[Resident Gynaecologists' Attitudes towards the Inclusion of the Screening for Gestational Diabetes into the Maternity Directive: A Qualitative Study]. / Die Aufnahme des Screenings auf Gestationsdiabetes mellitus in die Mutterschaftsrichtlinien aus Sicht niedergelassener Gynäkologen: Eine qualitative Studie.

BACKGROUND: In March 2012, the screening for gestational diabetes was included as a 2-step screening into the German maternity directive. However, up to now it is unclear what resident gynaecologists, who are affected directly by this change in the maternity directive, think about the inclusion of the screening and the kind of screening introduced. METHODS: In order to approach this topic from a scientific point of view, gynaecologists in the German cities Mannheim, Ludwigshafen, and Heidelberg were interviewed face-to-face using a semi-structured interview guide with open-ended questions (mean interview length: 33:12 min). The interviews were audiotaped, transcribed verbatim (191 pages), coded by 2 independent reviewers, and analysed using qualitative content analysis. RESULTS: The majority of the gynaecologists supported the introduction of the screening into the maternity directives. However, some gynaecologists felt that this amendment is not strong enough criticising the GCT with 50 g glucose. Many gynaecologists would prefer an oral glucose tolerance test (OGTT, 75 g glucose). But there were also some gynaecologists who thought that the OGTT would strain pregnant women too much and thus deemed it unsuitable for a screening. Additionally, the gynaecologists named difficulties concerning the implementation of the test such as, for example, the non-availability of a ready-made glucose syrup for the GCT and the delayed introduction of billing codes. DISCUSSION: In the framework of this qualitative study, resident gynaecologists--the main actors in the conduct of the screening--had the possibility to offer their opinion on this current topic. The results provide a first insight into the conduct of the screening and may serve as a basis for larger, quantitative studies.

[Progesterone for Prevention of Preterm Birth--Evidence-based Indications]. / Progesteron zur Prävention der Frühgeburt--Evidenz-basierte Indikationen.

BACKGROUND: The prevention and treatment of preterm birth remains an unsolved problem in modern obstetrics. Progesterone has a variety of actions on the myometrium and the cervix, among others inhibition of myometrial contractility and a cervix strengthening effect by inhibiting the production of proinflammatory cytokines and prostaglandins as well as by reducing the synthesis of proteins, which play a crucial role in initiating labour. Consequently, progesterone may be a promising candidate for the prevention of preterm birth. MATERIAL AND METHODS: We searched PubMed from 1956 to August 2014 using a combination of key words and text words related to preterm birth and progesterone. ('progesterone', progestins, 17-OHPC). The aim of the literature search was to determine evidence-based indications for the use of progesterone in the prevention of preterm birth. RESULTS: (i) Patients with a singleton pregnancy and history of preterm birth should receive vaginal progesterone daily (200 mg capsule or 90 mg containing gel) from 16+0 to 36+0 weeks of gestation (alternatively 250 mg intramuscular 17-OHPC weekly): level of evidence 1a, grade of recommendation ++ . Prophylactic progesterone reduces the incidence of preterm birth <34 and <37 weeks of gestation and perinatal mortality significantly. (ii) Patients with singleton pregnancies and a sonographically short cervix (≤25 mm) before 24 weeks of gestation should receive vaginal progesterone daily (200 mg capsule or 90 mg containing gel) until 36+6 weeks of gestation: level of evidence 1a, grade of recommendation ++ . Prophylactic progesterone leads to a significant reduction in the incidence of preterm birth <28, <33, and <35 weeks of gestation and is associated with a significant reduction of neonatal morbidity. (III) There is a lack of evidence to recommend vaginal progesterone or intramuscular 17-OHPC for primary tocolysis or for "adjunctive" tocolysis (in combination with conventional tocolytic agents). (IV) There is a growing body of evidence that vaginal progesterone (400 mg/day) after successful tocolysis ("maintenance therapy") is a promising option for prolongation of pregnancy: level of evidence 1b, grade of recommendation +. (V) Data from the literature are insufficient to recommend progesterone in patients with preterm rupture of membranes or in the perioperative management of patients requiring transvaginal cervical cerclage. (VI) The vaginal administration of progesterone is well-tolerated by the patients and has only minor maternal side effects, whereas intramuscular injections of 17-OHPC are associated with a significant higher rate of side effects (e. g. local pain, nausea, diarrhoea). It is mandatory to inform patients on the off-label use of progesterone in pregnancy. DISCUSSION: Prophylactic progesterone administration is an evidence-based method for the prevention of preterm birth in women with a previous preterm birth and in pregnant women with a sonographically short cervix (≤25 mm) before 24 weeks of gestation. Vaginal progesterone is favoured over intramuscularly applied 17-OHPC, especially because of the lower rate of maternal side effects. Whether progesterone is an effective approach for the treatment of preterm birth as a tocolytic agent (primary, adjunctive) or for maintenance therapy after arrest of preterm labour has to be shown in further well-designed randomised and controlled trials with adequate statistical power.

