Comparison of the resonance sonorheometry based Quantra® system with rotational thromboelastometry ROTEM® sigma in cardiac surgery – a prospective observational study

Background Measures of the sonorheometry based Quantra® viscoelastic hemostatic analyzer (HemoSonics, LCC, Charlottesville, VA, USA) were compared with corresponding results of the ROTEM® sigma device (Instrumentation Laboratory, Bedford, MA, USA). Methods In thirty-eight patients scheduled for elective cardiac surgery between December 2018 and October 2019, blood samples were taken after induction of anesthesia (sample 1) and after heparin neutralization (sample 2) and measured on Quantra (QPlus® Cartridge) and ROTEM sigma (ROTEM® sigma complete + hep Cartridge). Clot times and clot stiffness values were recorded. Clot stiffness values of ROTEM amplitudes (A in mm) were converted to shear modulus (G) in hectoPascal (hPa): G (hPa) = (5 x A)/(100-A). Additionally, time-to-results was recorded. Spearman rank test correlation and Bland Altman analysis were performed. Results Clot stiffness parameters of the Quantra correlated strongly with corresponding measurements of the ROTEM with r = 0.93 and 0.94 for EXTEM A10 vs CS and r = 0.94 and 0.96 for FIBTEM A10 vs FCS for sample 1 and 2, respectively. Quantra clot time correlated strongly with ROTEM INTEM CT with r = 0.71 for sample 1 and r = 0.75 for sample 2. However, Bland Altman analysis showed no agreement in all compared assays of both methods. The median time to delivery of first and complete results was significantly shorter for Quantra (412 and 658 s) compared to ROTEM sigma (839 and 1290 s). Conclusions The Quantra showed a strong correlation with the ROTEM sigma for determining clot times and clot stiffness and the parameters assess similar aspects of clot development. However, these parameters are not directly interchangeable and implicate that separate cut-off values need to be established for users of the Quantra device. Word count: 278. Trial registration The study was retrospectively registered with ClinicalTrials.gov (ID: NCT04210830) at December 20th 2019.

Association between ADCY9 Gene Polymorphisms and Ritodrine Treatment Outcomes in Patients with Preterm Labor

The purpose of this study was to investigate the genetic effects of ADCY9 on ritodrine responses in patients with preterm labor. Five single nucleotide polymorphisms (SNPs) of the ADYC9 gene in 163 patients in preterm labor were genotyped: rs879619, rs2601796, rs2531988, rs2531995, and rs2230739. Additionally, rs598961 of the PDE4B gene and rs1042719 of the ADRB2 gene were included for analysis. Patients with CC genotype of ADCY9 rs879619 had a 2.0-fold (95% confidence interval [CI]: 1.3, 3.2) higher hazard of time to delivery than T allele carriers. Patients with combined genotypes of CC in ADCY9 rs879619, AA in PDE4B rs598961, and GC, CC in ADRB2 rs1042719 showed a greater hazard of time to delivery than patients with other combinations (adjusted hazard ratio [AHR] 3.2; 95% CI: 1.7, 6.3), whereas patients carrying the C allele of ADCY9 rs2531995, G allele of PDE4B rs598961, and GG genotype of ADRB2 rs1042719 had a lower hazard of time to delivery than patients carrying other genotypes (AHR 0.4; 95% CI: 0.2, 0.7). Regarding ritodrine-induced adverse drug events (ADEs), height less than 160 cm and CC genotype of ADCY9 rs2531995 showed a greater risk of ADEs. The results of our study suggest that ADCY9 polymorphisms could affect the efficacy and safety of β2-adrenergic agonists.

Analysis of Preterm Pregnancies using Empirical Mode Decomposition based Fractal Features

Preterm birth (gestational age < 37 weeks) is a serious pregnancy related complication that could lead to fetal morbidity and mortality. Monitoring the activity of uterus is considered to be crucial for the early diagnosis of preterm birth. Uterine Electromyography (uEMG) is a non-invasive technique that provides a quantitative measure of uterine activity from the abdominal surface. In this work, an attempt has been made to characterize preterm uEMG signals using Empirical Mode Decomposition based Detrended Fluctuation Analysis (EMD-DFA). Preterm signals with varied gestational ages are considered from an online database. EMD-DFA is applied on these signals to compute the fluctuation function. The double-logarithmic plot of fluctuation function versus scale is evaluated and Chi-square analysis is performed for identifying linear scaling regions. Five features namely shortterm exponent (Hs), long-term exponent (Hl), inflection point, short-term fractal angle (αHs) and long-term fractal angle (αHl) are extracted and analyzed. Further, Coefficient of Variation (CV) is computed to examine the variations of these features among different subjects. Results show that EMD-DFA is able to characterize the fluctuations of preterm signals. From the double-logarithmic plot, a slow variation of fluctuation function is observed with respect to scale when the time to delivery is more. This indicates the presence of rapid signal fluctuations in the early stages of pregnancy. Based on the feature values, it is observed that the signal fluctuations are more correlated and smoother as the time to delivery approaches. Among the extracted features, CV values of Hs, Hl, αHs and αHl are observed to be low indicating that these features have least inter-subject variations in preterm signals. The EMD-DFA based fractal features show the ability to detect the subtle variations in uEMG signals. As early diagnosis of preterm delivery is imperative for timely medical intervention and treatment, it appears that the proposed approach could aid in determining the changes in uterine contractions in preterm condition.

