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591 The Prevalence and Clinical Significance of the Isolation of Ureaplasma Urealyticum in Midtrimester Amniocentesis
432
589
590
SPO Abstracts
January 1992 Am J Obstet Gynecol
FETAL ASCITES FLUID - A NEW SOURCE OF CELLS FOR CHROMOSOMAL ANALYSIS. J.R. Wax.. K.J. Blakemore. G. Stetten: Dept. of Gyn/Ob. The Johns Hopkins Univ. Sch. of Med. Baltimore. MD. Background: The optimal source of cells for chromosomal analysis of the sonographically anomalous fetus is influenced by the accessibility of the cells. procedure-related risks. and the speed with which results may be obtained. We have rapidly and reliably performed cytogenetic analysis using cells cultured from fetal ascites. Methods: Fetal ascites was obtained during therapeutic paracentesis from two patients at 33 weeks and 19 weeks gestation. Following a differential cell count. ascitic fluid was set up at 10· cells/ml of media. stimulated with phytohemagglutinin (PHAI. synchronized. and harvested at 96 hours according to a standard lymphocyte protocol. Results: In the first patient. the cultured ascites cell karyotype confirmed the diagnosis from fetal blood lymphocytes and amniocytes as 45.X. In the second patient. the ascites cell karyotype confirmed the amniocyte diagnosis of 47.XY.+13. Conclusion: Fetal ascites is an easily accessible source of cells for culture and rapid karyotype. The fluid is readily visible sonographically and easily removed without undue fetal risk by ultrasound-guided needle aspiration. More rapid cytogenetic results should be possible as with peripheral blood lymphocytes using shorter culture times.
591
PRENATAL DIAGNOSIS OF BIRTH DEFECTS. A REVIEW OF 67,349 DELIVERIES. D. OgynyemlX, P. Brownx , R. WiIIlsHassanx , M. Hernandez, T. Fukushima. King-Drew Medical Center, Los Angeles, CA This study was undertaken to examine the efficacy of current practices of prenatal care in detecting birth defects. ~ All deliveries from 1982 through 1989 were evaluated; chi-square test was used for statistical analysis. ~ A total of 385 cases of birth defects were ldentHled (5.7/1000). Birth defects were considered amenable to prenatal diagnosis in 250 (66%) cases and not detectable by current technology In 135 (34%). However, the actual number of cases detected by routine prenatal care was only 67 (27%). In 183 potentially detectable cases diagnoses were not made for the follOWing reasons: No PNC (26%); had PNC but was not tested (50%); tested but defect was missed (4%); too young for amniocentesis (30%).
592
BIRTH DEFECTS Detected (67)
CNS 45(41:11)
Not detec. (183) 64(59:11)
M-S§ CARDIAC CHROMOS. PN Deaths 5(31:11) 2( lOX) 11( 16:11) 39(59:11)
11(69:11) 19(9OX) 63(84:11)
(All differences p<.OOO1)
§ M-S
45(25:11)
= Musculo-Skeletal
Conclusions: In this population, the majority of birth defects was not detected prenatally, although only 4% were missed when appropriate diagnostic techniques had been used. To diagnose all potentially detectable cases, the following tests would have been required: Ultrasound (60%); amniocentesis (30%); and fetal echocardiography (10%). A more liberal use of these procedures, including amniocentesis for younger women «35 y/o), may enhance the rate of detection of birth defects.
THE PREVAU:NCE AND CUNICAL SIGNIFICANCE OF THE ISOLATION OF UREAPlASMA UREALYTICUM IN MIDTRlMESTER AMNIOCENTESIS. M. Mazor. S. Horowitz,X R. Romero, C. Walter,X M. Glezerman,x Depts.-;' Ob/Gyn, Soroka Mad. Center, Ben Gurion Univ., Israel and Yale Univ. School of Medicine, New Haven, CT The causes of pregnancy loss following midtrimester amniocentesis are unknown. Pre-existing subclinical microbial invasion of the amniotic cavity may be a predisposing factor for membrane rupture and chorioamnionitis following the procedure. The purpose of this study was to determine the frequency and clinical consequences of microbial invasion of the amniotic cavity in women undergoing midtrimester amniocentesis for genetic indications. This study focused on Mycoplasmas CUreaplasma urealyticum and Mycoplasma hominis) because these are the microorganisms most frequently Isolated in cases of microbial invasion of the amniotic cavity. Materials and Methods: Amniocentesis for genetic indications was performed in 193 consecutive patients. Amniotic fluid was cultured for Mycoplasma hominis and Ureaplasma urealyticum using methodology previously described. Cervical cultures were obtained following amniocentesis. Follow-up was available in all patients. Results: The prevalence of positive amniotic fluid cultures was 2.5% (5/193). Ureaplasma urealyticum was the only isolate from amniotic fluid. The rate of spontaneous preterm delivery was higher in patients with a positive amniotic fluid culture than in patients with a negative culture (42.8% [3/7) vs. 5.3% [10/186); p <0.05). One patient with a poSitive culture ruptured her membranes one hour after the amniocentesis. (All patients with a positive amniotic fluid culture had Ureaplasma urealyticum isolated from the lower genital tract.) Conclusions: 1) Microbial invasion of the amniotic cavity with Ureaplasma urealyticum was detected in 2.5% of women undergoing midtrimester amniocentesis. 2) Pre-existing microbial invasion of the amniotic cavity can be responsible for a fraction of postamniocentesis pregnancy loss. 3) Colonization of the amniotic cavity with Ureaplasma urealyticum is a risk factor for preterm delivery. 4) Routine culturing of amniotic fluid for Mycoplasmas must be considered at the time of mldtrimester amniocentesis.
