Severe liver injury due to hyperemesis gravidarum.
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Adult↗
Biomedical subjects
N Vitoratos
Publications and source records attributed to N Vitoratos.
Computerized analysis of fetal heart rate variability using the matching pursuit technique as an indicator of fetal hypoxia during labor.
OBJECTIVE: To determine whether the computerized analysis of fetal heart rate variability with the new matching pursuit technique can indicate fetal distress during labor. STUDY DESIGN: Eighty women were studied during the intrapartum period with external cardiotocography. In all cases, cord arterial pH and 5-min Apgar Scores were evaluated. Six cases that presented large segments of missing data were excluded from the study. The remaining 74 women were divided into two groups; 32 women with normal (Group A) and 42 women with non-reassuring FHR tracings (group B). Group B was divided in subgroup BI, including 24 women with pH > 7.20, and BII, including 18 women with pH < 7.20. In order to evaluate the FHR fluctuations, in different frequency ranges, we applied an adaptive time-frequency method, called Matching Pursuit. We estimated the power of the FHR signal in four frequency ranges. RESULTS: The 5-min Apgar Scores were significantly lower in both subgroup BI and subgroup BII (p = 0.003 and p = 0.003 respectively). The Low Low Frequency (LLF) parameter appears to recognize better the cases with lower pH (sensitivity 78.5%, specificity 52.3%) than the cases with non-reassuring FHR (66.6%, 56.2). The sensitivity and specificity of the Very Low Frequency (VLF) parameter were 72.2% and 59% respectively in recognizing the cases with lower pH and 64.2% and 53.1% in recognizing non-reassuring FHR. CONCLUSION: Fetal hypoxia during labor can be recognized using the MP technique for the analysis of FHR signal power in the VLF and LLF frequency ranges. Since the analysis is feasible in real-time, it can be a useful tool for the intrapartum evaluation of fetal well-being.
Apgar Score↗
Prediction of preterm delivery by sonographic estimation of cervical length.
BACKGROUND: Identification of pregnant women presenting with threatened preterm labor who are destined to deliver prematurely would greatly assist planning their management. OBJECTIVES: The purpose of the study was to evaluate the ultrasonographic measurement of cervical length as a prognostic factor for predicting preterm birth in cases of threatened preterm labor. METHODS: The study included 104 women with singleton pregnancies who presented with threatened preterm labor at 24-36 weeks of gestation. Cervical length at presentation was evaluated by transvaginal ultrasonography. Other potential prognostic factors, such as previous history of preterm labor, smoking, parity and administration of tocolytics were assessed. All women were observed for preterm delivery within 7 days of presentation. RESULTS: The only significant predictor of preterm delivery was cervical length assessed by ultrasound (p<0.000001, odds ratio 93.3, 95% Cl 10.4-837.1). CONCLUSIONS: Cervical length assessed by transvaginal ultrasonography in women presenting with threatened preterm labor is a powerful predictive tool for progression to preterm delivery.
Adult↗
No association between insulin resistance and preeclampsia.
OBJECTIVE: To investigate the possible link between insulin resistance and preeclampsia. METHODS: The study included 30 primigravidas between 28 and 34 weeks of gestation. The study subjects were divided into two groups: Group A consisted of 15 normotensive women of a mean gestational age of 31.6 weeks and group B consisted of 15 preeclamptic women of a mean gestational age of 29.9 weeks. Glucose and insulin levels were measured at 0, 1 and 2 h of an OGTT (after 75 g oral glucose administration). Insulin resistance and sensitivity were evaluated with the use of IR HOMA, QUICKI and IS OGTT. RESULTS: Glucose and insulin levels at 0, 1 and 2 h of the OGTT as well as IR HOMA, QUICKI and IS OGTT were comparable between preeclamptic and normotensive pregnant women. CONCLUSIONS: Our results indicate that preeclampsia is not associated with hyperinsulinaemia and/or insulin resistance, in either the fasting or the postprandial state.
Adult↗
Evaluation of non-reassuring fetal heart rate patterns with fetal pulse oximetry combined with vibratory acoustic stimulation.
