Martin Ulm

Human papillomavirus in the cervix and placenta.

Objective To determine the prevalence and association of human papillomavirus (HPV) infection in the cervices and placentas of pregnant women. Methods Cervical samples were taken from 179 of 226 women who had placental biopsies because of abnormal ultrasound findings or were older than 35 years, to detect HPV infections with hybrid capture II tests. Polymerase chain reaction (PCR) was done on placental tissue of 147 of the 226 women to detect HPV DNA. Results We found 44 of 179 women (24.6%, 95% confidence interval 18.3, 31.0) to test positive for HPV in their cervices. Logistic regression analyses showed decreased prevalence of HPV infection with increased maternal age (P = .039). The HPV DNA E6 PCR from the villus tissue was negative in the 147 cases examined. However, a significant contingency coefficient between low-risk HPV infection and elevated risk of chromosome aberration was found (&phis; = V = 0.15, P = .050). Conclusion The infection rate of 24.6% in women without clinical symptoms of HPV infection was high, but there seemed to be no virus transmission to the placenta in women with subclinical infections. Low-risk cervical HPV infection might be associated with a slightly higher risk of abnormal fetal karyotype.

Rapid decrease of serum cholesterol concentration and postpartum depression.

On the basis of studies of pharmacological reduction of serum lipid concentrations, it has been suggested that reduction in serum cholesterol and triglyceride is associated with occurrence of depressive symptoms, suicides, and violent deaths.1 2 3 Pregnancy induces a physiological rise in both serum cholesterol and triglyceride concentrations, with peak concentrations at term and a rapid decrease within a few days after delivery. Maternity blues is a common complication of the puerperium independent of obstetric variables.4 We postulated that the sudden fall in blood lipids after delivery could serve as a “natural” model to test the suggested association between serum lipids and mood. We studied 20 healthy primiparous women (mean age 25.3, SD 3.7, range 19-34 years) without substantial marital, health, or socioeconomic problems and without a history of psychiatric disorders who registered consecutively for obstetric …

Maternal cigarette smoking increases F2-isoprostanes and reduces prostacyclin and nitric oxide in umbilical vessels

The objective of this study was to evaluate the influence of smoking on F2-isoprostanes, prostacylin and nitric oxide in human umbilical vessels. Umbilical cords from 13 babies of smoking mothers and from 28 babies of non-smoking mothers were examined for levels of F2-isoprostanes, prostacyclin, L-arginine, and L-citrulline. Forty-one umbilical arteries and eleven umbilical veins were analyzed. Statistical analysis of data was done using modified t-test. Cigarette smoking increased F2-isoprostane levels and reduced the generation of prostacyclin, L-arginine and L-citrulline comparably in umbilical arteries and veins. Notably, in umbilical cords of babies of non-smoking mothers the F2-isoprostane level was significantly higher in arteries. Cigarette smoking correlates with a direct vasoconstrictive effect. We suggest that smoking might enhance the vasoconstrictory capacity in umbilical arteries by increased F2-isoprostanes and by a simultaneous decrease in the production of the vasodilatory compounds, prostacyclin, and nitric oxide.

Epidural Anaesthesia in Labour: Influence on Surgical Delivery Rates, Intrapartum Fever and Blood Loss

We retrospectively analyzed 7,317 fully documented deliveries to assess the effect of epidural anaesthesia (EA) on surgical delivery rates, on the incidence of intrapartum fever and on peripartal blood loss. 1,056 (14.4%) had EA and 6,261 (85.6%) had no or other analgesia. The use of EA was associated with a decreased spontaneous delivery rate (50.0 vs. 79.2%), increased forceps delivery rate (30.7 vs. 4.0%) and increased vacuum extraction rate (3.5 vs. 0.7%). The caesarean section rate was not significantly changed in patients with EA (14.4 vs. 13.0%). Fever greater than 38 degrees C during labour and intrapartum haemorrhage exceeding 500 ml were associated with the use of EA.

Male fetuses are particularly affected by maternal alloimmunization to D antigen.

BACKGROUND: It is hypothesized that male fetuses are more severely affected by fetomaternal alloimmunization to D antigen than female fetuses.