FOUR YEAR REVIEW OF PRENATAL DIAGNOSIS BY PUBS. R.D. Wilson, D.F. Farquharsonx• D_ Shaw', B.K_ Wittmannx. Dept. Ob/Gyn. Univ. British Columbia, Grace Hospital. Vancouver, B.C. Canada. Fetal evaluation by percutaneous umbilical blood sampling has allowed a more rapid diagnosis of fetal conditions. We present our four year experience with 214 PUBS procedures. Indications included fetal anomalies requiring chromosome diagnosis in 135 (63%), evaluation of fetal platelets 49 (23%). maternal Rh disease 24 (11%). and miscellaneous indications in 6 (3%)_ For the chromosome indication 122 were for fetal karyotypes and 13 for fragile X evaluation_ The number of failed procedures was 15 (7%). The number of post-procedural deaths was 4 (1.9%), and neonatal deaths 2 (0.9%) with an overall loss rate of 2.8%. The most common malformations necessitating chromosome diagnosis were intrauterine growth retardation (21), fetal hydrops (17). central nervous system abnormalities (15). and multiple congenital anomalies (14). Fetal blood sampling to evaluate fetal mosaicism was used in 7 cases where CVS or amniocentesis had indicated possible mosacism. Gestational ages at the time of the procedure was equally distributed between 5 gestational age groups - less than 20 weeks. 20-25 weeks, 25-30 weeks, 30-35 weeks, and greater than 35 weeks.
589
590
SPO Abstracts
January 1992 Am J Obstet Gynecol
FETAL ASCITES FLUID - A NEW SOURCE OF CELLS FOR CHROMOSOMAL ANALYSIS. J.R. Wax.. K.J. Blakemore. G. Stetten: Dept. of Gyn/Ob. The Johns Hopkins Univ. Sch. of Med. Baltimore. MD. Background: The optimal source of cells for chromosomal analysis of the sonographically anomalous fetus is influenced by the accessibility of the cells. procedure-related risks. and the speed with which results may be obtained. We have rapidly and reliably performed cytogenetic analysis using cells cultured from fetal ascites. Methods: Fetal ascites was obtained during therapeutic paracentesis from two patients at 33 weeks and 19 weeks gestation. Following a differential cell count. ascitic fluid was set up at 10· cells/ml of media. stimulated with phytohemagglutinin (PHAI. synchronized. and harvested at 96 hours according to a standard lymphocyte protocol. Results: In the first patient. the cultured ascites cell karyotype confirmed the diagnosis from fetal blood lymphocytes and amniocytes as 45.X. In the second patient. the ascites cell karyotype confirmed the amniocyte diagnosis of 47.XY.+13. Conclusion: Fetal ascites is an easily accessible source of cells for culture and rapid karyotype. The fluid is readily visible sonographically and easily removed without undue fetal risk by ultrasound-guided needle aspiration. More rapid cytogenetic results should be possible as with peripheral blood lymphocytes using shorter culture times.
591
PRENATAL DIAGNOSIS OF BIRTH DEFECTS. A REVIEW OF 67,349 DELIVERIES. D. OgynyemlX, P. Brownx , R. WiIIlsHassanx , M. Hernandez, T. Fukushima. King-Drew Medical Center, Los Angeles, CA This study was undertaken to examine the efficacy of current practices of prenatal care in detecting birth defects. ~ All deliveries from 1982 through 1989 were evaluated; chi-square test was used for statistical analysis. ~ A total of 385 cases of birth defects were ldentHled (5.7/1000). Birth defects were considered amenable to prenatal diagnosis in 250 (66%) cases and not detectable by current technology In 135 (34%). However, the actual number of cases detected by routine prenatal care was only 67 (27%). In 183 potentially detectable cases diagnoses were not made for the follOWing reasons: No PNC (26%); had PNC but was not tested (50%); tested but defect was missed (4%); too young for amniocentesis (30%).