OBJECTIVE: To determine the value of fetal pulse oximetry and vibratory acoustic stimulation in the presence of non-reassuring fetal heart rate patterns during labor. DESIGN: Prospective study in women monitored by cardiotocography and fetal pulse oximetry during labor. MATERIALS AND METHODS: During a period of 18 months, 907 consecutive parturients in labor were monitored by cardiotocography. Out of these women, 63 were selected on the basis of a non-reassuring fetal heart rate tracing during the first stage of labor. In these cases, fetal pulse oximetry was applied. Vibratory acoustic stimulation was applied in fetuses without spontaneous reactivity in order to evaluate the fetal status. RESULTS: Our cases were classified into three groups, according to the lower fetal oxygen saturation levels, from the time of oximetry application until delivery. Group A consisted of 29 cases where fetal oxygen saturation levels were > or = 41%, group B (20 cases) with fetal oxygen saturation of 31-40% and group C (14 cases) with levels of < 30%. Spontaneous reactivity was observed in 15 fetuses of group A and seven of group B, while no case of reactivity was noted in group C. Vibratory acoustic-induced reactivity was associated with low fetal oxygen saturation levels. The mean umbilical artery pH levels were 7.29 +/- 0.051 in group A, 7.21 +/- 0.057 in group B and 7.04 +/- 0.05 in group C. CONCLUSION: Fetal pulse oximetry should be indicated not only in fetuses without any reactivity but also in those with induced reactivity, after the application of vibratory acoustic stimulation.
Acoustic Stimulation↗
Matrix metalloproteinase-9 and tissue inhibitor of metalloproteinase-1 in plasma/serum and urine of women during term and threatened preterm labor: a clinical approach.
OBJECTIVE: To explore the concentrations of matrix metalloproteinase-9 (MMP-9) and tissue inhibitor of metalloproteinase-1 (TIMP-1) in plasma, serum and urine of women during term and threatened preterm labor. METHODS: Plasma and urine proMMP-9 as well as serum and urine TIMP-1 were evaluated in 60 healthy pregnant women; 20 of them presented in term labor following an uncomplicated pregnancy, 20 of them presented with threatened preterm labor and intact membranes at 24-36 gestational weeks and 20 of them were at 24-40 gestational weeks with no evidence of uterine contractions or other pregnancy complications. Data were analyzed with non-parametric statistical tests and cut-off values were determined with receiver operator characteristic curves. RESULTS: ProMMP-9 values were significantly higher and TIMP-1 values were significantly lower in cases with uterine term or preterm contractions compared to non-labor status; and in cases with preterm contractions that progressed to true preterm labor compared to those in which contractions were arrested. CONCLUSIONS: Alterations in the concentrations of proMMP-9 and TIMP-1 can be detected in plasma or serum and urine of pregnant women experiencing term or preterm uterine contractions. The altered values of proMMP-9 and TIMP-1 could possibly identify the inevitable progress of preterm contractions to true preterm labor.
Adult↗
Triplet pregnancy after oocyte donation in women 46 years of age and older: three case reports.
PURPOSE: Presentation of three triplet pregnancies achieved in women 46 years of age and older with the use of donated oocytes. MATERIAL & METHODS: Two healthy perimenopausal women 46 and 48 years old and one healthy menopausal woman 48 years old, requesting fertility options. All of them followed oocyte donation programs resulting in triplet pregnancy. Maternal as well as perinatal complications, mode of delivery and birth weight are reported. RESULTS: Three triplet pregnancies were achieved using donated oocytes. Prenatal diagnosis was reassuring. Preterm rupture of membranes, preterm labor and gestational diabetes complicated the pregnancies. Cesarean section was the mode of delivery for all the cases giving birth to nine healthy neonates weighing between 1,130 and 2,450 g. No postpartum complications were encountered. CONCLUSIONS: Triplet pregnancies achieved with the use of donated oocytes at a very advanced maternal age represent high-risk obstetrical cases. Cautious prenatal evaluation of maternal health and intensive antenatal surveillance are imperative principles allowing the most favorable outcome of these pregnancies.
Cesarean Section↗
Fetoplacental leptin levels and their relation to birth weight and insulin in gestational diabetic pregnant women.
