Ulrich Büscher

Frequency of denial of pregnancy: results and epidemiological significance of a 1‐year prospective study in Berlin

Background.  There has been an increasing number of reports on denial of pregnancy. However, only very few studies have involved a large number of patients. To date, no reliable calculation of this conditions general frequency, also from an epidemiological perspective, has been available.

Elevation of interleukin‐6 levels in cervical secretions as a predictor of preterm delivery

Background. The objective of this study was to evaluate the predictive value of interleukin‐6 (IL‐6) in cervical secretions for preterm delivery before 34+0 gestational weeks in patients with preterm labor.

Frequency and significance of preterm delivery in twin pregnancies.

Objective: We investigated the frequency of preterm delivery and its influence on the neonatal outcome in twin pregnancies at a perinatal center. Are there differences in the course of twin pregnancies with preterm or term delivery? Method: A retrospective investigation was carried out at the Department of Obstetrics on 502 twin pregnancies and deliveries between 1978 and 1993. Pregnancy history and clinical parameters were compared among preterm (<37+0 weeks) and term deliveries. Result: Median duration of all twin pregnancies was 36+3 weeks of gestation. In the preterm group, preterm labor was more frequent, both, the first and the second neonate had lower birth weight and were more often admitted to the neonatal intensive care unit (NICU) where they stayed longer than full‐term neonates needing intensive care. Perinatal deaths occurred only in the preterm group. Conclusions: The incidence of preterm delivery is significantly elevated in twin pregnancies and consequently the incidence of low‐ and very‐low‐birth‐weight‐infants and perinatal mortality. Preterm delivery is the main reason why twin pregnancies are at a higher risk for an adverse neonatal outcome and thereby cause considerable costs.

Pregnancy and delivery in a patient with mutilating dystrophic epidermolysis bullosa (Hallopeau-Siemens type)

Background Epidermolysis bullosa dystrophica of the mutilating Hallopeau-Siemens type is a rare inherited skin disease. Those afflicted have blisters and pronounced scarring of skin and mucous membranes after minor trauma. Pregnancies are very rare in affected women. Case A 24-year-old woman, gravida 1, with a severe form of the Hallopeau-Siemens type was monitored closely during pregnancy. The patient spontaneously delivered a healthy female neonate at term. Episiotomy wound healing was uncomplicated. Seven months later, she returned in her second pregnancy, which was complicated by mild anemia and polyhydramnios from possible gestational-onset diabetes mellitus. Again, vaginal delivery of a healthy neonate was performed at term. We did not observe pregnancyinduced exacerbations of the skin disease. Conclusion Women with epidermolysis bullosa dystrophica of the Hallopeau-Siemens type may decide to have children after careful evaluation of the degree of impairment and a thorough explanation of the risks associated with pregnancy and delivery. Close monitoring of the pregnant patient is important. Vaginal delivery should be the first choice. Breast-feeding is difficult, but not contraindicated.

Effects of oxytocin receptor antagonist atosiban on pregnant myometrium in vitro.

OBJECTIVE To investigate dose‐dependent effects of oxytocin receptor antagonist, atosiban, on oxytocin‐induced contractions of myometrial strips from healthy pregnant women. METHODS During elective cesareans, myometrial biopsies were taken from the lower uterine segment and trimmed into 2 × 2 × 10‐mm longitudinal strips within 36 hours. One hundred twenty‐two myometrial strips showed regular spontaneous contractions and were used for measurement. Each myometrial strip was mounted in a physiologic organ bath, and isometric contraction activity and contractile patterns were analyzed after stimulation with oxytocin. Frequency and amplitude of contractions and area under force‐time curves were determined by adding atosiban at concentrations of 1, 5, 10, 20, 50, 100, 250, and 500 μg/mL. Resulting contraction activity (at least 20 contractions per concentration) was compared with reference activity. RESULTS Atosiban had significant inhibitory effects on myometrial contractions at concentrations as low as 1 μg/ mL. Compared with reference activity (oxytocin stimulation only), resulting inhibition was higher than 50% with the lowest atosiban concentration used. This inhibition of contraction activity was dose‐dependent and referred to the area under the curve, frequency, and amplitude of contractions. At high concentrations of atosiban, contraction activity was even lower than spontaneous activity without oxytocin stimulation. CONCLUSION The oxytocin receptor antagonist atosiban showed a significant, dose‐dependent inhibition of oxytocin‐induced contractions of human myometrium in vitro. It might be effective in tocolysis at term.