Three-dimensional ultrasonographic imaging of fetal tooth buds for characterization of facial clefts

The purpose of this prospective study was to investigate whether the antenatal characterization of fetal facial clefts can be improved by three-dimensional ultrasonographic visualization of fetal tooth buds. Between January 1996 and June 1998, seventeen consecutive fetuses with facial clefts were examined for fetal maxillary tooth buds in the cleft area using three-dimensional multiplanar reconstruction. It was possible in all cases to classify the clefts either as cleft lip alone or unilateral cleft lip and palate or bilateral cleft lip and palate. Three-dimensional computed tomography and histological jaw sections of three stillborn infants were produced in order to examine the correlation between the sonographic, radiographical and histological findings. The prenatal characterization of the facial clefts by means of a visualization of the tooth buds showed to be accurate postnatally in all cases. The sonographic proof of tooth buds might gain increasing importance as this technique seems to facilitate and improve the prenatal classification of suspected facial clefts.

Sex-related changes in the bone mineral content of atrophic mandibles

In 25 edentulous anatomical mandible specimens (15 female, age range 69–90 years; 10 male, age range 68–88 years), the bone mineral content (BMC) was measured by dual-photon absorptiometry (DPA) and analyzed in a standardized area of the mandibular body. The results of our BMC examinations showed that there was a significant difference (P=0.05) between the two sexes. Another notable fact was that, with advancing age, the values measured in the male mandibles tended to increase slightly but in a statistically significant way. Those of the female mandibles tended to decrease with age. A possible explanation for this observation may be derived from the fact that a reduction of the mandibular height leads to a reduction of the moment of resistance. As functional adaptation in order to preserve the stability of the atrophic body of the mandible, the amount of inner cortical bone of the male mandibles increases, leading to a reduction of the cancellous portion. In the mandibles of women, postmenopausal osteoporosis seems to prevent an analogous compensation mechanism.

Umbilical arteries of babies born to cigarette smokers generate less prostacyclin and contain less arginine and citrulline compared with those of babies born to control subjects

OBJECTIVE The hypothesis of this study was that umbilical arteries of babies born to smoking mothers produce less nitric oxide and prostacyclin than do those of nonsmoking mothers. STUDY DESIGN L-Arginine, L-citrulline, L-cysteine, and prostacyclin were measured in the umbilical arteries of 11 babies born to smoking mothers and 16 infants born to nonsmoking controls. The concentrations in the two groups were compared with the modified t test. RESULTS The generation of prostacyclin was reduced in the umbilical arteries of infants of smoking mothers. Similarly, L-arginine and L-citrulline, but not L-cysteine levels, in these arteries were suppressed compared with those of the nonsmoking controls. CONCLUSION Along with the known direct vasoconstrictive effect of nicotine, nitric oxide and prostacyclin deficiency may affect the uteroplacental blood flow and contribute to the impaired fetal nutrition and increased perinatal mortality of babies born to women who smoke.

Ultrasound evaluation of fetal spine length between 14 and 24 weeks of gestation

The objective of our study was to establish a nomogram of fetal spine length in the second trimester of pregnancy by using two and three‐dimensional ultrasound. Fetal spine length was measured prospectively by means of transabdominal ultrasonography in 114 normal singleton pregnancies between 14 and 24 weeks of gestation. Regression analyses were performed on spine length, gestational age, biparietal diameter and femur length. Supplementary three‐dimensional ultrasound to assess fetal spine length was performed in 75 cases. Fetal spine length, as a function of gestational age, was expressed by the following regression equation: spine length (mm)=−47.2+7.16×gestational age (weeks), with a Pearson correlation coefficient of R2=0.956. The results of the measurements revealed no difference between two and three‐dimensional ultrasound. Our study defines the normal limits of fetal spinal length in the second trimester of pregnancy and demonstrates a high correlation between spinal length, gestational age, biparietal diameter and femur length. However, there are still too few prenatal research data to say whether and to what extent an assessment of fetal spine length at this stage of pregnancy can be used for prenatal diagnosis of congenital syndromes, which, among other manifestations, are marked by fetal spine lengthening or shortening. Copyright

Breech infants : vaginal or cesarean delivery ?

Background. This study was undertaken to determine whether planned vaginal or elective cesarean delivery is better for singleton term breech infants and their mothers.