To investigate the fetoplacental leptin circulation in gestational diabetes, we compared cord leptin and insulin levels in 17 healthy pregnant women and 17 women with gestational-onset diabetes. Leptin levels in the umbilical arteries (mean+/-SD 1.80+/-0.76 ng/ml) were significantly (P<0.006) lower than those in umbilical veins (2.67+/-0.98 ng/ml) in normal pregnancies. Similarly, leptin levels in umbilical veins (mean+/-4.59+/-1.60 ng/ml) were significantly (P<0.001) higher than those in umbilical arteries (mean+/-SD 2.08+/-0.90 ng/ml) in gestational diabetes. However, leptin levels in umbilical veins were significantly higher (P<0.002) in gestational diabetes than those in controls. Additionally, in women with diabetes but not in controls, the birth weight and the cord leptin concentrations were positively related to cord insulin levels. We conclude that there is a hyperleptinaemia in the fetoplacental circulation in pregnant women with carbohydrate intolerance and in these cases insulin and leptin may have antagonist roles regarding fetal development.
Adult↗
Maternal homocysteine levels and plasma lipids in gestational diabetes: is there any relationship?
The aim of the study was to investigate the possible relationship between maternal homocysteine levels and plasma lipid parameters and whether gestational diabetes can alter the serum maternal concentration of this substance. The study included 36 primigravidas divided into two groups: group A consisted of 21 healthy pregnant women with a mean gestational age of 38.2 weeks, and group B consisted of 15 diabetic women with a mean gestational age of 38.4 weeks. No difference in maternal homocysteine levels was noted between the two groups (6.006 +/- 1.64 vs. 7.004 +/- 1.36 micromol/L). Serum cholesterol levels and serum triglyceride levels in normal pregnant women were not statistically significantly different compared to those seen in diabetic pregnant women. Similarly, no difference was found between the two groups regarding LDL levels and atheromatic index. In women with diabetes there was a weak positive relation between plasma concentrations of homocysteine and LDL levels as well as atheromatic index, but this relation was not statisticially significant. We conclude that serum homocysteine levels are not elevated in women with gestational-onset diabetes. There was also no relation between serum concentrations of homocysteine and lipid parameters in this complication of pregnancy.
Adult↗
Abnormal fetal heart rate patterns during the active phase of labor: the value of fetal oxygen saturation.
OBJECTIVE: To determine the predictive value of intrapartum fetal oxygen saturation (SO2) for prediction of an umbilical artery pH less than 7.15 at birth in labors complicated by abnormal fetal heart rate traces. STUDY DESIGN: Eighty-five primigravidas in spontaneous labor complicated by abnormal fetal heart rate traces underwent fetal SO2 monitoring using the fetal pulse oximetry technique. Cases with an SO2 of < 30% were delivered by Cesarean section. Umbilical artery pH was measured at birth in all women. RESULTS: With the value set of 30% as the cut-off point of fetal oxygen saturation, the positive predictive value for umbilical artery pH of < 7.15 was 61.5% and the negative predictive value was 95.8%, with a sensitivity of 72% and a specificity of 93%. CONCLUSIONS: Fetal pulse oximetry is a promising technique for assessment of fetal well-being during labor and may decrease the number of unnecessary Cesarean sections.
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[von Recklinghausen's disease and pregnancy].
Neurofibrosis or the Von Recklinghausen disease constitutes a genetically transmitted disease that appears in many parts of the body as well as many symptoms. It is inherited from the autosomatic dominant type (gene NFI on chromosome 17) and is characterized by brownish blemishes of the skin (cafe au lait), multiple neurofibromas (small dermal or subcutaneous lumps), symptoms of the peripheral and central nervous systems as well as disorders of the eyes, skeletal system, gastric system and vascular system (aneurysms of the aorta, carotid and renal arteries). We describe the case study of a 25 year old female, second pregnancy with known history of the above mentioned disease. She delivered on the 39th week of pregnancy (male neonate weighing 3000 gr.), with no problems. On the 22nd week of her pregnancy she presented with a large distension of the anterior surface of the neck in the area of the thyroid that gradually increased in size. Differential Diagnosis includes nodular goiter and neurofibroma. One month postpartum the morphoma was surgically. Neurofibrosis during pregnancy can cause many complications such as IUGR, hypertensive disease, spontaneous abortions, oligohydraminios and neurofibroma development. This case study is being discussed in international bibliography.
