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To assess the prognostic validity of the Institute of Medicine/National Research Council (IOM/NRC) week-specific cutoff values for inadequate or excessive total gestational weight gain (GWG) by 4-week intervals. We merged data from two German cohorts (LMU cohort (all maternal-weight categories) and PEACHES cohort (obese women)) to provide information on GWG for 749 women (365 normal weight, 199 overweight and 185 obese). We calculated the prognostic values for suboptimal and excessive GWG according to the IOM/NRC cutoff values. The positive predictive values for excessive total GWG for those who experienced excessive GWG early in pregnancy was 70.1% (95% confidence interval (CI) 60.5; 78.6) as of week 12/1 to 16/0 in normal-weight women, 89.5% (95% CI 75.2; 97.1) and 95.2 (76.2; 99.9) 95.2% (95% CI 76.2; 99.9) as of week 8/1 to 12/0 for overweight and obese women, respectively. In absence of excessive GWG as of week 12/1 to 16/0, normal-weight women had 77.5% (95% CI 77.1; 83.1) probability of not experiencing excessive total GWG (negative predictive value). In overweight and obese women, the negative predictive value was considerably lower up to week 24/1 to 28/0 (60.0% (95% CI 48.8; 70.5) in week 20/1 to 24/0 and 50.6% (95% CI 39.3; 61.9) in week 24/1 to 28/0). Most women with inadequate GWG in the first and second trimester had adequate total final GWG (positive predictive value for total inadequate GWG

Background Prenatal 3-dimensional (3D) ultrasound allows volumetry of the fetal brain, liver and measurement of myocardial mass (MM). We studied the reliability of this method in an interdisciplinary approach, defined the relation of the values throughout gestation, and evaluated the results in fetuses with congenital heart disease (CHD). Methods In 104 fetuses (39 with CHD) between 14 and 38 weeks of gestation 3D ultrasound was prospectively performed. Data sets of brain, abdomen and heart were stored for off-line analysis of volumes and MM. Descriptive statistics, coefficients of correlation and of variation (CV) were performed. Results Volumetric data set acquirement was feasible in all pregnancies, lasted approximately 10 min, but off-line analysis was feasible in only 66% lasting about 45 min. MM increased in a linear fashion during gestation. CV were 11.0 and 10.8 for the left, 14.39 and 12.66, respectively, for the right MM. Median ratio between right and left MM was 0.88 in normal fetuses, and 8.25 in fetuses with hypoplastic left heart syndrome. Intra- and interobserver variabilities revealed CVs of 2.46 and 11.80, respectively, for brain volumetry, and CVs of 3.16 and 29.2, respectively, for liver volumetry. Both brain and liver volumes were positively associated with gestational age, and did not show different growth patterns in fetuses with CHD. Conclusions Prenatal volumetry is time-consuming, but reliable especially for left MM and brain volume. Linear growth of brain and liver volume is present in utero irrespective of CHD. Application of our reference graphs of MM growth allows early differentiation in CHD.

Diabet. Med. 27, 1379–1384 (2010) Abstract Aims Reducing the risk of adverse outcomes in diabetic pregnancies to the level of risk in non-diabetic pregnancies is a major goal in diabetes care. So far there have not been any data to show whether progress is being made towards this goal. Methods We used population-based data on 2 292 053 deliveries between 1987 and 2007 in Bavaria, Germany, to assess temporal trends for stillbirths, early neonatal mortality, preterm delivery, macrosomia and malformations in consecutive 7 year intervals. We estimated prevalences and prevalence odds ratios for these outcomes. For stillbirth, as the most severe adverse outcome, we assessed the contributions of several predictors using multiple regression models. Results With the exception of early neonatal deaths, the risks for all outcomes were significantly increased in the offspring of mothers with pregestational diabetes in all three time periods (e.g. odds ratio for stillbirths in diabetic compared with non-diabetic mothers in 2001–2007, 1.89; 95% confidence interval 1.24, 2.87). However, the prevalence of stillbirths, premature delivery and macrosomia decreased over time in diabetic mothers (e.g. 1.71% for stillbirths in 1987–1993 and 0.66% in 2001–2007), as did the respective odds ratios. Maternal smoking, hypertension and substandard utilization of antenatal care were significantly associated with stillbirths in diabetic women. Conclusions Although the risk of adverse pregnancy outcomes is still increased in diabetic mothers, considerable improvement has been achieved. We hypothesize that this improvement is possibly due to improved diabetes care.

