BACKGROUND: In this study separation and enrichment of fetal trophoblastcells have been investigated in venous blood of pregnant women, in order to see, if this non-risk method can replace invasive methods of gaining fetal cells for antenatal diagnosis. MATERIAL AND METHODS: First investigation of antigen-patterns of fetal cells, placenta-tissue and leucocytes as well as of different MAb 425-concentrations in chorioncells, A-431-cells and leucocytes was done, thereafter staining of A 431-cells, staining and evidence of A 431-leucocytes mixtures (group 1: n = 11), staining of chorioncells, staining and evidence of chorioncell-leucocytes mixtures (group 2: n = 13), staining and evidence of leucocyctes of nonpregnant (group 3: n = 18) and pregnant women (group 4: n = 6). A FACScan was used. Antigen patterns of fetal cells, placenta tissue and leucocytes were tested by means of specific antibodies. RESULTS: Almost all chorioncell-cultures have been EGF-receptor positive, whereas leucocytes were negative. For separation of trophoblastcells the EGF-receptor was the most suitable. 18 leucocyte samples of non-pregnant and 6 of pregnant women were tested. There were no significant differences either concerning staining with MAb 425 or in evidence in the MiniMACS. In pregnant women there was no sufficient number of EGF-receptor-positive cells available, in order to recognize, if these cells were of fetal origin. CONCLUSIONS: Before trophoblastcells could be used for antenatal diagnosis potential influences concerning presence time and separation of these cells should be investigated. DISCUSSION: We did not have enough fetal cells for further cytogenetic investigations. One reason for not enough evidence of fetal cells could be a lack of capacity of the MiniMACS. There were probably none or not enough trophoblastcells in the maternal blood. Which parameters could be of influence, is not yet known.

Antibodies, Monoclonal↗

PubMedDate not supplied

[Effect of modified labor posture on oxygenation of the fetus--a pulse oximetry study].

BACKGROUND: The evaluation of the birth position and its effects on maternal and fetal wellbeing has been a topic of perinatal research over the last decades. The aim of our observational study was to determine the effects of a modified and vertical maternal position on fetal oxygen saturation measured by pulse oximetry. METHODS: Fetal oxygen saturation was measured by pulse oximetry in 56 labouring women randomly and successively adopting the supine position in 96.4%, the sitting position in 25.0%, the standing position in 14.3% and the prone position in 12.5%. The statistical analysis addressed the integrated 10 minutes period of SpO2 registrations before versus after adopting the modified position. Furthermore the mean values and the standard deviation (SD) for the total registration periods of different birth position was calculated. RESULTS: While the supine position induced a reduction in oxygen saturation, sitting and prone position were favorable for fetal oxygenation as compared to horizontal position. DISCUSSION: These findings implicate a clinical benefit of the modified birth position.

Adult↗

PubMedDate not supplied

[Fetal pulse oximetry during risk deliveries in German clinics--a representative national survey in 81 obstetric departments].

BACKGROUND: The development of a new technique to evaluate the normal fetal acid-base balance in risk deliveries with pathological fetal heart rate has been seen with great expectations over the last years. The aim of this representative survey was to ask for the actual status of the fetal pulse oximetry in clinical use in German delivery rooms and to analyze hopes, expectations and system errors. PATIENTS RESPECTIVELY AND METHODS: Collecting data were done by a representative, time limited anonymous questionnaire in all German clinics who used Nellcors fetal pulse oximetry N-400 in measuring fetal arterial saturation in the years 1995 - 1999 during risk deliveries with non-reassuring fetal heart rate. RESULTS: With 66,6 % of the departments participating a number of 54 clinics returned the questionnaires. An average of 4.5 times per month fetal pulse oximetry was used per clinic and in over 90 % of all cases the handling and fixation of the sensor was without problems. There is qualified staff in every clinic and regarding the satisfaction with this system an average note of 2.8 was assigned. Fetal pulse oximetry will be established in some years to replace fetal blood analysis and to reduce operative deliveries. Technical problems in cases of insufficient sensor fixation at the fetal head and with the re-sterilization of fetal sensors must be solved in the future. CONCLUSIONS: Fetal pulse oximetry will be incorporated as the third method of monitoring the fetus during labor.

Attitude of Health Personnel↗

PubMedDate not supplied

[Changes of fibrinolysis during labour with and without aprotinin application].