Adult↗
[Adamantiades-Behcet's syndrome and pregnancy: a case report].
Is introducing a case study on a 20 year old female first time pregnant who presents with rare case of Adamantiadis-Bechet syndrome. These symptoms first appeared at the age of 9. The patient refers that from this age she has suffered from recurrent relapses of ulcerations of the mouth and genital organs, vescicular exanthema of the upper and lower extremities and severe headaches that would not subside with analgetic therapy. The patient upon the first trimester presented with a relapse of the disease and significant improvement during the remainder of the pregnancy. She delivered on the 39th week of her pregnancy a neonate male, alive and weighing 3640 gr. The Apgar--score 9 and 10 the 1st and 5th minute. Mother and neonate were discharged from the clinic on the 3rd postpartum day in good health. This case is also being discussed in international bibliography. Adamantiadis-Behcet syndrome constitutes systemic angiitis of unknown etiology that is characterized mainly by recurrent ulcers of the mouth and genital organs, serum negative arthritis, central nervous system disorders as well as ulcerations of the epidermis, nodular erythema, thrombophlebitis and vision disorders. It usually affects people in early adulthood, more often those in their 30s. Geographically it is seen more often in Japan, Korea, Turkey, Israel and other Mediterranean countries. Familial prevalence is also common.
Adult↗
The role of the mode of delivery in the alteration of intrapartum pathological cervical cytologic findings during the postpartum period.
OBJECTIVE: The aim of the study was to determine whether abnormal antepartum cervical cytologic findings change in the postpartum period and the relation of this alteration to the mode of delivery. STUDY DESIGN: Between 1991 and 2000, 192 pregnant women with antepartum abnormal cervical cytology were identified; complete demographic, clinical and cytologic reports were available for 90 of them. Papanicolaou smear tests were collected and separated in three groups using the Bethesda classification system (ASCUS, L-SIL and H-SIL). RESULTS: Of the 90 women, 52 (61.1%) were delivered vaginally and 38 (38.9%) by cesarean section. No difference was found between women delivered vaginally and those delivered by cesarean section, regardin age, parity and smoking history. The overall postpartum regression rate for the 20 women with antepartum H-SIL cells was 45%. Of the 12 women with H-SIL cells who were delivered vaginally, eight (66.6%) showed regression in the postpartum period while this regression was achieved only in one (12.5%) woman, who was delivered by cesarean section (p < 0.002). CONCLUSION: Postpartum spontaneous regression of suspicious Papanicolaou smears consistent with H-SIL occurs with increased frequency among women who are delivered vaginally compared to those delivered by cesarean section.
Adult↗
Alterations of maternal and fetal leptin concentrations in hypertensive disorders of pregnancy.
OBJECTIVES: To investigate whether hypertensive disorders of pregnancy alter the maternal and fetal leptin levels. METHODS: Fifty primigravidas between 28 and 34 weeks of gestation were divided into three groups: group A consisted of 17 normal pregnant women with a mean gestational age of 31 weeks, group B consisted of 15 women with gestational hypertension without proteinuria with a mean gestational age of 30 weeks and group C consisted of 18 pre-eclamptic women with a mean gestational age of 31 weeks. RESULTS: The pre-eclamptics had significantly higher serum leptin levels than those in normal pregnancies (p<0.001) but no difference was noted between normal and gestational hypertensive pregnancies. Pre-eclamptic women had significantly higher umbilical vein leptin levels (4.68+/-1.66ng/ml) compared to normal pregnancies (1.92+/-0.71ng/ml) and those with gestational hypertension (2.47+/-0.81ng/ml). CONCLUSIONS: Pre-eclampsia is associated with an increase in maternal plasma leptin levels and fetal of leptin production increases in gestational hypertension and even more in pre-eclampsia.
Adult↗
Maternal plasma leptin levels and their relationship to insulin and glucose in gestational-onset diabetes.