Background: Gestational weight gain (GWG) has been shown to be directly associated with birth weight. Objective: We aimed to define ranges for optimal GWG with respect to the risk of either small- or large-for-gestational-age offspring by using a new statistical approach. Design: For the purpose of an observational study, data on n = 177,079 mature singleton deliveries in Bavaria between 2004 and 2006 were extracted from a standard data set that is regularly collected for national benchmarking of obstetric units in terms of clinical performance. Joint predicted risks of either small- or large-forgestational-age births in relation to GWG (continuous measurement) were estimated by logistic regression models with adjustment for potential confounders. Results: The estimated optimal GWG ranges as defined by a joint predicted risk of 20% were substantially wider than those recommended by the Institute of Medicine for underweight (8‐25 compared with 12.5‐18.0 kg) and normal-weight (2‐18 compared with 11.5‐16.0 kg) women. Overweight and obese women’s optimal GWG ranged from 27 to 12 and 215 to 2 kg, respectively (Institute of Medicine recommendations: 7.0‐11.5 and 5.0‐9.0 kg, respectively). We observed considerable effect modifications by parity and smoking in pregnancy. In normal-weight primiparae, for example, the optimal GWG range was 10‐26 kg for nonsmokers compared with 23‐27 kg for smokers. Conclusions: Considerably wider optimal GWG ranges than recommended by the Institute of Medicine might be tolerated with respect to avoidance of adverse birth weight outcome. Stratification by maternal body mass index category alone might not be sufficient. Am J Clin Nutr 2009;90:1552‐8.

Die Schwangerenvorsorge in Deutschland ist gesetzlich in den so genannten Mutterschaftsrichtlinien verankert mit dem Ziel, frühzeitig Risikoschwangerschaften und potenzielle Risikogeburten zu erkennen, um sie weiterer risikoadaptierter Betreuung zuzuführen. Neben 3 Ultraschalluntersuchungen sind serologische und infektiologische Parameter verpflichtend in die Vorsorge integriert, wohingegen der orale Glukosetoleranztest weiter der individuellen Indikationsstellung bedarf.

Serum concentrations of the amino-terminal pro-B-type natriuretic peptide (NT-proBNP) may be used to monitor cardiac function during pregnancy but normal values are not established for this purpose. Therefore, we investigated NT-proBNP in normotensive healthy pregnancies compared to a non-pregnant control group. Serum NT-proBNP was measured in 94 normotensive, healthy pregnant women (32+/-6 years) every five weeks beginning from 12th gestational week (GW) in a longitudinal study and compared to a non-pregnant control group of 521 women (32+/-7 years). Pooled median serum NT-proBNP levels (25th; 75th percentile) were significantly higher in pregnant women compared to non-pregnant women (56 (33; 95) pg/ml vs. 38 (22; 62) pg/ml (p

Fetal long-chain polyunsaturated fatty acid (LC-PUFA) supply during pregnancy is of major importance, particularly with respect to docosahexaenoic acid (DHA) that is an important component of the nervous system cell membranes. Growing evidence points to direct effects of DHA status on visual and cognitive outcomes in the offspring. Furthermore, DHA supply in pregnancy reduces the risk of preterm delivery. Because of limited fetal capacity to synthesize LC-PUFA, the fetus depends on LC-PUFA transfer across the placenta. Molecular mechanisms of placental LC-PUFA uptake and transport are not fully understood, but it has been clearly demonstrated that there is a preferential DHA transfer. Thus, the placenta is of pivotal importance for the selective channeling of DHA from maternal diet and body stores to the fetus. Several studies have associated various fatty acid transport and binding proteins (FATP) with the preferential DHA transfer, but also the importance of the different lipolytic enzymes has been shown. Although the exact mechanisms and the interaction of these factors remains elusive, recent studies have shed more light on the processes involved, and this review summarizes the current understanding of molecular mechanisms of LC-PUFA transport across the placenta and the impact on pregnancy outcome and fetal development.

