence of intra-amniotic inflammation in a Spanish cohort of patients admitted with a diagnosis of preterm labor and intact membranes. METHODS: From 2017 to 2022, we prospectively evaluated a cohort of pregnant women diagnosed with preterm labor and intact membranes admitted below 34+0 weeks who underwent amniocentesis to rule-in/out intra-amniotic infection and/or inflammation. Vaginal sampling was performed at the time of amniocentesis or within 24-48 h. Amniotic fluid IL-6, vaginal alpha-fetoprotein and vaginal IL-6 concentrations were measured using a point-of-care tool provided by Hologic Inc., "Rapid IAI System". We defined intra-amniotic inflammation when amniotic fluid IL-6 values were greater than 11.3 ng/mL. During recruitment, clinicians were blinded to the results of the point-of-care tool. The original prediction model proposed by Hologic Inc. to predict intra-amniotic inflammation was validated in this cohort of patients. RESULTS: We included 151 patients diagnosed with preterm labor and intact membranes. Among these, 29 (19.2 %) had intra-amniotic inflammation. The algorithm including vaginal IL-6 and alpha-fetoprotein showed an area under curve to predict intra-amniotic inflammation of 80.3 % (±5.3 %) with a sensitivity of 72.4 %, specificity of 84.6 %, positive predictive valuve (PPV) of 52.5 %, negative predictive value (NPV) of 92.9 %, and a positive likelihood ratio (LR+) of 4.6 and negative likelihood ratio (LR-) of 0.33. CONCLUSIONS: External validation of a non-invasive rapid point-of-care tool, including vaginal alpha-fetoprotein and IL-6, showed very good diagnostic performance for predicting the absence of intra-amniotic inflammation in women with preterm labor and intact membranes.
- MeSH
- alpha-Fetoproteins * analysis metabolism MeSH
- Amniocentesis methods MeSH
- Chorioamnionitis * diagnosis MeSH
- Adult MeSH
- Risk Assessment methods MeSH
- Interleukin-6 * analysis blood metabolism MeSH
- Humans MeSH
- Amniotic Fluid * metabolism chemistry MeSH
- Point-of-Care Testing MeSH
- Obstetric Labor, Premature * diagnosis MeSH
- Predictive Value of Tests MeSH
- Prospective Studies MeSH
- Pregnancy MeSH
- Vagina metabolism MeSH
- Point-of-Care Systems MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Validation Study MeSH
Tento článek pojednává o vzácném metastatickém projevu nádorových abdominopelvických onemocnění, který se nazývá nodul sestry Marie Josefy. Jedná se o kožní metastázu do umbilikální krajiny, která byla poprvé popsaná již před téměř 200 lety. I když se jedná o vzácný úkaz, neměl by být opomínán při diferenciální diagnostice rezistencí v umbiliku. Součástí článku jsou také dvě kazuistiky.
This is a short review about a rare metastatic physical finding of abdomino-pelvic malignancies that is called Sister Mary Joseph’s nodule. It is cutaneous metastasis in the umbilical region and it was first used almost 200 years ago. Even though it is a rare finding, we should not forget it in the differential diagnosis of umbilical nodules. The article also includes two case reports.
- MeSH
- Middle Aged MeSH
- Humans MeSH
- Abdominal Neoplasms surgery complications MeSH
- Skin Neoplasms surgery diagnosis secondary MeSH
- Pelvic Neoplasms surgery complications MeSH
- Umbilical Cord pathology MeSH
- Sister Mary Joseph's Nodule * surgery history diagnosis MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Female MeSH
- Publication type
- Case Reports MeSH
Preterm prelabour rupture of membranes (PPROM) complicated by intra-amniotic inflammation (IAI) represents a substantial proportion of preterm birth cases. Currently, IAI is frequently defined as amniotic fluid IL-6 concentration above 2,600 pg/mL. However, the amniotic fluid IL-6 concentration was never correlated with the global response of other proinflammatory proteins to the ongoing IAI. In this cross-sectional study, protein quantification was performed using mass spectrometry (MS) analysis followed by target quantification of selected proinflammatory proteins. Levels of amniotic fluid proteins determined by MS were put into the correlation with IL-6 concentration determined by electrochemiluminescence immunoassay method (ECLIA). In total, 925 proteins were efficiently quantified and differential expression analysis revealed 378 proteins upregulated towards IL-6 concentration above 10,000 pg/mL. Four proteins (LCN2, MMP8, MPO, and S100A12) were selected to verify the achieved results and IL-6 concentration of 10,000 pg/mL was determined as the cut-off value for global IAI response.
