Maternal liver transplant: Another cause of discordant fetal sex determination using cell-free DNA

Noninvasive prenatal testing (NIPT) can very accurately determine fetal sex during pregnancy. We present an exceptional case where NIPT contradicts the ultrasound-based sex determination. The pregnant woman was recipient of a liver transplant from a male donor. Graft-derived cell-free DNA released into the maternal circulation clouded the NIPT-based sex determination. Hence, NIPT is not advisable when the pregnant mother underwent an organ transplant.     

Amniopatch for iatrogenic rupture of the fetal membranes

With the increased use of invasive fetal procedures, the number of women facing post-procedure membrane rupture is increasing. Here we review the use of platelets and fresh frozen plasma for sealing iatrogenic fetal membrane defects by describing the mechanisms of action of the amniopatch procedure as well as published experience. In cases of iatrogenic preterm pre-labour rupture of the membranes, amniopatch effectively seals the fetal membranes in over two-thirds of cases. There is a risk of 16% of in utero fetal death, which may occur at varying intervals from the procedure and often for unknown reasons. Amniopatch has also been used as a treatment of chorionic membrane separation. In summary, current experience suggests that in cases of early onset but persistent amniotic fluid leakage following an invasive fetal procedure, amniopatch is an option. Copyright © 2011 John Wiley & Sons, Ltd.     

Disaster Management in the Caribbean

This paper identifies the main trends in approaches to disaster management in the Caribbean at both regional and national levels over the past 20 years. It highlights the main reasons why and how the region has moved from an ad hoc response to an organised approach. Finally, it suggests ways in which future regional and national disaster management could be improved.     

Exposure to particulate matter in traffic: A comparison of cyclists and car passengers

Emerging evidence suggests that short episodes of high exposure to air pollution occur while commuting. These events can result in potentially adverse health effects. We present a quantification of the exposure of car passengers and cyclists to particulate matter (PM). We have simultaneously measured concentrations (PNC, PM2.5 and PM10) and ventilatory parameters (minute ventilation (VE), breathing frequency and tidal volume) in three Belgian locations (Brussels, Louvain-la-Neuve and Mol) for 55 persons (38 male and 17 female). Subjects were first driven by car and then cycled along identical routes in a pairwise design. Concentrations and lung deposition of PNC and PM mass were compared between biking trips and car trips.Mean bicycle/car ratios for PNC and PM are close to 1 and rarely significant. The size and magnitude of the differences in concentrations depend on the location which confirms similar inconsistencies reported in literature. On the other hand, the results from this study demonstrate that bicycle/car differences for inhaled quantities and lung deposited dose are large and consistent across locations. These differences are caused by increased VE in cyclists which significantly increases their exposure to traffic exhaust. The VE while riding a bicycle is 4.3 times higher compared to car passengers. This aspect has been ignored or severely underestimated in previous studies. Integrated health risk evaluations of transport modes or cycling policies should therefore use exposure estimates rather than concentrations.