Objective Bacteria have been identified in different regions of the placenta. Here, we tested the hypothesis that the maternal basal plate of the placenta harbors microbes which may be associated with adverse pregnancy outcomes. Study Design We performed a cross-sectional study of pregnancies from a single tertiary care hospital. Maternal medical and obstetric characteristics were obtained and pregnancies followed prospectively for outcomes and placental collection. After delivery, systematic random sampling of the placental basal plate was performed. Paraffin sections of basal plates were stained with four histological stains and scored for morphological evidence of bacteria. Results Of 195 total patients in the study, Gram positive and negative intracellular bacteria of diverse morphologies were documented in the basal plates of 27% of all placentas. 35% of the patients delivered preterm. No difference was noted between placental basal plates from preterm or term gestations. Intracellular bacteria were found in the placental basal plates of 54% spontaneous preterm deliveries before 28 weeks, and in 26% of term spontaneous deliveries (p=0.02). Intracellular bacteria were also documented in placentas without clinical or pathologic chorioamnionitis. Conclusions 27% of placentas demonstrated intracellular bacteria in the placental basal plate using morphological techniques. Thus, the maternal basal plate is a possible source of intrauterine colonization and placental pathological examination could include examination for bacteria in this important maternal fetal interface.

Objective: To measure the knowledge, attitudes and practices of health professionals regarding fetal alcohol syndrome (FAS) and alcohol use during pregnancy. Method: A postal survey of a representative random sample of health professionals was conducted in Western Australia (WA) in 2002/03. 1,143 (79%) of 1,443 eligible health professionals completed the survey (87 Aboriginal Health Workers, 286 allied health professionals, 537 community nurses, 170 general practitioners and 63 obstetricians). Results: Of 1,143 health professionals, 12% identified all four essential diagnostic features of FAS. Most (95%) had never diagnosed FAS. Although 82% believed that making a diagnosis of FAS might improve treatment plans and 85% agreed FAS was preventable, 53% said the diagnosis might be stigmatising. Only 2% felt very prepared to deal with FAS and most wanted information for themselves and their clients. Of the 659 health professionals caring for pregnant women, only 45% routinely ask about alcohol use in pregnancy, only 25% routinely provide information on the consequences of alcohol use in pregnancy and only 13% provide advice consistent with NHMRC guidelines on alcohol consumption in pregnancy. Conclusion: Health professionals have identified the need for educational materials for themselves and their clients. Implications: FAS is likely to be under‐ascertained in Australia due to a lack of knowledge of FAS by health professionals. Until this lack of knowledge is addressed, opportunities for diagnosis and prevention of FAS will be limited.

Objective To test the hypothesis that a combination of PP13, PAPP-A and first-trimester uterine artery Doppler would improve the prediction of preeclampsia. Methods This is a prospective cohort study of pregnant women followed from the first-trimester to delivery. PP13 and PAPPA were determined by immunoassay of maternal serum at 11 – 14 weeks’, when uterine artery Doppler measurements were assessed. Cases identified with any form of preeclampsiawere compared with a control group without preeclampsia. The sensitivity of each marker or their combinations in predicting preeclampsia for different fixed false positive rates was calculated from the ROC curves. Results Forty two women were diagnosed with preeclampsia and 410 women with pregnancies not complicated by preeclampsia were used as controls. For a fixed false positive rate (FPR) of 20%, PP13, PAPP-A and mean uterine artery pulsatility index identified 49%, 58% and 62% respectively, of women who developed any form of preeclampsia. PP13 was best in predicting early onset preeclampsia with a sensitivity of 79% at a 20% FPR.Combinations of the three first trimester assessments did not improve the prediction of preeclampsia in later pregnancy. Conclusion First-trimester PP13, PAPP-A and uterine artery PI are reasonable, individual predictors of women at risk to develop preeclampsia. Combinations of these assessments do not further improve the prediction of preeclampsia

Although an increase in older mothers was observed in most registers, the prevalence of DS births remained stable in most registers as a result of increasing use of prenatal diagnostic procedures and ToP with DS.