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17. 5 Gynaecologie

Author

Schutte, M.F., primary, van Lith, J.M.M., additional, and van Kesteren, P.J.M., additional

Published
2008
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21. Neonatal Morbidity After Induction Vs Expectant Monitoring in Intrauterine Growth Restriction at Term: A Subanalysis of the DIGITAT RCT EDITORIAL COMMENT

Author

Boers, K.E., van Wyk, L., van der Post, J.A.M., Kwee, A., van Pampus, M.G., Spaanderdam, M.E.A., Duvekot, J.J., Bremer, H.A., Delemarre, F.M.C., Bloemenkamp, K.W.M., de Groot, C.J.M., Willekes, C., Rijken, M., Roumen, F.J.M.E., Thornton, J.G., van Lith, J.M.M., Mol, B.W.J., Le Cessie, S., Scherjon, S.A., Obstetrics and gynaecology, and ICaR - Ischemia and repair

Published
2012

22. Microarrays as a diagnostic tool in prenatal screening strategies: ethical reflection

Author

de Jong, A., de Jong, A., Dondorp, W.J., Macville, M V E., de Die-Smulders, C.E.M., van Lith, J.M.M., de Wert, G.M.W.R., de Jong, A., de Jong, A., Dondorp, W.J., Macville, M V E., de Die-Smulders, C.E.M., van Lith, J.M.M., and de Wert, G.M.W.R.

Abstract

Genomic microarray analysis is increasingly being applied as a prenatal diagnostic tool. Microarrays enable searching the genome at a higher resolution and with higher sensitivity than conventional karyotyping for identifying clinically significant chromosomal abnormalities. As yet, no clear guidelines exist on whether microarrays should be applied prenatally for all indications or only in selected cases such as ultrasound abnormalities, whether a targeted or genome-wide array should be used, and what these should include exactly. In this paper, we present some ethical considerations on the prenatal use of microarrays. There is a strong consensus, at least in Western countries, that the aim of prenatal screening for foetal abnormalities should be understood as facilitating autonomous reproductive choice for prospective parents. The tests offered should be valid and useful to reach that purpose. Against this background, we address several ethical issues raised by the prenatal application of microarrays. First, we argue that the general distinction between a targeted and a genome-wide microarray needs to be scrutinised. Then we examine whether microarrays are 'suitable tests' to serve either a screening or a diagnostic purpose. Given the wide range of findings possibly generated by microarrays, the question arises whether microarrays actually promote or interfere with autonomous reproductive decision-making. Moreover, if variants of unknown clinical significance are identified, this adds to the burden and complexity of reproductive decision-making. We suggest a qualified use of microarrays in the prenatal context.

Published
2014

23. First-trimester maternal serum human chorionic gonadotrophin as a marker for fetal chromosomal disorders. The Dutch Working Party on Prenatal Diagnosis

Author

van Lith, J.M.M.

Subjects
endocrine system, ALPHA-FETOPROTEIN, PREGNANCIES, DOWNS SYNDROME, DOWNS-SYNDROME, reproductive and urinary physiology, 1ST-TRIMESTER SCREENING, FETAL CHROMOSOMAL DISORDER, HUMAN CHORIONIC GONADOTROPIN
Abstract

The Dutch Working Party on Prenatal Diagnosis has initiated a study on the possibilities of first-trimester screening for fetal chromosomal disorders. We report on maternal serum human chorionic gonadotrophin (MS-hCG) measurements in 1348 pregnancies with a chromosomally normal fetus and 53 pregnancies with a chromosomally abnormal fetus. The median MS-hCG concentration in 24 pregnancies with Down's syndrome was 1.19 multiples of the normal median (MoM). The MS-hCG distributions in normal and Down's syndrome pregnancies did not differ significantly (t-test: t = 1.945,p > 0.05). We also found no difference between normal pregnancies and pregnancies with other chromosomal disorders (six cases of trisomy 18, MoM = 0.80; four cases of sex chromosome abnormality, MoM = 1.01; 17 cases of chromosomal mosaicism in chorionic villi, MoM = 1.11). Selecting an upper limit at the 90th centile could detect 25 per cent of pregnancies with Down's syndrome. We conclude that, in the first trimester, MS-hCG as a screening factor for Down's syndrome is of minor value. However, MS-hCG could be a useful factor in a first-trimester screening programme based on a combination of markers.