[Prehospital obstetrical emergencies in a physician-staffed ground-based emergency service. A retrospective analysis over a 5-year period]. / Prähospitale geburtshilfliche Notfälle in einem bodengebundenen städtischen Notarztsystem. Retrospektive Analyse eines 5-jährigen Zeitraums.

BACKGROUND: In the German emergency medical system (EMS) obstetrical emergencies are rarely encountered, but are highly emotional situations for all concerned and form a special challenge for the emergency physician. The aim of this study was to evaluate the incidence, the course and the performance of rescue missions in a ground-based EMS system. METHODS: In a retrospective study the prehospital emergency charts concerning obstetrical emergencies over a 5-year period (10/2002-09/2007) were analysed. RESULTS: A total of 40 physician-staffed rescue missions with obstetrical emergencies were identified. On average seven rescue missions were performed per year. The majority of cases with 73% of the rescue missions was performed during the night service (16:00-07:00 h). On average the emergency patients (26th-41st week of gestation) were classified by the National Advisory Committee for Aeronautics (NACA) score as NACA III. Of the 40 obstetrical emergencies delivery occurred out of hospital in 18 cases (33rd-41st week of gestation), while the emergency physician was present in only 3 cases during childbirth. In 15 cases prehospital childbirth took place in the domestic environment of the patient, in 2 cases in an ambulance and in 1 case in the medical office of a gynecologist. In 20 cases the pregnant women were transported to hospital while labor had already begun. The emergency physicians on scene applied intravenous access, guided through labor and delivery, and administered tocolysis and in cases of prehospital delivery the emergency physicians also applied oxytocin, cut the umbilical cord and performed primary care of the newborn. CONCLUSIONS: Obstetrical emergencies are rare but recurrent in the ground-based EMS. However, prehospital management of women in labor, supervision of spontaneous prehospital delivery and the initial management of a newborn form a challenge for the emergency physician responsible. Consequently, prehospital management of obstetrical emergencies needs intensive consideration during education and training of emergency medical personnel.

[Universal newborn hearing screening. Methodical aspects]. / Universelles Neugeborenen-Hörscreening. Aspekte des methodischen Vorgehens.

BACKGROUND: In order to prepare for the introduction of a universal newborn hearing screening program on a larger scale, TEOAE and ABR were recorded on automated screening instruments from both ears of 501 newborns at the University Hospital Heidelberg over a period of 13 months. The parents of children in whom OAE and ABR could not be detected in both ears, were requested to allow a complete exploration of the auditory status of the children at the department of pediatric audiology. SUBJECTS AND METHODS: Internally available data networks were used for the acquisition and evaluation of data and for the organization of tracking and follow-up. Of the children 35% exhibited risk factors for congenital hearing impairment. RESULTS: The pass rate was 98.7% for the exclusion of binaural and 91.6% for monaural hearing disorders (TEOAE or ABR detectable). On the basis of the data it can be shown how pass rates can be optimized by selecting a suitable moment for the examination and by prescribing a minimum number of test repetitions (3 for TEOAE and 2 for AABR). CONCLUSION: Quality control of screening programs should include these parameters and, in particular the number of repetitions of test measurements in all screening steps.

