The advanced fetal programming hypothesis.
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Alleles↗
Biomedical subjects
H Halle
Publications and source records attributed to H Halle.
Association of maternal G protein beta3 subunit 825T allele with low birthweight.
Weight at birth has been associated with an increased risk for cardiovascular disease and type 2 diabetes in adult life. We found an association between the maternal G protein beta3 subunit 825T allele and low birthweight in babies born to women without other risks for reduced fetal growth.
Adult↗
Nitroglycerin to facilitate fetal extraction during cesarean delivery.
OBJECTIVE: To determine the efficacy of nitroglycerin in easing fetal extraction in elective cesarean deliveries in comparison with placebo and to collect maternal and fetal pharmacologic data after administration of nitroglycerin. METHODS: This randomized, double-blind clinical and descriptive pharmacokinetic study was carried out at the gynecology departments at Virchow Hospital and Charité Hospital (both university hospitals of Humboldt University, Berlin, Germany) between June 1994 and July 1996 in patients scheduled for elective cesarean delivery under general anesthesia. At the time of the uterine puncture incision, either 0.25 mg or 0.5 mg of nitroglycerin or a physiologic saline solution was administered as an intravenous bolus. Intraoperatively, maternal and neonatal pulse rates and blood pressure were monitored closely. The surgeons estimated reduction in uterine tone and the ease of fetal extraction by means of defined scales. Plasma concentrations of nitroglycerin and its metabolites were measured in maternal venous blood and from umbilical blood. RESULTS: Ninety-seven patients were included in the statistical evaluation of the study; 32 received 0.25 mg of nitroglycerin, 34 received 0.5 mg of nitroglycerin, and 31 received placebo. The evaluation of the surgeons' estimation revealed no significant difference in ease of fetal extraction (statistical power 0.7) and no significant reduction in uterine tone under treatment with both nitroglycerin dosages in comparison with placebo. Only substance-specific maternal side effects were noted. The neonates' conditions were not affected by administration of nitroglycerin. The median fetal-maternal ratio of venous nitroglycerin plasma levels was approximately 1:400 in the 0.25-mg nitroglycerin group and 1:160 in the 0.5-mg nitroglycerin group. Approximately 11-12 times more nitroglycerin was detected in the venous umbilical branch than in the arterial branch. CONCLUSION: Administration of nitroglycerin leads to no clinically relevant easing of fetal extraction, at least not in elective cesarean deliveries after the 34th week of gestation. With regard to pharmacokinetics, the measured median fetal-maternal venous nitroglycerin concentration was 1:400 in the 0.25-mg group and 1:160 in the 0.5-mg group.
Adult↗
[Vaginal ultrasound cervix imaging in pregnancy--predictive value of suspicious findings on the subsequent course of pregnancy].
To evaluate the use of serial measurement of cervical length and width of internal os by means of vaginal ultrasound 144 pregnant women were examined prospectively. We hypothesized, that cervical length and width of the internal os would be significantly different in normal patients and those with preterm labor or cervical incompetence. Predictive validity of suspicious findings indicating the occurrence of preterm labour and cervical incompetence in further course of pregnancy should be assessed. Anamnestic, sonographic and outcome data were analysed. To assess sensitivity, specifity, positive and negative predictive values, different values of cervical length and width of internal os between 20 and 27 weeks were analysed. Significant differences of cervical length and width of internal os in normal and pathologic pregnancies could be documented early in pregnancy course. By further investigation early suspicious findings indicating the developing pathology were found only for the subgroup with cervical incompetence. Sensitivity of vaginal ultrasound examination between 20 and 27 weeks indicating the whole pathologic collective was only 30%, whereas up to 55.5% of pregnancies complicated by cervical incompetence were detected. Specifity (up to 95%) and negative predictive value (90%) were high. The results show that cervical examination by vaginal ultrasound allows early detection of developing cervical incompetence. The high specifity and the high negative predictive value may be useful to exclude cervical incompetence in clinically unclear cases thus helping to avoid unnecessary therapeutical interventions.
Adult↗
[Immunologic parameters in women with normal pregnancy and pre-eclampsia].
Immunological investigations were carried in women with normal pregnancy and patients with preeclampsia. Regarding the lymphocyte subpopulation distribution an elevated number of T lymphocytes, especially of CD-4 carrying helper-inducer T cells, was registered resulting in an altered CD4/CD8 ratio. The T lymphocytes in patients with pre-eclampsia seem to be activated in vivo, shown by an elevated expression of the CD25 (IL-2 receptor) marker. Their responsibility to phytohemagglutinin (PHA) in vitro was found to be depressed. Furthermore, a pre-stimulation of macrophages in vivo was registered (expression of the transferrin receptor). In comparison to the control group the serum levels of IgG and IgA were seen to be low in patients with pre-eclampsia.
Adult↗
[Clinical significance and fetal outcome in end-diastolic decreased flow in the umbilical artery and/or fetal aorta: analysis of 51 cases].