Prophylactic antibiotics in patients with artificial rupture of membranes during labor: (Randomized controlled clinical trial)

Background Amniotomy, also known as artificial rupture of membranes (AROMs) and by the lay description "breaking the water," is the intentional rupture of the amniotic sac by an obstetrical provider. This procedure is common during labor management and has been performed by obstetrical providers for at least a few hundred years. Amniotomy during labor induction is associated with a faster time to delivery, most notably in nulliparous women, without an increase in cesarean delivery or maternal and neonatal morbidity. Shortening time to delivery is associated with decreased hospital costs and increased patient satisfaction, and therefore, early amniotomy, given the safety profile, should be considered when a faster delivery is of importance to patients and providers. Objective To determine the efficacy of prophylactic antibiotics in patient during labor on reducing maternal and neonatal morbidities. Methods This prospective randomized study was performed from January 2020 to July 2020, at maternity hospital of Ain Shams University. Informed consent was obtained from all participants. Candidates for this study included all patients with singleton gestations between 37 weeks and 41 weeks of gestation underwent artificial rupture of the membranes during active phase of labor. Gestational age was confirmed by a reliable last menstrual period, early sonogram. Amniotomy was confirmed by visualization of pooling fluid in the posterior vaginal fornix through the cervix after artificial rupture of membrane by sterile hook. Results There were no statistical significance differences between two groups regarding demographic characteristics, endometritis, cord-prolapse and abruptio placenta. Maternal septicemia was absent in both groups. Chorio-amnionitis, cesarean section rate, episiotomy infection, NICU admission, neonatal sepsis, neonatal hypoxia and intraventricular hemorrhage were significantly less frequent in prophylaxis group. Conclusion Using of prophylactic antibiotics with amniotomy in pregnant women during labor reduced maternal and neonatal morbidities as chorio-amnionitis, endometritis, cesarean section rate, episiotomy infection, NICU admission, neonatal sepsis, neonatal hypoxia and intraventricular hemorrhage. On the other side it had no proved protective effect against maternal septicemia, cord-prolapse and abruptio placenta.

Prognostic Value of Angiogenic Markers in Pregnant Women With Chronic Hypertension

Background Women with chronic hypertension face a 5‐ to 6‐fold increased risk of developing preeclampsia compared with normotensive women. Angiogenic markers, especially soluble fms‐like kinase 1 (sFlt‐1) and placental growth factor (PlGF), were identified as clinically useful markers predicting the development of preeclampsia, but data on the prediction of superimposed preeclampsia are scarce. Therefore, we aimed to evaluate the predictive value of the sFlt‐1/PlGF ratio for delivery because of superimposed preeclampsia in women with chronic hypertension. Methods and Results This retrospective study included 142 women with chronic hypertension and suspected superimposed preeclampsia. Twenty‐seven women (19.0%) delivered because of maternal indications only, 17 women (12.0%) because of fetal indications primarily, and 98 women (69.0%) for other reasons. Women who both delivered because of maternal indications and for fetal indications had a significantly higher sFlt‐1/PlGF ratio (median 99.9 and 120.2 versus 7.3, respectively, P <0.001 for both) and lower PlGF levels (median 73.6 and 53.3 versus 320.0 pg/mL, respectively, P <0.001 for both) compared with women who delivered for other reasons. SFlt‐1/PlGF ratio and PlGF were strong predictors for delivery because of superimposed preeclampsia, whether for maternal or fetal indications ( P <0.05). Half of women with angiogenic imbalance (sFlt‐1/PlGF ratio ≥85 or PlGF levels <100 pg/mL) delivered because of maternal or fetal indications within 1.6 weeks (95% CI, 1.0–2.4 weeks). Conclusions Angiogenic marker imbalance in women with suspected superimposed preeclampsia can predict delivery because of maternal and fetal indications related to superimposed preeclampsia and is associated with a significantly shorter time to delivery interval.

Course of the sFlt-1/PlGF ratio in fetal growth restriction and correlation with biometric measurements, feto-maternal Doppler parameters and time to delivery

Purpose The study aimed to assess the course of the soluble Fms-like tyrosine kinase 1 (sFlt-1)/placental growth factor (PlGF) ratio in pregnant women with fetal growth restriction (FGR) and to evaluate potential associations between the sFlt-1/PlGF ratio and feto-maternal Doppler parameters, fetal biometric measurements and the time between study inclusion and birth (“time to delivery”). Methods This was a retrospective longitudinal single center study including 52 FGR cases. The serum levels of sFlt-1 and PlGF were measured by using the BRAHMS Kryptor Compact PLUS. Fetal biometric and Doppler parameters, as well as the sFlt-1/PlGF ratio, were obtained both upon study inclusion and upon birth. Results Various associations between the levels of the biomarkers in maternal blood upon study inclusion and upon birth and sonographic parameters were observed in FGR cases: umbilical artery (p < 0.01), uterine arteries (p < 0.01), ductus venosus (p < 0.05), cerebroplacental ratio (CPR) (p < 0.01), femur length (p < 0.01) and birth weight (p < 0.01). The higher the sFlt-1/PlGF ratio upon study inclusion, the shorter the “time to delivery” (p < 0.01). The multivariate regression analysis showed that the greater the daily percentage increase of the angiogenic markers, the shorter the “time to delivery” (p < 0.01). Conclusion The fetal well-being, as measured by feto-maternal Doppler parameters such as CPR and the severity of the placental dysfunction, as measured by the urgency of birth and birth weight, is reflected by the level of the sFlt-1/PlGF ratio in the maternal serum. A rapid daily increase of the sFlt-1/PlGF ratio is significantly associated with the clinical progression of the disease.