Who smokes during pregnancy? An analysis of the German Perinatal Quality Survey 2005.

OBJECTIVES: Smoking during pregnancy greatly increases the risk of adverse fetal outcomes. This study was conducted to investigate the prevalence of smoking during pregnancy and to identify social, behavioural and preventable perinatal risk factors. STUDY DESIGN: This study was based on a national registry, acquired in the 2005 German Perinatal Quality Survey, which contains data on 99.31% of deliveries in Germany. METHODS: The database draws on prenatal and perinatal data on 668,085 newborns and 647,392 mothers at 917 maternity clinics. Bivariate methods and multiple logistic regression analyses were used. RESULTS: Thirteen percent of pregnant women smoked at least one cigarette per day after becoming aware of their pregnancy. Median cigarette consumption among pregnant smokers was 10 cigarettes per day. The prevalence of smoking was higher than average among women of low socio-economic status (20%), women without a partner (23%) and pregnant women under 20 years of age (34%). Multiparous women and women suffering from psychosocial stress smoked more than the respective reference groups. In addition, pregnant smokers displayed major deficits in terms of prenatal care. CONCLUSIONS: This study identified risk groups with above-average smoking prevalence during pregnancy. These risk groups are key target populations for preventive measures.

[Hemorrhaging during pregnancy]. / Blutungen während der Schwangerschaft.

Hemorrhaging during pregnancy is often fulminant and life-threatening for mother and child. Of maternal deaths occurring during pregnancy, 25% are caused by hemorrhaging. All physicians involved in the interdisciplinary treatment of hemorrhaging during pregnancy need to be familiar with the specific pathophysiology of hemostatic changes during pregnancy, e.g. elevated hemostatic capacity, reduced anti-coagulation activity and severe alterations of the fibrinolysis system. Therapists must be able to perform a consequent, goal-directed interdisciplinary approach to prevent adverse maternal and fetal outcomes. The major issues of therapy are causal obstetric treatment of the bleeding, early detection and therapy of hyperfibrinolysis, optimization of fibrinogen and platelet levels and knowledge of the possibilities of a targeted coagulation therapy.

[Pregnancies without prenatal care--which women are potentially affected, what are the inherent fetal risks?]. / Schwangerschaften ohne Vorsorgeuntersuchung--welche Frauen sind potenziell betroffen, welche Risiken ergeben sich für das Kind?

