Bevezetés: A széles spektrumú béta-laktamáz-termelő bélbaktériumok várandósok és koraszülöttek vastagbelében is tünetmentes hordozást okozhatnak. Célkitűzés: A szerzők intézményében felmérték a szülés napján azon édesanyák között e kórokozó hordozásának gyakoriságát, akiknek a gyermeke Neonatalis Intenzív Centrumba került felvételre, azzal a céllal, hogy megakadályozzák a felismert kolonizált édesanyák újszülöttjeiben a kolonizáció kialakulását. Mód-szer: 2013. október 1. és 2015. október 31. között a koraszülés napján az édesanyák szűrését végezték. 751 esetben levett anorectalis törlés vagy székletminta 19 esetben adott pozitív eredményt. A pozitív mintájú édesanyák személy-re szóló higiénés oktatásban részesültek kézhigiéné témakörben. A gyermekek ellátásában ezt követően aktívan részt vettek. Egyes gyermekektől a felvétel napján gyomormosó folyadékból és fülváladékból mintát küldtek tenyésztésre, majd kórházi kezelésük alatt minimum egy alkalommal anorectalis szűrést végeztek széles spektrumú béta-laktamázt termelő kórokozó okozta kolonizáció irányába. Eredmények: A 19 pozitív mintájú édesanya egyetlen újszülöttje sem vált pozitívvá a megfigyelés ideje alatt. Következtetés: Felismert anyai kolonizáció esetén a kórházhigiénés szabályok betartásával a terjedés megelőzhető. Orv. Hetil., 2016, 157(34), 1353-1356.Kulcsszavak: széles spektrumú béta-laktamáz-termelő bélbaktérium, koraszülött, kolonizáció Examination of maternal extended spectrum beta-lactamase bacterial colonization and follow-up of newborns requiring Neonatal Intensive Care Unit admissionIntroduction: The extended beta-lactamase producing Enterobacteriaceae may cause asymptomatic carriage if present in the colon of premature infants or pregnant women. Aim: To assess the incidence of colonization among mothers whose infants were admitted to Neonatal Intensive Center on the day of their delivery for this pathogen. Method: From October 1, 2013 until October 31, 2015 the authors screened mothers on the day of their delivery for this pathogen. Nineteen of the 751 anorectal swabs or stool samples were found to be positive. Mothers having positive samples were given personal education for hand hygiene, then they actively participated in the care of their babies. From some premature infants ear swab and stomach washing were taken and sent for culture on the day of their admission. In the course of their hospital stay, anorectal swabs were taken and screened for this bacteria colonization at least once. Results: None of the premature infants of the 19 extended beta-lactamase producing Enterobacteriaceae-positive mothers became positive in the studied period. Conclusion: If the mother is colonized, the spreading of pathogen to newborns can be prevented by observing the hygienic rules.

Objective: We evaluated placental alterations in different subtypes of fetal growth restriction (FGR) to determine any clinical associations. Methods: FGR placentas classified according to the Amsterdam criteria were correlated with clinical findings. Percentage of intact terminal villi and villous capillarization ratio were calculated in each specimen. Correlations of placental histopathology and perinatal outcomes were studied. 61 FGR cases were studied. Results: Early-onset-FGR was more often associated with preeclampsia and recurrence than late-onset-FGR; placentas from early-onset-FGR often had diffuse maternal (or fetal) vascular malperfusion and villitis of unknown etiology. Decreased percentage of intact terminal villi was associated with pathologic CTG. Decreased villous capillarization was associated with early-onset-FGR and birth weight below the second percentile. Avascular villi and infarction were more common when femoral length/abdominal circumference ratio was >0.26, and perinatal outcome was poor in this group. Conclusion: In early-onset-FGR and preeclamptic FGR, altered vascularization of villi may have a key role in pathogenesis, and recurrent FGR is associated with villitis of unknown etiology. There is an association between femoral length/abdominal circumference ratio >0.26 and histopathological alterations of placenta in FGR pregnancies. There are no significant differences in the percentage of intact terminal villi between different FGR subtypes by onset or recurrency.

Aim To evaluate the associations between placental histopathology (signs of maternal and fetal vascular malperfusion, delayed villous maturation, villitis of unknown etiology) and subtypes of preeclampsia by onset, clinical aspects of the disease and neonatal outcome. Methods Placental slides from preeclamptic pregnancies were retrospectively reviewed according to a uniform scheme. Information regarding obstetrical anamnesis, clinical data and perinatal outcome was collected from charts, and statistical analysis was performed in order to demonstrate associations between microscopic placental alterations and different aspects of preeclampsia. Results A total of 49 cases were studied. Diffuse signs of maternal vascular malperfusion and avascular villi were more common in early‐onset‐preeclampsia associated with worse prognosis. Preeclampsia with fetal growth restriction had more often diffuse signs of maternal and fetal vascular malperfusion and villitis of unknown etiology. Recurring preeclampsia was associated with more common perivasculitis. Umbilical and uterine artery Doppler indices were associated with medial hypertrophy and/or acute atherosis of maternal decidual vessels. Large foci of avascular villi correlated with extent of maternal 24‐h‐proteinuria which itself correlated with outcome of preeclampsia. Rate of capillarisation of villi was significantly lower in case of hypertension requiring a three‐drug combination of antihypertensive medications versus hypertension treated with one or two drugs, preeclampsia with growth restriction, and stillbirth versus live birth. Conclusions Early‐ versus late‐onset‐preeclampsia showed a markedly different profile of histopathological features and perinatal outcome, reflecting their distinguished pathogenesis and prognosis; preeclampsia complicated with fetal growth restriction also had distinctive features. Qualitative and quantitative changes define placental pathology of preeclampsia.

Objective: To evaluate the possible connections of cardiotocography (CTG) signs with neonatal outcome and placental histopathology between growth restricted preterms. Materials and Methods: Placental slides, baseline variability, and acceleration patterns of cardiotocograms, and neonatal parameters were studied retrospectively. Placental histopathological changes were diagnosed according to the Amsterdam criteria; percentage of intact terminal villi and capillarization of villi were also studied. 50 cases were analyzed: 24 were early-onset fetal growth restriction (FGR), 26 were late-onset FGR. Results: Reduced baseline variability was related to poor neonatal outcome; lack of accelerations similarly had associations with poor outcomes. Maternal vascular malperfusion, avascular villi, VUE, and chorangiosis were more common in the background of reduced baseline variability and absence of accelerations. Lower percentage of intact terminal villi was significantly associated with lower umbilical artery pH, higher lactate levels, and reduced baseline variability on CTG; absence of accelerations was correlated with decreased capillarization of terminal villi. Conclusions: Baseline variability and absence of accelerations seem to be useful and reliable markers in predicting poor neonatal outcome. Maternal and fetal vascular malperfusion signs, decreased capillarization, and lower percentage of intact villi in placenta could contribute to pathologic CTG signs and poor prognosis.