J. Reinhard

Comparison of non-invasive fetal electrocardiogram to Doppler cardiotocogram during the 1st stage of labor

Abstract Objective: We compared a non-invasive fetal electrocardiogram (fECG) to Doppler cardiotocogram (CTG) during the 1st stage of labor. Study design: This was a prospective observational study of non-invasive fECG using five abdominal electrodes and one Doppler ultrasound probe in 27 patients. Data were analyzed for reliability, clinical and statistical equivalence. Results: The fECG was similar to the traditional Doppler method. The fECG characterizes a fetal heart rate (FHR) trace in a similar way with regards to acceleration count, decelerations count and coincidence, variability and baseline. The FHR was overall correlated (Pearsons r=0.91). Conclusion: This non-invasive fECG presents an alternative, reliable and accurate assessment for fetal well-being during the 1st stage of labor.

Function of Survivin in Trophoblastic Cells of the Placenta

Background Preeclampsia is one of the leading causes of maternal and perinatal mortality and morbidity worldwide and its pathogenesis is not totally understood. As a member of the chromosomal passenger complex and an inhibitor of apoptosis, survivin is a well-characterized oncoprotein. Its roles in trophoblastic cells remain to be defined. Methods The placental samples from 16 preeclampsia patients and 16 well-matched controls were included in this study. Real-time PCR, immunohistochemistry and Western blot analysis were carried out with placental tissues. Primary trophoblastic cells from term placentas were isolated for Western blot analysis. Cell proliferation, cell cycle analysis and immunofluorescence staining were performed in trophoblastic cell lines BeWo, JAR and HTR-8/SVneo. Results The survivin gene is reduced but the protein amount is hardly changed in preeclamptic placentas, compared to control placentas. Upon stress, survivin in trophoblastic cells is phosphorylated on its residue serine 20 by protein kinase A and becomes stabilized, accompanied by increased heat shock protein 90. Depletion of survivin induces chromosome misalignment, abnormal centrosome integrity, and reduced localization and activity of Aurora B at the centromeres/kinetochores in trophoblastic metaphase cells. Conclusions Our data indicate that survivin plays pivotal roles in cell survival and proliferation of trophoblastic cells. Further investigations are required to define the function of survivin in each cell type of the placenta in the context of proliferation, differentiation, apoptosis, angiogenesis, migration and invasion.

[Foetal electrocardiography (ECG) is an alternative to Doppler ultrasound cardiotocogram (CTG) for antenatal assessment of foetal well-being--preliminary results].

INTRODUCTION Computer analysing software is required for the assessment of CTGs because of the low sensitivity and high intra- and interobserver variability. The German Society of Gynaecology and Obstetrics advises the use of computer analysing CTG software. This study is aimed at evaluating the use of a new foetal ECG analysis system as an alternative to the traditional Doppler ultrasound CTGs in the setting of a university labour suite. MATERIALS AND METHODS 10 pregnant women beyond the 32 (nd) week of gestation, who were admitted to hospital and gave informed consent to this study, were connected to the foetal EKG monitor system Monica AN24. Patient satisfaction, maternal and foetal EKG detection rates and time required to connect the patient were evaluated. RESULTS 8 out of 10 women would prefer the Monica AN24 monitor system over the traditional Doppler ultrasound CTG. In total, the mean foetal ECG detection rate was 62.3 % (SD +/- 30.4) during the recorded time interval; at rest the detection rate was 75.3 % (SD +/- 33.2); during the night time (23.00 to 7.00) the detection rate was 78.3 % (SD +/- 25.4); and during night time and at rest the detection rate was 82.2 % (SD +/- 24.3). The mean recorded time interval was 6 h and 54 min (SD +/- 2 h and 43 min). In total, the maternal ECG detection rate was as high as 99.7 % (SD +/- 0.4). The mean time required for applying the Monica AN24 monitor system was 3.2 min (SD +/- 0.6). CONCLUSION The foetal ECG monitor system may be a good alternative to Doppler ultrasound CTGs. With the perspective to analyse in a beat to beat manner foetal EKG heart rates, this new monitor system should be superior to Doppler ultrasound CTGs, however further larger studies are needed to confirm this hypothesis.

