Length, weight and head circumference as reliable signs of maturity in a modern German birth collective.

Signs of maturity such as weight, length and head circumference are still a measure used to investigate cases of suspected neonaticides as they help to differentiate between newborns born dead or alive. However, limit values for these signs have not changed for a long time. Our study considers whether limit values should have changed and which validity the current ones have. We investigated the cases of 3162 newborns, dividing them into a mature and an immature collective on the basis of the gestational week. Application of these signs of maturity (2500g, 48cm, 34cm) had a high predictive value concerning maturity (>99%), and even applying only one sign of maturity gave a predictive value over 97%. Clinically the mature collective showed a slightly lower rate of ventilation (2% compared to 2.4% for the non-mature collective). Coherences between maternal age/weight and postnatal ventilation could be shown. Coherences with reanimation could not be investigated since the case number was too low. Our results show that, for valid forensic investigation, these numeric signs of maturity have to be supplemented by further investigations and other influencing factors have to be considered. Therefore, clinical instruments such as the Petrussa-Index, clavicule length measuring and foot length measuring must be considered.

Umbilical cord entanglement's frequency and its impact on the newborn.

Neonaticide is a serious allegation that needs a complete chain of criminal investigations. In this context, a nuchal cord is considered to be responsible for an infant's death, but there is a clear lack of evidence. The purpose of our study is to reveal if a nuchal cord can be responsible for stillbirth, poor perinatal outcome, or neonatal death in the forensic aspect. We conducted a prospective study in collaboration with the Augustinian Sisters' Hospital in Cologne, Germany in the period from February 2014 to May 2016. Four-hundred eighty-six children were enrolled. All births were assessed regarding the occurrence of an umbilical cord entanglement, and perinatal outcome was measured by arterial blood gas analysis, Apgar after 1, 5, and 10 min after birth as well as the general vitality. The prevalence of a nuchal cord was 16.87%. Apgar decrease and acidosis were significantly associated with a nuchal cord. No adverse perinatal outcome was recorded in this constellation. There was no child death regarding the first 24 h, and no mother experienced a syncope while giving birth. We can conclude that a nuchal cord is not associated with adverse perinatal outcome.

Caput succedaneum and facial petechiae--birth-associated injuries in healthy newborns under forensic aspects.

In cases of suspected neonaticide, the results of a forensic autopsy might be important for conviction or acquittal. But autopsy findings in dead newborns are often unspecific and can rarely provide corroborative evidence of inflicted injury, as they are known to occur during normal birth as well. In our study, we examined 59 vaginally delivered, healthy newborns within the first 30 min after birth to know more about the prevalence and possible correlations of a caput succedaneum and facial petechiae. Caput succedaneum occurred in 33.9%, facial petechiae in 20.3%. As for the occurrence of caput succedaneum, statistically significant differences could be shown for the duration of delivery and the mother's parity. These correlations could not be shown for the occurrence of facial petechiae. Within the scope of our study, we could demonstrate that neither caput succedaneum nor facial petechiae are rare findings in healthy newborns. In the forensic investigation of suspected neonaticide, their potential significance can only be ascertained together with further investigations of the circumstances of death and a thorough forensic pathological autopsy.

Adhesion molecules, activin and inhibin--candidates for the biochemical prediction of hypertensive diseases in pregnancy?

BACKGROUND: The aim of the prospective study was to compare standard parameters as Doppler ultrasound and 24-h blood pressure measurement with possible maternal serological markers regarding their prognostic value in predicting hypertensive diseases in pregnancy. MATERIALS: Twenty-four-hour blood pressure measurement was performed before and after 32+0 gestational week in 57 pregnant women with either chronic hypertension ( n=13), preeclampsia ( n=21), pregnancy-induced hypertension (PIH; n=12) or normotension ( n=11). Blood samples were taken and the concentrations of soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), activin A and inhibin A were determined as well as serum uric acid, creatinine, total serum protein and serum albumin. Doppler ultrasound of the uterine arteries was examined before 32+0 gestational week in the same patients. For the statistical evaluation Kruskal-Wallis-Test and Mann-Whitney-U-Test were performed. Differences in the predictive value were evaluated by receiver-operating characteristics. RESULTS: VCAM-1 was significantly elevated in women developing hypertensive diseases as compared to normotensive women (preeclampsia: p<0.001; PIH: p<0.05; chronic hypertension: p<0.001). In early pregnancy activin A and inhibin A were significantly higher in preeclamptic patients than in the other groups (activin A: normotension: p<0.005; PIH: p<0.001; chronic hypertension: p<0.005) (inhibin A: normotension: p<0.005; PIH: p<0.001; chronic hypertension: p<0.01), thus suggesting them to be specific markers for the development of preeclampsia. Mean arterial pressure was significantly elevated in preeclampsia ( p<0.001) and chronic hypertension ( p<0.005) as compared to normotensives. CONCLUSION: Twenty-four-hour blood pressure monitoring with determination of mean arterial pressure and measurement of VCAM-1, activin A and inhibin A as serum parameters can be suggested as useful tests in the specific prediction of different types of hypertensive diseases in pregnancy.

Immunohistochemical reactivity of myometrial oxytocin receptor in extracorporeally perfused nonpregnant human uteri.

INTRODUCTION: In the pregnant uterus oxytocin and the oxytocin receptor play a major part for uterine contractility and the induction of labor. Clinical evidence implicates that with regard to contractility associated disorders like for example dysmenorrhea also in the nonpregnant and very early pregnant myometrium oxytocin and the oxytocin receptor seem to be more important than believed at the moment. However, little is known about the mutual dependence of the oxytocin receptor, oxytocin and 17-beta-estradiol in the nonpregnant myometrium and about the distribution of the oxytocin receptor in the nonpregnant uterus. Therefore, in the present study we investigated in the nonpregnant myometrium if oxytocin receptor expression can be affected by 17-beta-estradiol and oxytocin stimulation. METHODS: We used a previously established experimental perfusion system for the human uterus. We perfused 10 uteri for 27 h under physiological conditions without 17-beta-estradiol (group A, n=5) or with high 17-beta-estradiol stimulation (group B, n=5) followed by oxytocin stimulation in both groups in the last 3 h of the experiment. The expression of the myometrial oxytocin receptor in both groups was compared immunohistochemically. RESULTS: In comparison to the negative controls the immunohistochemical reactivity demonstrated increasing oxytocin receptor concentrations with maximum levels under 17-beta-estradiol and oxytocin stimulation in the uterine fundus (40% of positive stained cells, p<0.01). However, oxytocin receptor levels did not reach concentrations comparable to specimen of third trimester of pregnancy, which were used as positive controls. CONCLUSIONS: Taken together, our data demonstrate that the dynamics of oxytocin receptor expression can be affected by stimulation with 17-beta-estradiol and oxytocin not only in the pregnant uterus, but also in the nonpregnant uterus. Therefore, dyscontractile phenomena of the nonpregnant myometrium also may be mediated via 17-beta-estradiol, oxytocin and the oxytocin receptor.