Bacterial vaginosis (BV), a condition affecting millions of women each year, is primarily caused by the gram-variable organism Gardnerella vaginalis. A number of organisms associated with BV cases have been reported to develop multidrug resistance, leading to the need for alternative therapies. Previously, we reported the antimicrobial peptide subtilosin has proven antimicrobial activity against G. vaginalis, but not against the tested healthy vaginal microbiota of lactobacilli. After conducting tissue sensitivity assays using an ectocervical tissue model, we determined that human cells remained viable after prolonged exposures to partially-purified subtilosin, indicating the compound is safe for human use. Subtilosin was shown to eliminate the motility and forward progression of human spermatozoa in a dose-dependent manner, and can therefore be considered a general spermicidal agent. These results suggest subtilosin would be a valuable component in topical personal care products aimed at contraception and BV prophylaxis and treatment. (Source: Infectious Diseases in Obstetrics and Gynecology)

Objective. To measure the incidence of ampicillin-resistant uropathogens in acute antepartum pyelonephritis and to determine if patients with resistant organisms had different clinical outcomes. Study design. This was a secondary analysis of a prospective cohort study of pregnant women admitted with pyelonephritis, diagnosed by standard clinical and laboratory criteria. All patients received ampicillin and gentamicin. Results. We identified 440 cases of acute pyelonephritis. Seventy-two percent (316 cases) had urine cultures with identification of organism and antibiotic sensitivities. Fifty-one percent of uropathogens were ampicillin resistant. The patients with ampicillin-resistant organisms were more likely to be older and multiparous. There were no significant differences in hospital course (length of stay, days of antibiotics, ECU admission, or readmission). Patients with ampicillin-resistant organisms did not have higher complication rates (anemia, renal dysfunction, respiratory insufficiency, or preterm birth). Conclusion. A majority of uropathogens were ampicillin resistant, but no differences in outcomes were observed in these patients. (Source: Infectious Diseases in Obstetrics and Gynecology)

There is considerable uncertainty about the management of hypothyroidism in pregnancy. Our aim was to establish the pattern of thyroxine dose adjustment needed and to determine the clinical reasons for these changes and the contributory factors. Of 89 pregnancies, thyroxine dose was unchanged in 50, increased (by a mean of 38 micrograms) in 34, and decreased in 5. Twenty-three percent of women who were tested in the first trimester needed an immediate increase in thyroxine. One-quarter (26%) of the women who needed a gestational increase in thyroxine dose had had a recent pre-pregnancy increase in thyroxine requirement (compared with 0% in women on static dose in pregnancy, P < 0.001). Furthermore, they did not require a decrease in thyroxine dose postpartum, suggesting a long-term need for more thyroxine rather than a transient gestational effect. None of the women who had stable doses of thyroxine during pregnancy had required recent pre-pregnancy changes in dose or needed postnatal changes. Inadequate pre-pregnancy control of thyroid function is associated with a need to increase thyroxine dosage during pregnancy. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

New research to be published in BJOG: An International Journal of Obstetrics and Gynaecology examines the effects of a miscarriage on subsequent pregnancies. Miscarriage (or spontaneous pregnancy loss) is defined as pregnancy loss before 24 completed weeks of gestation. (Source: Health News from Medical News Today)

Although sonohysterography is associated with transtubal fluid spills, there is little likelihood of endometrial cancer cell dissemination during the procedure, according to a report in the American Journal of Obstetrics and Gynecology for September. Reuters Health Information (Source: Medscape Ob/Gyn & Women's Health Headlines)

New research shows women who develop diabetes during pregnancy (gestational diabetes mellitus) have reduced levels of an insulin-sensitive hormone, adiponectin, as early as nine weeks into the pregnancy. The findings, published in the latest edition of Clinical Endocrinology, show early warning signs of gestational diabetes (GDM) are evident months before the clinical diagnosis is currently made (20-22 weeks). (Source: Pregnancy News From Medical News Today)

US scientists have developed a non-invasive way to detect chromosomal disorders such as Down Syndrome in a fetus that only needs a sample of the pregnant woman's blood and therefore does not carry the risk of miscarriage of more invasive methods. (Source: Genetics News From Medical News Today)

(Source: BMJ)