592
BIRTH DEFECTS Detected (67)
CNS 45(41:11)
Not detec. (183) 64(59:11)
M-S§ CARDIAC CHROMOS. PN Deaths 5(31:11) 2( lOX) 11( 16:11) 39(59:11)
11(69:11) 19(9OX) 63(84:11)
(All differences p<.OOO1)
§ M-S
45(25:11)
= Musculo-Skeletal
Conclusions: In this population, the majority of birth defects was not detected prenatally, although only 4% were missed when appropriate diagnostic techniques had been used. To diagnose all potentially detectable cases, the following tests would have been required: Ultrasound (60%); amniocentesis (30%); and fetal echocardiography (10%). A more liberal use of these procedures, including amniocentesis for younger women «35 y/o), may enhance the rate of detection of birth defects.
THE PREVAU:NCE AND CUNICAL SIGNIFICANCE OF THE ISOLATION OF UREAPlASMA UREALYTICUM IN MIDTRlMESTER AMNIOCENTESIS. M. Mazor. S. Horowitz,X R. Romero, C. Walter,X M. Glezerman,x Depts.-;' Ob/Gyn, Soroka Mad. Center, Ben Gurion Univ., Israel and Yale Univ. School of Medicine, New Haven, CT The causes of pregnancy loss following midtrimester amniocentesis are unknown. Pre-existing subclinical microbial invasion of the amniotic cavity may be a predisposing factor for membrane rupture and chorioamnionitis following the procedure. The purpose of this study was to determine the frequency and clinical consequences of microbial invasion of the amniotic cavity in women undergoing midtrimester amniocentesis for genetic indications. This study focused on Mycoplasmas CUreaplasma urealyticum and Mycoplasma hominis) because these are the microorganisms most frequently Isolated in cases of microbial invasion of the amniotic cavity. Materials and Methods: Amniocentesis for genetic indications was performed in 193 consecutive patients. Amniotic fluid was cultured for Mycoplasma hominis and Ureaplasma urealyticum using methodology previously described. Cervical cultures were obtained following amniocentesis. Follow-up was available in all patients. Results: The prevalence of positive amniotic fluid cultures was 2.5% (5/193). Ureaplasma urealyticum was the only isolate from amniotic fluid. The rate of spontaneous preterm delivery was higher in patients with a positive amniotic fluid culture than in patients with a negative culture (42.8% [3/7) vs. 5.3% [10/186); p <0.05). One patient with a poSitive culture ruptured her membranes one hour after the amniocentesis. (All patients with a positive amniotic fluid culture had Ureaplasma urealyticum isolated from the lower genital tract.) Conclusions: 1) Microbial invasion of the amniotic cavity with Ureaplasma urealyticum was detected in 2.5% of women undergoing midtrimester amniocentesis. 2) Pre-existing microbial invasion of the amniotic cavity can be responsible for a fraction of postamniocentesis pregnancy loss. 3) Colonization of the amniotic cavity with Ureaplasma urealyticum is a risk factor for preterm delivery. 4) Routine culturing of amniotic fluid for Mycoplasmas must be considered at the time of mldtrimester amniocentesis.
FOUR YEAR REVIEW OF PRENATAL DIAGNOSIS BY PUBS. R.D. Wilson, D.F. Farquharsonx• D_ Shaw', B.K_ Wittmannx. Dept. Ob/Gyn. Univ. British Columbia, Grace Hospital. Vancouver, B.C. Canada. Fetal evaluation by percutaneous umbilical blood sampling has allowed a more rapid diagnosis of fetal conditions. We present our four year experience with 214 PUBS procedures. Indications included fetal anomalies requiring chromosome diagnosis in 135 (63%), evaluation of fetal platelets 49 (23%). maternal Rh disease 24 (11%). and miscellaneous indications in 6 (3%)_ For the chromosome indication 122 were for fetal karyotypes and 13 for fragile X evaluation_ The number of failed procedures was 15 (7%). The number of post-procedural deaths was 4 (1.9%), and neonatal deaths 2 (0.9%) with an overall loss rate of 2.8%. The most common malformations necessitating chromosome diagnosis were intrauterine growth retardation (21), fetal hydrops (17). central nervous system abnormalities (15). and multiple congenital anomalies (14). Fetal blood sampling to evaluate fetal mosaicism was used in 7 cases where CVS or amniocentesis had indicated possible mosacism. Gestational ages at the time of the procedure was equally distributed between 5 gestational age groups - less than 20 weeks. 20-25 weeks, 25-30 weeks, 30-35 weeks, and greater than 35 weeks.