Problem The immunological equilibrium at the feto-maternal interphase contributes towards late gestational diseases like growth restriction (IUGR) pre-eclampsia (PE) and hemolysis, elevated liver enzymes, low platelets (HELLP)-syndrome. The state of activation of decidual dendritic cells (DC) has emerged as one of the central players influencing this immunological equilibrium. Method of study Paraffin-embedded tissue sections from 27 pregnancies were immunostained for DC markers DEC-205, DC-SIGN, DC-LAMP and costained for DC-SIGN/CD56 and DC-SIGN/ vascular endothelial growth factor receptor (VEGFR) -1 and -2. We investigated placental tissue of IUGR fetuses and of patients who developed PE or HELLP-syndrome as well as placental tissue derived from normal pregnancies. Results We found that expression of DEC-205 and DC-SIGN was significantly upregulated in HELLP placentas, whereas expression of DC-LAMP was abrogated almost entirely. Costaining showed an interaction between DC-SIGN+ DC and natural killer cells as well as costaining of VEGFR-1 and -2 and DC-SIGN. Pre-eclamptic and IUGR placentas showed no significant change in any of the investigated markers compared to normal controls. Conclusion Our data suggest a participation of DC-mediated immunological mechanisms in HELLP syndrome.

Background Galectin-1 (gal-1) and galectin-3 (gal-3), which are members of the mammalian β-galactoside-binding proteins, recognise preferentially (Galβ1-4GlcNAc) sequences of several cell surface oligosaccharides. In addition, gal-1 also binds to the Thomsen–Friedenreich (TF) antigen (Galβ1-3GalNAc-). Materials and methods Slides of frozen and paraffin-embedded placental tissue of patients with fetal intrauterine growth retardation (IUGR), preeclampsia, haemolysis, elevated liver enzymes, low platelets (HELLP) and normal term placentas were incubated with monoclonal and polyclonal antibodies against gal-1, gal-3 and TF. Staining reaction was performed with the avidin–biotinylated peroxidase complex (ABC) reagent. The intensity of the immunohistochemical reaction on the slides was analysed using a semi-quantitative score. The identity of galectin-expressing cells was analysed by using a double immunofluorescence method. Results We demonstrated immunohistochemically that the expression of gal-1 and gal-3 on the extravillous trophoblast (EVT) is significantly up-regulated in preeclamptic and HELLP placentas and unchanged compared with normal controls in IUGR placentas. The expression of the TF antigen is significantly up-regulated in IUGR and preeclamptic extravillous trophoblast cells and unchanged in HELLP placentas compared with normal controls. In addition, the expression of gal-1 is significantly up-regulated in the decidual tissue of preeclamptic placentas and in the villous trophoblast tissue of HELLP placentas. Conclusion Our data showed that gal-1, gal-3 and TF were up-regulated on the membrane of EVT in preeclamptic placentas. In addition, the expression of gal-1 is significantly up-regulated in decidual tissue of preeclamptic placentas and villous trophoblast tissue of HELLP placentas. Taking into consideration the results of this study, we speculate that expression of both galectins and TF on the membrane of preeclamptic EVT and up-regulation of gal-1 in preeclamptic decidual cells may at least in part compensate for the apoptotic effects of maternal immune cells.

Zusammenfassung Unter den Begriff der Invasiven Pränataldiagnostik fallen Eingriffe bzw. Verfahren, die auf der Untersuchung von Zellen des Ungeborenen, Fruchtwasser- bzw. Blutproben basieren. Die Eingriffe zur Gewinnung dieser Zellen bzw. Flüssigkeiten beinhalten ein Eingriffsrisiko, vor allem das einer Fehlgeburt bzw. eines intrauterinen Fruchttodes. Daher ist die Invasive Pränataldiagnostik im Gegensatz zu den nicht-invasiven Screeningmethoden, die zum Teil auch Bestandteil der allgemeinen Mutterschaftsrichtlinien sind, grundsätzlich an eine Indikation gebunden. Diese Indikation ergibt sich in der Regel aus einem individuellen Risiko für eine bestimmte Erkrankung beim Ungeborenen.