OBJECTIVE: The aim of this study was to determine (a) if alpha-2-antiplasmin, plasminogen and plasminogen-activator-inhibitors (PAI 1 - 4) change in the peripartal period, (b) if these changes are explainable by the detachment of the placenta and the release of coagulation factors, and (c) if aprotinin could affect postpartal fibrinolysis when given shortly before delivery. PATIENTS AND METHODS: 84 patients have been examined (41 normal deliveries, 43 cesarean sections). After informed consent and randomization, 30 of these patients were administered 1 million KIU aprotinin (Trasylol(R)) at the latest 15 minutes before delivery (15 normal deliveries, 15 cesarean sections). The results of PAI (1 - 4), alpha-2-antiplasmin and plasminogen were collected shortly before and after delivery and 30 and 120 min after detachment of the placenta. RESULTS: Normal deliveries and cesarean sections without aprotinin showed an evident decrease of PAI (1 - 4) after delivery while alpha-2-antiplasmin and plasminogen values did not change. After administration of aprotinin the activity of PAI (1 - 4) increased slightly after labour in normal deliveries and cesarean sections and then slowly decreased later. alpha-2-Antiplasmin levels increased post partum and then decreased to the original values. Plasminogen did not change. There were no significant differences between normal deliveries and cesarean sections with regard to the three parameters studied in this work. DISCUSSION AND CONCLUSION: Changes in PAI (1 - 4) and alpha-2-antiplasmin after administration of aprotinin could be the result of a minimal demand on the fibrinolytic system. Finally, aprotinin can reduce the consumption of coagulation and fibrinolysis factors induced by detachment of the placenta. This could be used in therapy and prophylactic treatment in high-risk patients (e.g., pre-eclampsia, HELLP syndrome, etc.).

Adult↗

PubMedDate not supplied

[Evaluation of the reproducibility of Doppler ultrasonographic measurements in obstetrics].

BACKGROUND: Are obstetric doppler ultrasonographic measurements of the fetal and maternal flow parameters reproducible? PATIENTS AND METHODS: For internal quality management, doppler ultrasonographic measurements were performed on 81 patients (random screening sample) with an Acuson Sequoia Ultrasound at the Universitätsfrauenklinik Marburg. Successively two experienced investigators measured the umbilical artery, medial cerebral artery, and the uterine arteries. The correlation between the measurements of the two investigators was presented in a spread chart. In order to exclude systematic differences between the measurements, linear regression was analyzed and the distance to the abscissa was calculated. A relative divergence of more than 20% was determined as a non corresponding measurement. RESULTS: The distance of the linear regression to the abscissa was calculated for the four vessels: umbilical artery 0.4 (95% CI; 0.124 - 0.486), medial cerebral artery 0.9 (95% CI; 0.534 - 1.264), right uterine artery 0.2 (95% CI; 0.124 - 0.305), and left uterine artery 0.2 (95% CI; 0.121 - 0.317). Concerning the four arteries, a divergence of more than 20% between the two investigators was found: umbilical artery 16%, medial cerebral artery 42%, right uterine artery 28%, and left uterine artery 37%. CONCLUSIONS: Because the interobserver variability was surprisingly high and acceptable correlation could be stated only for the umbilical artery, internal quality standards are essential. Routine use of different devices should be made after careful consideration only, especially if clinical decisions are to be based on them.

Blood Flow Velocity↗

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[Fetal reflectance pulse oximetry sub partu. Experiences--prognostic significance and consequences--goals].

Reflectance pulse oximetry is a new method to monitor the fetus during labour in order to get a better assessment of the fetus's condition than by CTG interpretation alone. In this study the method is investigated with regard to its prognostic value concerning fetal outcome and complications possibly due to its application: Increased uterine bleeding, umbilical cord complications, amniotic infection syndrome. Arterial oxygen saturation was continuously recorded during labour in a total of 122 patients with a gestational age between 37 and 42 weeks and correlated to the umbilical cord-pH post partum and, if available, to intrapartum fetal blood gas analysis. 30% seems to be a threshold value below which oxygen saturation should not drop for a longer period of time. A post partum pH < 7.2 can be expected in more than 50% of the cases in which the saturation remains below this value for more than ten minutes. The application of the fetal pulse oximeter sensor did not affect maternal or fetal morbidity.

Adult↗

PubMedDate not supplied

[Cytokines in the diagnosis of amniotic infection syndrome].

Accumulating evidence indicates an association between intraamniotic infection and raising concentrations of amniotic cytokines, resulting in preterm labor and preterm rupture of fetal membranes, because these cytokines are able to stimulate prostaglandin biosynthesis. Therefore the purpose of our study was to investigate if quantitative determination of Il-1 beta, Il-6, Il-8 and TNF-a in amniotic fluid may be a practicable method to diagnose intraamniotic infection. Since invasive amniocentesis doesn't allow repeated cytokine detection, in case of preterm rupture of fetal membranes, amniotic fluid also was obtained by placing a sterile gauze and cotton pad into the women's vagina, absorbing draining amniotic fluid for cytokine detection. Our results clearly indicate that Il-1 beta and TNF-a are not detectable in normal pregnancy, while Il-6 and Il-8 are produced in low, but constant levels. In contrast, in amniotic fluid of patients with intraamniotic infection high amounts of Il-6 and Il-8 were found, while Il-1 beta and TNF-a bioactivity became measurable, indicating that biosynthesis was activated. These results demonstrate, that infection associated cytokines detectable in amniotic fluid are highly sensitive markers for intraamniotic infection. In case of preterm rupture of fetal membranes recovery of amniotic fluid from a vaginal pad allows monitoring of cytokine bioactivity in daily intervals to control success of antibiotic treatment.

Adult↗