Volume 37, Issue 4

Aims: Bilateral pelvic neurectomy (BPN) interferes with delivery in rats. This work measures the effect of BPN on uterine and abdominal electromyography (EMG) and pressure during gestation and delivery. Methods: Uterine EMG and intra-uterine pressure (IUP), as well as abdominal muscle EMG and intra-abdominal pressure (IAP), were recorded on days 19–24 in rats. Mean values were determined for the peak frequency of the power density spectrum (PDS) of the uterine and abdominal EMG “bursts,” the integral of the abdominal EMG power spectrum (IPS), and the area under the IUP and IAP curves (AUIUP and AUIAP). Results: Uterine EMG power density spectrum peak frequency and AUIUP were low during days 19–21 in all rats, and on days 22–23 increased sharply and significantly in both groups. Before delivery, sham rat recordings showed sudden sharp increases in AUIAP, AUIUP and IPS as “pushing” was observed. Pushing was not observed or recorded in laboring BPN rats and they did not deliver normally. Conclusions: A functional pelvic nerve is required for normal labor and delivery in rats. BPN inhibits abdominal EMG and contractions necessary to expel the fetus.

Objective: To evaluate the relationship between assisted reproduction technology (ART) and parental mental representations during late pregnancy and early parenthood. Study design: Women (n=25) following ART pregnancies were compared with their partners (n=23) and with women following spontaneous conceptions (n=39). Subjects were interviewed on mental representations at late gestation and three months postpartum. Results: Socio-demographic and obstetrical characteristics were similar between groups. ART women tend to decrease scores of intensity of investment from before to after delivery. During pregnancy and postpartum, ambivalent representations were more often present and well-integrated representations were less often present among ART women as compared with non-ART women. ART women had significantly more ambivalent representations that persisted at three months postpartum, and men had more disengaged representations. Conclusions: A greater desire for pregnancy exists in ART women which might not always coincide with a desire for maternity. ART men, however, manifest greater disengagement from the entire child project.

Objective: Progesterone (P 4 ) has been clinically shown to prevent the recurrence of preterm birth. The mechanism(s) of action is unclear, but may involve modulation of the immunologic inflammatory response of the lower genital tract. We evaluated the effects of P 4 on interleukin-8 (IL-8) production by vaginal and cervical epithelial cells stimulated with bacterial species that are commonly associated with preterm birth. Methods: Vaginal and endocervical epithelial cells were incubated with up to 10,000 ng/mL P 4 overnight and stimulated with heat-killed Escherichia coli, Gardnerella vaginalis , or Ureaplasma urealyticum . Concentrations of IL-8 in conditioned medium were quantified by ELISA and viability of the cell cultures was measured by the reduction of a tetrazolium salt. Results: E. coli , G. vaginalis and U. urealyticum- stimulated IL-8 production for both cell lines. P 4 inhibited basal and bacteria-stimulated IL-8 production for vaginal epithelial cells but enhanced IL-8 production by endocervical cells. P 4 reduced the number of viable cells for both cell lines. Conclusions: P 4 inhibits IL-8 production by vaginal epithelial cells stimulated with pathogens associated with preterm birth, possibly by reducing the number of viable cells or by inhibiting their proliferation. Although P 4 also reduces proliferation of endocervical cells it also increases their production of IL-8.

External cephalic version (ECV) at term is a safe procedure and reduces the incidence of cesarean sections for breech presentation. One of the known complications, however, is an ECV-related disruption of the placental barrier and a subsequent transfusion of fetal blood into maternal circulation. While the incidence of ECV-related fetomaternal hemorrhage (FMH) has been determined recently in a large trial using a manual Kleihauer-Betke test (KBT), questions remain on the amount of ECV-related FMH. KBT, which detects fetal red blood cells (RBC) on the basis of acidic resistance of fetal hemoglobin (HbF), is known to be a sensitive test, yet prone to procedural errors limiting its accuracy in quantifying FMH. In this study we investigated 50 patients for FMH before and after ECV, using a dual-color flow cytometric test kit with a lower limit of quantification of 0.05% fetal RBC in maternal peripheral blood. Three patients had a quantifiable increase of fetal RBC detected after ECV (0.06%; 0.08%; 0.1%). None of these subtle increments was predictable by ECV-related clinical parameters or translated into fetal compromise. Using a sensitive and accurate flow cytometric test method, our data provide further assurance to mothers on the safety of ECV at term.

