[Management of postpartum hemorrhage (PPH): algorithm of the interdisciplinary D-A-CH consensus group PPH (Germany - Austria - Switzerland)]. / Management der postpartalen Blutung (PPH): Algorithmus der Interdisziplinären D-A-CH-Konsensusgruppe PPH (Deutschland - Österreich - Schweiz).

Postpartum hemorrhage (PPH) is one of the main causes of maternal deaths even in industrialized countries. It represents an emergency situation which necessitates a rapid decision and in particular an exact diagnosis and root cause analysis in order to initiate the correct therapeutic measures in an interdisciplinary cooperation. In addition to established guidelines, the benefits of standardized therapy algorithms have been demonstrated. A therapy algorithm for the obstetric emergency of postpartum hemorrhage in the German language is not yet available. The establishment of an international (Germany, Austria and Switzerland D-A-CH) "treatment algorithm for postpartum hemorrhage" was an interdisciplinary project based on the guidelines of the corresponding specialist societies (anesthesia and intensive care medicine and obstetrics) in the three countries as well as comparable international algorithms for therapy of PPH.The obstetrics and anesthesiology personnel must possess sufficient expertise for emergency situations despite lower case numbers. The rarity of occurrence for individual patients and the life-threatening situation necessitate a structured approach according to predetermined treatment algorithms. This can then be carried out according to the established algorithm. Furthermore, this algorithm presents the opportunity to train for emergency situations in an interdisciplinary team.

Ruptured false abdominal aortic aneurysm during pregnancy: Caesarean delivery followed by aortic reconstruction.

We describe a case of a successfully treated ruptured abdominal aortic aneurysm during pregnancy. The importance of close clinical follow-up after any aortic reconstructions is highlighted.

New insights in hypertensive disorders of pregnancy.

Research reported during the past year has enhanced our understanding of conditions that lead to the complex changes that are observed in hypertensive disorders of pregnancy. An association between placental pathology and a multisystem disorder that is characterized by endothelial dysfunction which involves genetic and immunological investigations has been identified. On the basis of these findings, promising screening tools for early detection of pre-eclampsia were identified. No marked changes in anaesthetic approach to hypertensive disorders of pregnancy occurred during the period of review, apart from a reappraisal of spinal anaesthesia as a safe technique in caesarean section, even in patients with severe pre-eclampsia. A multidisciplinary approach to management and therapy is needed and the right balance must be sought between the needs of the mother and baby, both of which are jeopardized by the hypertensive disorders of pregnancy.

Pre-eclampsia: a disorder of placental mitochondria?

Pre-eclampsia is a common, pregnancy-induced, multisystem disease leading to severe complications in the mother and foetus. The aetiology of pre-eclampsia remains a mystery, but a growing body of evidence suggests that a mitochondrial defect might cause the impairement of differentiation and invasion of the trophoblast that leads to this disorder. This hypothesis is the topic of ongoing studies that, if confirmed, would be highly relevant to preventative strategies for this disease.

[Prediction of preeclampsia:new hypotheses, new approaches]. / [Prädiktion der Präeklampsie: neue Hypothesen, neue Ansätze]

Preeclampsia is a multisystem disorder affecting 5.8% of primigravidas. It is a progressive disease with a very variable mode of presentation and rate of progression. Of all the features of the syndrome, hypertension and pregnancy-induced proteinuria are the classic clinical manifestations. This disease causes severe complications of the mother and the fetus. Neither are factors available for prediction, nor are there strategies for prevention and therapy of this disease. The accumulated evidence strongly suggests that failure or incomplete trophoblastic invasion (end of first, beginning of second trimester) of the spiral arteries, resulting in narrowed spiral arteries and subsequent endothelial damage, is responsible for the occurrence of this disease (third trimester). The reason for trophoblastic failure is not known. After clinical symptoms have occurred, only symptomatic therapeutic options are available. In this paper, we discuss potential ways to find specific and sensitive predictive parameters according to the current knowledge of the pathophysiology of this pregnancy-induced severe disorder.

Activity of retinoic acid receptor-gamma selectively binding retinoids alone and in combination with interferon-gamma in breast cancer cell lines.

Retinoids modulate several cell functions and especially inhibit the growth of a wide variety of cells including breast cancer. Retinoic acid receptor-gamma (RAR-gamma) has been shown to mediate the antiproliferative activity of retinoids. To further test this hypothesis we examined the effects of different RAR-gamma selectively binding retinoids (CD2325, CD2247, CD666 and CD437) on breast cancer cell lines. With exception of CD2247, all retinoids inhibited proliferation of MCF-7, SKBR-3, T47D and ZR-75-1 breast cancer cell lines, similar to the natural compound all-trans retinoic acid (ATRA). In addition, all 4 compounds were able to act synergistically with interferon-gamma (IFN-gamma) in all breast cancer cell lines including the retinoid-resistant BT-20 and 734-B lines. In functional transactivation assays we demonstrated that only in the MCF-7 cell line, TPA-mediated AP-1 activity was suppressed only by ATRA and CD2325, whereas in SKBR-3, another RA-sensitive breast cancer cell line, it was not. The synergistic antiproliferative activity involving retinoids and IFN-gamma could not be explained by an enhanced anti-AP-1 activity. No correlation was found between expression of RARs and cellular retinoic acid binding proteins (CRABPs) and antiproliferative effects of the retinoids. RAR-gamma selectively binding retinoids are potent inhibitors of breast cancer cell proliferation, alone and in combination with IFN-gamma. For this reason and because of a possible low toxicity, as compared with retinoic acid, we speculate that these RAR-gamma selective binding retinoids might be of clinical importance.