Browsing by Author "Erez, O."

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    A rapid MMP-8 bedside test for the detection of intra-amniotic inflammation identifies patients at risk for imminent preterm delivery
    (2006) Nien, J. K.; Yoon, B. H.; Espinoza, J.; Kusanovic, Juan Pedro; Erez, O.; Soto, E.; Richani, K.; Gómez Mora, Ricardo Alberto; Hassan, S.; Mazor, M.; Edwin, S.; Bahado-Singh, R.; Romero, R.
    Objective: Matrix metalloproteinase-8 (MMP-8) is an enzyme that is released during neutrophil activation. MMP-8 amniotic fluid concentrations are elevated not only in patients with intra-amniotic infection, but also in patients with negative amniotic fluid cultures who deliver preterm neonates. The objective of this study was to determine whether the results of a rapid MMP-8 bedside test predict imminent preterm delivery. This test can be performed in 15 minutes and without laboratory equipment. Study design: Amniotic fluid was retrieved from 331 patients admitted with increased preterm uterine contractions and intact membranes who met the inclusion criteria. Amniotic fluid was processed for microbial cultures, Gram stain, glucose concentration, and white blood cell count. Amniotic fluid samples were stored, and the MMP-8 rapid test was performed after delivery. End points included spontaneous preterm delivery within 48 hours, 7 days, and 14 days. Diagnostic indices, predictive values, and likelihood ratios were calculated. Results: The prevalence of spontaneous preterm delivery within 48 hours, 7 days, and 14 days was 11.6% (38/327), 20.2% (66/327), and 24.5% (80/327), respectively (4 patients with augmentation of labor were excluded). A positive MMP-8 rapid test had a positive predictive value of 70% (23/33) for the identification of patients who delivered spontaneously within 48 hours, and 94% (31/33) for patients who were delivered within 7 days and 14 days (likelihood ratios: 17.5 [95% CI, 9-33.9], 61.3 [95% CI, 15.1-250], and 50 [95% CI, 12-196], respectively). Conclusion: The MMP-8 rapid test can identify patients at risk for preterm delivery within 7 days and 14 days. Moreover, a positive MMP-8 rapid test result can identify patients with intraamniotic infection/inflammation with a high sensitivity and specificity. This rapid test will give clinicians a fast and accurate assessment of the inflammatory status of the amniotic cavity and allow for better identification of patients at risk for impending preterm delivery.
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    Adiponectin in severe preeclampsia
    (2007) Nien, J. K.; Mazaki-Tovi, S.; Romero, R.; Erez, O.; Kusanovic, Juan Pedro; Gotsch, F.; Pineles, B. L.; Gómez Mora, Ricardo Alberto; Edwin, S.; Mazor, M.; Espinoza, J.; Yoon, B. H.; Hassan, S. S.
    Aims: Adiponectin is an adipokine with insulin-sensitizing, anti-atherogenic, anti-inflammatory and angiogenic properties. The aims of this study were to determine whether maternal plasma adiponectin concentrations differ between patients with severe preeclampsia and those with normal pregnancies, and to explore the relationship between plasma adiponectin and the results of Doppler velocimetry of the uterine arteries. Methods: This case-control study included two groups: (1) patients with severe preeclampsia (ns50) and (2) patients with normal pregnancies (ns150). Pulsedwave and color Doppler ultrasound examination of the uterine arteries were performed. Plasma adiponectin concentrations were determined by ELISA. Non-parametric statistics were used for analysis. Results: (1) Patients with severe preeclampsia had a higher median plasma concentration of adiponectin than that of normal pregnant women. (2) The median plasma adiponectin concentration did not differ between women with severe preeclampsia who had a high impedance to blood flow in the uterine arteries and those with normal impedance to blood flow. (3) Among patients with normal pregnancies, plasma adiponectin concentrations were negatively correlated with BMI in the first trimester and at sampling. Conclusions: Women with severe preeclampsia have a higher median plasma concentration of adiponectin than that of normal pregnant women. This may reflect a compensatory feedback mechanism to the metabolicallyaltered, anti-angiogenic and pro-atherogenic state of severe preeclampsia.
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    Adiponectin multimers in maternal plasma
    (2008) Mazaki-Tovi, S.; Romero, R.; Kusanovic, Juan Pedro; Erez, O.; Vaisbuch, E.; Gotsch, F.; Mittal, P.; Than, G. N.; Nhan-Chang, C.; Chaiworapongsa, T.; Edwin, S.; Camacho, N.; Nien Shy, Jyh-Kae; Hassan, S. S.