- MeSH
- Biomarkers metabolism MeSH
- Chorioamnionitis * metabolism MeSH
- Adult MeSH
- Interleukin-6 metabolism MeSH
- Humans MeSH
- Amniotic Fluid * metabolism MeSH
- Fetal Membranes, Premature Rupture * metabolism pathology MeSH
- S100A12 Protein metabolism MeSH
- Cross-Sectional Studies MeSH
- Pregnancy MeSH
- Inflammation * metabolism MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Limited knowledge exists on persistent organic pollutants (POPs), including polychlorinated biphenyls (PCBs) and organochlorine pesticides (OCPs), in mother-child pairs from Northern Finland. This study examines plasma PCB and OCP concentrations and their determinants. Blood plasma concentrations of 13 PCBs and 6 OCPs were measured in mothers and in cord samples from the NUGEN birth cohort (N = 102, 2012-2014). Correlations between maternal and cord POPs were assessed using Spearman correlation, and linear regression identified factors influencing lipid-adjusted POPs. Maternal age and alcohol consumption during pregnancy were positively associated with PCBs and OCPs. Pre-pregnancy BMI and weight change during pregnancy were inversely associated with PCBs, but positively with p,p'-DDE in children. Increasing parity and smoking were associated with lower PCBs. Maternal fish consumption was associated with higher PCBs in children. Finnish pregnant women had lower PCBs and OCPs than other European populations. These findings inform exposure risk assessment and prevention strategies.
- MeSH
- Hydrocarbons, Chlorinated * blood MeSH
- Child MeSH
- Adult MeSH
- Fetal Blood chemistry MeSH
- Cohort Studies MeSH
- Environmental Pollutants * blood MeSH
- Humans MeSH
- Maternal Exposure * MeSH
- Young Adult MeSH
- Infant, Newborn MeSH
- Pesticides * blood MeSH
- Polychlorinated Biphenyls * blood MeSH
- Pregnancy MeSH
- Prenatal Exposure Delayed Effects MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Humans MeSH
- Young Adult MeSH
- Male MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Finland MeSH
OBJECTIVES: To analyze the prevalence and severity of fetal aortic regurgitation (AR) after undergoing successful fetal aortic valvuloplasty (FAV) and to evaluate its effects on fetal circulation and left ventricular (LV) growth. METHODS: This was a retrospective review of all fetuses with critical aortic stenosis who underwent successful FAV at our center between 2010 and 2024 for whom postnatal echocardiograms were available in digital format. Fetal and postnatal echocardiographic examinations were analyzed for ventricular and valvular dimensions and characteristics, and Z-scores were calculated for middle cerebral artery (MCA) pulsatility index (PI), umbilical artery (UA) PI and cerebroplacental ratio. AR severity was classified into no/mild AR or significant (moderate/severe) AR. The balloon-to-aortic valve ratio (BVR) was calculated as the ratio between the maximum actual balloon diameter and the aortic valve (AV) annulus diameter. The primary endpoints of this study were the prevalence, severity and risk factors for fetal AR following successful FAV. RESULTS: Ninety-nine fetuses who underwent successful FAV were included. Immediate post-FAV echocardiograms showed that 87% of fetuses developed some degree of AR, including 45% of all fetuses with significant AR. BVR was significantly higher in fetuses with significant AR compared to those with no/mild AR (mean, 1.09 (95% CI, 1.06-1.12) vs 1.02 (95% CI, 0.99-1.04); P < 0.001). In a subgroup of 66/99 fetuses with available postnatal echocardiograms, the prevalence of AR decreased significantly from 86% before birth to 58% after birth (P < 0.001), with the proportion of fetuses with significant AR reducing from 47% before birth to 17% after birth (P < 0.001). In the overall cohort of fetuses, AV maximum velocity (Vmax) increased significantly from post-FAV to after birth (mean, 1.93 (95% CI, 1.75-2.11) m/s vs 3.21 (95% CI, 2.89-3.55) m/s; P < 0.001), regardless of AR severity, but Vmax after birth was lower in the significant-AR group compared with the no/mild-AR group (mean, 2.85 