Delayed interval delivery in twin and triplet pregnancies: 6 years of experience in one perinatal center.

Abstract Objective: This study aimed to know the outcome of delayed-interval delivery for twin and triplet pregnancies at 22+0 to 25+0 weeks of gestation. Study design: A retrospective cohort of twin and triplet deliveries at the 23rd to 26th weeks of gestation were managed with delayed interval delivery from 2005 to 2011. Results: From 2005 until 2011, delayed delivery in five twin pregnancies and two triplet pregnancies were performed. The interval between delivery of the first fetus and the remaining twin/triplets was 1–18 days (mean, 9.7 days). In all cases, the first fetus was born vaginally. Survival of the first twin/triplet was 14.3%, whereas 57.1% of the second born twin/triplets survived. Birth weight gained due to delayed delivery was 131 g on average. No severe maternal complications were observed. When compared with a gestation age-matched group, where the delay was not possible, the delayed twin/triplet had a higher survival rate (57.1% vs. 0%, P=0.05). Conclusion: In multiple pregnancies with preterm delivery between completed 22 and completed 25 weeks of gestational age, delayed delivery seems to be a useful therapeutic option to achieve a better outcome of the remaining fetus or fetuses.

Clinical Hypnosis Before External Cephalic Version

Three to four percent of full-term singleton pregnancies present themselves as breech deliveries. External cephalic version (ECV) is a procedure to try to turn a breech fetus to cephalic by externally maneuvering the fetus through the maternal abdomen. This trial examines a clinical hypnosis intervention against standard medical care of women before ECV. A total of 78 women, who received a hypnosis intervention prior to ECV, had a 41.6% (n = 32) successful ECV, whereas the control group of 122, who had similar baseline characteristics, had a 27.3% (n = 33) successful ECV procedure (p < 0.05). This trial found that a relaxation technique with the help of clinical hypnosis was successful at increasing the likelihood of a successful ECV procedure.

Targeted gene analysis: increased B-cell lymphoma 6 in preeclamptic placentas

Preeclampsia is a leading cause for maternal and perinatal mortality and morbidity. Microarray-based transcriptional profiling has been widely used for identifying genes responsible for preeclampsia. These studies deliver multiple pictures of gene signatures, implying the complicated pathophysiology. In the present work, we designed our own gene array containing genes involved in various signaling transduction pathways and analyzed placental samples from patients with preeclampsia and controls. We verify that genes associated with angiogenesis and migration pathways are mostly altered in preeclamptic placentas. Interestingly, several genes including B-cell lymphoma 6 have been identified to be linked to preeclampsia. Increased expression of B-cell lymphoma 6 is correlated with enhanced FLT1 and LEPTIN, the hallmarks of preeclampsia. Moreover, the protein level of B-cell lymphoma 6 is elevated in preeclamptic placentas and is predominantly localized in the nucleus of villous cytotrophoblasts lying directly underneath the syncytial layer, suggestive of an involvement in the function of villous trophoblasts. Altered B-cell lymphoma 6, a key oncogene in B-cell lymphomagenesis, may be involved in the pathogenesis of preeclampsia, and further investigations are required to decipher the molecular mechanisms.

The Effects of Clinical Hypnosis versus Neurolinguistic Programming (NLP) before External Cephalic Version (ECV): A Prospective Off-Centre Randomised, Double-Blind, Controlled Trial