    Objective: Adiponectin is an anti-diabetic, anti-atherogenic, anti-inflammatory, and angiogenic adipokine that circulates in oligomeric complexes including: low molecular weight (LMW) trimers, medium molecular weight (MMW) hexamers, and high molecular weight (HMW) isoforms. The aim of this study was to determine whether there are changes in adiponectin multimers in pregnancy and as a function of maternal weight. Study design: In this cross-sectional study, plasma concentrations of total, HMW, MMW, and LMW adiponectin were determined in women included in three groups: (1) normal pregnant women of normal body mass index (BMI) (n ¼ 466), (2) overweight pregnant women (BMI 25; n ¼ 257), and (3) non-pregnant women of normal weight (n ¼ 40). Blood samples were collected once from each woman between 11 and 42 weeks of gestation. Plasma adiponectin multimer concentrations were determined by enzyme-linked immunosorbent assay (ELISA). Non-parametric statistics were used for analysis. Results: (1) The median HMW adiponectin concentration and the median HMW/total adiponectin ratio were significantly higher, and the median LMW adiponectin concentration was significantly lower in pregnant women than in non-pregnant women. (2) Among pregnant women, the median plasma concentration of total, HMW, and MMW adiponectin was significantly higher in normal weight women than in overweight patients. (3) Maternal HMW was the most prevalent adiponectin multimer regardless of gestational age or BMI status. (4) There were no significant differences in the median concentration of total, MMW, and LMW adiponectin and their relative distribution with advancing gestation. Conclusion: Human pregnancy is characterized by quantitative and qualitative changes in adiponectin multimers, especially the most active isoform, HMW adiponectin.
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    Amniotic fluid heat shock protein 70 concentration in histologic chorioamnionitis, term and preterm parturition
    (2008) Chaiworapongsa, T.; Erez, O.; Kusanovic, Juan Pedro; Vaisbuch, E.; Mazaki-Tovi, S.; Gotsch, F.; Than, N. G.; Mittal, P.; Kim, Y. M.; Camacho, N.; Edwin, S.; Gómez Mora, Ricardo Alberto; Hassan, S. S.; Romero, R.
    Objective: Heat shock protein (HSP) 70, a conserved member of the stress protein family, is produced in almost all cell types in response to a wide range of stressful stimuli, and its production has a survival value. Evidence suggests that extracellular HSP70 is involved in the activation of the innate and adaptive immune response. Furthermore, increased mRNA expression of HSP70 has been observed in human fetal membranes following endotoxin stimulation. This study was conducted to determine the changes in amniotic fluid HSP70 concentrations during pregnancy, term and preterm parturition, intra-amniotic infection (IAI), and histologic chorioamnionitis. Study design. A cross-sectional study was conducted in 376 pregnant women in the following groups: (1) women with a normal pregnancy who were classified into the following categories: (a) women in the mid-trimester (14–18 weeks) who underwent amniocentesis for genetic indications and delivered normal infants at term (n¼72); (b) women at term not in labor (n ¼ 23); and (c) those at term in labor (n ¼ 48). (2) Women with spontaneous preterm labor and intact membranes who were subdivided into the following categories: (a) preterm labor who delivered at term without IAI (n ¼ 42); (b) preterm labor who delivered preterm without IAI (n ¼ 57); and (c) preterm labor and delivery with IAI (n ¼ 30). (3) Women with preterm prelabor rupture of membranes (PROM) with (n ¼ 50) and without (n ¼ 54) IAI. Among patients with preterm labor with intact membranes and preterm PROM who delivered within 72 hours of amniocentesis, placenta, umbilical cord, and chorioamniotic membranes were collected and assessed for the presence or absence of acute inflammatory lesions in the extraplacental membranes (histologic chorioamnionitis) and/or umbilical cords (funisitis). HSP70 concentrations in amniotic fluid were determined using a sensitive and specific immunoassay. Non-parametric statistics were used for analysis. A p value of 50.05 was considered statistically significant. Results. Immunoreactive HSP70 was detected in 88% (332/376) of amniotic fluid samples. The median amniotic fluid HSP70 concentration was significantly higher in women at term without labor than in those in the mid-trimester (term no labor: median 34.9 ng/mL, range 0–78.1 ng/mL vs. mid-trimester; median 6.6 ng/mL, range 0–20.8 ng/mL; p50.001). Among patients with spontaneous preterm labor and preterm