Objective: The aim of this prospective study was to compare serum and urine concentrations of progesterone-induced blocking factor (PIBF) and serum concentrations of anti-inflammatory (IL10) and pro-inflammatory (IL6, TNFα, IFNγ) cytokines of women with threatened spontaneous abortion with normal pregnancy and to evaluate the impact of PIBF on outcome of pregnancy. Methods: A sample of 30 women with threatened spontaneous abortion (study group) and 20 healthy pregnant women (control group) between 6 th and 24 th gestational weeks was studied. Serum and urine PIBF, IL10 and IL6, TNFα, IFNγ cytokine concentrations were measured by enzyme-linked immunosorbent assay (ELISA). Results: Five (16.7%) pregnancies in the study group ended missed abortion vs. none in the control group (P<0.05). Five (20%) threatened aborters delivered between 24 th and 37 th weeks of gestation, whereas two (10%) preterm deliveries occurred in the controls (P>0.05). PIBF concentrations in urine (19.5±12.9 ng/mL) and serum (214.4±120.6 of patients with threatened abortion were significantly lower than in healthy pregnant women (45.3±33.7 ng/mL and 357.3±159.9 ng/mL, respectively). Women with threatened abortion had significantly lower serum levels of anti-inflammatory cytokine, but levels of proinflammatory cytokines were higher in this group compared with healthy controls. Conclusions: Determination of progesteron-induced blocking factor level in body fluids in early pregnancy might be used for the diagnosis and prognosis of threatened abortion.

Objective: Cytokine imbalance might have a pivotal role in hypercoagulability seen in preeclampsia. Our objective was to determine the relationship of blood coagulation related factors in placental tissue and peripheral blood in preeclamptic and normal pregnancies. Methods: We compared mRNA and protein levels of tissue-type plasminogen activator (t-PA), plasminogen activator inhibitor-1 (PAI-1), and tissue factor (TF) in the placenta of normal and preeclamptic pregnancies. Placental and peripheral blood t-PA and PAI-1 levels were examined. Trophoblasts were used to study the effects of hypoxia, hypoxia-reperfusion, and inflammatory cytokines on t-PA, PAI-1, tissue factor pathway inhibitor (TFPI), and TF. Results: PAI-1 and TF mRNA and protein levels were higher in placental tissue of preeclamptic pregnancies and in the peripheral blood of patients with preeclampsia. mRNA and protein secretion of TF, TFPI, PAI-1, but not t-PA, was increased in trophoblast cell culture under hypoxia and hypoxia-reoxygenation. Cell cultures with high levels of tumor necrosis factor-alpha (TNF-α) exhibited increased expression and secretion of TF and PAI-1, decreased TFPI, and no significant change of t-PA. Conclusions: Imbalanced synthesis of t-PA, PAI-1, TFPI, and TF in trophoblasts may contribute to hypercoagulability in patients with preeclampsia.

