Volume 31, Issue 4

Objective: The aim of this study was to correlate bioelectrical impedance analysis (BIA) with the clinical course of preeclampsia with edema. Design: 440 pregnant women with apparently normal, single pregnancy participated in this longitudinal study. Anthropometric measurements and BIA were performed during pregnancy and postpartum period. Results: All of the measurements were completed in 333 of the women; 279 of the women had a normal pregnancy (control group). The remaining 54 women developed edema during the third trimester of pregnancy. Of these, 40 women had only edema, and 14 women had edema followed by hypertension and/or proteinuria (preeclampsia group). The BIA index (the height squared divided by resistance) in the control group increased significantly towards late pregnancy, compared to that in early pregnancy. The indexes in the edema group were significantly higher during the third trimester compared to those of the control group at the same gestational week. The index in the preeclampsia group was higher relative to that in the control group. Moreover, a substantial increase in the index preceded the development of edema in the cases in which pregnancy was terminated due to deterioration of preeclampsia. Conclusions: Our results show that BIA is a useful method for monitoring longitudinal changes in total body water in pregnant women, and that BIA may be a powerful predictor of deterioration of preeclampsia preceded by edema.

Aims: The aim of the presented study was to clarify the relationship between the pulsatility index of the uterine arteries and the maternal cubital artery and peripheral concentrations of the metabolites of nitric oxide (NO) and its second messenger cyclic guanosinmonophophate (cGMP) during the normal course of pregnancy and postpartum. Methods: 49 uncomplicated pregnancies were investigated every 4–6 weeks until delivery, 29 of them were additionally investigated postpartum. Paralleling each Doppler sonografic investigation maternal blood and urine samples were taken. The measurements of nitrite/nitrate and cGMP were performed with a colorimetric and radio immuno assay. We demonstrate a significant decrease of the PI of the uterine arteries and of the cubital artery with inverse correlation to advancing gestational age. Results: The concentrations of nitrite/nitrate and cGMP remain stable during gestation and do not correlate to the PI of the uterine and cubital artery. Postpartum a re-increase in the uterine and peripheral resistance can be shown. The concentrations of urinary cGMP and nitrite/nitrate as well as plasma cGMP remain unchanged, whereas plasma nitrite/nitrate decreases postpartum. Conclusions: The status of NO biosyntheses in normal pregnancy remains controversial. We hypothesize further systemically acting mediators which contribute to the decreasing vascular resistance.

Objective: To prepare a tissue engineering approach to fetal membrane repair after premature rupture of the membranes (PROM) by characterizing the proliferation potential of human amnion epithelial and mesenchymal cells from preterm and term placenta in primary culture. Methods: Amnion epithelial and mesenchymal cells from 15 preterm (23–36 week) and 27 term placentas collected at cesarean section were separated enzymatically, characterized immunohistochemically (anti-cytokeratin 18 and anti-E-cadherin, and anti-vimentin, respectively), and their ratio determined. Proliferation on tissue culture polystyrene (TCPS) or collagen in one medium and on TCPS in four different media after 14 days was measured photometrically and compared in preterm vs. term placenta. For statistical analysis the Mann-Whitney test was used. Results: Preterm and term epithelial : mesenchymal cell ratios were 4.3:1 and 7.8:1. Term epithelial cells proliferated similarly on TCPS or collagen. Mesenchymal cells proliferated only with fetal bovine serum (FBS). Proliferation of term amnion cells in medium containing FBS, epithelial growth factor (EGF), insulin, transferrin and triidothyronine(T 3 ) was significantly increased (p < 0.001) compared with the other three media, and percentage proliferation was slightly higher in preterm cells. Conclusion: Characterization of human amnion epithelial and mesenchymal cells identified the most potent proliferation-inducing medium yet. Studies of the wound-healing potential of these cells are needed, examining their behavior and proliferation on fibrin microbeads and other extracellular matrixes as the next step towards engineering membrane repair in PROM.

Aims. To compare the obstetric outcome of excessively-and appropriately-grown fetuses. Methods. Medical records of mothers who delivered excessively overgrown fetuses, defined as birthweight ≥ 5000 g, in our hospital between 1996 and 2000 (n = 47, study group), and a control group who delivered fetuses with normal birthweight (n = 47) were reviewed. Results. Incidence of excessively overgrown fetuses was 0.24% and 68% were boys. Mothers in this group were significantly older, overweight and multiparous (p < 0.0001) and had gestational diabetes mellitus (p < 0.0001) and prolonged pregnancies (p = 0.04). A previous big baby was also significant (p < 0.0001) and the commonest risk factor. There were no obvious risk factors in nine (19.1%) cases. More than half (n = 28,59.5%) of these babies were delivered vaginally without clinical suspicion of excessive fetal size. Duration of second stage of labor and incidence of maternal trauma were similar in both groups. Cesarean delivery (p = 0.0003), postpartum hemorrhage (p = 0.004), birth asphyxia (p = 0.007), shoulder dystocia (p < 0.0001) and fetal trauma (p = 0.03) were significantly more frequent in the study group. Conclusions. Excessively overgrown fetuses are associated with the same risk factors as fetal macrosomia and should be delivered by cesarean if diagnosed antenatally because of increased maternal and perinatal morbidity during vaginal delivery.