Lewis antigens belong to the blood group of antigens and mediate cellular adhesion through interaction with selectins. Invasive trophoblasts use an array of adhesion molecules to facilitate cell-cell and cell-extracellular matrix interactions. Here, we examined immunohistochemically the expression of Sialyl Lewis a (sLe(a)), Sialyl Lewis x (sLe(x)) and Lewis y (Le(y)) in term placentas obtained from cases of normal, intrauterine growth retardation (IUGR), preeclamptic (PE) and hemolysis, elevated liver enzymes and low platelets syndrome (HELLP) pregnancies. We report the expression of sLe(x) in third trimester extravillous trophoblasts (EVT). sLe(x) was significantly decreased in IUGR and moderately decreased in PE compared to normal placentas. sLe(x) was additionally found in syncytiotrophoblast, without however any significant differences in staining intensity between normal and pathological cases. sLe(a) was restricted to amnion epithelium. Finally, Le(y) was expressed in cytotrophoblasts and villous endothelial cells. Le(y) expression was significantly upregulated in IUGR and HELLP, whereas there was a trend toward increase in PE compared to normal placentas. The present study suggests that downregulation of sLe(x) in EVT might be associated with IUGR and PE. Furthermore, Le(y), which was recently described as a potent angiogenic factor, is upregulated in placental villi in conditions associated with placental malperfusion.

quartile range, and Receiver Operator Characteristic (ROC) curves. Results: Median PlGF concentrations in cases and controls were [Triage; 12 (IQR 12–15) v 256 (IQR 130–781) pg/ml, and Delfia; 38 (IQR 28–43) v 236 (IQR 161–419) pg/ml], respectively. The area under the ROC curve (AUC) for the diagnosis of early onset preeclampsia was 1.0 (95% CI, 1.0–1.0) for Triage and 0.97 (95% CI, 0.94–1.0) for Delfia. Conclusions: The Triage PlGF assay achieves greater separation of cases from controls. Further studies are needed to understand whether differences in analytical specificity (PlGF isoforms or complexed vs non-complexed PlGF) explain the lower levels of PlGF in preeclampsia for the Triage immunoassay.

Background Nitric oxide seems to play important roles in the physiology of placental blood circulation, although their expression in pathological placentas and their role is still unclear. Therefore, the aim of this study was to investigate the expression of estrogen receptor alpha (ERα), estrogen receptor beta (ERβ) and the endothelial NO synthase (eNOS) and inducible NO synthase (iNOS) in intrauterine growth-restricted (IUGR) placentas, hemolysis, elevated liver enzymes, low platelets (HELLP) placentas and in normal healthy control placentas. Methods Slides of paraffin-embedded placental tissue were obtained after delivery from patients diagnosed with IUGR, HELLP and normal term placentas and analyzed for eNOS and iNOS, as well as ERα/β expression. Intensity of immunohistochemical reaction was analyzed using a semi-quantitative score, and statistical analysis was performed. In addition, Western blot experiments were performed for comparison of staining intensities obtained by immunohistochemistry and Western blot. Results Expression of eNOS and iNOS is significantly reduced in trophoblast cells of placentas with HELLP. However, ERβ expression in HELLP placentas demonstrated a significantly elevated expression intensity compared to normal controls. ERα expression was not significantly different in all three pathologies investigated. Conclusions We speculate that the increased ERβ expression in both syncytiotrophoblast and extravillous trophoblast cells represents accelerated proliferation of placental tissue or can be seen as a compensatory effect in HELLP placentas.

During human pregnancy the placenta produces a variety of proteins like steroid hormones and their receptors that are responsible for the establishment and ongoing of the feto-placental unit. Inhibins are dimeric glycoproteins, composed of an alpha-subunit and one of two possible beta-subunits (beta (A) or beta (B)). Aims of the present study were the determination of the frequency and tissue distribution patterns of the inhibin/activin subunits in human placental tissue of normal pregnancies and pregnancies complicated with fetal growth restriction (IUGR). Slides of paraffin embedded placental tissue were obtained after delivery from patients diagnosed with IUGR (n = 6) and normal term placentas (n = 8). Tissue samples were fixed and incubated with monoclonal antibodies inhibin/activin-subunits -alpha, -beta (A), -beta (B). Intensity of immunohistochemical reaction on the slides was analysed using a semi-quantitative score and statistical analysis was performed (P