BACKGROUND: In the past decades prenatal care has lead to a reduction in maternal and fetal-neonatal morbidity and mortality. However, the number of examinations that should be recommended - especially in low-risk pregnancies - is still unclear. OBJECTIVE: Women not taking part in prenatal care resemble a subgroup of pregnant women at risk. The objective of this study was to define characteristic parameters based on patient's history and clinical outcome and which maternal and fetal-neonatal morbidity has to be taken into account. PATIENTS AND METHODS: From 913 255 data sets of the Perinatal Registry Lower Saxony, Germany, between 1987 and 1999 n = 2 208 pregnancies (0.24 %) were documented as 'not taken part in prenatal care', while n = 163 143 pregnancies were identified as having undergone optimal prenatal care according to the recommendations. Both groups were compared regarding pregnancy associated and obstetrical parameters. Data are given as odds ratio (OR) and 95 % confidence interval (CI) for pregnancies without any prenatal care vs. pregnancies with standard prenatal care. RESULTS: History of still birth: OR 1.750 (1.175 - 2.609), p < 0.05; mother single: 7.271 (6.603 - 8.006), p < 0.01; maternal age < 18 yrs: 9.904 (7.771 - 12.624), p < 0.01; maternal age > 40 yrs: 3.781 (2.900 - 4.907), p < 0.01; German vs. other origin: 0.214 (0.196 - 0.234), p < 0.01; preterm birth: 2.667 (2.380 - 2.989), p < 0.01; cesarean section: 0.728 (0.644 - 0.823), p < 0.05; birth weight < 5 %: 2.552 (2.140 - 2.943), p < 0.01; APGAR at 1 min < 3: 5.463 (4.521 - 6.602), p < 0.01; umbilical artery pH < 7.0: 2.941 (1.753 - 4.932), p < 0.01; neonatal intubation: 3.945 (3.244 - 4.797), p > 0.01; still birth: 6.089 (4.731 - 7.838), p < 0.01; death post partum: 4.444 (3.008 - 6.567), p < 0.01. CONCLUSION: Pregnant women not taking part in prenatal care are younger or older, more frequently foreigners, and present characteristics of a lower socioeconomic status. These pregnancies are associated with a very high potential of neonatal morbidity. From a both medical and economic point of view, it appears to be reasonable to specifically look after those women before or during pregnancy.

[Intrauterine fetal death in pregnancies of women with preconceptional and gestational diabetes mellitus and of women without glucose tolerance disorders. Results of the perinatal registry of Lower Saxony, Germany]. / Intrauteriner Tod des Feten bei präkonzeptionellem Diabetes, Gestationsdiabetes und Schwangerschaften ohne diabetische Stoffwechsellage. Ergebnisse der Perinatalstatistik Niedersachsen.

OBJECT: The prevalence of intrauterine fetal death as well as the relevant risk factors in pregnancies of women with preconceptional and gestational diabetes mellitus and non-diabetic women were investigated. METHODS: The data of the Perinatal Registry of Lower Saxony between 1987 and 1999 for pregnancies of women with preconceptional diabetes mellitus (PDM, n = 3351), gestational diabetes mellitus (GDM, n = 3954) and women without diabetes mellitus (non-diabetic pregnancies, NDM, n = 887,779) were retrospectively analysed. RESULTS: Intrauterine fetal death occurred in 46 women with PDM (1.35 %), 32 women with GDM (0.79 %) and 2756 non-diabetic women (0.31 %). The odds ratio (OR, 95 % CI) for PDM vs. NDM was 4.468 (3.332 - 5.992; p < 0.01) and for GDM vs. NDM it was 2.595 (1.829 - 3.682; p < 0.01). The percentage of death, which occurs before the 32nd week of gestation, was 13 % in pregnancies with PDM, 12.5 % in pregnancies with GDM and 27.7 % in non-diabetic pregnancies. 50 % of fetal deaths in the PDM group, 43.8 % of those in the GDM group and 39.3 % of those in the NDM group occurred after the 36th week of gestation. The percentages of dead fetuses who were under the 10th percentile of growth (small for gestational age, SGA), in pregnancies with PDM, GDM and NDM were 15.2 %, 6.3 %, and 28.7 %, respectively. The percentages of dead fetuses above the 90th percentile of growth (large for gestational age, LGA) were 41.3 % (PDM), 37.5 % (GDM), and 8.7 % (NDM), (p < 0.01 for PDM vs. NDM and for GDM vs. NDM). CONCLUSION: The risk of intrauterine fetal death in pregnancies of diabetic women is still increased. It seems that especially the LGA fetuses of diabetic mothers and SGA fetuses of non-diabetic mothers are at greater risk of intrauterine death.

[Perinatal morbidity in pregnancies of women with preconceptional and gestational diabetes mellitus in comparison with pregnancies of non-diabetic women. Results of the perinatal registry of Lower Saxony, Germany]. / Perinatale Morbidität in Schwangerschaften von präkonzeptionellen Diabetikerinnen und Gestationsdiabetikerinnen im Vergleich mit Nichtdiabetikerinnen. Ergebnisse der Niedersächsischen Perinatalerhebung.