Aims: To study the effect of maternal glucose ingestion during a 100 g oral glucose tolerance test on fetal heart rate indices. Study design: Prospective study including 50 pregnant patients with an abnormal glucose challenge test who underwent a 100 g glucose tolerance test at 26–28 weeks gestation. Fetal heart rate was recorded and analyzed with the computerized Sonicaid Fetal Monitor System (Oxford 8000). Results: Baseline fetal heart rate significantly increased 120 and 180 minutes following glucose ingestion (p < 0.05) both in patients who were subsequently diagnosed to have gestational diabetes and in these in whom the diagnosis was excluded. No significant changes were noted in other fetal heart indices. Conclusions: The significant and consistent increase in baseline fetal heart rate following maternal glucose ingestion indicates that the fetus responds to changes in its' environment. The exact mechanism which causes this response has yet to be defined.

Objectives: To examine the differences of perinatal outcome in fetuses with absent and reversed enddiastolic flow velocity waveforms of the umbilical artery or fetal descending aorta. Design: In a retrospective study, 30 pregnant women with reversed enddiastolic flow in the umbilical artery or fetal aorta (group I) were compared with 30 cases of absent enddiastolic flow (group II). Patients were included in the groups according to the last Doppler finding before delivery. Perinatal and neonatal outcome was correlated with antenatal Doppler flow findings. Results: The mean gestational age at birth was 31 weeks in both groups. Fetuses with reverse flow showed higher perinatal (27% and 7% respectively) and overall mortality (53.3% and 10% respectively) compared to the absent enddiastolic flow group (p < 0.05). All the intrauterine fetal deaths occurred in the reversed flow group (n = 12). The rates of intrauterine growth retardation, oligohydramnios and hypocalcemia were different between the groups (p < 0.05). The cesarean section rate, perinatal and neonatal complications including the incidence of acidosis, the number of cases admitted to neonatal intensive care unit and mean treatment time were not different between the groups. A tendency to higher incidence of neonatal cerebral hemorrhage in reversed flow cases (28%) compared to absent enddiastolic flow cases (17%) was observed, but this was not statistically significant. Conclusions: The present study suggests that reversed flow should be seen as a particular clinical entity with higher incidences of perinatal and overall mortality, and severe intrauterine growth retardation (< 5. perc) compared to the absent enddiastolic flow group. The optimal timing of delivery in pregnancies complicated by highly pathological Doppler flow findings is only to be resolved in well-designed randomized, multicenter clinical trials.

We report on an innovative therapeutic attempt in a case with obstructive uropathia in a fetus. Placement of an anterograd urethral stent was performed in the 26 th gestational week. Transurethral catheterization via the fetal megacystis, the urethra and the orificium externum of the penis was feasible during fetal endoscopy (Fetendo). During serial ultrasound scans from the 27 th to the 36 th gestational week a normalization of the amniotic fluid volume was observed. The postpartal evaluation demonstrated that the kidney structure, values of kreatinin serum levels and renal clearance were in the normal range. The boy's development after the seventh month is completely normal. Fetendo with urethral stent application for obstructive uropathy should be performed for the carefully selected patient with oligohydramnion and normal kidney appearance.

Aims: Umbilical cord blood can be used as an alternative source for related and unrelated allogeneic stem cell transplantation. This study was undertaken to determine whether intrapartum factors have an influence on the hematopoietic cell compartment of cord blood. Methods: Cord blood samples were obtained from 102 normal full-term deliveries for the banking of stem cells. We analyzed the influence of intrapartum factors on the count of CD34+ cells, total nucleated cells, colony forming units and total volume of collection. Fluorescence-activated cell sorting was used to measure CD34+ cell numbers. Statistical analysis was undertaken using Pearson correlation test and multiple regression analysis. Results: The higher the infants' birthweight the larger was the volume. A lower arterial umbilical pH and a larger blood volume resulted in an increased number of CD34+ cells. A large blood volume, long duration of labor, lower arterial and venous pH were correlated with more nucleated cells. A higher birthweight, larger blood volume and lower arterial pH resulted in an increased number of colony forming units. Conclusions: Some intrapartum factors have an impact on the characteristics of collected cord blood cells. Stress during delivery may influence the number of hematopoetic cells, through altered cytokine production. This knowledge may facilitate the selection of optimal cord blood samples for unrelated banking and the early discarding of suboptimal cord blood samples thus resulting in the saving of costs related to expensive further processing.