Background: The Nitric Oxide (NO) system plays an important role in the establishment and maintenance of the feto-placental circulation. Research on the pathogenesis of preeclampsia in several studies has established the involvement of the NO-system in preeclampsia and fetal intrauterine growth restriction (IUGR). In the presented study we analyzed the urine and plasma concentrations of nitrite/nitrate, the stable endproducts of NO and its second messenger, cyclic Guanosinemonophosphate (cGMP) in normal, preeclamptic and IUGR pregnancies. Patients and methods: In total 76 patients were investigated in a prospective study for repeated determination of plasma and urinary levels of nitrate/nitrite and cGMP: 49 patients with a normal course of pregnancy, 14 patients with fetal IUGR and 13 patients with preeclampsia were included into the study. Plasma and urine Nitrite/Nitrate-concentrations were determined using a Colorimetric Assay (Cayman Inc., USA), concentrations of the second messenger cGMP in plasma and urinary samples were determined with a J125-Radio-Immuno-Assay (ibl Inc., Germany). The Stat View Program (Abacus Concepts, Inc., Berkeley, CA, 1992–1998) was used for statistical analysis, a P value

During human pregnancy the placenta produces a variety of proteins for the establishment of the fetoplacental unit, including inhibins and activins. Inhibins are dimeric glycoproteins, composed of an alpha-subunit and one of two possible beta-subunits (betaA or betaB). Aims of the present study were (a) the determination of the frequency and tissue distribution patterns of the inhibin/activin subunits in human placental tissue of normal pregnancies and pregnancies complicated with preeclampsia and HELLP syndrome (hemolysis, elevated liver enzymes, low platelets) and (b) the assessment of a combined expression of inhibin-alpha- and both beta-subunits (betaA-and betaB-subunits) using double immunofluorescence technique. A significant lower expression of the inhibin-alpha subunit in preeclamptic and HELLP placental tissue compared to normal pregnancies was observed, while the inhibin-alpha immunostaining was significantly upregulated in syncytotrophoblast. Additionally, we demonstrated a significant down-regulation of inhibin-betaB subunit in extravillous trophoblast cells between normal and preeclamptic compared to HELLP placental tissue, while inhibin-betaA-subunit was significantly higher in preeclamptic syncytotrophoblast cells. A colocalization of inhibin-alpha and the beta-subunits could be demonstrated, suggesting a production and secretion of intact inhibin A and inhibin B. Therefore, inhibin A and activin A might be useful markers in preeclampsia. Valuable parameters in HELLP syndrome could be inhibin A, rather than inhibin B, and activin B. Furthermore, the lower betaB-subunit production in extravillous trophoblast cells demonstrates that this subunit might have an important role in the pathogenesis of HELLP syndrome. Additionally, the higher production of the betaA-subunit in syncytotrophoblast cells suggest a higher production of activin A rather than inhibin A in preeclampsia that might be utilized as a marker of placental function.

Physiological fetal circulation requires patency of the ductus arteriosus. As gestation proceeds, the sensitivity of the ductus to dilating prostaglandins diminishes. The sensitivity to constricting agents like PGE-synthetase inhibitors, present in many analgetics, however, increases. Fetuses affected by an antenatal constriction of the ductus arteriosus (DC) may present with different signs of cardiac failure including dilated right ventricle, tricuspid regurgitation and abnormal venous Doppler. We report on four cases with prenatal DC, presenting at 34, 35, 36 and 37 weeks of gestation. They were referred to fetal echocardiography because of abnormal routine echo scans with unexplained signs of right heart decompensation. Three patients were medicated during pregnancy with either aspirin (low dose), metamizole or ibuprofen. One patient did not take any drugs, especially no pain medication drug in pregnancy. Immediate delivery was performed in all cases. The neonates were in a good condition; echocardiography showed different degrees of right heart hypertrophy which disappeared in all infants by the age of 3 months except in case 2. Unexplained fetal right heart decompensation requires detailed echocardiographic evaluation of the ductus arteriosus and a sophisticated medical history with regard to analgesics. In contrast to ibuprofen and high-dose aspirin, metamizole and low-dose aspirin have not yet been reported as possible agents constricting the fetal arterial duct. In any suspected context, early delivery as in our cases may save babies life. Any application of non-steroidal anti-inflammatory drugs in pregnancy requires close fetal follow-up due to their potentially life-threatening effect.