m/s vs 3.55 m/s; P = 0.020). Fetuses with significant AR exhibited higher relative LV length increases from immediately post-FAV to after birth than did those with no/mild AR (25% (95% CI, 16-33%) vs 14% (95% CI, 6-21%); P = 0.044), although there was no significant difference in mean LV length Z-score after birth between the two groups. FAV led to significant short-term increases in MCA-PI and UA-PI Z-scores, with greater increases observed in fetuses with significant AR. CONCLUSIONS: FAV is associated with a high prevalence of fetal AR, which lessens in severity over the course of gestation. Significant fetal AR had the largest association with greater BVR and had significant impact on fetal hemodynamics. © 2025 The Author(s). Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
- MeSH
- Aortic Valve diagnostic imaging embryology MeSH
- Aortic Valve Insufficiency * diagnostic imaging epidemiology physiopathology MeSH
- Aortic Valve Stenosis diagnostic imaging embryology epidemiology physiopathology MeSH
- Balloon Valvuloplasty * MeSH
- Adult MeSH
- Echocardiography methods MeSH
- Fetal Heart diagnostic imaging physiopathology MeSH
- Gestational Age MeSH
- Humans MeSH
- Fetal Diseases epidemiology diagnostic imaging MeSH
- Infant, Newborn MeSH
- Prevalence MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Severity of Illness Index MeSH
- Pregnancy MeSH
- Ultrasonography, Prenatal * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
Janus kinase (JAK) inhibitors are effective anti-inflammatory agents for treatment of ulcerative colitis (UC).1 According to drug regulatory agencies and international guidelines, JAK inhibitors should be avoided during pregnancy and lactation.2-4 The existing evidence on safety of JAK inhibitors during pregnancy is scarce and almost exclusively limited to tofacitinib.4-7.
- MeSH
- Adult MeSH
- Fetal Blood * chemistry MeSH
- Janus Kinase Inhibitors therapeutic use MeSH
- Pregnancy Complications drug therapy MeSH
- Humans MeSH
- Milk, Human * chemistry MeSH
- Infant, Newborn MeSH
- Piperidines * therapeutic use MeSH
- Pyrimidines * therapeutic use MeSH
- Pregnancy MeSH
- Colitis, Ulcerative drug therapy blood MeSH
- Pregnancy Outcome * MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Keywords
- novorozenecké záchvaty,
- MeSH
- Hyponatremia blood MeSH
- Case Reports as Topic MeSH
- Humans MeSH
- Infant, Newborn MeSH
- Poisoning diagnosis etiology classification MeSH
- Amniotic Fluid * MeSH
- Seizures * diagnosis etiology drug therapy classification MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Publication type
- Review MeSH
The fetus develops normally in a hypoxic environment but exaggerated hypoxia late in pregnancy is a worrisome sign often observed in hypertensive disorders of pregnancy, placental insufficiency, or fetal growth restriction (FGR). Serial fetal biometry and the cerebroplacental ratio (CPR, calculated as the middle cerebral artery [MCA] / the umbilical artery [UmbA] pulsatility indices [PI]), are commonly used to indicate fetal "brain sparing" resulting from exaggerated fetal hypoxia. But unclear is the extent to which a low CPR indicates pathology or is a physiological response for maintaining cerebral blood flow. We studied 31 appropriate for gestational age (AGA) pregnancies at low (LA, 1670 m) or high (HA, 2879 m) altitude, given the chronic hypoxia imposed by HA residence, and 54 LA women with a clinical diagnosis of FGR. At week 34, the MCA PI was lower in the LA-FGR than the LA-AGA group but lower still in the HA-AGA compared to either LA groups due to a trend toward higher end-diastolic velocity (EDV). We concluded that the lower MCA PI was likely due to greater cerebral vasodilation in the HA AGA group and an indication of physiological versus pathological fetal hypoxia. Future reporting of serial MCA and UmbA values and their determinants along with the CPR could improve our ability to distinguish between physiological and pathological fetal brain sparing. Keywords: Birth weight, Cerebroplacental ratio, Fetal physiology, HDP, High altitude.