Objective. To examine the effects of clinical hypnosis versus NLP intervention on the success rate of ECV procedures in comparison to a control group. Methods. A prospective off-centre randomised trial of a clinical hypnosis intervention against NLP of women with a singleton breech fetus at or after 370/7 (259 days) weeks of gestation and normal amniotic fluid index. All 80 participants heard a 20-minute recorded intervention via head phones. Main outcome assessed was success rate of ECV. The intervention groups were compared with a control group with standard medical care alone (n = 122). Results. A total of 42 women, who received a hypnosis intervention prior to ECV, had a 40.5% (n = 17), successful ECV, whereas 38 women, who received NLP, had a 44.7% (n = 17) successful ECV (P > 0.05). The control group had similar patient characteristics compared to the intervention groups (P > 0.05). In the control group (n = 122) 27.3% (n = 33) had a statistically significant lower successful ECV procedure than NLP (P = 0.05) and hypnosis and NLP (P = 0.03). Conclusions. These findings suggest that prior clinical hypnosis and NLP have similar success rates of ECV procedures and are both superior to standard medical care alone.

Intrapartum ST segment analyses (STAN) using simultaneous invasive and non-invasive fetal electrocardiography: a report of 6 cases.

The objective of this study was to analyze ST segment analyses (STAN) using simultaneous traditional - gold standard invasive (fetal scalp electrode) and newly available non-invasive abdominal fetal electrocardiography (fECG) during delivery.This was a prospective observational study of non-invasive fetal ECG using 5 abdominally sited electrodes (Monica AN24) against the traditional fetal scalp electrodes (STAN S31) on 6 patients. Data were analyzed when the STAN S31 found the baseline and when there was a baseline rise.Successful fECG signal acquisition was achieved in 6/6 (100%) patients. Using the non-invasive fECG, P and QRS waves were seen in all cases, and T waves in 3/6 (50%). ST segment analysis analysis was possible in 6/6 (100%) and 3/6 (50%) using invasive and non-invasive fECG, respectively.This study demonstrates that ST segment analysis is feasible using invasive and non-invasive fECG. Further studies are warranted to confirm the preliminary results and improve ECG morphology of non-invasive fECG.

Hypnotherapie, Gestationsalter und Frühgeburtenrate

PURPOSE This study examines whether or not those women who have participated in a hypnoreflexogenous birth preparation course have a lower incidence of preterm labour and higher gestational age. MATERIAL AND METHODS 101 women participated in the birth preparation hypnosis course (hypnomental birth preparation) and were evaluated against a parallelised control group. The following parameters were evaluated: education, number of previous pregnancies and live births, average number of cigarettes smoked per day and age of the mother. The control group was selected out of the hospital birth register from 2001 to 2008 (n=10 812). RESULTS In the hypnosis group (n=101) there were six late preterm deliveries (5.49%) whereas in the parallelised control group there were significantly more preterm deliveries (n=11; 11.3%; p=0.02). There was also a statistically significant correlation between gestational age and maternal participation in the hypnomental birth preparation. CONCLUSION In the hypnosis group there were significantly less preterm deliveries after parallelising the socio-economical demographics. A planned randomised controlled study of preterm labour should identify whether clinical hypnosis can reduce the incidence of preterm labour.

[Changes in resistance of the umbilical artery, foetal movements and short time variation through clinical hypnosis--preliminary results].

BACKGROUND The aim of this study was to determine whether there are any changes in short time variation (STV), foetal movements, and blood flow in the umbilical artery in the trance state. METHODS Six pregnant patients who had already attended two hypnoreflexogenous birth preparation course units had a standardised hypnosis intervention under cardiotocography (CTG). Using the CTG-Player ((R)) STVs and foetal movements were calculated from the electronically saved CTG traces and evaluated against control CTGs recorded before and after hypnosis. Before and after the induction of hypnosis, blood flow in the umbilical artery was measured. RESULTS Using the Wilcoxon test there is a significant lowering of blood flow resistance in the umbilical artery after hypnosis (p=0.042). There was a trend that the foetal movements increas at the beginning of the trance (Wilcoxon test, p=0.075). There was no significant difference in the STVs before, during and after trance. CONCLUSIONS Preliminary results showed that blood flow of the umbilical artery can be improved by hypnosis. Further clinical studies are required to verify this hypothesis. The subjective impression of participants that foetal movements increase at the beginning of the trance seems to be correct.