Tamás Csermely

Effects of maternal central hemodynamics on fetal heart rate patterns

Background. This study was undertaken to evaluate the effects of maternal central hemodynamics on fetal heart rate patterns near term, with special regard to the maternal body position. Methods. Brief non‐stress test and bioimpedance cardiography were carried out in the supine position, then repeated in a full left lateral decubitus position of mothers with singular, 36–39 week‐old normal pregnancies in 106 cases. Computer‐aided data were processed by SPSS statistic program. Results. Due to the appearance of inferior vena cava syndrome, examinations had to be interrupted in 6 cases. Analysis of 100 complete registrations revealed a significantly increased number of accelerations, overall and short‐term variations, and longer high episodes with lower basal fetal heart rates were found in the lateral decubitus than in the supine maternal position. Turning to the left resulted in a significant increase of the stroke volume; however, due to decreasing pulse rate, the cardiac output remained unchanged. Parameters of non‐stress test showed correlations to hemodynamic indices. In the supine position, the short‐term variation correlated with cardiac output (r = 0.232, p = 0.020); in the left lateral position, the number of accelerations correlated with stroke volume (r = 0.221, p = 0.027) and cardiac output (r = 0.220, p = 0.028). Changes of stroke volume due to altered body position correlated to similar changes of overall variation (r = 0.264, p = 0.018), and marginally to those of short‐term variation (r = 0.221, p = 0.051). Conclusion. Maternal central hemodynamics influences fetal heart rate patterns in connection with different maternal body position.

Ghrelin and acyl ghrelin in preterm infants and maternal blood: relationship with endocrine and anthropometric measures

OBJECTIVE The objective of the present study was to examine the association of acylated and total ghrelin levels at birth in preterm infants with anthropometric features and with related hormones in infants and their mothers. DESIGN Prospective, descriptive study. METHODS In total 23 pregnant women and their 26 preterm infants were involved in the study (3 twin pregnancies; gestational age, 25-35 weeks). Maternal and umbilical vein blood samples were taken after the delivery. Serum acylated and total ghrelin, leptin, cortisol, insulin, GH, and glucose were determined. RESULTS The mean level of acylated ghrelin concentration was higher in the maternal than in the cord blood (P<0.01) and there was a significant correlation between the fetal and maternal acylated ghrelin levels (P<0.01). The total ghrelin concentration was higher in neonates than in mothers (P<0.01), but there was no correlation between them. The multivariate regression analysis for fetal acylated and maternal total ghrelin as dependent variables shows that the fetal acylated ghrelin has two independent predictors, the maternal acylated ghrelin (P<0.01) and the fetal cortisol (P<0.05), whereas the maternal total ghrelin has only one independent predictor, the maternal glucose (P<0.05). CONCLUSIONS These data provide the first evidence that umbilical cord acylated ghrelin concentrations are lower than in maternal blood and support the hypothesis that the acylation process in the fetus is partly affected by cortisol and the placenta may play a role in this process.

Sexual Function after Modified Laparoscopic Vecchietti’s Vaginoplasty

STUDY OBJECTIVE To report on minor modification of laparoscopic Vecchietti vaginoplasty and to examine the quality of sexual life after the operation. DESIGN A retrospective study to examine the role of minor modification during laparoscopic Vecchietti operation to prevent injuries and to evaluate the sexual function of patients with neovagina. SETTING Department of Obstetrics and Gynecology, University of Pécs, Faculty of Medicine, a tertiary supply center in Hungary. PATICIPANTS: Twenty-three adolescents or young adults, ages 16 to 26 with vaginal agenesis (Mayer-Rokitansky-Küster-Hauser syndrome) were operated. Twenty-five sexually active patients with matched age served as controls. INTERVENTIONS Laparoscopic Vecchietti operation was modified with the use of endovaginal ultrasound transducer to visualize the narrow vesico-rectal space. The quality of sexual life 2-11 years after the operation was measured by the Female Sexual Function Index (FSFI). MAIN OUTCOME MEASURES Complications occurring during operations; desire, arousal, orgasm, satisfaction, lubrication, and pain during sexual intercourse. RESULTS The technical modification of the operation, with endovaginal transducer, improved the method. Serious injuries of the bladder or rectum could be avoided. Anatomic and functional results shown by the total FSFI scores did not differ from that of the control group. Desire, arousal, orgasm, and satisfaction of the operated patients were similar to controls; however, patients with neovagina tended to have less lubrication and more pain during sexual intercourse. CONCLUSIONS Laparoscopic Vecchietti operation modified by the use of endovaginal transducer is a safe procedure to create a neovagina, which guarantees good quality of sexual life with high satisfaction for patients.

Calcium dobesilate lowers the blood pressure in mild to moderate midtrimester hypertension: a pilot study.

