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Objective: Aim of the study was to examine the influence of the various medical indications on a successful induction of labor by prostaglandins and to determine the explanatory variables., Study Design: Retrospective analysis of 729 pregnancies, which fulfilled following criteria: only one medical indication for induction, 37 completed weeks of gestation or more, alive singleton pregnancy with cephalic presentation and induction with prostaglandins locally. The chosen endpoint was delivery., Results: The Kaplan-Meier curves demonstrating the percentage of deliveries in function of the time interval from induction to delivery showed a significant longer time interval for those without pre-labor rupture of membranes (PROM) than for those with PROM as indicated by log rank testing (vaginal deliveries and caesarean sections: hazard ratio=0.67, 95% CI=0.48-0.82, P<0.001; vaginal deliveries only: hazard ratio=0.65; 95% CI=0.45-0.80; P<0.001). In a similar way, those without diabetes had a shorter induction to delivery time interval than those with diabetes when all deliveries, including caesarean sections, were considered (hazard ratio=1.59; 95% CI=1.05-2.06; P=0.02), but there was a "borderline missed" statistical difference when only vaginal deliveries were considered (hazard ratio=1.48; 95% CI=0.96-2.03; P=0.08). Subsequently, univariate analysis in a Cox proportional hazards regression model was used to identify possible explanatory variables of the outcome, followed by multivariate analysis using the Cox proportional hazards regression model again in order to determine the independent contribution of each of these variables to the outcome. Uni- and multivariate analysis showed the cervix score, parity, the number of applied vaginal prostaglandin tablets, the gestational age and PROM to be significant explanatory variables of the induction to delivery time interval. Diabetes, body mass index and body weight were related to the outcome in a univariate analysis, but after adjustment in a multivariate analysis these variables were not significant., Conclusion: PROM was the only medical reason to influence the outcome of an induction with prostaglandins locally, other significant explanatory variables were the cervix score, parity, the number of applied prostaglandin tablets and the gestational age, whereas other factors, such as diabetes, body mass index and body weight had no significant influence.

The development of diseases in later life, such as diabetes type II, hypertension and cardiovascular disease, is linked to abnormal intrauterine conditions that reduce birth weight. Obviously, fetal development can be disturbed so profoundly, that fetal programming is changed permanently. We have examined the effects of hypoxia, or more precisely hypoxemia, on the fetal hypothalamic-pituitary-adrenal (HPA) axis and lungs using molecular biology techniques in order to elucidate the underlying mechanisms. Chronically catheterized fetal sheep were subjected to a hypoxemia (48 h) without change in arterial pH or paCO2. Major changes occurred, although the degree of hypoxemia was just moderate. There was a transient increase in the fetal plasma ACTH-concentrations with an upregulation of the cortisol-concentrations, which was more pronounced in the older, hypoxemic fetuses (134-136 days of gestation) than in the younger, hypoxemic animals (126-130 days of gestation; term is 145 days). There was an unique, differential regulation for pro-opiomelanocortin messenger RNA (mRNA), the precursor molecule of e.g. ACTH, in the pars distalis and pars intermedia of the pituitary gland. This finding supported the increased bioactivity besides the increased concentrations for ACTH. Simultaneously, there was an increase in the mRNAs of the ACTH-receptor and of the steroid-synthesizing enzymes in the fetal adrenal gland of the older, hypoxemic fetuses. No changes in the fetal plasma androstenedione-concentrations were observed. Clearly, there was a selective increase of the cortisol-synthesis. Growth and maturation of the fetal lung might also have been affected, because of the increase in surfactant-protein A mRNA in the older, hypoxemic animals and the decrease in the insulin-like growth factor-I and its binding protein-5 mRNA in the younger, hypoxemic fetuses. In summary, even a moderate degree of hypoxemia was shown to affect the different levels of fetal organism profoundly, offering a pathophysiological basis for changes in fetal development.

An adequate increase of uterine blood flow throughout gestation is essential for uterine, placental and fetal growth. Maternal cardiovascular adaptation has to provide the uterine perfusion that is necessary to meet the requirements of the developing and growing fetus by providing transport of nutrients and oxygen to the placenta and the fetus. Thus, uterine blood flow is inextricably linked to fetal growth and survival. Reductions of uterine blood flow can occur under acute or chronic conditions or in a combination of both. Chronic reductions of uterine blood flow can be observed in pregnancy-induced hypertension (PIH), diabetes mellitus in pregnancy and intrauterine growth restriction (IUGR). Chronic restrictions in uterine blood flow will elicit a placental and fetal response in the form of growth adaptation to the reduced supply of oxygen and nutrients to the conceptus. If compensatory growth restriction reaches its limits intrauterine fetal distress can ensue. Among the great number of experimental models of intrauterine growth restriction, those involving a generalized reduction in the uteroplacental blood supply are of significance to questions relating to human pregnancy. Despite physiological differences, particularly with regard to maternal metabolism and placentation, the occlusion model in the pregnant sheep is suitable for investigating questions about fetal and placental growth.