- MeSH
- Middle Cerebral Artery * diagnostic imaging physiopathology MeSH
- Umbilical Arteries diagnostic imaging physiopathology MeSH
- Adult MeSH
- Fetal Hypoxia * physiopathology MeSH
- Hypoxia physiopathology MeSH
- Humans MeSH
- Brain physiopathology blood supply diagnostic imaging MeSH
- Cerebrovascular Circulation physiology MeSH
- Altitude MeSH
- Fetal Growth Retardation * physiopathology MeSH
- Pregnancy MeSH
- Ultrasonography, Prenatal methods MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
In the first days of life, the newborns' intestinal microbiota develops simultaneously with the intestinal gut barrier and follows intestinal immunity. The mode of delivery shows significant impact on microbial development and, thus, the initiation of the tryptophan catabolism pathway. Further antibiotics (ATB) treatment of mothers before or during delivery affects the microbial and tryptophan metabolite composition of stool of the caesarean- and vaginal-delivered newborns. The determination of microbiome and levels of tryptophan microbial metabolites in meconium and stool can characterize intestinal colonization of a newborn. From 134 samples from the Central European Longitudinal Studies of Parents and Children: The Next Generation (CELSPAC: TNG) cohort study, 16S rRNA gene sequencing was performed, and microbial tryptophan metabolites were quantified using ultra-high-performance liquid chromatography with triple-quadrupole mass spectrometry. Microbial diversity and concentrations of tryptophan metabolites were significantly higher in stool compared to meconium. Treatment of mothers with ATB before or during delivery affects metabolite composition and microbial diversity in stool of vaginal- and caesarean-delivered newborns. Correlation of microbial and metabolite composition shows significant positive correlations of indol-3-lactic acid, N-acetyl-tryptophan and indol-3-acetic acid with Bifidobacterium, Bacteroides and Peptoclostridium. The positive effect of vaginal delivery on newborns' microbiome development is degraded when mother is treated with ATB before or during delivery. KEY POINTS: • Antibiotic treatment diminishes the positive effects of vaginal delivery. • Antibiotic treatment affects metabolite and microbial composition in newborns. • Bifidobacterium and Peptoclostridium could be the producer of indole-lactic acid.
- MeSH
- Anti-Bacterial Agents * MeSH
- Bifidobacterium metabolism growth & development MeSH
- Feces * microbiology chemistry MeSH
- Indoles metabolism MeSH
- Indoleacetic Acids metabolism MeSH
- Humans MeSH
- Longitudinal Studies MeSH
- Meconium * microbiology chemistry MeSH
- Infant, Newborn MeSH
- RNA, Ribosomal, 16S * genetics MeSH
- Gastrointestinal Microbiome * drug effects MeSH
- Tryptophan * metabolism MeSH
- Chromatography, High Pressure Liquid MeSH
- Check Tag
- Humans MeSH
- Infant, Newborn MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
OBJECTIVE: The aim of this study was to evaluate changes in the relative counts of different leukocyte subsets in peripheral and umbilical cord blood in pregnancies complicated by preterm prelabor rupture of membranes (PPROM) with respect to the presence of intraamniotic inflammation (IAI) and fetal inflammatory response syndrome (FIRS). METHODS: Fifty-two women with singleton pregnancies complicated by PPROM were included in this study. From samples of peripheral and umbilical cord blood, relative counts of these leukocyte subpopulations were determined using multicolor flow cytometry: granulocytes, monocytes, lymphocytes, T cells and their subpopulations, B cells and their subpopulations, and NK cells and their subpopulations. IAI was defined as increased concentrations of interleukin 6 in the amniotic fluid. Amniotic fluid samples were obtained by transabdominal amniocentesis. RESULTS: Women with IAI had higher relative counts of monocytes (p = 0.04) in peripheral blood. There was an increased relative number of granulocytes (p = 0.003) and a decreased number of lymphocytes (p = 0.0048), helper CD4+ T cells (p = 0.019), NK cells (p = 0.0001) within leukocytes, NK cells within lymphocytes (p = 0.003) and CD16+ NK cells within NK cells (p = 0.005) in umbilical cord blood samples of women with FIRS. However, after adjusting the results for gestational age at sampling, all differences disappeared. CONCLUSIONS: The presence of IAI or FIRS is not accompanied by significant changes in the relative counts of immune cells in peripheral blood or umbilical cord blood in pregnancies complicated by PPROM.
- MeSH
- Chorioamnionitis immunology blood MeSH
- Adult MeSH
- Fetal Blood * immunology cytology MeSH
- Interleukin-6 blood metabolism MeSH
- Leukocytes immunology MeSH
- Humans MeSH
- Amniotic Fluid immunology metabolism MeSH
- Leukocyte Count MeSH
- Fetal Membranes, Premature Rupture * immunology blood MeSH
- Flow Cytometry MeSH
- Systemic Inflammatory Response Syndrome immunology blood MeSH
- Pregnancy MeSH
- Inflammation immunology MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Pregnancy MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