PROM, those with IAI had a significantly higher median amniotic fluid HSP70 concentration than those without IAI (preterm labor with IAI: median 82.9 ng/mL, range 0–500 ng/mL vs. preterm labor without IAI: median 41.7 ng/mL, range 0–244 ng/mL; p ¼ 0.001; preterm PROM with IAI: median 86.5 ng/mL, range 0– 428 ng/mL vs. preterm PROM without IAI: median 55.9 ng/mL, range 14.9–299.9 ng/mL; p ¼ 0.007). There was no significant difference in the median amniotic fluid HSP70 concentration between patients with preterm labor who delivered preterm without IAI and those who delivered at term (p ¼ 0.6). However, among patients with preterm labor without IAI, there was an inverse relationship between amniotic fluid concentration of HSP70 and the amniocentesis-to-spontaneous delivery interval (Spearman’s Rho ¼70.26; p ¼ 0.02). Patients with histologic chorioamnionitis/funisitis had a significantly higher median amniotic fluid HSP70 concentration than those without inflammation (inflammation: median 108.7 ng/mL, range 0– 500 ng/mL vs. without inflammation: median 67.9 ng/mL, range 7.1–299.9 ng/mL; p ¼ 0.02). Women at term in labor had a median amniotic fluid concentration of HSP70 significantly higher than those not in labor (term in labor: median 60.7 ng/mL, range 0–359.9 ng/mL vs. term not in labor: median 34.9 ng/mL, range 0–78.1 ng/mL; p ¼ 0.02).
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    Changes in amniotic fluid concentration of thrombinantithrombin III complexes in patients with preterm labor: Evidence of an increased thrombin generation
    (2009) Erez, O.; Romer, R.; Vaisbuch, E.; Chaiworapongsa, T.; Kusanovic, J.P.; Mazaki-Tovi, S.; Gotsch, F.; Gómez Mora, Ricardo; Maymon, E.; Pacora, P.; Edwin, S.S.; Kim, C.J.; Than, N.G.; Mittal, P.; Yeo, L.; Dong, Z.; Yoon, B.H.; Hassan, S.S.; Mazor, M.
    Objective.Preterm labor is associated with excessive maternal thrombin generation, as evidenced by increased circulatingthrombin–antithrombin (TAT) III complexes concentration. In addition to its hemostatic functions, thrombin hasuterotonic properties that may participate in the mechanism leading to preterm birth in cases of intrauterine bleeding.Thrombin also has a proinflammatory role, and inflammation is associated with increased thrombin generation. The aim ofthis study was to determine whether intra-amniotic infection/inflammation (IAI) is associated with increased amniotic fluid(AF) thrombin generation in women with preterm and term deliveries.Study design.This cross-sectional study included the following groups: (1) mid-trimester (n¼74); (2) term not in labor(n¼39); (3) term in labor (n¼25); (4) term in labor with IAI (n¼22); (5) spontaneous preterm labor (PTL) who delivered atterm (n¼62); (6) PTL without IAI who delivered preterm (n¼59); (7) PTL with IAI (n¼71). The AF TAT III complexesconcentration was measured by enzyme linked immunosorbent assay (ELISA). Non-parametric statistics were used for analysis.Results.(1) TAT III complexes were identified in all AF samples; (2) patients with PTL who delivered preterm, with andwithout IAI, had a higher median AF TAT III complexes concentration than those with an episode of PTL who delivered atterm (p50.001,p¼0.03, respectively); (3) among patients with PTL without IAI, elevated AF TAT III complexesconcentration were independently associated with a shorter amniocentesis-to-delivery interval (hazard ratio, 1.5; 95% CI,1.07–2.1); (4) among patients at term, those with IAI had a higher median AF TAT III complexes concentration than thosewithout IAI, whether in labor or not in labor (p¼0.02); (5) there was no significant difference between the median AF TATIII complexes concentration of patients at term with and without labor; (6) patients who had a mid-trimester amniocentesishad a lower median AF TAT III complexes concentration than that of patients at term not in labor (p50.001).Conclusions.We present herein a distinct difference in the pattern of intra-amniotic thrombin generation between term andpreterm parturition. PTL leading to preterm delivery is associated with an increased intra-amniotic thrombin generationregardless of the presence of IAI. In contrast, term delivery is associated with an increased intra-amniotic thrombingeneration only in patients with IAI.
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    Clinical significance of early (< 20 weeks) vs. late (20-24 weeks) detection of sonographic short cervix in asymptomatic women in the mid-trimester
    (2010) Vaisbuch, E.; Romero, R.; Erez, O.; Kusanovic, J.P.; Mazaki-Tovi, S.; Gotsch, F.; Romero, V.; Ward, C.; Chaiworapongsa, T.; Mittal, P.; Sorokin, Y.; Hassan, S.S.
