Frank Chih-Kang Chen

Comparison of two rapid strip tests based on IGFBP-1 and PAMG-1 for the detection of amniotic fluid.

Our objective was to compare two rapid strip tests for the detection of amniotic fluid, based on the detection of insulin-like growth factor-binding protein-1 (IGFBP-1) and of placental alpha-microglobulin-1 (PAMG-1). Samples of amniotic fluid were taken in 20 pregnant women between 31 3/7 and 41 2/7 gestational weeks at elective cesarean section before delivery of the newborn. These samples were diluted with 0.9% saline solution in a dilution series down to concentrations of 1:320. Immunoassay strip tests were then compared in their ability to detect remaining concentrations of amniotic fluid. In 5 cases, both test methods showed the same results. In all remaining 15 cases, the test based on PAMG-1 proved to be superior by detecting amniotic fluid at least at one descending concentration below the test based on IGFBP-1. Thus, the rapid strip test based on PAMG-1 seems to be a more sensitive bedside test compared with the test based on IGFBP-1 for the detection of amniotic fluid.

Il-1β, Il-6, Il-8 and G-CSF in the diagnosis of early-onset neonatal infections

Abstract Objective: To determine whether inflammatory cytokine concentrations (Il-1β, Il-6, Il-8 and G-CSF) in umbilical cord blood are useful predictors of an early-onset neonatal infection. Material and methods: 240 women and their newborns were enrolled in our study and umbilical cord blood samples collected from neonates (n = 240) were subjected to ELISA for Il-1β, Il-6, Il-8 and G-CSF. Clinical outcome of the neonates was followed and documented. Placenta histology was also available in majority of the cases (n = 195). Results: Early-onset neonatal infection was diagnosed in 5.4% of neonates (13/240) and placental examination showed histologic chorioamnionitis in 17.9% (35/195). Both Il-1β and Il-6 cord blood concentrations were elevated in association with histologic chorioamnionitis (Il-1β – 2.7 vs. 2.1 pg/ml, p < 0.05 and Il-6 15.6 vs. 12.8 pg/ml, p < 0.005). Only Il-6 was elevated (16.0 vs. 13.2 pg/ml, p < 0.05) in neonates with early-onset bacterial infections. ROC analysis showed acceptable diagnostic performance of Il-6 in the identification of acute histologic chorioamnionitis and clinical neonatal infection. Conclusion: Il-6 in umbilical cord blood seems to be a promising predictor for early-onset neonatal infections.

Detection of Spina Bifida by First Trimester Screening - Results of the Prospective Multicenter Berlin IT-Study.

Purpose To evaluate the potential of routine assessment of intracranial translucency (IT) and other posterior brain parameters in the early detection of open spina bifida during the 11 - 14 weeks screening examination. Materials and Methods This prospective, multicenter longitudinal study was conducted with the participation of 20 certified DEGUM II or III experts in Berlin, Germany, between June 2010 and October 2013. All pregnant women undergoing a first trimester screening were included in the study and in every patient were the IT, brain stem (BS), cisterna magna (CM), BS to occipital bone distance (BSOB) and BS/BSOB ratio measured. All patients with continuing pregnancy underwent a second trimester scan. Our data was used to develop our own reference ranges. The primary outcome parameter was the presence of open spina bifida. Results A total of 15 526 women with 16 164 fetuses were examined. Median of the IT was 2.1 mm, of the CM 1.6 mm, of the BS 2.7 mm, of the BSOB 5.5 mm, and of the BS/BSOB ratio 0.49. There were 11 cases with open spina bifida (incidence of 6.8/10 000). The detection rate was 100 % and in all cases of spina bifida, the anomaly was detected either at the first examination (n = 8) or considered suspicious and the lesion then detected a few weeks later (n = 3). Considering individual measurements, however, the detection rate was 18 % with the complete absence of the IT and 45 % with cut-off values. For the CM measurement, the detection rate was 64 % with the absence of the CM and 73 % with cut-off values. The other parameters proved not to be predictive of open spina bifida. Conclusion In the hands of an expert, open spina bifida can be reliably diagnosed early in gestation during the 11 - 14 weeks screening. The measurement of different parameters of the posterior brain, especially the CM and the use of cut-off values are of tremendous benefit in achieving a high sensitivity in the detection rate.