To investigate the changes in leptin levels and the relationship between this substance and insulin and glucose in pregnant women with gestational-onset diabetes, we measured plasma leptin levels in the maternal peripheral vein of 17 healthy and 17 diabetic women at 29 and 33 weeks of gestation. We also correlated maternal plasma leptin levels in diabetic women with fasting plasma insulin levels and plasma glucose levels obtained 1 h after oral administration of 50 g of glucose. Maternal serum leptin levels in women with gestational diabetes (mean +/- SD 16.52 +/- 5.07 ng/ml, range 10.84-27.4 ng/ml) were significantly higher (p < 0.001) than those found in uncomplicated pregnancies (10.61 +/- 1.47 ng/ml, range 7.28-13.4 ng/ml). A positive correlation was found between maternal serum leptin levels and glycosylated haemoglobin values in diabetic pregnant women (r = 0.94, p < 0.001). A positive correlation was also found between maternal leptin concentrations and fasting serum insulin levels, as well as between leptin concentrations and plasma glucose levels obtained 1 h after the administration of 50 g of glucose in women with gestational diabetes (r = 0.84, p < 0.001, and r = 0.92, p < 0.001, respectively). We conclude that leptin levels are elevated in pregnant women with gestational diabetes, and its metabolism depends on insulin levels and the severity of diabetes.
Adult↗
The value of transvaginal ultrasonography in diagnosis and management of cervical incompetence.
To determine the value of transvaginal sonography in women with a previous history of second trimester miscarriage due to cervical incompetence, 55 patients were subjected to either elective cervical cerclage or follow-up (every second patient) with weekly evaluations of the cervix by transvaginal ultrasonography. Emergency cerclage was applied when significant cervical changes were noted. All patients were evaluated with cervical cultures and ultrasound. Women with infection, fibroids, uterine malformations and multiple pregnancies were excluded from the study. The study population was divided in two groups. In group I (n=27) elective cerclage was applied during the 14th week. Women in group II (n=28) were subjected to serial weekly evaluations of the cervix by transvaginal ultrasonograms. In 18 cases emergency cerclage was applied due to significant cervical changes. In group I, labor started before the 33rd week in two cases (7.4%), between 33 and 37 weeks in nine (33.3%) and after the 37th week in 16 cases (59.2%). Out of the 18 patients in group II who had cervical cerclage after ultrasonographic evaluation, four (22.2%) delivered before the 33rd week, three (16.6%) between 33 and 37 weeks and 11 (61.1%) after the 37th week. No statistical difference was noted between the two groups referring to pregnancy outcome (p<0.1). We concluded that ultrasound-guided management despite cervical shortening, does not result in unfavorable pregnancy outcome. A significant number of patients can avoid the operation.
Adult↗
Complex congenital heart disease and pre-eclampsia. A case report.
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Adult↗
Sweeping of the membranes versus uterine stimulation by oxytocin in nulliparous women. A randomized controlled trial.
The aim of this study was to evaluate whether sweeping of the membranes at term could shorten the length of pregnancy and reduce the incidence of postterm pregnancies. We randomly selected 104 nulliparas with uncomplicated pregnancy and gestational age between 281 and 287 days. Our patients were divided into three groups. Group A consisted of 34 women who were subjected to sweeping of the membranes. Uterine stimulation with oxytocin was applied in 35 women (group B), and 35 women (group C) were used as a control group. We had no significant reduction of the time interval from sweeping of the membranes until delivery (1.9 +/- 1.2 days), compared to that of group B (2.1 +/- 0.8 days) as well as that of the control group (2.5 +/- 0.9 days). The incidence of spontaneous labor in patients after sweeping of the membranes was greater (67.6%) when compared with oxytocin-stimulated patients and the control group (p < 0.05). Furthermore, a better Bishop score was noted in patients of group A. No statistically significant difference was noted in the mode of delivery between the groups, but sweeping of the membranes significantly decreased the incidence of postterm pregnancies (p < 0. 05). We concluded that sweeping of the membranes is an effective method for initiating labor in women with a gestational age between 40 and 41 weeks, thus reducing the need for induction.
Adult↗