Background: Type 1 diabetes mellitus is common in Europeans. Optimal glucometabolic control at conception and during early pregnancy is necessary to reduce the risk of early miscarriage and congenital malformations. Safe and effective contraceptive methods are essential for these women in order to have a "planned pregnancy" under optimal conditions., Aim: To find out which recommendations Greek gynaecologists give to young patients with type 1 diabetes mellitus with respect to contraception. To regard the experience of Greek gynaecologists in counselling with women. To compare the Greek gynaecologists with German gynaecologists in a previously published similar survey., Subjects and Methods: A structured questionnaire containing questions about attitude, health care and contraception in young women with type 1 diabetes was given to 400 Greek gynaecologists working in Athens., Results: Only 70 (17.5%) of the Greek gynaecologists returned the questionnaire. Condoms were the preferred recommendation as contraceptive method for young women with diabetes mellitus type 1 in 64%. About 57% of the gynaecologists recommended this type of contraception as first line contraceptives for young women with diabetes type 1 who smoke. The two most important criteria for selection of a contraceptive method for Greek gynaecologists were the safety and the diabetes specific problems. The Greek gynaecologists had only limited experience in regard to counselling and treating young and adolescent women with type 1 diabetes., Conclusion: There was no consensus with respect to contraception among Greek gynaecologists. This is similar to our previous findings in a survey involving German gynaecologists. Practical experience in counselling and treating adolescent and young women with type 1 diabetes was limited among the gynaecologists who participated in this study. Working out proper recommendations for contraception crucial for optimal medical care for type 1 diabetic women in Europe.

Background: The ovarian hyperstimulation syndrome (OHSS) following ovulation induction is characterized by a cystic enlargement of the ovaries with an acute third space fluid sequestration. Inflammatory cytokines mediate the inflammatory response (IL-1, IL-2, IL-6, IL-8, TNFalpha) and play a crucial role in the pathogenesis of OHSS., Objective: To determine the role of the anti-inflammatory cytokine interleukin-10 (IL-10) in OHSS and to examine its correlation with 17beta-estradiol and progesterone., Study Design: Peritoneal fluid and serum samples were collected from 9 patients with severe OHSS after ovulation induction by administration of GnRH-analogues followed by hMG (n=5) or recombinant FSH (n=4). Patients (n=19) without pathological findings at laparoscopy served as non-pregnant controls and pregnant women (n=14) between 7 and 16 weeks of gestation served as positive controls. Samples were assayed for IL-10 by commercially available ELISA and for for 17beta-estradiol and progesterone by RIA. Statistical analysis was performed by non-parametric Mann-Whitney U-test and results are presented as the median and range., Results: OHSS patients had significantly higher peritoneal fluid IL-10, 17beta-estradiol and progesterone levels than patients during early pregnancy and than the control group. No correlation was found between peritoneal fluid or serum IL-10 and 17beta-estradiol or progesterone in the different groups. Serum 17beta-estradiol and progesterone, but not serum IL-10 levels were elevated in OHSS and during early pregnancy., Conclusions: High concentrations of IL-10 in peritoneal fluid suggest a role of this anti-inflammatory cytokine during OHSS. 17beta-estradiol and progesterone were elevated in peritoneal fluid and serum during OHSS but no correlation with IL-10 concentrations was found. Therefore, we assume that IL-10 has a role in OHSS as a local mediator of inflammation, however, it presents different aspects of the OHSS than the sex steroids 17beta-estradiol and progesterone.

Reduction of lethal and compromised fetal outcome is a benefit of rising socio-economic standards and better health care, including technologies such as cardiotocography and fetal blood analysis. The pursuit of higher standards in obstetrics leads to new and improved techniques. The transcutaneously measured carbon dioxide tension (tc PCO2) was proposed as a continuous and non-invasive method revealing the acid-base status of the fetus. Nonetheless, intrapartum surveillance by measuring tc PCO2 is rarely used in clinical practice. To assess the value of fetal monitoring by tc PCO2 during parturition, tc PCO2 measurements were compared with the fetal acid-base status. Tc PCO2 was measured by a recently developed electrode during 21 deliveries. The tc PCO2 electrode was disinfected, calibrated and applied to the presenting part of the fetus after rupture of membranes. The acid-base status of the fetus was determined with a commercial blood gas analyser in capillary blood (n = 33) and umbilical artery samples (n = 15). Tc PCO2 was correlated with the PCO2 of the capillary blood (r = 0.56; n = 33; P < 0.001) as well as with the PCO2 in the umbilical artery (r = 0.75; n = 15; P < 0.01). The pH value of capillary blood was related to tc PCO2 (r = -0.56; n = 33; P < 0.001). However, tc PCO2 did not show a significant relation with the pH value in the umbilical artery (r = -0.34; n = 15). Variations in skin blood flow are known to decrease the transcutaneously measured oxygen tension (tc PO2) below the PO2 in the capillary and umbilical blood.(ABSTRACT TRUNCATED AT 250 WORDS)