Nifedipine Prevents Apoptosis of Alcohol-Exposed First-Trimester Trophoblast Cells.

Background: Maternal alcohol abuse leading to fetal alcohol spectrum disorder (FASD) includes fetal growth restriction (FGR). Ethanol (EtOH) induces apoptosis of human placental trophoblast cells, possibly disrupting placentation and contributing to FGR in FASD. EtOH facilitates apoptosis in several embryonic tissues, including human trophoblasts, by raising intracellular Ca .

Enhancement of trophoblast differentiation and survival by low molecular weight heparin requires heparin-binding EGF-like growth factor.

Study Question: Does low molecular weight heparin (LMWH) require heparin-binding epidermal growth factor (EGF)-like growth factor (HBEGF) signaling to induce extravillous trophoblast differentiation and decrease apoptosis during oxidative stress?

Summary Answer: LMWH increased HBEGF expression and secretion, and HBEGF signaling was required to stimulate trophoblast extravillous differentiation, increase invasion in vitro and reduce trophoblast apoptosis during oxidative stress.

What Is Known Already: Abnormal trophoblast differentiation and survival contribute to placental insufficiency syndromes, including preeclampsia and intrauterine growth restriction. Preeclampsia often manifests as a pro-thrombotic state, with unsuccessful transformation of the spiral arteries that reduces oxygen supply and can produce placental infarction.

Altered Biomarkers in Trophoblast Cells Obtained Noninvasively Prior to Clinical Manifestation of Perinatal Disease.

A contributing factor to poor placental perfusion, leading to intrauterine growth restriction and preeclampsia, is the failure of invading extravillous trophoblast (EVT) cells to remodel the maternal uterine arteries during the first and second trimesters of pregnancy. Noninvasive assessment of EVT cells in ongoing pregnancies is possible beginning three weeks after conception, using trophoblast retrieval and isolation from the cervix (TRIC). Seven proteins were semi-quantified by immunofluorescence microscopy in EVT cells obtained between gestational weeks 6 and 20 from pregnancies with normal outcomes (N = 29) and those with intrauterine growth restriction or preeclampsia (N = 12).

Reduced homeobox protein MSX1 in human endometrial tissue is linked to infertility.

Study Question: Is protein expression of the muscle segment homeobox gene family member MSX1 altered in the human secretory endometrium by cell type, developmental stage or fertility?

Summary Answer: MSX1 protein levels, normally elevated in the secretory phase endometrium, were significantly reduced in endometrial biopsies obtained from women of infertile couples.

What Is Known Already: Molecular changes in the endometrium are important for fertility in both animals and humans. Msx1 is expressed in the preimplantation mouse uterus and regulates uterine receptivity for implantation.

Assisted reproductive technology alters deoxyribonucleic acid methylation profiles in bloodspots of newborn infants.

Objective: To evaluate the effect of infertility and intracytoplasmic sperm injection (ICSI) on DNA methylation of offspring.

Design: Microarray analysis of DNA methylation in archived neonatal bloodspots of in vitro fertilization (IVF)/ICSI-conceived children compared with controls born to fertile and infertile parents.

Setting: Academic research laboratory.

Trophoblast Retrieval and Isolation From the Cervix for Noninvasive, First Trimester, Fetal Gender Determination in a Carrier of Congenital Adrenal Hyperplasia.

Congenital adrenal hyperplasia (CAH) is an autosomal recessive defect in cortisol biosynthesis that elevates fetal androgen levels to cause genital ambiguity and external genital masculinization in newborn females. Introducing dexamethasone in utero by 7 weeks gestation precludes virilization of affected females. However, identification of a male fetus prior to week 7 could avert the necessity of steroid treatment in half of pregnancies at risk of CAH.

Trophoblast retrieval and isolation from the cervix (TRIC) is unaffected by early gestational age or maternal obesity.

Objective: The objective of this study is to evaluate whether trophoblast yield obtained by trophoblast retrieval and isolation from the cervix (TRIC) is affected by pregnancy outcome, gestational age (GA) at retrieval, maternal body mass index (BMI), parity, or maternal age.

Methods: TRIC was performed on 224 ongoing pregnancies between 5 and 20 weeks of GA. Trophoblast cells were isolated from cervical cells using anti-human leukocyte antigen-G antibody coupled to magnetic nanoparticles.

Reproductive Outcomes in Women Following Radiofrequency Volumetric Thermal Ablation of Symptomatic Fibroids. A Retrospective Case Series Analysis.

Objective: To report reproductive outcomes in women who underwent radiofrequency volumetric thermal ablation (RFVTA) of symptomatic uterine fibroids.

Study Design: Retrospective analysis of fibroid characteristics, treatment parameters, and pregnancy outcomes of 6 subjects in 3 prospective trials of laparoscopic ultrasound-guided RFVTA.

Results: Despite the requirement that women enrolled in the RFVTA studies did not desire current or future childbearing and were to continue contraception, 6 subjects conceived at between 3.

Noninvasive detection of trophoblast protein signatures linked to early pregnancy loss using trophoblast retrieval and isolation from the cervix (TRIC).

Objective: To examine the expression pattern of biomarker proteins in extravillous trophoblast (EVT) cells obtained noninvasively by trophoblast retrieval and isolation from the cervix (TRIC) in patients with early pregnancy loss compared with control patients with uncomplicated term delivery.

Design: Case-control study.

Setting: Academic medical center.