Aggressive angiomyxoma of the female perineum in pregnancy

A 32-year-old Caucasian first gravidae, primiparae in the 32nd gestational week, was transferred by her attending physician because of suspected massive condylomata accuminata of the vulva to plan an elective caesarean section. The structure was detected and had grown during the pregnancy. Her medical history and physical examination were otherwise normal. Physical examination of the vulva showed a soft proliferation of 3 4 cm of the commissura posterior (Fig. 1) that was not differentiated from the surrounding tissue. Inspection was therefore untypical for condylomata and the smear for human papilloma virus was negative. Excision of the mass was performed in the 36th gestational week under local anesthesia when the structure had grown further. Histopathology showed an aggressive angiomyxoma (AAM). Nuclear staining for estrogen receptors in immunohistochemistry was positive, and negative for progesterone (Fig. 2). The patient was able to deliver spontaneously. Nine months after delivery there was no sign of a recurrence.

Accuracy of fetal pulse oximetry

Background. The goal of this investigation was to evaluate the agreement of fetal pulse oximetry to saturation readings from hemoximetry at low oxygen saturation.

Zuverlässigkeit der Abschätzung des Frühgeburtsrisikos

ZusammenfassungDie Frühgeburt ist eine wesentliche Ursache kindlicher Mortalität und Morbidität. Wir bemühen uns, die Rate der Frühgeburten durch geeignete soziale und medizinische Maßnahmen zu senken, wobei besondere Hoffnung auf die Prävention gesetzt werden muß. Um präventiv tätig werden zu können, ist die Identifikation der frühgeburtsgefährdeten Frauen mit Hilfe von anamnestischen, klinisch befundbaren, ultrasonographischen, laborchemischen und mikrobiologischen Frühgeburtsmarkern notwendig.

Condoms are not a risk factor for sensitization to latex.

The study was conducted to assess the prevalence of sensitization to latex in a group of women with a high risk for atopy and to determine whether the use of condoms is a relevant risk factor. In a prospective study, 100 atopic women (defined as having specific IgE to common aero- or nutritional allergens) were screened for specific IgE antibodies to latex after delivery: Ten of the 100 women (10%) showed specific IgE to latex. Total IgE concentrations were higher with a history of occupational exposure or of symptoms after contact with latex (p < 0.05, and p < 0.005, respectively), but condom users were not significantly more frequent in the latex-positive group. Our results indicate that prior use of condoms does not appear to be a specific risk factor for sensitization to latex in post-partum women at high-risk for atopy. Latex-free condoms should only be recommended to women already known to be sensitized to latex.

Akute-Phase-Proteine und Zytokine im Nabelschnurblut zur Infektionsdiagnostik beim Neugeborenen

ZusammenfassungDie Bestimmung von Akute-Phase-Proteinen und Zytokinen im Nabelschnurblut stellt eine wertvolle Ergänzung der Diagnostik des Neugeborenen dar. Die Analyse des Nabelschnurbluts ist einfach durchzuführen, die Ergebnisse sind schnell erhältlich. Problematisch ist, dass die Evaluierung der Bestimmung dieser Parameter im Nabelschnurblut noch nicht für alle Parameter befriedigend durchgeführt ist.Angesichts der schweren Erkrankungen, die lebenslang aus einer Infektion vor und während der Neonatalphase resultieren können, muss allerdings die Bestimmung von Infektparametern im Nabelschnurblut weiter verfolgt werden und wird voraussichtlich in wenigen Jahren bei bestimmten Geburtsverläufen selbstverständlich werden.AbstractThe determination of acute phase proteins and cytokines in umbilical cord blood provides a useful addition to the possibilities available for the diagnosis neonatal diseases. The analysis of umbilical cord blood is easy to carry out and the results are rapidly available. One problem is that the determination and evaluation can not be carried out satisfactorily for all blood parameters.Considering the severe, life long illnesses which can result from a neonatal infection, it is necessary to continue work on the determination of parameters in umbilical cord blood relating to infection. It is likely that the evaluation of such parameters will become routine in certain birth senarios within the next few years.