Published
1992

26. Impaired immunomodulatory effects of seminal plasma may play a role in unexplained recurrent pregnancy loss: Results of an in vitro study.

Author

du Fossé, N.A., Lashley, E.E.L.O., Anholts, J.D.H., van Beelen, E., le Cessie, S., van Lith, J.M.M., Eikmans, M., and van der Hoorn, M.L.P.

Subjects
*RECURRENT miscarriage, *MISCARRIAGE, *T cells, *GENE expression, *MESSENGER RNA
Abstract

Seminal plasma contains signaling molecules capable of modulating the maternal immune environment to support implantation and pregnancy. Prior studies indicated that seminal plasma induces changes in gene transcription of maternal immune cells. Reduced immune suppressive capacity may lead to pregnancy loss. The aim of this study was to investigate the immunomodulating effects of seminal plasma on T cells and monocytes in the context of recurrent pregnancy loss (RPL). Female T cells and monocytes were incubated with seminal plasma of 20 males in unexplained RPL couples (RPL males) and of 11 males whose partners had ongoing pregnancies (control males). The effect of seminal plasma on messenger RNA (mRNA) expression of immune cells was measured. Levels of mRNA expression were related to key signaling molecules present in the seminal plasma. Agglomerative hierarchical cluster analysis was performed on seminal plasma expression profiles and on mRNA expression profiles. Expression of CD25 and anti-inflammatory IL-10 by female T cells was significantly lower after stimulation with seminal plasma of RPL males compared to control males. Female monocytes treated with seminal plasma of RPL males showed an immune activation signature of relatively elevated HLA-DR expression. Expression of these T cell and monocyte components was particularly correlated with the amounts of TGF-β and VEGF in the seminal plasma. Our findings indicate that seminal plasma has immunomodulating properties on female immune cells compatible with the induction of a more regulatory phenotype, which may be impaired in cases of unexplained RPL. • Seminal plasma (SP) induced changes in gene expression of female immune cells. • Changes in gene expression compatible with induction of more regulatory phenotype. • Immunomodulatory effects of SP impaired in unexplained recurrent pregnancy loss. • Immunomodulatory effects of SP correlated with immunological factors present in SP. [ABSTRACT FROM AUTHOR]

Published
2022
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28. Strategies in intrauterine growth restriction at term

Author

Boers, K.E., Van Lith, J.M.M., Mol, B.W.J., Scherjon, S.A., le Cessie, S., and Leiden University

Subjects
Neonatal morbidity, Induction of labour, Caesarean section, Intrauterine growth restriction, Expectant management, RCT
Abstract

To establish consensus and to collect evidence on the best management policy in intrauterine growth restriction (IUGR) at term, the DIGITAT-trial (Disproportionate Intrauterine Growth Intervention Trial At Term) was designed. The aim of the DIGITAT study was to compare the effect of induction of labour with an expectant management monitoring mother and child for suspected intrauterine growth restriction at term in singleton pregnancies in cephalic presentation beyond 36 weeks gestation on neonatal and obstetrical outcomes. The results of the DIGITAT study including the randomised trial form the basis of this thesis.

Published
2012

29. Targeting NF-kB to modulate immune responses in arthritis

Author

Tas, S. W., Bleker, O.P., Bonsel, G.J., Stronks, K., van Lith, J.M.M., Faculteit der Geneeskunde, Bleker, Otto P., Bonsel, Gouke J., van Lith, J. M. M., and Clinical Immunology and Rheumatology

Subjects
animal structures, education, mental disorders, biochemical phenomena, metabolism, and nutrition, psychological phenomena and processes
Published
2006

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