Reducing Pain after Second Trimester Genetic Amniocentesis by Postprocedural Cryotherapy: A Randomized Controlled Trial

Objective: To evaluate the effectiveness of cryotherapy on pain reducing after the second trimester genetic amniocentesis. Materials and Methods: A prospective randomized controlled trial was performed at Maternal-Fetal-Medicine (MFM) Unit at Thammasat University Hospital, Thailand between December 2019 and March 2020. The participants were pregnant women who underwent amniocentesis for genetic evaluation during the study period were divided into two groups, study and control. After finishing amniocentesis, study and control groups received jelly pack at temperature 4-degree Celsius and room temperature, respectively. The pain measurement was 10-cm visual analog scale (VAS) before, during, and 15 and 30 minutes after amniocentesis. Demographic characters and VAS score were recorded and evaluated. Results: Two hundred forty pregnant women between 15 and 22 weeks of gestation were recruited and equally allocated into two groups. There were no differences between the two group in demographic data, indication, anticipated, and actual pain scores (p=0.327 and 0.401, respectively). Median pain score at 15 and 30 minutes after the procedure in the study group were 1 and 0 (p=0.202) while in the control group it was 2 and 1 (0.039). Patients’ satisfaction after finishing the procedure was not significantly different. Conclusion: Cryotherapy was effective in decreasing maternal pain perception after amniocentesis. Keywords: Pregnancy; Amniocentesis; Cold pack; Cryotherapy; Pain

Increased Hyaluronic Acid Level in Mid-Trimester Amniotic Fluid of Trisomy 21 Fetuses with Hydrops

Background: Trisomy 21 is the most prevalent chromosomal anomaly among new-borns with mental disability. The phenotypes with trisomy 21 may involve short stature, mental retardation, shortness of the extremities, congenital heart disease and hydropsMaterial and methods: To evaluate the hyaluronic acid concentrations in amniotic fluid of trisomy 21 fetuses with and without hydrops.Materials and Methods: Totally 56 amniotic fluid supernatant samples were collected from pregnant women who underwent genetic amniocentesis for this study: group 1 were euploid fetuses without hydrops (n=30), group 2 were trisomy 21 fetuses without hydrops (n=16), group 3 were euploid fetuses with hydrops (n=6) and group 4 were trisomy 21 fetuses with hydrops (n=4). Hyaluronic acid concentrations in AF supernatants were evaluated by ELISA method.Results: There are no significant differences of hyaluronic acid concentrations between euploid and trisomy pregnancy in AF obtained from genetic amniocentesis. AF in the gestational age of amniocentesis among the four groups of fetuses; maternal age at amniotic fluid collected is oldest in group 2 fetuses. The amniotic fluid hyaluronic acid concentration is highest in group 4 fetuses, and is not significant difference among the other three groups. (P= 0.014, one way ANOVA test).Conclusion: Elevated hyaluronic acid concentration in amniotic fluid may associate with the pathophysiology of fetal hydrops in trisomy 21 fetuses.

Vaginal Lactoferrin Modulates PGE2, MMP-9, MMP-2, and TIMP-1 Amniotic Fluid Concentrations

Inflammation plays an important role in pregnancy, and cytokine and matrix metalloproteases (MMPs) imbalance has been associated with premature rupture of membranes and increased risk of preterm delivery. Previous studies have demonstrated that lactoferrin (LF), an iron-binding protein with anti-inflammatory properties, is able to decrease amniotic fluid (AF) levels of IL-6. Therefore, we aimed to evaluate the effect of vaginal LF administration on amniotic fluid PGE2level and MMP-TIMP system in women undergoing genetic amniocentesis. One hundred and eleven women were randomly divided into controls (n=57) or treated with LF 4 hours before amniocentesis (n=54). Amniotic fluid PGE2, active MMP-9 and MMP-2, and TIMP-1 and TIMP-2 concentrations were determined by commercially available assays and the values were normalized by AF creatinine concentration. PGE2, active MMP-9, and its inhibitor TIMP-1 were lower in LF-treated group than in controls (p<0.01,p<0.005, andp<0.001, resp.). Conversely, active MMP-2 (p<0.0001) and MMP-2/TIMP-2 molar ratio (p<0.001) were increased, whilst TIMP-2 was unchanged. Our data suggest that LF administration is able to modulate the inflammatory response following amniocentesis, which may counteract cytokine and prostanoid imbalance that leads to abortion. This trial is registered with Clinical Trial numberNCT02695563.