OBJECTIVE: Pregnancies of women with glucose tolerance disorders are still associated with high maternal and perinatal morbidity. In the present population-based study, we investigated the fetal and neonatal risks and complications in pregnancies of women with preconceptional and gestational diabetes in comparison with pregnancies of non-diabetic women. METHODS: A total of 913,255 pregnancies with 926,685 newborns documented by the Perinatal Registry of Lower Saxony, Germany, between 1987 and 1999 was retrospectively evaluated. In particular, the obstetric parameters of 3439 women with preconceptional diabetes mellitus (PDM, n = 3485 neonates), 4051 women with gestational diabetes mellitus (GDM, n = 4155 neonates) and 905,765 non-diabetic women (NDM, n = 919.053 neonates) were analysed. RESULTS: The diabetes groups had a higher rate of preterm birth < 31st week of gestation (PDM vs. NDM odds ratio [OR] 2.341; GDM vs. NDM OR 1.483) and between the 32nd and 37th weeks of gestation (OR 3.688 and 2.418, respectively). The incidences of pathological cardiotocograms (OR 1.519 and 1.258, respectively) and acidosis as indication for operative delivery (OR 5,015 and 2,102, respectively) were increased in the diabetes groups. There was a higher prevalence of birth weight > 4500 g (OR 2.775 and 2.742, respectively) and >95. percentile (OR 4.268 and 3.610, respectively) in newborns of diabetic women. The higher rate of umbilical arterial pH < 7.00 (OR 2.481 and 1.195, respectively) as well as Apgar score at 1 minute <7 (OR 2.971 and 1.897, respectively) indicated a poorer neonatal outcome in pregnancies of women with diabetes mellitus. The frequency of necessary intubation of the infants was significantly higher in the diabetes group (OR 3.384 and 1.317, respectively). There also was an increased prevalence of intrauterine fetal death in pregnancies of diabetic women (OR 4.197 and 2.511, respectively). CONCLUSION: Pregnancies of women with diabetes mellitus are still correlated with higher perinatal risks and complications. The neonatal morbidity in pregnancies with gestational diabetes mellitus was more similar to that of pregnancies with preconceptional diabetes mellitus than to the morbidity in the group of non-diabetic women. Changes of the parameters within the observation period were the same in all three groups and therefore cannot be attributed to a primary more intensive prenatal care of diabetic women.

[Hospitalization, type of obstetrical clinic and anamnestic risk profile of pregnant women with pregestational diabetes mellitus--results of the perinatal registry of Lower Saxony, Germany]. / Krankenhausaufenthalte, Entbindungskliniken und anamnestisches Risikoprofil präkonzeptioneller Diabetikerinnen--Ergebnisse der Niedersächsischen Perinatalerhebung.

INTRODUCTION: Obstetric and diabetic societies recommend an intensive care of pregnancies in women with pregestational diabetes, an early hospitalization in case of obstetric and internal complications as well as delivery in a perinatal center. OBJECTIVE: To evaluate the number and duration of hospitalization of pregnant women with pregestational diabetes in comparison with non-diabetic women and further more the type of clinics in which both groups were delivered. We also investigated if there were any differences in anamnestic risk factors in correlation with the type of hospital. MATERIAL AND METHODS: The data of the Perinatal Registry of Lower Saxony, Germany, between 1990 and 1999 were analyzed retrospectively. The pregnancies of 2 543 women with pregestational diabetes were compared with the pregnancies of 707 695 non-diabetic women. RESULTS: There was at least one admission to hospital in 40 % of diabetic and 18.6 % of non diabetic women and more than one admission in 11.9 and 3.6 %, respectively (p < 0.001). The number and duration of hospitalization in both groups decreased significantly within the observation period. 57.7 % of all hospitals performed 1 to 4 and 11 % of the hospitals 5 to 9 deliveries of diabetic women per year. In the group of pregnant women with pregestational diabetes 45 % were delivered in clinics with 1 to 4 and 26.4 % in clinics with 5 to 9 deliveries of diabetic women per year. CONCLUSIONS: A higher number and duration of hospitalization was observed in the diabetic group, but both decreased significantly in each group during the observation period. No significant trend for delivering diabetic women in specialized high-risk units could be detected.