To test the effects of calcium dobesilate (Doxium) in pregnancies complicated with pregnancy-induced hypertension or mild/moderate pre-eclampsia a double-blind, placebo-controlled pilot study was carried out. Primigravida patients (gestational age ≤34 weeks) daily took 2 g Doxium or placebo until delivery. Twelve patients received placebo for 53 days, and 11 patients took the drug for 57 days on average. At the start of the study 2 patients in the placebo group (PG) and 8 in the Doxium group (DG) had pre-eclampsia. The mean arterial pressure (mean ± SD) significantly decreased from 118 ± 7 to 99 ± 9 mm Hg in the DG (p = 0.003), while in the PG it had slightly increased by the end of the study. Proteinuria was higher in the DG at the start but not at the end; however, significant changes of this parameter were detected in neither of the groups throughout the study. Fibronectin decreased significantly in both groups but it was more pronounced in the DG (23.8 vs. 9.4%). Changes of platelet count, plasma and blood viscosity, and erythrocyte deformability were favourable in the DG but in the PG these parameters had deteriorated although the alterations were not significant. No marked differences were found between the two groups regarding fetal well-being, courses of deliveries, and the neonatal period. Neither maternal nor fetal/neonatal side effects were noticed. It seems that Doxium favourably influences the blood pressure and consequently decreases the requirement for medication and hospitalisation in cases of mild to moderate midtrimester hypertension.

Assessment of postoperative postvoid residual bladder volume using three-dimensional ultrasound volumetry.

The aim of our prospective study was to assess the concordance between postvoid residual volumes (PVR) of the urinary bladder obtained by two different three-dimensional (3-D) ultrasound (US) volumetric methods (VOCAL and XI VOCAL) and with measurement by the catheter in postoperative patients who have undergone radical hysterectomy. The 3-D sonographic volume-determination of PVR with both methods correlated significantly with the actual amount of PVR by the catheter. The accuracy of both 3-D US volumetric methods was significantly higher under 300 mL of PVR. Bland-Altman plots were generated to examine limits of agreement. Both noninvasive 3-D sonographic methods are appropriate for the correct volume-determination of PVR following radical hysterectomy. Thus, we may avoid routine, albeit often unnecessary, catheterization to measure postoperative residual bladder volumes and subsequently the incidence of lower urinary tract infection may be reduced and better postoperative comfort for patients may be permitted.

Simultaneous use of intrapartum fetal pulse oximetry and amnioinfusion in meconium stained amniotic fluid

OBJECTIVE Fetal pulse oximetry is a minimally invasive, simple technique which continuously helps to reflect in utero well-being. The presence of meconium in the amniotic fluid may be a clinical sign of fetal hypoxaemia. Amnioinfusion has a beneficial effect on the incidence of meconium aspiration syndrome (MAS), and the presence of meconium below the level of the vocal cords. STUDY DESIGN We studied the impact of amnioinfusion combined with fetal pulse oximetry on the incidence of meconium aspiration syndrome and operative delivery. RESULTS The retrospective analysis revealed that the presence of meconium below the level of vocal cords was significantly reduced. The frequency of cesarean section is decreased, however, it did not reach statistical significance. CONCLUSION Fetal pulse oximetry may be used in combination with amnioinfusion and cardiotocography (CTG) to reduce the risk of meconium aspiration syndrome and the number of instrumental deliveries and improve perinatal outcome.

The application of 'endovaginal' sonography during a laparoscopy-assisted Vecchietti operation

Background. Many types of operations are described to create a neovagina in a patient with Mayer‐Rokitansky‐Küster‐Hauser (MRKH) syndrome, that sometimes result in injury of the surrounding organs. Many trials are detailed in the literature to avoid these complications. Our goal was to examine the benefit of ‘endovaginal’ sonography during a laparoscopy‐assisted Vecchietti operation to avoid bladder injuries. Methods. A neovagina was created in 15 women with MRKH syndrome by the method of Vecchietti assisted by laparoscopy. The method was modified with the use of ‘endovaginal’ sonography, in order to reduce bladder and rectal injuries. The vaginal ultrasound transducer, placed in front of the vaginal dimple, can guide penetration from the perineum into the peritoneal cavity. With this technique, the narrow space between the bladder and rectum can be well identified. Results. All operations were successful, without any complication, forming a well‐functioning 8–10 cm long neovagina, allowing easy introduction of two fingers in all cases, and with good quality of sexual life for the couples. Conclusion. Creation of a neovagina by any method in MRKH syndrome may sometimes result in injury of the bladder or rectum due to the narrow space between the bladder and rectum. The placement of the endovaginal ultrasound transducer in front of the vaginal dimple seems to be a promising method to avoid these complications during a laparoscopy‐assisted Vecchietti operation.