Background: The frequency of intra-amniotic infection/inflammation (IAI/I) in patients with midtrimester cervical insufficiency is up to 50%. Our purpose was to determine the perinatal outcomes of cervical cerclage in patients with acute cervical insufficiency with bulging membranes, and to compare the admission-to-delivery interval and pregnancy outcomes according to the results of amniotic fluid (AF) analysis and cerclage placement. Methods: This was a retrospective cohort study including singleton pregnancies with cervical insufficiency between 15–26.9 weeks in two tertiary health centers. IAI/I was defined when at least one of the following criteria was present in AF: a) a WBC count >50 cells/mm3; b) glucose concentration <14 mg/dl; and/or c) a Gram stain positive for bacteria. Three different groups were compared: 1) absence of IAI/I with placement of cerclage; 2) amniocentesis not performed with placement of cerclage; and 3) IAI/I with or without cerclage. Results: Seventy patients underwent an amniocentesis to rule-out IAI/I. The prevalence of IAI/I was 19%. Forty-seven patients underwent a cerclage. Patients with a cerclage had a longer median admission-to-delivery interval (33 days vs. 2 days; p<0.001) and delivered at a higher median gestational age (27.4 weeks vs. 22.6 weeks; p=0.001) than those without a cerclage. The neonatal survival rate in the cerclage group was 62% vs. 23% in those without cerclage (p=0.01). Patients without IAI/I that underwent a cerclage had a longer median admission-to-delivery interval [43 days vs. 1 day; p<0.001], delivered at a higher median gestational age (28 weeks vs. 22.1 weeks; p=0.001), and had a higher neonatal survival rate (67% vs. 8%; p<0.001) than those with IAI/I. Conclusions: The pregnancy outcomes of patients with midtrimester cervical insufficiency and bulging membranes are poor since they have a high prevalence of IAI/I. Therefore, a pre-operative amniocentesis is key to identify the best candidates for the subsequent placement of a cerclage.

Objective The aim of this study was to assess long-term effects for women following the use of magnesium sulphate for pre-eclampsia.Design Assessment at 2-3 years after delivery for women recruited to the Magpie Trial (recruitment in 1998(recruitment in -2001, which compared magnesium sulphate with placebo for pre-eclampsia.Setting Follow up after discharge from hospital at 125 centres in 19 countries across five continents.Population A total of 7927 women were randomised at the followup centres. Of these women, 2544 were not included for logistic reasons and 601 excluded (109 at a centre where <20% of women were contacted, 466 discharged without a surviving child and 26 opted out). Therefore, 4782 women were selected for follow-up, of whom 3375 (71%) were traced.Methods Questionnaire assessment was administered largely by post or in a dedicated clinic. Interview assessment of selected women was performed.Main outcome measures Death or serious morbidity potentially related to pre-eclampsia at follow up, other morbidity and use of health service resources.Results Median time from delivery to follow up was 26 months (interquartile range 19-36). Fifty-eight of 1650 (3.5%) women allocated magnesium sulphate died or had serious morbidity potentially related to pre-eclampsia compared with 72 of 1725 (4.2%) women allocated placebo (relative risk 0.84, 95% CI 0.60-1.18). ConclusionsThe reduction in the risk of eclampsia following prophylaxis with magnesium sulphate was not associated with an excess of death or disability for the women after 2 years.

A G3P2 patient who conceived while using an intrauterine contraceptive device (IUD) presented at 20 weeks of gestation with mild irregular uterine contractions and vaginal bleeding. Sonographic examination at admission showed the presence of dense amniotic fluid "sludge" and a long sonographic uterine cervix (42 mm). To assess the microbiologic significance of amniotic fluid "sludge", we performed a transabdominal amniocentesis. The procedure was performed under real-time ultrasound, and fluid resembling pus at gross examination was noted. Rapid amniotic fluid analysis showed the presence of a high white blood cell count and structures resembling hyphae. Amniotic fluid cultures were positive for Candida albicans. Treatment was begun with broad-spectrum antibiotics, including Fluconazole, upon the visualization of pus in the "sludge" material because of the presence of hyphae in the Gram stain. Despite treatment, the patient went into spontaneous preterm labor and delivered five days after admission. Placental examination revealed acute fungal histologic chorioamnionitis and funisitis. This represents the first report of transabdominal collection and analysis of amniotic fluid "sludge" and the microbiologic detection of Candida albicans in this material. This report provides evidence that transabdominal retrieval of "sludge" is possible and may be of significant value for patient management and selection of antimicrobial agents.

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SUMMARYCoeliac disease (CD) is described as an autoimmune enteropathy associated with the presence of IgG and IgA antigliadin and antitransglutaminase autoantibodies. While of diagnostic significance, the role of these autoantibodies in the immunopathogenesis of CD is elucidated. An inappropriate T cell immune response to gluten is also involved in the pathogenesis of CD, as evidenced by autoantibody switching. The N-glycans released from serum IgG of CD patients and three groups of healthy controls, of differing age ranges, were analysed by NH2-high performance liquid chromatography (HPLC). The fucosylated biantennary N-glycans were the most abundant neutral oligosaccharides; in particular, the agalacto form (G0F) showed a mean value of 42% (s.d. ± 7·4), 30% (s.d. ± 5·9), 26% (s.d. ± 4·2) and 35% (s.d. ± 6·8) for CD patients, healthy children, healthy adults under 40 and healthy adults over 40 years old, respectively. The ratio of asialo agalacto fucosylated biantenna to asialo monogalacto fucosylated biantenna (G0F)/(G1F) for CD patients showed a significant increase compared to healthy children ( P < 0·0002), healthy adults under 40 ( P < 0·0002) and healthy adults over 40 years old ( P < 0·01). Hypogalactosylation was more pronounced for CD patients than for the patients with other autoimmune diseases such as rheumatoid arthritis or psoriatic arthritis.Keywords autoimmune disease coeliac disease immunoglobulin G oligosaccharides