Excretion of Vitamin A in Urine of Women during Normal Pregnancy and Pregnancy Complications

Background/Aims: The renal function, including the excretion of low-molecular-weight proteins, changes during pregnancy and may cause a urinary excretion of retinol-binding protein (RBP). Whether it is accompanied by a substantial loss of vitamin A (retinol) has not been established yet. We therefore determined the excretion of retinol and RBP in urine of pregnant women. Methods: The study involved analyses of urine samples from 40 healthy pregnant women and 29 women with pregnancy complications during the third trimester. Analyses of plasma and urine of 7 healthy women and 5 women with pregnancy complications were also carried out 6 weeks antepartum, at time of delivery and 1 week postpartum. Results: Urinary retinol was higher in women who suffered from pregnancy disorders with an influence on maternal metabolism (p < 0.01). RBP was excreted at substantial concentrations in the urine of all 69 women, but there were no differences between the groups. Women with a concomitant excretion of retinol had higher levels of urinary RBP than those without a retinol excretion (p < 0.05). Differences in plasma retinol and RBP were not significant. Conclusion: The excretion of urinary retinol may increase significantly during pregnancy complications, which needs further clarification to which extent this condition may negatively affect the vitamin A status in such women.

Risk factors for fetal-to-maternal transfusion in Rh D-negative women--results of a prospective study on 942 pregnant women.

Abstract Aims: To investigate the incidence of severe fetal-to-maternal transfusion after delivery and to identify risk factors. Material and methods: In a prospective study at the Department of Obstetrics, Charité, Campus Virchow- Klinikum, Berlin, Germany, we analyzed the incidence of severe fetal-to-maternal transfusion (>10 ml) and fetalto- maternal hemorrhage (>25 ml) in Rh D-negative pregnant women after delivery of Rh D-positive infants. 942 women were included in the study and Kleihauer-Betke tests were performed. The results were compared to perinatal data. Results: Fetal-to-maternal hemorrhage occurred in 13 cases out of 942 (incidence of 1.3%) and severe fetalto- maternal transfusion in 61 cases (6.5%). In all of the cases with fetal-to-maternal hemorrhage, mothers were compatible with their infants in ABO-system. The incidence of fetal-to-maternal transfusion and its severe form was significantly higher in twin pregnancies (7/21 cases and 5/21 cases respectively, 33.3% and 23.8%) than in singleton pregnancies (22.5% and 5.9%, P<0.001). All other factors, such as maternal age, parity, ethnicity, mode of delivery, presentation, duration of first and second stage of labor, CTG, or Apgar score were not associated with an increased risk of severe fetal-to maternal transfusion. Conclusions: Twin pregnancy is the only independent risk factor for severe fetal-to-maternal transfusion. ABO-incompatibility between mother and infant seems to be protective against Rh D-alloimmunization.

Comparison of the relaxation effect in vitro of nitroglycerin vs. fenoterol on human myometrial strips

Abstract Aims: Substance dose-related comparison of relaxation effect of nitroglycerin (GTN) and the β2-mimetic substance fenoterol in human myometrial tissue. Methods: Test criterion is the isometric force development of isolated human myometrial strips. These muscle strips were removed from the lower uterine segment at cesarean section. Fenoterol in concentrations of 3 × 10−8–10−5 mol/l or GTN in concentrations of 1.7 × 10−8–5.8 × 10−4 mol/l were applied to the 2 × 2 × 10-mm strips, which were fixed and maintained in tissue baths. The curves were plotted on line. The integral or the “area under the curve” (AUC) served as the parameter for muscle strip activity. Results: A total of 100 strips from 20 patients were used. GTN demonstrated a significant relaxation effect in the in vitro model on human myometrial strips from pregnant women already treated with oxytocin. The effect was able to be enhanced to a point where oxytocin-induced contractions were completely absent. A relatively clear connection was demonstrated between dose and effect whereby increased muscle relaxation resulted at increased concentrations. Compared to GTN application, muscle strip relaxation was less pronounced under fenoterol; a complete inhibition of myometrial activity was not achieved under fenoterol. Conclusions: With respect to relaxation of the myometrial tissue samples the NO donor GTN is at least as potent as the standard tocolytic agent fenoterol in the in vitro model.

