Christian Egarter

Mode of delivery is associated with maternal and fetal endocrine stress response

Objective  To determine whether mode of delivery is associated with the endocrine stress response in mother and child.

A meta‐analysis of low dose aspirin for the prevention of intrauterine growth retardation

Objective To determine more precisely the effect of prophylactic low dose aspirin on intrauterine growth retardation and perinatal mortality.

Uterine hyperstimulation after low-dose prostaglandin E2 therapy: Tocolytic treatment in 181 cases

There is limited information about uterine hyperstimulation after low-dose prostaglandin E2 therapy. The purpose of this retrospective study was to describe our combined experience with this undesired effect by use of three techniques for prostaglandin E2 administration. Uterine hyperstimulation was present if the contraction frequency was more than five in 10 minutes or if contractions exceeded 2 minutes in duration. A total of 181 cases were evaluated during a 51-month period. The rates of hyperstimulation were 7.3% (167/2297) in the group that received intravaginal tablets (3.0 mg), 2.9% (12/408) with intravaginal gel (2.5 mg), and 0.5% (2/394) with intracervical gel (0.5 mg). Hyperstimulation usually began within the first hour for the group that used gel and within the first 4 hours for the tablet group. A beta 2-adrenergic drug (hexoprenaline or terbutaline) was infused routinely without adverse effects and with rapid resolution of the worrisome findings in 178 (98.3%) cases. The remaining three cases required cesarean delivery and had no evidence of neonatal compromise. We conclude from this large, combined series that uterine hyperstimulation after low-dose prostaglandin E2 therapy is uncommon and usually rapidly reversible with beta 2-adrenergic therapy without apparent untoward effects.

Molecular cloning of the human Hand1 gene/cDNA and its tissue-restricted expression in cytotrophoblastic cells and heart.

The basic helix-loop-helix (bHLH) factor Hand1 plays a role in the developing chicken heart and is required for trophoblast giant cell differentiation and cardiac looping of mouse embryonic development. Here, we report the cloning of the human Hand1 cDNA and gene from a heart-specific cDNA library and a genomic lambda-DNA library, respectively. We present the nucleotide sequence of a 1.75kb cDNA clone, encoding the presumptive 215 amino acid human Hand1 protein, and show homology comparison of the conserved bHLH region between different species. In vitro transcription-translation of Hand1 mRNA and analysis of protein size suggest that the Hand1 polypeptide is (post)translationally modified. By Southern blot analysis we demonstrate that the isolated genomic DNA clone harbours the entire Hand1 gene and describe molecular structure and sequences of the two 799 and 938bp exons and the single 1.56kb intron. The expression pattern of the mRNA in different human tissues revealed that Hand1 transcripts are restricted to the heart, suggesting that the protein could be required for cardiac-specific gene transcription and function in adults. Hand1 transcripts were undetectable in a non-tumorigenic villous trophoblast cell line, immunopurified cytotrophoblasts undergoing in vitro differentiation, and first trimester placental tissue, suggesting that the transcription factor is not involved in the development of villous and extravillous trophoblast cell lineages. Hand1 mRNA, however, was abundantly expressed in cytotrophoblastic Jeg-3 and BeWo cells, suggesting that Hand1 could be required for early trophoblast differentiation.

Low Dose Oral Contraceptives and Quality of Life

This study investigated the effects of a low dose oral contraceptive (OC) (Mercilon) on womens satisfaction and quality of life based on a detailed questionnaire. A total of 614 first-time users of oral contraceptives were enrolled by 102 gynecologists for a treatment period of > or = 4 months. The Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) was filled in both before and during pill intake. The total quality of life score was significantly increased under OC intake. In contrast to older preparations, modern low dose OCs appear to act favorably on a number of psychological parameters, thus increasing satisfaction with various aspects of daily life and, consequently, improving quality of life.

Cytokine and prostaglandin production by amnion cells in response to the addition of different bacteria

OBJECTIVE Our goal was to evaluate the effect of Escherichia coli, Bacteroides fragilis, Mycoplasma hominis, and Staphylococcus aureus on cytokine and prostaglandin production by amnion cells in vitro. STUDY DESIGN Amnion cells were obtained from women undergoing elective cesarean section before the onset of labor and cultured in a primary cell culture. Confluent amnion cells were incubated with heat-inactivated bacteria in different concentrations (10(1) to 10(6) colony-forming units/ml) for 48 hours. Samples for quantification of interleukin-1 beta, interleukin-6, interleukin-8, tumor necrosis factor-alpha, and prostaglandin E2 were collected at 6, 12, 24, and 48 hours. RESULTS Under basal conditions, minor amounts of interleukin-6 and interleukin-8 were detectable. Incubation of amnion cells with E. coli enhanced the secretion of interleukin-8 and also induced an transient increase of prostaglandin E2 in a dose-dependent manner. B. fragilis produced an increase in the secretion of interleukin-6 and interleukin-8. M. hominis and S. aureus did not cause an increase in either interleukin-6, interleukin-8, or prostaglandin E2. CONCLUSION The gram-negative bacteria E. coli and B. fragilis stimulated interleukin-6 and interleukin-8 to a greater degree than the other bacteria investigated in this study. This finding may be of clinical interest in the onset of preterm birth.

