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.

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.

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.

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.

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.

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.

Axillary cavernous lymphangioma in pregnancy and puerperium.

Background: Cavernous lymphangioma is a form of benign congenital abnormality grouped under lymphatic malformations, which can clinically manifest as a cystic tumor. Common areas are the neck and axillary region. Most cases are diagnosed in children under the age of 2, and occasionally the diagnosis is made in utero.

Evidence for compromised aldosterone synthase enzyme activity in preeclampsia.

Background: In normal pregnancy, an increased aldosterone (Aldo) concentration coincides with volume expansion. In preeclampsia, Aldo levels are low despite intravascular volume depletion. The present investigation aimed to characterize the compromised Aldo synthesis in preeclampsia, and to identify the molecular basis hereof.

Twin pregnancies discordant for anencephaly-management, pregnancy outcome and review of literature.

Aims And Methods: To examine the prognosis of conservative management in twin pregnancies discordant for anencephaly, we review the literature and report on four of our own cases, which were analyzed retrospectively.

Results: In the University Hospital of Erlangen, six twin pregnancies discrepant for anencephaly were observed during an 8-year period (1992-2000). Four of these pregnancies were managed conservatively.

Neurokinin B peptide serum levels are higher in normotensive pregnant women than in preeclamptic pregnant women.

Objectives: The purpose of this study was to examine neurokinin B levels in serum from preeclamptic and normotensive and to investigate the role of neurokinin B in preeclampsia.

Study Design: Peripheral and uterine venous blood neurokinin B levels were measured in 14 normotensive and 8 preeclamptic pregnant women by radioimmunoassay.

Results: Neurokinin B levels in normotensive women were 4.

Pathophysiology of pre-eclampsia: update on the role of nitric oxide.

Women with chronic hypertension and pregnancy-induced hypertension are at substantial risk for developing pre-eclampsia/eclampsia, a disease with high fetomaternal morbidity and mortality. However, the etiology of this disease is still unknown. In this article, recent concepts on the pathophysiology of pre-eclampsia, with special attention to the role of nitric oxide, are reviewed.

Association of maternal and/or fetal factor V Leiden and G20210A prothrombin mutation with HELLP syndrome and intrauterine growth restriction.

This study was conducted to investigate the association of maternal and/or fetal factor V Leiden (FVL) and G20210A prothrombin mutation with HELLP syndrome. FVL and G20210A prothrombin mutation were determined using PCR. Sixty-three pregnant women, 36 of them diagnosed with HELLP syndrome, were included in the study.