The AEDV in the umbilical artery or the foetal aorta is considered to be the most severe waveform abnormality. Using pulsed Doppler, we found such a waveform in 51 foetuses out of 954 high-risk pregnancies (33/51 in both vessels, 17/51 aorta only and 1/51 umbilical artery only). A reverse flow was registered in 24 foetuses. The outcome was compared with that of a control group (n = 72) showing normal Doppler findings. The following parameters were highly significant (p less than 0.001): Rate of Caesarean section owing to foetal distress (85.3% to 4.8%), of growth retardation (IUGR) (66.7% to 6.0%), of premature delivery (73.5% to 7.5%), of low postnatal pH- and Apgar score (73.5 to 12.1%), of admission to the neonatal intensive care unit (94.1% to 8.6%), of morbidity (35.3% to 2.3%) and of mortality (41.1% to 0%). We observed 17/51 intrauterine and 4/51 postnatal deaths. The rate of malformations was 35.3% with 4 cases of aneuploidy. Considering the malformations, the rate of corrected mortality was 23%. We found, that the association of an AEDV and the absence of severe IUGR is highly suspicious of malformation. We also observed, that congenital heart diseases (CHD) could lead to an AEDV too. An AEDV precedes a pathological cardiotocogram (CTG) with a latency of 0 to 35 days (mean 9.5 days). This latency is not predictable, but we think, that a reliable assessment of jeopardy is possible by analysing further vessels (Aa. arcuatae, A. renalis, A. carotis interna): 72.5% of the foetuses with AEDV had high indices in the carotid artery and 93.1% among these showed a pathological CTG pattern.(ABSTRACT TRUNCATED AT 250 WORDS)
Aorta↗
[Prenatal use of pulsed Doppler ultrasound within the scope of the differential diagnosis of bilateral kidney abnormalities].
Pulsed Doppler ultrasound was used in the differential diagnosis of 22 cases suspected of bilateral malformations of the foetal kidneys. In cases of kidney malformations, the pulsatility indices (PI) of the umbilical artery and the foetal aorta were in the normal range. In cases showing pathological PI values of both vessels, we found a severe intrauterine growth (IUGR) retardation with oligohydramnion. These results underline the importance of pulsed Doppler as a non invasive means in the management of oligohydramnions to differentiate among bilateral kidney malformations and IUGR.
Abnormalities, Multiple↗
[Assessment of uteroplacental circulation in uncomplicated pregnancies using pulsed Doppler ultrasound].
The Doppler sonography enable as a new non-invasive procedure the assessment of the uteroplacental circulation. 209 blood flow measurements (pulsed wave Doppler) were recorded between the 20th and 40th weeks of gestation from the arcuate arteries in 130 women with uncomplicated pregnancy. The S/D Ratio, the Resistance Index (RI) and the Pulsatility Index (PI) were calculated. These Indices show throughout the observation time persisting low values which reflect the optimal uteroplacental circulation in a system with low downstream impedance. We found that the S/D Ratio and the RI are appropriate parameters in the qualitative analysis of the uteroplacental perfusion. On the other side we could demonstrate that the PI depends on the maternal heart rate which explains the high variability of the values. Therefore is the PI not appropriate for the impedance measurements in uteroplacental vessels.
Blood Flow Velocity↗
[Qualitative analysis with Doppler spectra of the umbilical artery and fetal aorta in normal pregnancies].
Blood flow velocity waveforms were recorded between the 20th and 40th week of gestation from the umbilical and fetal aorta (n = 230 each) in 130 uncomplicated pregnancies. The S/D ratio, the Resistance Index (RI) and the Pulsatility Index (PI) were calculated. In the umbilical artery the indices showed a significant decrease in the observation interval. In the fetal aorta we could not register any significant change of these indices. All values are presented as reference curves. The importance of the Doppler assessment of the circulation in these vessels for the management of high-risk pregnancy is emphasized.
Aorta↗
[Type and frequency of gynecological tumors in the Gondar region of Ethiopia].
The present work was done to examine the type and frequency of benign and malignant gynecological tumors in patients treated during the 5 years period from 1982 to 1986 in the Gondar College of Medical Sciences. The different pathohistological findings were compared with the history and chief complaints of the patients. A total number of 208 patients with benign and of 93 patients with malignant tumors could be analyzed. In the group of benign tumors we observed most frequently breast tumors (25.5%), endometrial and cervical polyps (24.5%), and myoma uteri (23.1%). Patients with benign ovarian tumors were treated in 40 (19.2%) cases. In the group of malignant tumors we have seen breast carcinomas (31.2%) and cervical carcinomas (34.4%) most frequently followed by the endometrial (13.0%) and ovarian (11.8%) neoplasms. Comparison with the data of the literature has shown that the mean age of our patients is lower and the number of women with advanced carcinomas is higher than in other reports.
Adolescent↗
Development of enolase isoenzymes in various regions of the human brain.