Binge eating disorder and menstrual cycle in unmedicated women with bipolar disorder.

OBJECTIVE Weight increase is a problem in women with bipolar disorder (BD). Furthermore, there is evidence that both binge eating disorder (BED) and menstrual cycle abnormalities occur more frequently in women with affective disorders than in the general population. We investigated whether there is a clinical link between the two disorders and menstrual cycle. METHOD Epidemiological and clinical variables associated with both BD and BED were assessed as well as menstrual cycle influence. RESULTS The prevalence of BED in the sample was 28.8%. Menstrual cycle significantly influenced BED in all participants in that BED became worse prior to menses. 80% of the participants noticed regular weight gain prior to menses. DISCUSSION BED is a common comorbidity in unmedicated subjects with BD, as is overweight. In women with BD menstrual cycle should be taken into consideration, as it can worsen the BD itself and associated comorbidities such as BED and overweight. Alteration in menstrual cycle-associated eating behavior should be routinely assessed in women with BD.

NO-donor nitroglycerin versus the prostaglandin gemeprost for cervical ripening in first trimester missed abortion

Application of prostaglandins is widely used for cervical priming in pregnancy. Prostaglandininduced cervical ripening is often associated with painful myometrial contractions. NO-donors may be an alternative, as NO inhibits myometrial contractions of the pregnant corpus uteri while inducing cervical ripening. The objective of this study was to compare NOdonor nitroglycerin applied as a vaginal gel with gemeprost, a vaginal suppository, for cervical ripening prior to first trimester curettage in patients with missed abortion. Thirty women with missed abortion (defined as no fetal heart motion, no vaginal bleeding, unripe cervix) between 6q0 and 12q6 gestational weeks were included in this prospective, randomized, non-placebo controlled trial at the Department of Gynecology, Charite, Campus Virchow-Klinikum, ́ Berlin. After informed consent, either 1 mg gemeprost as vaginal suppository (Cergem, Nourypharma, Oberschleißheim, Germany ) or 0.5 mg nitroglycerin as vaginal gel(own preparation) were applied following a random list before dila-

Lipopolysaccharide binding protein in the early diagnosis of intraamniotic infection of pregnant women with premature rupture of the membranes

Abstract Aims: To investigate whether lipopolysaccharide binding protein (LBP) level is an early marker of intraamniotic infection in pregnant women with premature rupture of the membranes (PROM) and compare it to C-reactive protein (CRP). Methods: Seventy-two pregnant women with PROM were included in the study if remained undelivered for more than 24 h. CRP and LBP concentrations were determined in 12-h-intervals and the last value before delivery was correlated with obstetrical data and placenta histology. Results: LBP concentrations ranged from 1.6 to 48.7 μg/mL (median of 16 μg/mL) and CRP concentrations from 0.02 to 6.8 mg/dL (0.64 mg/dL). CRP was significantly elevated when full blown chorioamnionitis was proven by histology (P<0.01) and when the neonates had to be admitted to the intensive care unit because of suspected infection (P<0.05 mg/dL). There were significantly higher LBP levels when fetal tachycardia occurred (20.3 vs. 14.5 μg/mL, P<0.05) and when intraamniotic infection was diagnosed by histology (22.8 vs. 14.1 μg/mL, P<0.005), but the differences were too little to provide prognostic cut-off values. Conclusion: Increase of LBP and CRP levels after PROM seem to reflect intramniotic infection, but no cut-off values could be defined for the prediction of intraamniotic infection.

Prognostic factors for recurrence and survival among patients with invasive vulvar Paget disease included in the VULCAN study.

To identify prognostic factors associated with recurrence and overall survival among patients with invasive vulvar Paget disease.