Ultrasound simulators: experience with the SonoTrainer and comparative review of other training systems.

Ultrasound has become indispensable in prenatal diagnosis. Ultrasound training, however, still lacks proper quality assessment and control. Moreover, most fetal anomalies which must be diagnosed during pregnancy are extremely rare. Ultrasound simulators could provide an opportunity to overcome this dilemma. This review summarizes the potential benefits of simulator-based ultrasound training, briefly describes the properties of a variety of ultrasound simulators that have been developed for various applications including prenatal diagnosis, and presents the SonoTrainer sonography simulation system which makes it possible to run a real-time simulation of a complete prenatal ultrasound examination. We evaluated the system for the training of first- and second-trimester screening for both normal and pathological findings and found that physicians who received theoretical training and were additionally trained with the simulator (T + S) significantly improved their skills in measurements of nuchal translucency thickness (NT) and crown-rump length (CRL) as compared with colleagues who only underwent theoretical instruction (T) [mean +/- SD NT deviation: 0.31 +/- 0.1 mm (T + S) vs. 0.62 +/- 0.2 mm (T), P < 0.05; mean +/- SD CRL deviation: 1.48 +/- 2.0 mm (T + S) vs. 3.27 +/- 2.5 (T), P < 0.05]. Simulator-based training enabled physicians to diagnose rare fetal anomalies in the second trimester with a sensitivity of 86% and a specificity of 100%. In a study in which second-trimester scans including fetal anomalies were presented to physicians, 96% of the participants subjectively estimated their training effect as being good. We therefore conclude that simulator-based training would provide an ideal educational tool to test, improve and monitor a physician's or technician's ultrasound skills in detecting fetal anomalies.

Non-invasive transabdominal uterine electromyography correlates with the strength of intrauterine pressure and is predictive of labor and delivery.

OBJECTIVE: The study was conducted to investigate whether the strength of uterine contractions monitored invasively by intrauterine pressure catheter could be determined from transabdominal electromyography (EMG) and to estimate whether EMG is a better predictor of true labor compared to tocodynamometry (TOCO). STUDY DESIGN: Uterine EMG was recorded from the abdominal surface in laboring patients simultaneously monitored with an intrauterine pressure catheter (n = 13) or TOCO (n = 24). Three to five contractions per patient and corresponding electrical bursts were randomly selected and analyzed (integral of intrauterine pressure; integral, frequency, amplitude of contraction curve on TOCO; burst energy for EMG). The Mann-Whitney test, Spearman correlation and receiver operator characteristics (ROC) analysis were used as appropriate (significance was assumed at a value of p < 0.05). RESULTS: EMG correlated strongly with intrauterine pressure (r = 0.764; p = 0.002). EMG burst energy levels were significantly higher in patients who delivered within 48 h compared to those who delivered later (median [25%/75%]: 96,640 [26,520-322,240] vs. 2960 [1560-10,240]; p < 0.001), whereas none of the TOCO parameters were different. In addition, burst energy levels were highly predictive of delivery within 48 h (AUC = 0.9531; p < 0.0001). CONCLUSION: EMG measurements correlated strongly with the strength of contractions and therefore may be a valuable alternative to invasive measurement of intrauterine pressure. Unlike TOCO, transabdominal uterine EMG can be used reliably to predict labor and delivery.

Nitric oxide and its role during pregnancy: from ovulation to delivery.