Various brain regions from 4 fetuses (21st to 28th gestational week) and from a 3-month-old infant were investigated for the total enolase activity and their isoenzyme distribution. In the brain tissue from a 3-month-old infant, the activity of the so-called neuron-specific enolase amounted to about 50% of the total enolase activity. In various brain regions different developmental patterns emerged for nonneuronal (NNE) and neuron-specific enolase (NSE). By the 21st gestational week the medulla, pons and thalamus had already reached a relatively high NSE activity (about 60-90% of that of the 3-month values), whereas the cortex regions had 10-30% only. It is concluded that in phylogenetically old regions, the switch from NNE to NSE-subunits appears before the 21st gestational week, in the phylogenetically young regions between the 21st and 28th gestational week.
Brain↗
[Flowmetry of the fetal renal artery--a possibility for improving the assessment of fetal circulatory centralization].
The use of flowmetry of the foetal renal artery offers a diagnostic improvement by analysing intrauterine centralisation of the foetal circulation. We used the examination results of 82 pregnant women, who were in intensive prenatal care, to check the prediction of foetal distress using the flowmetry of the renal artery. In foetuses showing an increased flow resistance of the aorta and a pathological flow of the renal artery, the rate of caesarian section, necessitated by foetal distress, was 63.6%. By the forming of quotients from the pulsatility indices of the internal carotid artery and the aorta on the one hand, and the renal artery and the internal carotid artery on the other hand, it seems to be possible to get information about the severity of the centralisation of the foetal circulation by existence of an intrauterine hypoxia. The rate of the operative delivery as a consequence of a foetal distress rises from 6.6% with normal PI quotients to 83.4% if both quotients are outside the double standard deviation.
Blood Flow Velocity↗
Colonization of pregnant women and their newborn infants with group B streptococci in the Gondar College of Medical Sciences.
In a study of Group B streptococcal carriage, 200 postpartum women and 80 newborn infants were investigated in the Gondar College of Medical Sciences from January to April 1987, using swabs from the vagina and rectum, and from the throat and external ear, respectively. We found a colonization rate of 9% (18/200) in the mothers and 5% (4/80) in the neonates. The serological typing of the 25 isolated strains showed 60% (15/25) to be Type Ib/c and 16% (4/25) to be Type Ia strains. Therefore, in newborn infants with infections, diagnostic and bacteriological procedures should include a search for Group B Streptococci.
Carrier State↗
[HELLP syndrome - a serious complication in pregnancy].
Report on a severe Hellp-Syndrome. The Hellp-Syndrome fully develops in the postpartal period accompanied by a breakdown of the kidney and liver functions. Therapeutical success has been achieved only by plasmapheresis.
Acute Kidney Injury↗
[Colonization of pregnant females and their newborn infants with group B streptococci at the Gondar College of Medical Sciences].
The importance of neonatal septicemia and meningitis caused by group B streptococci (GBS) has risen worldwide in the last ten years. Between January and June 1987 200 nonselected intrapartum women at Gondar College of Medical Sciences were examined for GBS colonization. One rectal and vaginal swab was collected from each woman and cultured in 5% sheepblood agar. Cultures also from 80 newborns were obtained from throat and ear. The colonization rate of women was 9.0%. 5% of the newborns were positive for GBS. The most frequent isolated GBS-type was I b/c, this result is different from those in Europe and the USA. The authors believe, that GBS infections of newborns in development countries are also possible. These severe infections should be included in the diagnostic and therapeutic measures in future.
Ethiopia↗
[Group B streptococcal infections in newborn infants and young infants. A 5-year analysis].
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Humans↗
[Incidence of B streptococcal diseases and colonization--a clinico-epidemiological study].
The incidence of newborn infections caused by group B streptococci (GBS) has risen significantly in recent years. In 1983 and 1984 ten GBS diseases of the newborns were registered in the Department of Neonatology of the University Hospital (Charité). This is a morbidity of 1.2 per 1,000 live births. Eight infants showed an early onset and 2 a late onset type. Three of the neonates died. These were term infants with a birth weight of more than 2,500 g. The isolated types in these cases were Ia, Ia/c and III. In 1983 and 1984 430 nonselected women between the 34th and 40th weeks of gestation were examined for GBS colonization. One rectal, vaginal and cervical swab was collected from each women and cultured both in a selective broth medium and a selective blood agar plate. The colonization rate was 11.4% in pregnant women. The most frequent colonized region was the rectum, followed by vagina and cervix. Cultures from infants were obtained from throat, left and right ear. 2.7% of the newborns were positive for GBS. The most frequent isolated types are III/R and Ia. In all cases, positive for maternal and neonatal colonization, the isolated types were identical.
Bacteriological Techniques↗
Prostaglandin gel for cervical ripening before induction of labour.
In cases with a low pelvic score (Bishop) before induction of labour a gel was locally applied consisting of 1 mg prostaglandin F2 alpha in 2 ml. The single dose was 1.5 to 2.5 mg prostaglandin F2 alpha. In cases with insufficient effect this therapy was repeated once up to three times. This method reduced the duration of delivery. No maternal side-effects were observed in a total of 220 cases.
Cervix Uteri↗