Aims: To study relationships between nucleated red blood cell count (NRBC), persistence of NRBC count elevation and neonatal complications in growth restricted fetuses (IUGR). Methods: Observational study of IUGR neonates (birthweight < 10 th percentile). NRBC's/100 WBC were ascertained in a peripheral blood sample. Subsequent daily samples were analyzed until NRBC's fell < 10/100 WBC. NRBC count and days of NRBC elevation were related to complications (respiratory distress syndrome (RDS), bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), necrotising enterocolitis (NEC), circulatory insufficiency (CI), day 28 oxygen requirement, mortality). Results: 157/298 IUGR neonates (52.7%) had complications, which were associated with a higher NRBC count and persistence of NRBC elevation (12 vs. 189 NRBC's and 1 vs. 4 days; p < 0.0001 respectively). This relationship applied to each complication. Prematurity was the main determinant of RDS, BPD and mortality, while IVH was related to mechanical ventilation, CI to birthweight percentile and NEC to degree of acidemia. Persistence of NRBC count elevation was a statistical contributor for RDS, CI and mortality, and the NRBC count to day 28 oxygen requirement. Conclusion: NRBC count elevation and persistent NRBC count elevation are associated with perinatal complications in IUGR. Wide ranges in numbers, complex relationships between triggering factors and impacts of other perinatal variables limit the use of NRBC parameters as predictors of complications.

The aim of the study was to compare a variety of neonatal outcome variables of growth concordant twin gestations (CT) to that of growth discordant twins (DT). Maternal and neonatal charts of live, non-anomalous twins > 25 weeks' gestation from 1984–2000 with no evidence of twin-twin transfusion syndrome were reviewed for several variables. DT occurred in (N = 81) 11.9% of all twin pregnancies. In 61.7% of DT, twin B was the smaller of the twins. There was no difference in maternal age, admission indications, or antepartum complications between both groups. DT had a significantly higher incidence of growth restriction compared to CT (88.9% vs 43.5%, p < 0.001). More mothers of DT required oxytocin (37.0% vs 26.3%, p = 0.024); however, cesarean delivery rate and indications were similar in both groups. A similar percentage of infants had AS < 4 at 1 min and AS < 7 at 5 min in both groups. There was no difference between the 2 groups in neonatal complications including:trauma, respiratory distress syndrome, intraventricular hemorrhage, necrotizing enterocolitis, pneumonia, seizures, or neonatal mortality. However, DT had a significantly higher incidence of hyperbilirubinemia, need for mechanical ventilation and a longer nursery stay. The neonatal outcome of growth discordant twins is worse than that of concordant twins even in pregnancies uncomplicated by twin-twin transfusion syndrome or congenital anomalies.

Aims and objectives: Rupture of an unscarred gravid uterus is a rare and dangerous event. We carried out a postal questionnaire survey of the Fellows of the Royal College of Obstetricians and Gynaecologists (United Kingdom), to ascertain the past and present management policies in such an event. 210 Fellows responded (43.5%) and 85 of them managed at least one case of uterine rupture in previously unscarred gravid uterus. Results: A total of 108 cases were reported of which 74 (68.5%) were diagnosed during labor. The tear was repaired and the uterus conserved in 56.5% cases. Maternal mortality was 10.2% (95% CI 5.2, 17.5) and perinatal mortality was 34.3% (95% CI 25.4, 44). When asked how they would manage such a case in the absence of life threatening circumstances in future, 80.8% of Fellows would opt for uterine repair. Fellows with previous hands-on experience of uterine rupture would involve urologists more often in operative management (22% v 8%, OR 3.4, 95% CI 1.2, 10.1). 48% of Fellows felt that in-patient management is indicated in subsequent pregnancies and 91% would perform an elective cesarean section in subsequent pregnancy.

Lithium medication during pregnancy is uncommon and the problems of a neonate who has been exposed to lithium represents a rare situation in neonatology. The clinical presentation and management of a newborn whose mother received lithium during pregnancy is presented. The newborn manifested a four day course of lethargy with unexplained high lithium levels in the adult toxic range. The infant improved clinically under intravenous hydration therapy, nevertheless lithium serum levels increased again and we did not know for certain if our clinical instinct or the actual figures were correct. Finally we noticed that our confusion had resulted from test tubes containing lithium heparine.

Chronic alcohol exposure during pregnancy and the resulting toxic effects for the fetus has been the subject of many investigations. In contrast, acute alcohol intoxication during pregnancy is a rare event and less is known about the consequences for fetal life. We report a case of the acute ethanol intoxication of a pregnant woman at the 35 th week of gestation and the consecutive cardiac arrest of the neonate. Despite the life threatening event, the newborn recovered after resuscitation and intensive care treatment and could be discharged from hospital in good physical condition. We suggest that acute alcoholized pregnant women should be transferred to Perinatal Centers to cater for the possible need for emergency cesarean section and resuscitation of the newborn.

We report a case of acute pancreatitis, which occurred after delivery in a woman who had an uneventful course of pregnancy and parturition. A 17-year-old Japanese woman was referred to our department because of nausea and vomiting two hours after delivery, followed by severe abdominal and back pain. On admission, in addition to elevated serum and urine amylase, plain computed tomography demonstrated a swollen pancreas and high density in the peripancreatic lesion with a large amount of ascites, suggesting the presence of an inflammation of the pancreas as well as peripancreatic lesion. Accompanied by subsiding abdominal and back pain, serum amylase concentration gradually decreased and returned to a normal level on the 11 th postpartum day. Acute pancreatitis must be kept in mind when evaluating patients presenting with abdominal pain after delivery.