Background During the physiological course of pregnancy maternal peripheral vascular resistance decreases. Using the Doppler technique, the decreasing resistance and disappearance of the early diastolic notch in the arterial uterine perfusion can be observed. These changes in the Doppler flow velocity wave form are caused by the trophoblast invasion in which the spiral arteries loose their musculoelastic structure of the arterial wall. The aim of this study was to investigate whether maternal systemic alteration in the Doppler flow velocity waveform and Pulsatility Index (PI) could be monitored at the cubital artery during normal pregnancy. Methods and results Forty-five patients were investigated in a prospective study in 4–6-week intervals for Dopplersonographic evaluation of the two uterine arteries and the right cubital artery; 20 of the patients were also investigated after delivery. The presence or absence of the early diastolic reverse flow of the cubital artery was analyzed. Furthermore, the PI was calculated for all vessels. With increasing duration of gestation, the reverse flow of the cubital artery disappeared. During the course of gestation a significant decrease in the PI of the cubital artery was observed in addition to a significantly decreased PI of the uterine arteries. The PI of the placental and nonplacental uterine arteries showed a significant correlation to the PI of the cubital artery. Conclusions This study demonstrates systemical changes in arterial resistance correlating to those of the uterine arteries during the course of physiological pregnancy.

Acta Obstet Gynecol Scand 2002; 81: 214-221. © Acta Obstet Gynecol Scand 2002 Objective. While obstetrical management has changed significantly over years, the optimal duration of the second stage of labor still remains to be defined. The purpose of this study was to evaluate the effect of the duration of labor on fetal distress and maternal perinatal morbidity. Methods. There were 1457 consecutive patients delivered of a singleton fetus in cephalic presentation beyond the 34th week of gestation at the I. Frauenklinik, Ludwig-Maximilians University, Munich between May 1999 and June 2000. The 257 patients (17.6%), who underwent cesarean section prior to or during labor, were excluded from the study. Of the 1200 vaginal deliveries, 1017 (84.8%) were normal spontaneous deliveries, while 183 (15.2%) were instrumentally assisted. Data were contemporaneously collected and analyzed for the presence of severe pelvic floor damage, maternal hemorrhage, maternal fever, delayed involution of the uterus, fetal acidosi...

Sowohl die fetale als auch die maternale Myokarditis sind seltene perinatale bzw. peripartale Ereignisse.

Objective Hypertensive disorders during pregnancy remain a major health burden. Normal pregnancy is associated with systemic cardiovascular adaptation. The augmentation index and pulse wave velocity measures may serve as surrogate markers of cardiovascular pathology, including pre-eclampsia. We evaluated these parameters during and after normotensive and pre-eclamptic pregnancies. Design Longitudinal cohort trial involving a case–control analysis of healthy women and women with pre-eclampsia. Setting University hospital. Population Fifty-three healthy pregnant women between 11+6 and 13+6 gestational weeks, as well as 21 patients with pre-eclampsia. Methods The augmentation index and pulse wave velocity were measured seven times during pregnancy and postpartum. Main outcome measures Changes in augmentation index and pulse wave velocity during and after healthy pregnancies were measured. The influence of early-onset and late-onset pre-eclampsia on these measurements both during and after pregnancy was evaluated. Results The normotensive pregnancies exhibited a significant decrease in the augmentation index from the first trimester to the end of the second trimester; however, the normotensive pregnancies showed an increase in the augmentation index during the third trimester as term approached. The patients with early-onset and late-onset pre-eclampsia displayed a significantly elevated augmentation index during pregnancy. The postpartum augmentation index and pulse wave velocity were significantly elevated in the early-onset pre-eclampsia group. Conclusion After pregnancy, early-onset and late-onset pre-eclamptic patients exhibit differences in vascular function. This result indicates the presence of a higher cardiovascular risk in patients after early-onset pre-eclampsia.

