[Management of postpartum hemorrhage (PPH): algorithm of the interdisciplinary D-A-CH consensus group PPH (Germany - Austria - Switzerland)].

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.

[Impact of iatrogenic preterm birth on newborn morbidity].

The incidence of premature births is not decreasing in developed countries, but rather shows a tendency to increase. This rise is primarily due to an increase in the number iatrogenic late preterm births at a gestational age between 34 + 0 and 36 + 6 weeks. Late preterm births account for up to 80% of all preterm births and these newborns have higher morbidity and mortality rates and a higher rate in neurodevelopmental long-term impairment in comparison to term infants.

Plasma copeptin in preterm infants: a highly sensitive marker of fetal and neonatal stress.

Context: Copeptin is a stable by-product of arginine-vasopressin synthesis and reflects its secretion by the pituitary.

Objective: The objective of the study was to investigate perinatal factors affecting copeptin concentrations in preterm infants at birth and at 3 d of life.

Design And Setting: This was a prospective cross-sectional study at two Swiss university hospitals.

NEK1 mutations cause short-rib polydactyly syndrome type majewski.

Defects of ciliogenesis have been implicated in a wide range of human phenotypes and play a crucial role in signal transduction and cell-cycle coordination. We used homozygosity mapping in two families with autosomal-recessive short-rib polydactyly syndrome Majewski type to identify mutations in NEK1 as an underlying cause of this lethal osteochondrodysplasia. NEK1 encodes a serine/threonine kinase with proposed function in DNA double-strand repair, neuronal development, and coordination of cell-cycle-associated ciliogenesis.

"Broken heart" after cesarean delivery. Case report and review of literature.

Objective: To present a rare case of a multiparous woman undergoing elective cesarean section with apparent symptoms of acute coronary syndrome and who was later diagnosed with Takotsubo cardiomyopathy (TCM; "broken heart syndrome"). To review similar case reports already reported in literature.

Methods: Literature search on the occurrence of TCM in pregnancy using MEDLINE and Cochrane databases.

High copeptin concentrations in umbilical cord blood after vaginal delivery and birth acidosis.

Context: The pituitary-secreted nonapeptide arginine-vasopressin (AVP) is unstable and therefore unsuited for diagnostic use, but its secretion can be estimated by measuring copeptin, the C-terminal portion of the AVP precursor (pro-AVP).

Objective: Our objective was to investigate perinatal factors affecting copeptin concentrations in infants at birth and at 3 d of life.

Design And Setting: We conducted a prospective cross-sectional study at a tertiary university hospital.

Impact of the estrus cycle and reduction in estrogen levels with aromatase inhibition, on renal function and nitric oxide activity in female rats.

Estradiol increases mRNA and/or protein expression of the nitric oxide synthase (NOS) isoforms in a variety of tissues including kidney. In this study we determined the relationship between cyclical variations in estradiol levels and renal function and total NO production in the virgin female rat. In addition, we used an aromatase inhibitor (Anastrozole), to inhibit synthesis of estradiol from testosterone.

Effect of antenatal betamethasone administration on neonatal cardiac autonomic balance.

Beneficial effects of antenatal glucocorticoid treatment in pregnancies at risk for preterm delivery may entail long-term consequences for the establishment of sympathoadrenergic system balance. We analyzed the cardiac autonomic system activity in neonates with a single course of antenatal betamethasone (2 × 12 mg) treatment by calculating heart rate variability (HRV) time-domain parameters from 24 h ECG recordings and short-term frequency-domain parameters during infant active and resting states. In addition, resting and challenged salivary α-amylase levels were measured in 23 betamethasone-exposed neonates and compared with controls.

Fetal MRI of conjoined twins who switched their relative positions.

Conjoined twinning is a very rare occurrence with no genetic predisposition. Twisting of conjoined twins around the axis of their connecting tissue bridge, close to the third trimester, has not been previously reported. We describe a unique case of in utero twisting of conjoined omphalopagus twins who survived without any adverse effects.

Intrauterine subdural hemorrhage in a preterm neonate possibly associated with maternal low-molecular weight heparin treatment.

We report intrauterine subdural hemorrhage in a preterm infant delivered by cesarean section at 32 weeks following vaginal bleeding of a mother treated with low-molecular weight heparin (LMWH) for deep vein thrombosis. The subdural hematomas were partially calcified, proving antenatal occurrence. Maternal trauma during pregnancy, intrauterine infection, cerebral vascular malformation and congenital coagulopathy as known etiologies of subdural hemorrhage could be ruled out.

Antenatal betamethasone administration alters stress physiology in healthy neonates.

Objective: To analyze hypothalamic-pituitary-adrenal axis balance in healthy newborns after antenatal betamethasone treatment for lung maturation where delivery could be prolonged until or near term.

Methods: In a prospective observational study, salivary cortisol and cortisone levels were measured at the fourth day of life during resting conditions and in response to a pain-induced stress event in 23 neonates with antenatal exposure to a single course of betamethasone (2x12 mg) and compared with 40 controls. The mean interval between betamethasone treatment and delivery was 60+/-23 days.

[Fetal growth retardation and diseases in adult life].

Numerous epidemiologic studies in different populations reveal an association between intrauterine growth restriction and the occurrence of arterial hypertension, arteriosclerosis, hyperlipidemia, type 2 diabetes mellitus and mental diseases later in life. Animal studies confirm these associations to be independent from genetic conformation and postpartum influences. However, both the mechanisms of intrauterine programming and the critical time of an insult to result in fetal problems are unclear.