Transfer of erythropoietin across the placenta perfused in vitro

Objective The purpose of this study was to investigate the placental passage of erythropoietin in a placental perfusion model ex vivo. Methods In an open system 18 placentas were perfused on both the maternal and the fetal side. Erythropoietin and a reference substance were added to either the maternal or fetal perfusion medium. In the first series of experiments, radiolabeled erythropoietin was added to the perfusion medium in four different concentrations to help determine the transfer rate of erythropoietin. Based on the results of these experiments unlabeled erythropoietin was added to the perfusate in three different concentrations. Radiolabeled erythropoietin was used in addition to erythropoietin because measuring radioactivity in a gamma counter is less expensive than measuring by immunoassay. Results Accumulation of radioactivity in the venous portion of the fetal circuit was only 3.21% of the activity added to the maternal circuit. No evidence of transfer of erythropoietin to the contralateral compartment was noted, regardless of whether the test substance was added maternally or fetally. These results were independent of the concentration used. The reference compound antipyrine showed a mean transfer rate of 27.9%, which is in keeping with previous results. Conclusion There is no transport of erythropoietin across fetal membranes. This finding is particularly remarkable in view of results published recently indicating the placenta as a site of erythropoietin production. The lack of its transport across the human placenta is most likely due to its high molecular weight.

Fetal fibronectin as a selection criterion for induction of term labor

OBJECTIVE We examined whether the presence of fetal fibronectin in cervicovaginal secretions can be used as a selection criterion for induction of labor at term. STUDY DESIGN Cervicovaginal secretions of 64 women who were scheduled for induction of labor were examined for fetal fibronectin and divided into group A (positive for fibronectin) and group B (negative for fibronectin). Both groups were examined for Bishop score, the number of prostaglandin tablets administered, and the interval between induction of labor and delivery. RESULTS In group A the interval between induction of labor and delivery was significantly shorter (p < 0.0001) than in group B. The number of prostaglandin tablets administered to group A was likewise significantly lower (p < 0.0001). Unsuccessful induction of labor only occurred in women with fibronectin-negative cervicovaginal secretions. CONCLUSION The assessment of the fibronectin content of cervicovaginal secretions constitutes a viable instrument in the decision-making process preceding induction of labor.

Fetal fibronectin as a marker to predict the onset of term labor and delivery

OBJECTIVE We examined whether the presence of fetal fibronectin in cervicovaginal secretions may be a marker to predict the onset of term labor and delivery. STUDY DESIGN A prospective study was performed in 100 primiparous and multiparous women having reached their expected date of confinement. Fetal fibronectin was assayed by taking samples of both the cervical and vaginal mucus with two different fetal fibronectin tests. The study population was divided into women delivering within 48 hours and women giving birth > 48 hours after sampling. RESULTS Seven patients had to be excluded from evaluation. Of the remaining 93 women, 37 were delivered within 48 hours; fetal fibronectin was detected in 30. Fifty-six women were delivered later than 48 hours; 51 of them had negative results for fetal fibronectin (positive accuracy 86%, negative accuracy 88%, p < 0.0001). CONCLUSION Fetal fibronectin in the cervicovaginal secretions of women who have reached their expected date of confinement is a useful predictor of the onset of term labor and delivery.

The transfer of interleukin-8 across the human placenta perfused in vitro.

Objective To assess the placental transfer of interleukin (IL)-8 in vitro. Methods Eighteen placentas obtained immediately after delivery were perfused with a mixture of 125I-Iabeled IL-8 (IL-8*) and unlabeled IL-8 in two different concentrations. Antipyrine was coinfused in all experiments as a reference compound. Fetal-to-maternal and maternal-to-fetal perfusions were performed. Radioactivity was measured in a gamma counter at the end of each perfusions experiment. In four experiments, unlabeled IL-8 was analyzed in addition to labeled IL-8 to exclude a change in the IL-8/IL8* ratio resulting from membrane transfer. Results Two of the 18 experiments had to be discarded because of poor transfer of antipyrine. There was only faint accumulation of radioactivity in the transplacental compartment, regardless of whether the test substance was added maternally or fetally. Because measurement of unlabeled IL-8 yielded negative results, the radioactivity is clearly attributable to free iodine 125, which is generated during IL radiolabeling or which disassociates from IL-8 in small amounts after radiolabeling. Conclusion Interleukin-8 does not appear to cross the placenta by simple diffusion, regardless of the concentration or the perfusion rate. The impermeability of the placenta to the diffusion of IL-8 might explain why there is insufficient correlation between serum and amniotic fluid cytokine concentration of pregnant women and the presence of the amnion infection syndrome.