Objective To explore pregnancy outcomes in women following an initial miscarriage.Design Retrospective Cohort Study.Setting Aberdeen Maternity Hospital, Aberdeen, Scotland.Population All women living in the Grampian region of Scotland with a pregnancy recorded in the Aberdeen Maternity and Neonatal Databank between 1986 and 2000.Main outcome measures (A) Maternal outcomes: Pre-eclampsia, antepartum haemorrhage, threatened miscarriage, malpresenation, induced labour, instrumental delivery, Caesarean delivery, postpartum haemorrhage and manual removal of placenta. (B) Perinatal outcomes: preterm delivery, low birth weight, stillbirth, neonatal death, Apgar score at 5 minutes.Methods Retrospective cohort study comparing women with a first pregnancy miscarriage with (a) women with one previous successful pregnancy and (b) primigravid women. Data were extracted on perinatal outcomes in all women from the Aberdeen Maternity and Neonatal Databank between 1986 and 2000.Results We identified 1561 women who had a first miscarriage (1404 in the first trimester and 157 in the second trimester), 10 549 who had had a previous live birth (group A) and 21 118 primigravidae (group B). The miscarriage group faced a higher risk of pre-eclampsia (adj OR 3.3, 99% CI 2.6[ndash]4.6), threatened miscarriage (adj OR 1.7, 99% CI 1.5[ndash]2.0), induced labour (adj OR 2.2, 99% CI 1.9[ndash]2.5), instrumental delivery (adj OR 5.9, 99% CI 5.0[ndash]6.9), preterm delivery (adj OR 2.1, 99% CI 1.6[ndash]2.8) and low birthweight (adj OR 1.6, 99% CI 1.3[ndash]2.1) than group A. They were more likely to have threatened miscarriage (adj OR 1.5, 99% CI 1.4[ndash]1.7), induced labour (adj OR 1.3, 99% CI 1.2[ndash]1.5), postpartum haemorrhage (adj OR 1.4, 99% CI 1.2[ndash]1.6) and preterm delivery (adj OR 1.5, 99% CI 1.2[ndash]1.8) than group B.Conclusion An initial miscarriage is associated with a higher risk of obstetric complications. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Objective To evaluate the risk of adverse maternal and perinatal outcomes among pregnant women hospitalised following falls.Design A population-based retrospective cohort study.Setting Washington State, USA.Population Pregnant women with a fetal death or live birth certificate linked to the hospitalisation discharge data from 1987 to 2004.Methods Pregnant women who experienced a fall (n = 693) were identified by the presence of an International Classification of Disease[mdash]9th Edition external causation code of E880 through E888 and were compared with a randomly chosen group of pregnant women (n = 2079) not experiencing a fall hospitalisation during pregnancy. Poisson regression analysis was used to estimate adjusted relative risks (RR) and 95% CI for associations between falls and pregnancy outcomes.Main outcome measures Preterm labour and delivery, placental abruption, fetal distress, and fetal hypoxia.Results This study found an incidence rate of 48.9 pregnant fall hospitalisations per 100 000 deliveries. The majority of the fall hospitalisations occurred in the third trimester (79.3%), with 11.3% in the second trimester and 9.4% in the first trimester. The majority of injuries due to falls were fractures (47.4%), especially of the lower extremity, followed by contusions (18.0%) and sprains (17.3%). Falls were associated with an increased risk of preterm labour (RR 4.4, 95% CI 3.4[ndash]5.7), placental abruption (RR 8.0, 95% CI 4.3[ndash]15.0), fetal distress (RR 2.1, 95% CI 1.6[ndash]2.8), and fetal hypoxia (RR 2.9, 95% CI 1.3[ndash]6.5).Conclusion In light of the increased risk of adverse maternal and perinatal outcomes associated with major falls resulting in hospitalisation, careful maternal and fetal monitoring following a major fall is warranted. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Objective To determine the relationship between presence of amniotic fluid (AF) biomarkers characteristic of inflammation (defensins 2 and 1 and calgranulins C and A) and fetal inflammatory status at birth.Design Prospective observational cohort.Setting Tertiary referral University hospital.Population One hundred and thirty-two consecutive mothers (gestational age, median [interquartile range]: 29.6 [24.1[ndash]33.1] weeks) who had a clinically indicated amniocentesis to rule out infection and their newborns.Methods Intra-amniotic inflammation was diagnosed by mass spectrometry surface-enhanced-laser-desorption-ionization time of flight (SELDI-TOF). The AF proteomic fingerprint (mass-restricted [MR] score) ranges from 0[ndash]4 (none to all biomarkers present). The intensity of intra-amniotic inflammation was graded based on the number of proteomic biomarkers: MR score 0: 'no' inflammation, MR score 1[ndash]2: 'minimal' inflammation and MR score 3[ndash]4: 'severe' inflammation. At birth, cord blood was obtained for all women. Severity of histological chorioamnionitis and early-onset neonatal sepsis (EONS) was based on established histological and haematological criteria. Interleukin-6 (IL-6) levels were measured by sensitive immunoassays. The cord blood-to-AF IL-6 ratio was used as an indicator of the differential inflammatory response in the fetal versus the AF compartment.Main outcome measures To relate proteomic biomarkers of intra-amniotic infection to cord blood IL-6 and to use the latter as the primary marker of fetal inflammatory response.Results Women with intra-amniotic inflammation delivered at an earlier gestational age (analysis of variance, P < 0.001) and had higher AF IL-6 levels (P < 0.001). At birth, neonates of women with severe intra-amniotic inflammation had higher cord blood IL-6 levels (P = 0.002) and a higher frequency of EONS (P = 0.002). EONS was characterised by significantly elevated cord blood IL-6 levels (P < 0.001). Of the 39 neonates delivered by mothers with minimal intra-amniotic inflammation, 15 (39%) neonates had umbilical cord blood IL-6 levels above the mean for the group and 2 neonates had confirmed sepsis. The severity of the neutrophilic infiltrate in the chorionic plate (P < 0.001), choriodecidua (P = 0.002), umbilical cord (P < 0.001) but not in the amnion (P > 0.05) was an independent predictor of the cord blood-to-AF IL-6 ratio. Relationships were maintained following correction for gestational age, birthweight, amniocentesis-to-delivery interval, caesarean delivery, status of the membranes, race, MR score and antibiotics and steroid exposure.Conclusions We provide evidence that presence of proteomic biomarkers characteristic of inflammation in the AF is associated with an increased inflammatory status of the fetus at birth. Neonates mount an increased inflammatory status and have positive blood cultures even in the context of minimal intra-amniotic inflammation. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Objective To assess the internal consistency, construct validity and sensitivity to change of a pelvic organ prolapse symptom score (POP-SS).Design Analysis of data from three prolapse studies, including symptomatic and asymptomatic women who completed the POP-SS.Setting (1) A community setting in New Zealand, (2) two gynaecology outpatient departments in Scotland and (3) a gynaecological surgery department in Scotland.Population or sample (1) Participants from a survey of postnatal women at 12-year follow up, invited to complete a prolapse questionnaire and have prolapse assessment, (2) new gynaecology outpatients presenting with prolapse symptoms, randomised to pelvic floor muscle training (PFMT) or control and (3) women having anterior and/or posterior prolapse surgery, randomised to mesh insert or no mesh.Method Data were analysed to assess internal consistency, construct validity and sensitivity to change of the POP-SS.Main outcome measures Cronbach's alpha, significance of differences in POP-SS scores between studies and significance of difference in POP-SS scores pre- to post-intervention.Results For internal consistency, Cronbach's alpha ranged from 0.723 to 0.828. Women having surgery had higher POP-SS scores than those having conservative management (mean difference 5.0, 95% CI 3.1[ndash]6.9), who in turn had higher scores than the asymptomatic women (mean difference 5.9, 95% CI 4.4[ndash]7.4). Significant differences in POP-SS score were detected after surgery and PFMT. The improvement due to surgery was significantly greater than that associated with PFMT (z =[minus]3.006, P = 0.003).Conclusion The POP-SS has good internal consistency and construct validity and is sensitive to change. (Source: BJOG: An International Journal of Obstetrics and Gynaecology)

