Dataset Information

Treatment of Retained Fetal Membranes in the Mare-A Practitioner Survey.

ABSTRACT: Retained fetal membranes (RFM) is a common post-partum problem in mares for which the treatment is highly variable. The aim of this study was (i) to investigate the different treatments used by equine practitioners for RFM and (ii) to determine if there is a difference between treatments used by reproductive specialists and general equine practitioners. Information regarding treatment of RFM was sought from veterinary practitioners via a survey and this was compared to recommendations in the current literature. The survey was sent out to equine veterinarians and mixed practitioners with a high equine case load. Most treatments of RFM were in line with current recommendations, while some obsolete practices are still routinely performed by a small number of practitioners. Treatment recommendations for RFM have changed over the last few decades, but there are no universally accepted guidelines. The vast variety of treatments reported by practitioners in the present survey reflect this lack of guidance. More extensive research is needed in this area to establish evidence-based, uniformly agreed upon protocols.

SUBMITTER: Warnakulasooriya DN

PROVIDER: S-EPMC6018472 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Treatment of Retained Fetal Membranes in the Mare-A Practitioner Survey.

Warnakulasooriya Dinuka N DN Marth Christina D CD McLeod Jacqueline A JA Hanlon David W DW Krekeler Natali N

Frontiers in veterinary science 20180619

Retained fetal membranes (RFM) is a common post-partum problem in mares for which the treatment is highly variable. The aim of this study was (i) to investigate the different treatments used by equine practitioners for RFM and (ii) to determine if there is a difference between treatments used by reproductive specialists and general equine practitioners. Information regarding treatment of RFM was sought from veterinary practitioners via a survey and this was compared to recommendations in the cur ...[more]

PMID: 29971242

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Project description:Inflammation is central to the mechanisms of parturition, but the lack of understanding of how it is controlled in normal parturition hampers our ability to understand how it may diverge resulting in preterm birth. Cell-free fetal DNA is found in the amniotic fluid, and it is thought to be able to activate inflammation as a danger-associated molecular pattern. Although its levels increases with gestational age, its effect has not been studied on the human fetal membranes. Thus, the aim of this study was to determine if the fetal DNA can trigger inflammation in the human fetal membranes and, thus, potentially contribute to the inflammatory load. Isolated human amniotic epithelial cells and fetal membrane explants were treated apically with fetal DNA causing the translocation of NF-KB into the nucleus of cells and throughout the cells of the explant layers with time. Fetal membrane explants were treated apically with either small or larger fragments of fetal DNA. IL-6, TNFα, and GM-CSF secretion was measured by ELISA, and pro-MMP2 and pro-MMP9 activity was measured by zymography from apical and basal media. Increased apical IL-6 secretion and basal pro-MMP2 activity was seen with small fragments of fetal DNA. When the data were disaggregated based on fetal sex, males had significant increases in IL-6 secretion and basal increased activity in pro-MMP2 and 9, whereas females had significantly increased basal secretion of TNFα. This was caused by the smaller fragments of fetal DNA, whereas the larger fragments did not cause any significant increases. Male fetal DNA had significantly lower percentages of methylation than females. Thus, when the cytokine and pro-MMP activity data were correlated with methylation percentage, IL-6 secretion significantly correlated negatively, whereas GM-CSF secretion positively correlated. These data support the role of fetal DNA as an inflammatory stimulus in the FM, as measured by increased NF-κB translocation, cytokine secretion, and increased pro-MMP activity. However, the data also suggested that the responses are different from FM tissues of male and female fetuses, and both the fragment size and methylation status of the fetal DNA can influence the magnitude and type of molecule secreted.

Project description:Rupture of membranes (ROM) before the onset of uterine contractions, particularly in pregnancies less than 37 weeks gestational age, is a common diagnostic problem in obstetrical practice. Timely detection of ROM is vital to support gestational age-specific interventions to optimize perinatal outcomes and minimize the risk of serious complications such as preterm delivery, fetal distress and maternal/fetal infections. Rapid bedside immunoassay tests designed to detect amniotic fluid proteins in cervicovaginal fluids have emerged as valuable clinical tools to provide timely ROM diagnosis.In this prospective observational study, two commercially-available immunoassay tests (ROM Plus®, AmniSure®) were evaluated concurrently in 111 pregnant women who presented with the chief complaint of ROM. Immunoassay results were compared to clinical parameters for determining ROM via comprehensive, retrospective clinical chart review. Diagnostic performance characteristics were calculated including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy.Overall, diagnostic performance characteristics were robust and similar between ROM Plus® and AmniSure®, respectively: sensitivity (96.4 and 89.3%), specificity (98.8 and 100%), PPV (96.4 and 100%), NPV (98.8% and 96.5) and accuracy (98.2 and 97.3%). For term patients (?37 weeks gestation), the sensitivities were 93.8 and 81.3% and specificities were 97.1 and 100% for ROM Plus® and AmniSure®, respectively. For preterm patients (<37 weeks gestation), both immunoassay tests provided exact concordance with clinical confirmation of ROM resulting in 100% diagnostic accuracy.Both rapid immunoassay tests provided similarly excellent diagnostic accuracy for the rapid detection of ROM with only two discrepant results for ROM Plus® and three discrepant results for AmniSure® compared to clinical confirmation. The findings from this study recommend these tests for pregnant women presenting with suspected ROM to guide correct clinical management decisions to improve obstetrical and neonatal outcomes.ClinicalTrials.gov, NCT02208011 (1 August 2014).

Dataset Information

Treatment of Retained Fetal Membranes in the Mare-A Practitioner Survey.

Publications

Treatment of Retained Fetal Membranes in the Mare-A Practitioner Survey.

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