Browsing by Author "Mazor, M."

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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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    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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    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.