Sildenafil stimulates human trophoblast invasion through nitric oxide and guanosine 3',5'-cyclic monophosphate signaling.

Objective: To determine the effect of sildenafil, a phosphodiesterase type 5 inhibitor, on trophoblast invasiveness.

Design: Laboratory investigation.

Setting: Academic medical center.

Postoperative adhesions as a consequence of pelvic surgery.

Adhesions represent a frequent thought-provoking surgical ramification that greatly affects clinical practice, thereby making adhesion deterrence an important area of public health intervention, research, and the fiscal budget. Postoperative adhesions have been observed in up to 94% of patients after laparotomy. Adhesion-related readmissions, 1 year after surgery, were found to be in 1.

Sildenafil Prevents Apoptosis of Human First-Trimester Trophoblast Cells Exposed to Oxidative Stress: Possible Role for Nitric Oxide Activation of 3',5'-cyclic Guanosine Monophosphate Signaling.

Human first-trimester trophoblast cells proliferate at low O2, but survival is compromised by oxidative stress, leading to uteroplacental insufficiency. The vasoactive drug, sildenafil citrate (Viagra, Sigma, St Louis, Missouri), has proven useful in reducing adverse pregnancy outcomes. An important biological function of this pharmaceutical is its action as an inhibitor of cyclic guanosine monophosphate (cGMP) phosphodiesterase type 5 activity, which suggests that it could have beneficial effects on trophoblast survival.

Apoptosis of alcohol-exposed human placental cytotrophoblast cells is downstream of intracellular calcium signaling.

Background: Apoptosis is induced by ethanol (EtOH) in human placental trophoblast cells, possibly disrupting placentation and contributing to intrauterine growth restriction in fetal alcohol spectrum disorder (FASD). EtOH induces programmed cell death in several embryonic tissues by raising intracellular Ca(2+) . Therefore, the role of Ca(2+) signaling in EtOH-induced apoptosis was examined using human first trimester cytotrophoblast cell lines, examining the hypothesis that apoptosis is dependent on intracellular Ca(2+) signaling.

Trophoblast retrieval and isolation from the cervix (TRIC) for noninvasive prenatal screening at 5 to 20 weeks of gestation.

Objective: To use trophoblast cells accumulating in the endocervical canal at the beginning of pregnancy for noninvasive prenatal testing.

Design: Prospective, double-blinded test for fetal gender.

Setting: Academic medical center.

Demographic differences in Down syndrome livebirths in the US from 1989 to 2006.

Objective: To explore demographic differences in Down syndrome livebirths in the United States.

Methods: Using National Center for Health Statistics (NCHS) birth certificate data from 1989 to 2006 we analyzed Down syndrome livebirths after correcting for under-reporting. We created six subsets based on maternal age (15-34 and 35-49 years old); US regions, that is, Northeast, Midwest, South and West; marital status, (married, unmarried); education, ( ≤ 12 years, ≥ 13 years); race, (white, black); and Hispanic ethnicity, (non-Hispanic, Hispanic).

Down syndrome screening in the United States in 2001 and 2007: a survey of maternal-fetal medicine specialists.

Objective: The purpose of this study was to determine changes in screening and performance of invasive diagnostic procedures for Down syndrome between 2001 and 2007.

Study Design: The Society for Maternal-Fetal Medicine members completed a survey in 2007 regarding screening tests and diagnostic procedures for Down syndrome. With the use of descriptive statistics, the chi(2) test, and the Student t test, responses from 2007 were compared with responses from a similar 2001 survey.

Cross-over trial of fetal heart rate response to halogen light and vibroacoustic stimulation.

Objective: The purpose of this study was to compare the effect of halogen light and vibroacoustic stimulation on fetal heart rate (FHR) responsiveness and on nonstress test (NST) results.

Methods: Sixty consecutively-chosen patients between 33 and 39 weeks of gestation underwent an NST on at least three weekly occasions. Each received halogen light (Vector Compact Sport Spot, Ft Lauderdale, FL, USA), vibroacoustic (SolaTone Artificial Larynx, Temecula, CA, USA), and no stimulation in a randomized order.

Selecting an external light source for fetal biophysical testing.

Objective: To select the most intense light source that penetrates tissues and is safe for fetal biophysical testing

Study Design: A 3-step series of experiments was undertaken using a digital light meter (Extech Light Probe Meter, Extech Instruments, Waltham, Massachusetts). First, the density of light through a light filter was compared between the sun and 4 commercially available light sources. Second, penetration of light through the abdominal subcutaneous tissue (3-4 cm thick) of 6 pigs was compared between these light sources.

Effect of halogen light stimulation on nonstress testing.

Objective: This study was undertaken to determine whether external stimulation using a halogen light source influences fetal heart rate (FHR) responsiveness and nonstress test results.

Study Design: A total of 107 patients at 32 to 42 weeks' gestation undergoing a nonstress test were randomly assigned to have either transabdominal light stimulation or no light stimulation. The light (Vector Compact Sport Spot, Ft Lauderdale, Fla) was turned on for 10 seconds.

Substance use disorders in women: special considerations during pregnancy.

Care of substance-using pregnant women is complex, difficult, and often demanding. Women's care providers must be aware of these women's unique psychologic and social needs and the related legal and ethical ramifications surrounding pregnancy. In addition, relating specific substances to perinatal outcome is difficult, because concurrent use of multiple substances is frequent and many pregnant abusers are members of economically disadvantaged segments of society in which unfavorable perinatal outcomes are more common.