Faculty Bibliography

Objective Hypertensive disorders play a significant role in maternal morbidity and mortality. There is limited data on prehypertension (pre-HTN) during the first half of pregnancy. We sought to examine the risk of adverse pregnancy outcomes in patients with prehypertension in early pregnancy (<20 weeks' gestational age). Study Design A retrospective cohort study of 377 patients between 2013 and 2014. Patients were divided based on the highest blood pressure in early pregnancy, as defined per the JNC-7 criteria. There were 261 control patients (69.2%), 95 (25.2%) pre-HTN patients, and 21 (5.6%) chronic hypertension (CHTN) patients. The groups were compared using X2, Fisher's Exact, Student t-test, and Mann-Whitney U test with p < 0.05 used as significance. Results Patients with pre-HTN delivered earlier (38.8 +/- 1.9 weeks vs 39.3 +/- 1.7 weeks), had more pregnancy related hypertension (odds ratio [OR], 4.62; confidence interval [CI], 2.30-9.25; p < 0.01) and composite maternal adverse outcomes (OR, 2. 10; 95% CI, 1.30-3.41; p < 0.01), NICU admission (OR, 2.21; 95% CI, 1.14-4.26; p = 0.02), neonatal sepsis (OR, 6.12; 95% CI, 2.23-16.82; p < 0.01), and composite neonatal adverse outcomes (OR, 2.05; 95% CI, 1.20-3.49; p < 0.01). Conclusion Although women with pre-HTN are currently classified as normal in obstetrics, they are more similar to women with CHTN. Pre-HTN in the first half of pregnancy increases the likelihood of adverse outcomes.

BACKGROUND: Mechanical alteration of the cervical angle has been proposed to reduce spontaneous preterm birth (sPTB). Performance of the uterocervical angle (UCA) as measured by ultrasound for predicting sPTB is poorly understood. OBJECTIVE: To determine whether a novel ultrasonographic marker, UCA, correlates with risk of sPTB in a general population. STUDY DESIGN: We conducted a retrospective cohort study from May 2014 to May 2015 of singleton gestations between 16 0/7 - 23 6/7 weeks undergoing transvaginal ultrasound (TVU) for cervical length (CL) screening. Images were re-measured for UCA between the lower uterine segment and the cervical canal. Primary outcome was prediction of sPTB <34 weeks and <37 weeks by UCA and secondary outcome evaluated CL and sPTB. RESULTS: A total of 972 women were studied. The rate of sPTB in this cohort was 9.6% for delivery <37 weeks and 4.5% for <34 weeks. A UCA of >/=95o was significantly associated with sPTB <37 weeks with sensitivity of 80% (p<0.001, CI 0.70-0.81, NPV 95%). A UCA of >/=105 o predicted sPTB <34 weeks with sensitivity of 81% (p<0.001, CI 0.72-0.86, NPV 99%). CL /=95o and >/=105o detected during the 2nd trimester was associated with an increased risk for sPTB <37 and <34 weeks, respectively. UCA performed better than CL in this cohort. Our data indicate that UCA is a useful, novel transvaginal ultrasonographic marker that may be used as a screening tool for sPTB.

BACKGROUND: Human neutrophil antigen (HNA)-4a/4bw is encoded by 230G>A in ITGAM, which results in an Arg61His substitution of the alphaM chain (CD11b) of complement receptor 3 (CR3; CD11b/18 or Mac-1). HNA-4a antibodies have been detected in the sera of female blood donors and in maternal sera that caused alloimmune neonatal neutropenia (ANN), in which maternal immunoglobulin (Ig)G antibodies against a paternally inherited HNA cross the placenta and destroy fetal and neonatal neutrophils. However, to date, antibodies specific for HNA-4b have not been reported. Here, we report the first two examples of HNA-4b antibodies. STUDY DESIGN AND METHODS: The two sera studied were both from previously pregnant females, one a multiparous female blood donor implicated in two separate transfusion reactions and the second a mother whose first pregnancy resulted in the birth of a severely neutropenic (0 x 106 neutrophils/L) infant affected with ANN. Serum neutrophil antibody testing was by flow cytometry and CD11b/18 monoclonal antibody immobilization of granulocyte antigens assay, and HNA genotyping was performed by polymerase chain reaction with sequence-specific priming and allele-specific 5' exonuclease assays. RESULTS: Sera from both women contained IgG antibodies reactive only with HNA-4b+ neutrophils and both typed HNA-4a/a. Both were immunized through pregnancy since their husbands and children all typed HNA-4a/b. CONCLUSIONS: The serologic results, together with the genotype results, confirm that these are the first reported cases of neutrophil antibodies specific for HNA-4b.