Infants born more than one week past their due dates have a higher risk of both impaired health and death, according to two new studies by authors from the University of California's San Francisco and Berkeley campuses. The studies compared more than 2.5 million normal-weight births from healthy pregnancies of 37 to 42 weeks gestation, the range that is considered to be full-term. (Source: Health News from Medical News Today)

Pregnant women worried about their babies' genetic health face a tough decision: get prenatal gene testing and risk miscarriage, or skip the tests and miss the chance to learn of genetic defects before birth. But a new prenatal test could make this dilemma obsolete. (Source: Genetics News From Medical News Today)

In order to determine the clinical significance of fetal abdominal cysts detected in the first trimester, we reviewed our experience with such cases collected over a 5-year period.Five cases in which a fetal abdominal cyst was detected by ultrasound in the first trimester were identified. Information on the ultrasound findings, antenatal course and perinatal outcome was obtained in all cases.The abdominal cyst was confirmed by an early second-trimester scan at 14-16 weeks in all cases, at which time no associated anomalies were detected. The standard detailed second-trimester scan at 18-22 weeks demonstrated complete resolution in three cases. These women had an uneventful antenatal course, and normal newborn infants were delivered at term. However, one of these infants had intestinal malrotation, chronic abdominal distension and midgut volvulus requiring surgery at the age of 7 months. Among the remaining two cases in which the abdominal cyst persisted, one required prenatal aspiration at 19 weeks owing to significant enlargement and resolved. The other remained stable in size and was managed conservatively, but the infant required surgery at the age of 7 weeks owing to a choledochal cyst causing intermittent episodes of acholia.Abdominal cysts in early pregnancy often resolve spontaneously or remain small and are usually associated with a good outcome. Nevertheless, as they can also be associated with serious underlying gastrointestinal pathological conditions, close surveillance in the perinatal period is advocated. Copyright © 2008 ISUOG. Published by John Wiley & Sons, Ltd. (Source: Ultrasound in Obstetrics and Gynecology)

(Source: BMJ)

A clinical trial has shown that pregnant women who receive the influenza vaccine provide immunity to their newborns as well. (Source: NYT > Health)