Objective: Obesity, insulin resistance, and dyslipidemia are associated with preeclampsia. Recently, “adipose tissue failure”, characterized by dysregulation of adipokine production, has been implicated in the pathophysiology of these metabolic complications. Adiponectin, an insulin-sensitizing, anti-atherogenic, anti-inflammatory and angiogenic adipokine, circulates in oligomeric complexes including: low-molecular-weight (LMW) trimers, medium-molecular-weight (MMW) hexamers and high-molecular-weight (HMW) isoforms. These multimers exert differential biological effects, and HMW to total adiponectin ratio (S A ) has been reported to be a specific marker of adiponectin activity. The aim of this study was to determine whether preeclampsia is associated with changes in circulating adiponectin multimers. Study design: This cross-sectional study included women with: 1) normal pregnancy (n=225); and 2) patients with mild preeclampsia (n=111). The study population was further stratified by first trimester BMI (normal weight <25 kg/m 2 vs. overweight/obese ≥25 kg/m 2 ). Serum adiponectin multimers (total, HMW, MMW and LMW) concentrations were determined by ELISA. Non-parametric statistics were used for analysis. Results: 1) The median maternal HMW and LMW adiponectin concentrations were lower in patients with preeclampsia than in those with normal pregnancies (P<0.001 and P=0.01, respectively); 2) patients with preeclampsia had a lower HMW/total adiponectin ratio (P<0.001) and higher MMW/total adiponectin and LMW/total adiponectin ratios than those with a normal pregnancy (P<0.001 and P=0.009, respectively); 3) the presence of preeclampsia was independently associated with lower maternal serum HMW adiponectin concentrations (P=0.001) and with a low HMW/total adiponectin ratio (P<0.001) after correction for maternal age, maternal BMI, the difference in BMI between the third and the first trimester, and gestational age at sampling; and 4) overweight/obese pregnant women had a lower median total and HMW adiponectin concentration than normal weight pregnant women among women with normal pregnancies, but not among those with preeclampsia. Conclusion: 1) Preeclampsia is associated with a lower median concentration of the HMW adiponectin isoform, the most active form of this adipokine, and a low HMW/total adiponectin ratio, a specific marker of adiponectin biologic activity; 2) in contrast to normal pregnancy, preeclampsia is not associated with decreased circulating adiponectin multimers in overweight/obese individuals suggesting altered regulation of this adipokine in preeclampsia; 3) collectively, these findings suggest that preeclampsia is characterized by alterations in adiponectin multimers and their relative distribution implying a role for adiponectin multimers in the mechanism of disease in preeclampsia.

Aim: To determine the effect of maternal cigarette smoking on cord blood concentrations of E3, hPL, β-hCG, FSH, LH, and cortisol. Methods: Hormone concentrations were measured in term neonates of 100 smoking and 100 non-smoking mothers. Results: The median E3, hPL, β-hCG, FSH, LH and cortisol cord blood concentrations in the non-smoking mothers' offspring were 212 ng/mL, 2.00 μg/mL, 57.5 mIU/mL, 0.10 mIU/mL, 0.20 mIU/mL, and 14.3 μg/mL, respectively; in the smoking they were 163, 1.39, 45.4, 0.10, 0.20, and 25.1, respectively (P=0.008, 0.004, 0.037, 0.498, 0.286, 0.004, respectively). There was a significant but poor negative correlation between number of cigarettes/day and E3 (r=−0.163, P=0.021), hPL (r=−0.191, P=0.007), and β-hCG (r=−0.143, P=0.044), whereas the correlation with cortisol was positive (r=0.259, P<0.0001). Multiple linear regression analyses showed that maternal smoking is a determinant of cord blood E3, hPL, β-hCG, FSH, and cortisol concentrations. Conclusions: Tobacco smoking is associated with a reduction in cord blood E3, hPL, and β-hCG concentrations, whereas it is associated with increased cortisol concentrations. The disturbed endocrine equilibrium of the fetus induced by tobacco smoking could have adverse consequences on the fetus and child since fetal brain is a target organ for hormonal actions.

We studied changes in the width of the symphysis pubis in 32 women examined serially by ultrasound during labor. Measurements were made at the superior border of the symphysis and at its narrowest breadth in the latent phase, the active phase, and the second stage of labor. There was a significant increase in the width of the symphysis between the first and second stages of labor at both measured levels. Widening was observed in 94% at the superior symphyseal breadth and in 59% at the narrowest. Of those cases in which the width of the symphysis increased, there was a large spectrum of change, ranging from 9 to 98% of the original width at the narrowest measurement site and from 2 to 139% at the superior breadth. There was a strong inverse correlation between maternal age and the degree of symphyseal widening in nulliparas, but not in multiparas. We conclude that labor is associated with a substantial widening of the symphysis pubis in most, but not all women.