Pro-inflammatory immunity, either infectious or sterile-derived, is one of the major causes of preterm birth and associated with enhanced maternal and fetal morbidity and mortality. Diagnosing intrauterine inflammation at an early stage is tremendously important. Amniotic fluid interleukin (IL)-6 concentration is currently the most investigated diagnostic tool for detecting intrauterine inflammation. Amniotic fluid samples were obtained from women with no signs of intrauterine infection [amniocentesis (n = 82), cesarean section (n = 110), spontaneous delivery (n = 20) and those with clinical signs of intrauterine infection or inflammation (AIS, n = 16)]. Amniotic fluid was screened by commercial ELISAs for IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, growth regulated oncogene-α (gro) α, macrophage inflammatory protein (MIP) 1α, MIP1β, histone, tumor necrosis factor (TNF) α, proIL1β and interferon γ-induced protein (IP) 10. ProIL-1β, MIP1β, IL-10 and IL-8 levels were significantly elevated in the AIS group, whereas IL-4 levels were significantly lower in the AIS group. No significant differences were found regarding IL-2, IL-6, IL-12, IL-15, IL-17, GROα, MIP1α, histone, TNFα, ProIL1β and IP10. MIP1β, IL-4, IL-8, IL-10 and proIL-1β might be potential singular biomarkers in diagnosing intrauterine inflammation. The combinations of elevated levels of IL-17/GROα, MIP1β/IL-15 and histone/IL-10 are new potentially advantageous biomarker combinations.

Small for gestational age neonates (SGA) could be subdivided into two groups according to the underlying causes leading to low birth weight. Intrauterine growth restriction (IUGR) is a pathologic condition with diminished growth velocity and fetal compromised well-being, while non-growth restricted SGA neonates are constitutionally (genetically determined) small. Antenatal sonographic measurements are used to differentiate these two subgroups. Maternal metabolic changes contribute to the pathogenesis of IUGR. A disturbed lipid metabolism and cholesterol supply might affect the fetus, with consequences for fetal programming of cardiovascular diseases. We evaluated fetal serum lipids and hypothesized a more atherogenic lipoprotein profile in IUGR fetuses.Umbilical cord serum lipids and oxidative modified, low-density lipoprotein (oxLDL) concentrations were measured by colorimetric enzymatic measurements, or by ELISA. Values of IUGR (n=36) and constitutionally small for gestational age neonates (SGA, n=22) were compared with those of healthy, adequate for gestational age, born neonates (CN, n=97). SAS-statistic software was used and two-way ANOVA was adjusted for gestational age at delivery.Fetal high-density lipoprotein cholesterol (HDL-C) and total cholesterol (TC) concentrations were found to be lower in the IUGR compared to the CN and SGA groups (HDL-C: P0.001, TC: P0.01). Atherogenic indices, including the oxLDL/LDL-C ratio, were increased in the IUGR compared to the CN group (oxLDL/LDL-C ratio: P0.001).Our results support the hypothesis of a disturbed cholesterol supply in IUGR fetuses. Born SGA has been shown to be a risk factor for developing cardiovascular disease later in life. Since HDL-C has anti-inflammatory properties, a reduced HDL-C during fetal development, and an increase in atherogenic indices, might provide a link to this observation in IUGR fetuses.

Definition nach der Deutschen Gesellschaft fur Gynakologie und Geburtshilfe (DGGG): Descensus genitalis: Verlagerung von Uterus und Vagina nach kaudal bis zum Hymenalsaum. Prolaps: Tiefertreten von Uterus und Vagina uber den Hymenalsaum hinaus.

Inhibins and activins are important regulators of the female reproductive system. Recently, a novel inhibin betaC subunit has been identified. However, only limited data on the expression of this novel inhibin-betaC subunit in normal and pathological human placentas exist. Tissue specimens of normal, preeclamptic, hemolysis, elevated liver enzymes, low platelets (HELLP), and intrauterine growth restriction (IUGR) pregnancies (n=24) were obtained at the conclusion of a cesarean section. Normal and pathological placental tissues were analyzed by an immunohistochemical staining reaction with a specific antibody against this novel inhibin-betaC subunit. Overall, expression of the inhibin-betaC subunit could be demonstrated in normal and pathological placental tissue. The immunoreactive score (IRS) for inhibin-betaC did not show any significant differences between normal, preeclamptic, HELLP, and IUGR tissue in extravillous trophoblast and syncytiotrophoblast cells. Immunolabelling of this novel inhibin-βC protein in normal and pathological placental tissue was demonstrated, although no differences in the staining intensity could be observed. Therefore, the inhibin-βC isoform might not primarily be involved in the pathogenesis of these pregnancy-associated disorders. The functional role of this novel inhibin-betaC subunit in normal and pathological human placenta is still quite unclear and should thus be further investigated.