Nitric oxide (NO) is a major paracrine mediator and important regulatory agent in various female reproductive processes, such as ovulation, implantation, pregnancy maintenance, labor and delivery. Ovulation: Circulating NO-products are increased during follicle development and decreased right after ovulation. INOS-inhibition results in a 50% reduction of ovulation, an effect completely reversed by an NO. Endometrium/Implantation: NO also regulates endometrial functions such as endometrial receptivity, implantation and menstruation. NO-donors may be useful for promoting fertility, while NO-inhibitors might be used for contraception. Uterine contractility: Throughout gestation myometrial NO-production is upregulated thus contributing to achieve uterine quiescence. Close to term, NO-production decreases promoting effective contractions resulting in labor. Clinical trials have demonstrated that NO-donors are effective tocolytics. Cervical ripening: In contrast to the myometrium, NO-production in the cervix is low during gestation and becomes upregulated once pregnancy advances to term. NO-donors are effective and safe cervical ripening agents. This finding from animal studies has been confirmed by several clinical trials. Vasoreactivity: In blood vessels, NO is a potent vasodilator and platelet-aggregation-inhibitor. Lack of NO during gestation was related to the development of pregnancy-induced hypertension and preeclampsia. In conclusion, NO-donors and NOS-inhibitors may provide novel, effective, safe, and inexpensive drugs to regulate and steer various functions in female reproductive life. The benefits reach from contraception to preventing possibly lethal pregnancy complications such as preeclampsia. Introducing NO-donors as tocolytics and cervical ripening agents may contribute to a reduction of fetal and maternal perinatal morbidity and mortality.

Uterine electromyography and light-induced fluorescence in the management of term and preterm labor.

OBJECTIVE: Understanding the physiology of the uterus and cervix during term and preterm parturition is crucial for developing methods to control their function and is essential to solving clinical problems related to labor. To date, only crude, inaccurate, and subjective methods are used to assess changes in uterine and cervical function in pregnancy. METHODS: In the past several years, we have developed noninvasive methods to quantitatively evaluate the uterus and cervix based on recording of uterine electrical signals from the abdominal surface (uterine electromyography) and measurement of light-induced fluorescence (LIF) of cervical collagen (Collascope), respectively. Both methods are rapid and allow immediate assessment of uterine contractility and cervical ripening. RESULTS: Studies in animals and humans indicated that uterine and cervical performance can be monitored successfully during pregnancy using those approaches and that these techniques can be used during labor to better define management in a variety of conditions associated with labor. CONCLUSION: The potential benefits of the proposed instrumentation and methods include reducing the rate of preterm delivery, improving maternal and perinatal outcome, monitoring treatment, decreasing cesarean rate and providing research methods to understand uterine and cervical function.

Methods and devices for the management of term and preterm labor.

In this review, we outline studies showing that the uterus (myometrium) and cervix pass through a conditioning step in preparation for labor. This step is not easily identifiable with present methods designed to assess the uterus or cervix. In the uterus, this seemingly irreversible step consists of changes in the electrical properties that make muscle more excitable and responsive and produce forceful contractions. In the cervix, the step consists of softening of the connective tissue components. Progesterone and nitric oxide appear to have important roles in these processes. The progress of labor can be assessed noninvasively using electromyographic (EMG) signals from the uterus (the driving force for contractility) recorded from the abdominal surface. Uterine EMG bursts detected in this manner characterize uterine contractile events during human and animal pregnancy. A low uterine EMG activity, measured transabdominally throughout most of pregnancy, rises dramatically during labor. EMG activity also increases substantially during preterm labor in humans and rats and may be predictive of preterm labor. A quantitative method for assessing the cervix is also described. A collascope estimates cervical collagen content from a fluorescent signal generated when collagen crosslinks are illuminated with an excitation light of about 340 nm. The system has proved useful in rats and humans at various stages of pregnancy and indicates that cervical softening occurs progressively in the last one-third of pregnancy. In rats, collascope readings correlate with resistance measurements made in the isolated cervix, which may help to assess cervical function during pregnancy and indicate controls and treatments.