Aims: To assess temporal trends in birth weight and pregnancy weight gain in Bavaria from 2000 to 2007. Methods: Data on 695,707 mother and infant pairs (singleton term births) were available from a compulsory reporting system for quality assurance, including information on birth weight, maternal weight at delivery and at booking, maternal smoking, age, and further anthropometric and lifestyle factors. Pregnancy weight gain was defined as: weight prior to delivery minus weight at first booking minus weight of the newborn. Results: Although mean weight gain during pregnancy increased considerably from 10.10 to 10.73 kg in seven years, the mean birth weight in mature singletons decreased slightly from 3433 to 3414 g. These trends could not be explained by concurrent changes in the rates of primiparity, smoking and gestational diabetes. Conclusions: These German data confirm an increased weight gain during pregnancy with adjustment for potential confounders.

Aim: Assess vascular indices of 7–10 week embryos using three-dimensional power Doppler (3DPD) and correlate them with the crown-rump length (CRL). Methods: This cross-sectional study included 65 healthy pregnancies between 7 and 10 weeks. The three-dimensional volume of the embryo was obtained using an endocavitary volumetric transducer and the VOCAL (Virtual Organ Computer-aided Analysis) method, with a 12° rotation angle and 15 sequential planes. The vascularization (VI), flow (FI) and the vascular and flow (VFI) indices were obtained using 3DPD and the mean, median, standard deviation, maximum and minimum values were calculated for each gestational age. Pearson's correlation coefficient (r) was used to evaluate the correlation between vascular indices and CRL. Results: The VI ranged from 0.77 to 41.67, mean 14.68 (±8.60), the FI went from 25.71 to 139.50, mean 90.61 (±21.51) and the VFI from 0.20 to 81.57, mean 15.69 (±12.42). The correlation between CRL and all 3D power Doppler vascular indices was low (VI – r=−0.073, P=0.566; FI – r=0.173, P=0.168 and VFI – r=−0.004, P=0.974). Conclusion: 3D power Doppler vascular indices in 7–10 week embryos do not correlate with CRL.

Aims: To shorten the analysis time needed for non-stress testing (NST) without decreasing efficacy in compromised fetuses. Methods: We selected 80 cases with a 5-min Apgar score <7 as a study group and 259 cases with a 5-min Apgar score ≥9 as a control group. We applied four different criteria (A, B, C, and D) to each study and control group for the first 20-min window of NST data to evaluate reactivity. Criteria A, B, and C consisted of conventional reactivity criteria according to amplitude (15 or 10 beats per minute), duration (15 or 10 s) and weeks of gestation (≤31, ≥32), and criteria D combined criteria C with approximate entropy (ApEn). Results: The sensitivity of criteria D (91.25%) was greater than the other three criteria (P<0.0001). The specificities of criteria C (96.14%) and D (99.23%) were also higher than criteria A and B (P<0.0001). The positive and negative predictive value of criteria D were better than that of criteria C (97.33 vs. 83.87, P=0.0066) and (97.35 vs. 89.89, P=0.0004), respectively. Conclusion: Adding ApEn to the conventional criteria for reactivity shortened NST analysis time without decreasing efficacy, facilitating a decision of reactivity within a single 20-min NST window.

Aims: To evaluate fetal disorders using detailed quantitative values from the actocardiogram (ACG) involving simultaneous tracing of ultrasonic Doppler fetal movement bursts and fetal heart rate (FHR). Methods: Duration of FHR accelerations and fetal movement bursts were measured manually in 20 common fetal disorders. The severity of the fetal disorder was estimated using the FHR acceleration duration to movement burst ratio (A/B ratio) and 10–0 clinical severity ranks derived from the A/B ratio. The correlation of the A/B ratio and 1 and 5 min Apgar scores, as well as numerically expressed long-term outcomes were studied. Results: A/B ratios were significantly correlated with the 1 and 5 min Apgar scores and the numerically evaluated long-term outcomes. Controversial cases of FHR pattern were more easily understood using the A/B ratio. The 10–0 severity derived from the A/B ratio was useful in clinical fetal studies. Conclusion: Common fetal disorders were evaluated quantitatively and in more detail using the A/B ratio from the actocardiogram than when using common binary good or bad evaluation. The A/B ratio was useful in outcome estimation, where the prognostic capability of the A/B ratio was confirmed by significant correlation with 1 and 5 min Apgar scores and long-term outcomes of fetal disorders.