Inhibins and activins are important regulators of the female reproductive system. Recently, a novel inhibin subunit, named betaE, has been identified and shown to be expressed in several human tissues. However, only limited data on the expression of this novel inhibin-betaE subunit in normal and pathological human placenta as well as and human chorionic carcinoma cell lines exist.Tissue specimens of normal, preeclamptic and HELLP pregnancies (n = 18) were obtained at the course of an cesarean section. Normal and pathological placental tissues as well as chorionic carcinoma cells (BeWo and JEG) were analyzed by using immunohistochemistry and RT-PCR.Expression of the inhibin betaE subunit could be demonstrated at the protein level by means of immunohistochemical evaluation and at the transcriptional level by betaE-specific RT-PCR analysis. The immunoreactive score for inhibin-betaE did not show any significant differences between normal, preeclamptic and HELLP tissue in extravillous trophoblast and syncytiotrophoblast cells. Expression of inhibin betaE could further be demonstrated for the human chorionic carcinoma cell lines JEG and BeWo.We demonstrated that inhibin-betaE is expressed in normal and pathological human placenta tissues. Although the precise role of this novel inhibin subunit for human placenta development is quite unclear, similarities with the well-characterized betaA- and betaB-subunits suggest an involvement in autocrine/paracrine signaling pathways, angiogenesis, decidualization and tissue remodeling under normal as well as malignant conditions. Additionally, the human chorionic carcinoma cell lines JEG and BeWo synthesize this subunit and therefore can be used as a cell culture model for further functional analysis of this subunit in human placental tissue.

Eine Hyperextension des fetalen Kopfes in utero kann unerkannt zu schwerwiegenden Komplikationen fuhren. Deflexionshaltungen konnen sonographisch pranatal zuverlassig diagnostiziert werden. Im Folgenden wird uber sechs Patientinnen mit extremer fetaler Hyperextension im HWS-Bereich berichtet. Die Deflexionshaltungen wurden erstmals zwischen der 33+3 SSW und 40+6 SSW (Mittelwert: 35+5 SSW) per Ultraschall diagnostiziert. Vier Feten befanden sich in BEL, einer in Schraglage und ein Fet in SL. Bei funf der Patientinnen fiel eine fetale SGA bzw. IUGR auf. Die Indikation zur primaren Sectio wurde bei allen Patientinnen aufgrund der fixierten Deflexionshaltung gestellt und zwischen 35+0 SSW und 40+6 SSW (Mittelwert: 37+1 SSW) durchgefuhrt. Die Entwicklung des Kindes konnte in allen sechs Fallen problemlos durchgefuhrt werden. Die Neugeborenen wogen zwischen 2050g und 3340g (1.–28. Perzentile) mit einem Kopfumfang von 31–36 cm. Alle Kinder wurden zunachst auf der Kinderintensivstation betreut. Postnatal fiel bei zwei Neugeborenen ein Opisthotonus und bei einem Kind zusatzlich extrapyramidale Bewegungsstorungen auf, die sich im weiteren Verlauf besserten. Ein anderes Kind wies eine Hyperlordose auf, die sich durch krankengymnastische Behandlung besserte. Intrapartale Schaden an der kindlichen Wirbelsaule konnten ausgeschlossen werden. Bei rechtzeitiger Diagnosestellung der Deflexionshaltung kann mit der Sectio caesarea ein Entbindungsmodus gewahlt werden, der eine Traumatisierung der fetalen Wirbelsaule verhindert. Literatur: 1. Westgren M, Grundsell H, Ingemarsson I, Muhlow A, Svenningsen NW. Hyperextension of the fetal head in breech presentation. A study with long-term follow-up. Br J Obstet Gynaecol. 1981 Feb;88(2):101-104. 2. Ballas S, Toaff R. Hyperextension of the fetal head in breech presentation: radiological evaluation and significance. Br J Obstet Gynaecol. 1976 Mar;83(3):201-204. 3. Maekawa K, Masaki T, Kokubun Y. Fetal spinal-cord injury secondary to hyperextension of the neck: no effect of caesarean section. Dev Med Child Neurol. 1976 Apr;18(2):228-232. 4. Bresnan MJ, Abroms IF. Neonatal spinal cord transection secondary to intrauterine hyperextension of the neck in breech presentation. J Pediatr. 1974 May;84(5):734-737.