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    First-trimester maternal serum PP13 in the risk assessment for preeclampsia
    (2008) Romero, R.; Kusanovic, J.P.; Than, N.G.; Erez, O.; Gotsch, F.; Espinoza, J.; Edwin, S.; Chefetz, I.; Gomez, R.; Nien, J.K.; Sammar, M.; Pineles, B.; Hassan, S.S.; Meiri, H.; Tal, Y.; Kuhnreich, I.; Papp, Z.; Cuckle, H.S.
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    Personalized assessment of cervical length improves prediction of spontaneous preterm birth : a standard and a percentile calculator
    (2020) Gudicha, D. W.; Romero, R.; Kabiri, D.; Hernandez Andrade, E.; Pacora, P.; Erez, O.; Kusanovic, Juan Pedro; Jung, E.; Paredes, C.; Berry, S. M.; Yeo, L.; Hassan, S. S.; Hsu, C. D.; Tarca, A. L.
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    Preeclampsia is associated with low concentrations of protein Z
    (2007) Erez, O.; Hoppensteadt, D.; Romero, R.; Espinoza, J.; Goncalves, L.; Nien, J.K.; Kusanovic, J.P.; Fareed, J.; Gotsch, F.; Pineles, B.; Chaiworapongsa, T.
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    Prelabor Rupture of the Membranes
    (2008) Santolaya-Forgas, J.; Romero, R.; Espinoza, J.; Erez, O.; Friel, L.A.; Kusanovic, J.P.; Bahado-Singh, R.; Nien, J.K.
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    Prenatal diagnosis of coarctation of the aorta with the multiplanar display and B-flow imaging using 4-dimensional sonography
    (2009) Espinoza, J.; Romero, R.; Kusanovic, J.P.; Gotsch, F.; Erez, O.; Hassan, S.; Yeo, L.
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    Prenatal diagnosis of truncus arteriosus using multiplanar display in 4D ultrasonography
    (2010) Gotsch, F.; Romero, R.; Espinoza, J.; Kusanovic, J.P.; Erez, O.; Hassan, S.; Yeo, L.
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    Proteomic analysis of amniotic fluid to identify women with preterm labor and intra-amniotic inflammation/infection: The use of a novel computational method to analyze mass spectrometric profiling
    (2008) Romero, R.; Espinoza, J.; Rogers, W.T.; Moser, A.; Kae Nien, J.; Pedro Kusanovic, J.; Gotsch, F.; Erez, O.; Gomez, R.; Edwin, S.; Hassan, S.S.
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    Resistin: A hormone which induces insulin resistance is increased in normal pregnancy
    (2007) Nien, J.K.; Mazaki-Tovi, S.; Romero, R.; Kusanovic, J.P.; Erez, O.; Gotsch, F.; Pineles, B.L.; Friel, L.A.; Espinoza, J.; Goncalves, L.; Santolaya, J.; Gomez, R.; Hong, J.-S.; Edwin, S.; Soto, E.; Richani, K.; Mazor, M.; Hassan, S.S.
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    Soluble receptor for advanced glycation end products (sRAGE) and endogenous secretory RAGE (esRAGE) in amniotic fluid: Modulation by infection and inflammation
    (2008) Romero, R.; Espinoza, J.; Hassan, S.; Gotsch, F.; Kusanovic, J.P.; Avila, C.; Erez, O.; Edwin, S.; Schmidt, A.M.
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    The fetal inflammatory response syndrome
    (2007) Gotsch, F.; Romero, R.; Kusanovic, J.P.; Mazaki-Tovi, S.; Pineles, B.L.; Erez, O.; Espinoza, J.; Hassan, S.S.
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    Three-dimensional sonography of placental mesenchymal dysplasia and its differential diagnosis
    (2009) Vaisbuch, E.; Romero, R.; Kusanovic, J.P.; Erez, O.; Mazaki-Tovi, S.; Gotsch, F.; Chong, J.K.; Kim, J.-S.; Yeo, L.; Hassan, S.S.
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    Twin-to-twin transfusion syndrome: an antiangiogenic state?
    (2008) Kusanovic, J.P.; Romero, R.; Espinoza, J.; Nien, J.K.; Kim, C.J.; Mittal, P.; Edwin, S.; Erez, O.; Gotsch, F.; Mazaki-Tovi, S.; Than, N.G.; Soto, E.; Camacho, N.; Gomez, R.; Quintero, R.; Hassan, S.S.