Werner Stein

The determination of the fetal D status from maternal plasma for decision making on Rh prophylaxis is feasible

BACKGROUND: Noninvasive fetal RHD genotyping might become a valuable tool in decision making on antenatal Rh prophylaxis, which is currently in routine practice for all D− pregnancies in several countries. This study provides a large‐scale validation study of this technology to address questions concerning feasibility and applicability of its introduction into clinical routine.

Peripartum cardiomyopathy—a new treatment option by inhibition of prolactin secretion

Peripartum cardiomyopathy (PPCM) is a rare disease of unclear etiology with a frequent poor outcome, despite optimal medical therapy. Recent experimental data implicate a causal role of prolactin. We report a patient with PPCM who responded well to treatment with Bromocriptine in addition to standard therapy of heart failure.

Twin-to-twin delivery time interval : influencing factors and effect on short-term outcome of the second twin

Background. Following vaginal delivery of the first twin, the further management to deliver the second twin is in dispute. Controversial discussions have taken place on the importance of the time interval between the birth of the first and the second twin. Objective. To evaluate factors influencing twin‐to‐twin delivery time interval, and short‐term outcome of the second twin in a complete population‐based cohort in Hesse, Germany. Study design. In a population‐based cohort study, between January 1990 and December 2004, all twin pregnancies of ≥34+0 weeks’ gestation with a vaginally delivered first twin were evaluated. Pregnancies with intrauterine death of either one of the twins before the onset of labour, complicated by twin–twin transfusion or fetal malformations were excluded. Some 4,110 twin pregnancies were analysed. Maternal and fetal characteristics for an increased twin‐to‐twin delivery time interval and its impact on an adverse short‐term neonatal outcome, and the effect of the twin‐to‐twin delivery interval on umbilical arterial pH and base excess of the second twin have been investigated. Results. In univariate analysis, breech, transverse lie, birth weight discordance with the second twin ≥20% larger, fetal distress, vaginal operative delivery, and caesarean section were associated with an increased time interval. Maternal characteristics were not related to an increased time interval. Increasing time interval was related to a decline in the mean umbilical arterial pH and base excess, and fetal acidosis, Apgar score <7 after 1, 5 and 10 min. In multivariate analysis, birth weight discordance, mode of delivery, and twin‐to‐twin delivery time interval were associated with an adverse short‐term outcome of the second twin. Conclusion. As twin‐to‐twin delivery time interval seems to be an independent risk factor for adverse short‐term outcome of the second twin, it should be kept short.

Cell-free fetal DNA in specimen from pregnant women is stable up to 5 days.

Before noninvasive prenatal diagnosis on the fetal Rhesus D status (NIPD RhD) can be implemented on a mass‐scale, it is crucial to define requirements regarding sample transport. The aim of this study was to determine the relation between the transport time of samples for NIPD and the concentration of fetal DNA in maternal plasma.

Cell-free fetal DNA and adverse outcome in low risk pregnancies

OBJECTIVE To analyze in a large prospective cohort study of low risk pregnancies whether cell-free fetal (cff) DNA in maternal plasma of the second trimester might be associated with the development of preeclampsia, preterm delivery, and small for gestational age. STUDY DESIGN A subset of a large prospective cohort study in serological RhD negative pregnant women with RHD positive fetuses was used. Cff DNA was determined through the detection of RHD specific sequences with real-time PCR. RESULTS In 611 pregnancies, rates of 7.2% preeclampsia, 1.6% preterm birth ≤32, 2.9% ≤34, and 12.4% ≤37 weeks of gestation, 5.7% of small for gestational age <5th percentile, and 8.2% <10th percentile were observed. For none of these risk groups an association with cff DNA could be established. CONCLUSION Cff DNA in maternal plasma of the second trimester was not found to be a marker for an adverse pregnancy outcome in low risk pregnancies.

The impact of the time interval between two successive deliveries in an obstetric unit in terms of the mode of each delivery and the rate of perinatal mortality

Abstract Objective: To analyze the relationship of the time interval between two deliveries, done by one obstetric team, on the delivery mode of the subsequent birth; to define the length of this interval; and to evaluate this time interval as a risk factor for increased perinatal mortality in a population-based cohort. Methods: All singleton deliveries at ≥24 weeks’ gestation in Lower Saxony, Germany, between 2001 and 2005 (a total of 317,663 deliveries including 402 cases of perinatal mortality) were analyzed. The mode of the previous and the subsequent delivery, the time interval between the two deliveries, the time of birth, the hospital volume, and the existence of an affiliated neonatal ward were investigated. Results: When the first vaginal delivery was <45 min, there was a reduced probability that the subsequent birth would be a cesarean section. In case of a previous cesarean section, the cesarean rate of the following birth was influenced up to 165 min. In a multivariate analysis, vaginal deliveries following an earlier vaginal birth and occurring within <45 min were associated with increased perinatal mortality. Repeated cesarean sections within <165 min were associated with increased perinatal mortality when occurring at night or on weekends. Conclusion: A short time interval between two deliveries in an obstetric unit constitutes an independent risk factor for perinatal mortality.

Neue Lösungsansätze für ein globales Problem

Die Sichelzellerkrankung ist sowohl in Schwarzafrika als auch unter der afrikanischstammigen Bevolkerung in Industriestaaten ein erhebliches gesundheitliches Problem. Um die Erkrankung zu bekampfen, mussten neue Therapie formen so angepasst sein, dass sie auch in armeren Landern anwendbar sind.