Decreased umbilical artery compliance and igf-I plasma levels in infants with intrauterine growth restriction - implications for fetal programming of hypertension.

Epidemiological studies link intrauterine growth restriction (IUGR) to arterial hypertension in adulthood. We compared umbilical arteries from IUGR (n=12, <5th weight percentile) vs. appropriate for gestational age (AGA) infants (n=12) using structural and functional analyses.

Blunted stress response in small for gestational age neonates.

There is evidence that adverse conditions during intrauterine development affect future health of the offspring. Hypothalamus-pituitary-adrenal (HPA) axis dysregulation is assumed to play an important role in the association of small for gestational age (SGA) and the pathogenesis of hypertension and the metabolic syndrome. Stress response patterns in SGA neonates may identify a link with intrauterine-induced permanent maladaptation of the HPA axis.

Changes in olfactory function with several pregnancies?

Objective: To investigate whether olfactory performance decreases as a function of the number of pregnancies, previous research having indicated that olfactory function decreases in the course of pregnancy.

Methods: In a prospective study three groups of women were investigated (total n = 93), women who have given birth to no children (group 0), to one child (group 1), and to two or three children (group 2). Olfactory function was assessed using the "Sniffin' Sticks" kit.

Post-delivery oxidative stress in women with preeclampsia or IUGR.

Aim: To compare oxidative stress in patients with preeclampsia (PE) or intrauterine growth restriction (IUGR) vs. normal pregnancy (controls) during 48 h after delivery.

Study Design: Women with singleton pregnancies were recruited immediately after delivery (gestational age >26.

17-Hydroxyprogesterone in premature infants as a marker of intrauterine stress.

Aims: Amniotic infection (AI) and preeclampsia (PE), which are commonly the reason for prematurity, inflict stress of different duration on immature fetuses. Whether chronic stress, as reflected by intrauterine growth retardation, influences the level of 17-OH progesterone (17-OHP), was not previously examined.

Methods: We analyzed 17-OHP and TSH levels during neonatal screenings in the first hours of life of 90 premature infants born between 25 and 33 weeks of gestation in infants with AI (n=37) or with PE (n=53).

Cardiac autonomic balance in small-for-gestational-age neonates.

The cardiac sympathetic nervous system is one putative key factor involved in the intrauterine programming of adult cardiovascular disease. We therefore analyzed cardiac autonomic system activity in small for gestational age (SGA) neonates. Heart rate variability (HRV) from 24-h ECG recordings were analyzed for time-domain and frequency-domain parameters in 27 SGA neonates [median 261 (240-283) days of gestation] compared with 27 appropriate for gestational age (AGA) neonates [median 270 (239-293) days of gestation].

Abnormal placental invasion experience at 1 center.

Objective: To identify the incidence, risk factors, and maternal and neonatal outcome of pregnancies with abnormal placentation at a single center.

Study Design: A retrospective review of the medical records of the deliveries in 1999-2003 at the Department of Obstetrics, University Hospital Zurich, was conducted with respect to abnormal placentation, and the incidence, risk factors and outcomes were observed.

Results: Thirty-one women with abnormal placentation were identified.

Scar appearance of different skin and subcutaneous tissue closure techniques in caesarean section: a randomized study.

Objectives: To determine the role of skin and subcutaneous space closure in caesarean section on the cosmetic appearance of the scar and the patients' satisfaction.

Study Design: 153 patients undergoing caesarean section without prior abdominal delivery were included and randomly assigned in a non-blinded study to four different combinations of skin and subcutaneous tissue closure. The scar was assessed after a period of at least 4 months by a self-developed protocol and the patient was asked to complete a survey regarding her satisfaction with the scar.

[Calcium-supplementation in pregnancy--is it a must?].

The pregnant woman's body provides daily doses between 50 and 330 mg to support the developing fetal skeleton. This high fetal demand for calcium in pregnancy is facilitated by profound physiological interactions between mother and fetus. The D-A-CH organization (which represents the German, Austrian and Swiss Nutrition Offices) and the Institute of Medicine (IOM) of the US recommend a daily consumption of 1000 mg calcium for pregnant and lactating women at an age over 19 years.

Metabolic changes, hypothalamo-pituitary-adrenal axis and oxidative stress after short-term starvation in healthy pregnant women.

Aim: To compare metabolic effects and oxidative stress in pregnant and non-pregnant women after 12 h of fasting.

Methods: Twenty-six healthy women with uncomplicated singleton pregnancies between the 24(th) and 28(th) gestational week were recruited. After an overnight fast, venous blood samples and urine samples were tested for metabolic parameters characteristic for starvation, cortisol and oxidative stress products.

[The impact of epidural analgesia on birth experience].

Background: The satisfaction of our patients with the intrapartum analgesia and differences between labour with and without epidural analgesia (EDA) were analysed retrospectively.

Patients And Methods: In March 2004 questionnaires were sent to all women who gave birth between 1 January 2003 and 30 June 2003 at the University Hospital of Zurich.

Results: 45.

Temporary resolution of preeclamptic symptoms after intrauterine death of one twin.

In a 34 year old woman with dichorionic twin pregnancy preeclampsia resolved after the intrauterine death of one of the HLA-identical twins and recurred with the growth of the placenta of the surviving twin later in pregnancy. This case gives indirect evidence that the clinical course of preeclampsia is a dose-dependent phenomenon in conjunction with vital placental tissue.