Tissue concentrations of cytokines in the lower uterine segment during preterm parturition.

AIMS: To determine the concentrations of tumor necrosis factor alpha, interleukin-1 beta, interleukin-6, and interleukin-8 in the lower uterine segment during preterm parturition. METHODS: In 71 patients who delivered prematurely by non-elective cesarean tissue specimens were obtained from the lower uterine segment. The patients were grouped in relation to the stage of cervical dilatation (< 2 cm, 2- < 4 cm, > or = 4 cm), duration of labor (< or = 6 h, > 6-12 h; > 12 h), and parity (1 versus > 1). Cytokine concentrations in protein extracts of the tissue samples were measured using enzyme-linked immunosorbent assays. RESULTS: Median concentration of tumor necrosis factor alpha did not change, but that of interleukin-1 beta, interleukin-6, and interleukin-8 were significantly higher at 2- < 4 cm than at < 2 cm cervical dilatation (6.6, 67.7, and 125.8 versus 1.1, 17.6, and 22.2 pg/mg protein, respectively). The concentrations of interleukin-6 and interleukin-8 showed a further increase at > or = 4 cm (297.2 and 468.6 pg/mg, respectively), but for interleukin-1 beta a decrease was observed (0.6 pg/mg). Cytokine concentrations were not related to duration of labor or parity. CONCLUSIONS: Local inflammation-associated changes that are mainly related to the stage of cervical dilatation and to only a minor degree to uterine activity may play a crucial role in preterm parturition.

Antigastric autoantibodies in Helicobacter pylori infection: implications of histological and clinical parameters of gastritis.

BACKGROUND: It has recently been shown that humoral antigastric autoreactivities occur in a substantial number of Helicobacter pylori infected patients. AIMS: To analyse the relevance of such antigastric autoantibodies for histological and serological parameters of the infection as well as for the clinical course. METHODS: Gastric biopsy samples and sera from 126 patients with upper abdominal complaints were investigated for evidence of H pylori infection using histology and serology. Autoantibodies against epitopes in human gastric mucosa were detected by immunohistochemical techniques. Histological and clinical findings of all patients were then correlated with the detection of antigastric autoantibodies. RESULTS: H pylori infection was significantly associated with antigastric autoantibodies reactive with the luminal membrane of the foveolar epithelium and with canalicular structures within parietal cells. The presence of the latter autoantibodies was significantly correlated with the severity of body gastritis, gastric mucosa atrophy, elevated fasting gastrin concentrations, and a decreased ratio of serum pepsinogen I:II. Furthermore the presence of anticanalicular autoantibodies was associated with a greater than twofold reduced prevalence for duodenal ulcer. CONCLUSION: The data indicate that antigastric autoantibodies play a role in the pathogenesis and outcome of H pylori gastritis, in particular in the development of gastric mucosal atrophy.

[Relevance of antigastric autoantibodies in Helicobacter pylori gastritis]. / Untersuchungen zur Bedeutung antigastraler Autoantikörper bei der Helicobacter pylori Gastritis.

We have recently shown that antigastric autoantibodies occur in a considerable number of Helicobacter pylori (H. pylori) infected patients. Particularly, autoantibodies to canaliculi within parietal cells of human gastric body mucosa are strongly associated with H. pylori gastritis. In this study we analyzed the implications of this type of autoantibody for histological and for clinical parameters of the disease. 126 patients with upper abdominal complaints were included in our study. Several histological and clinical parameters were evaluated. Presence of anticanalicular autoantibodies is significantly correlated with a higher degree of gastritis in the body mucosa, with atrophic changes in the gastric mucosa, with elevated fasting gastrin levels and a decreased pepsinogen I/pepsinogen II ratio. These data indicate, that the host's autoimmune response to canaliculi of parietal cells is of relevance for the pathogenesis and outcome of H. pylori gastritis.