This study investigated the reciprocity between parental mental health and the different stages of child development at 6, 18, and 36 months. As the pilot of a birth cohort study, this study comprised 2048 children and their parents who were randomly selected and invited to participate. The development of these children and the mental health of their parents were followed at 6, 18, and 36 months postpartum. Child development was assessed using the Taiwan Birth Cohort Study instrument, and parental health was assessed using the Taiwanese version of the 36-Item Short Form Health Survey. Complete responses for all three stages were received from 844 families. Our results showed that parental mental health had a direct effect on language and social development; however, this effect did not become significant until 36 months. The reciprocity between child development and parental mental health and proper intervention are vital.

Aims: To study the normal levels of oxygen saturation (SpO 2 ) in healthy newborns during the first 24 h of life and the possible relationship to birth weight and mode of delivery. Methods : SpO 2 was measured by pulse oximetry on one occasion between 2 and 24 h after birth in 6805 asymptomatic newborns with gestational age ≥34 weeks and birth weight ≥2500 g. Results : The average SpO 2 for all children was 98.0% (SD 1.4). SpO 2 was negatively related to birth weight and ranged from 98.2% (1.4) in children with birth weight 2750–2999 g to 97.6% (1.3) in children weighing >4500 g (P<0.001). No relationship exists between SpO 2 and gestational age or gender when correcting for birth weight. SpO 2 was independently related to mode of delivery, with higher levels in children born by cesarean section (98.3%; 1.3) than by vaginal delivery (98.0; 1.4; P<0.001). There was no relationship between SpO 2 and the interval from delivery to measurement. Conclusions : In healthy newborns, levels of SpO 2 measured between 2 and 24 h of life are negatively related to birth weight and related to mode of delivery. However, the variation was within a small range and probably has few implications for the routine use of SpO 2 in newborns.

Objective: To evaluate whether using a sitting-type car safety seats for preterm infants is advisable. Patients and methods: A total of 65 preterm infants underwent polysomnography in the supine and sitting positions. The infants with <95% of SpO 2 were assigned to the desaturation (DS) group. Their backgrounds, breathing patterns, and breathing types were analyzed. Results: Of the 65 cases, 18 were assigned to the DS group. No significant differences were observed between the DS and non-DS groups in their background characteristics. Of the 18 DS cases, 15 were included in the non-obstructive group (8, periodic breathing; 6, tachypnea; 1, irregular breathing). Conclusions: Immaturity of the respiratory center and decompensation for the respiratory changes caused by the sitting position were suspected to cause DS in infants. Sitting-type car safety seats should be used with caution for preterm infants, and all preterm infants need to be screened by polysomnographic examination in the sitting position.

Objective: We investigated the diurnal variation in oxygen consumption to determine the optimal time periods of calorimetry in preterm infants. Methods: Oxygen consumption (VO 2 ) was measured continuously for 24 h using indirect calorimetry. Twenty-two premature infants with gestational age of 27–31 (31±1.7) weeks were enrolled in the study. Heart rate, respiratory rate, oxygen saturation, skin and rectal temperature and physical activity were monitored continuously. Results: The averaged values of VO 2 showed a significant pattern (P<0.0001) of circadian rhythm with a peak in the afternoon and a nadir during the night with significantly differences between the mean VO 2 values. A circadian variation of VO 2 was found in more than 80% of preterm infants and was unrelated to gestational age, physical activity or environmental stress. The infants spent 90.4% of their time sleeping. Conclusions: These findings indicate the possible existence of an endogenous circadian rhythm of VO 2 in preterm infants beginning shortly after birth. Day-night variations of VO 2 should be considered when VO 2 values are extrapolated from short measurement periods to prevent overestimation of values.

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