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Biomedical subjects

P Husslein

Publications and source records attributed to P Husslein.

At least 19 recordsLinked to original sources
PubMed2006

Effects of different human chorionic gonadotrophin preparations on trophoblast differentiation.

Recent evidence from the literature suggested that hCG preparations purified from urine of pregnant women, which are widely used in in vitro studies and IVF programs, may contain contaminants such as EGF. To determine the putative biological effects of the contaminating growth factor, we here investigated distinct trophoblast differentiation processes in the presence of various hCG compounds. Western blot analyses indicated that treatment of trophoblastic SGHPL-5 cells and purified term trophoblasts with potentially EGF-contaminated hCG (hCG-A) resulted in auto-phosphorylation of the EGF receptor at tyrosine 1173 whereas supplementation of another urine-purified hCG preparation (hCG-B), recombinant holo-hCG or recombinant alphahCG had no effects. Phosphorylation was specifically blocked by the EGF receptor inhibitor PD153035. Urinary hCG-A was most effective in promoting invasion of SGHPL-5 cells through Matrigel-coated transwells, but increased invasiveness was also observed in the presence of hCG-B or recombinant holo-hCG. Similarly, the extent of syncytialisation of term trophoblasts, quantitated by nuclei in desmoplakin-negative areas, was highest upon addition of hCG-A or recombinant EGF as a control. PD153035 reduced invasion and fusion of trophoblasts supplemented with hCG-A, but did not diminish the effects provoked by hCG-B. In conclusion, the data suggest that the EGF contamination of hCG considerably affects trophoblast function. Experiments using EGF-free hCG preparations demonstrate that the hormone increases trophoblast invasion and syncytialisation.

Cell Differentiation↗
PubMed2006

Mode of delivery is associated with maternal and fetal endocrine stress response.

OBJECTIVE: To determine whether mode of delivery is associated with the endocrine stress response in mother and child. DESIGN: Prospective observational study. SETTING: Tertiary care centre, University hospital. POPULATION: A total of 103 nulliparous women with uncomplicated singleton pregnancies at term undergoing either spontaneous labour for vaginal delivery or delivering by caesarean section without labour. Thirty women delivered vaginally without any pain relief, 21 women delivered vaginally with epidural anaesthesia, 23 women had ventouse extraction and 29 women underwent caesarean section with epidural analgesia. METHODS: After delivery, maternal and umbilical cord blood was collected for determination of different stress-associated hormones. MAIN OUTCOME MEASURES: Concentrations of epinephrine (EP), norepinephrine (NOR), adrenocorticotropic hormone (ACTH), cortisol (CORT), prolactin (PRL), corticotropin-releasing factor and beta-endorphin (BE). RESULTS: Caesarean section was associated with significantly lower maternal concentrations of EP, NOR, ACTH, CORT, PRL and BE and lower newborn levels of EP, NOR and CORT compared with all other modes of delivery. Concentrations of EP, ACTH and BE differed significantly in newborns delivered by normal vaginal delivery, vaginal delivery with epidural anaesthesia and ventouse extraction. CONCLUSIONS: The mode of delivery and analgesia used during birth are associated with maternal and fetal endocrine stress responses.

Adrenocorticotropic Hormone↗
PubMed2006

Clinical practice evaluation of atosiban in preterm labour management in six European countries.

OBJECTIVE: To evaluate the efficacy and safety of early administration compared with standard administration of atosiban, when predefined eligibility criteria were met. DESIGN: A prospective, open-label, randomised clinical trial. Women were randomised to receive atosiban either immediately (early) or when specified criteria, in terms of duration/frequency of uterine contraction or status of cervical dilation/effacement, were fulfilled (standard). SETTING: Carried out at 105 centres in six European countries. POPULATION: Pregnant women admitted to hospital in threatened preterm labour between 24 and 34 weeks of gestation, comprising a subgroup of women enrolled in the Tractocile Efficacy Assessment Survey in Europe (TREASURE) clinical experience review. MAIN OUTCOME MEASURES: Efficacy was defined as the successful delay of delivery with no alternative tocolytic agent for 48 hours. RESULTS: More women in the early group remained undelivered at 48 hours with no alternative tocolytic agent compared with those who received atosiban when specified criteria were fulfilled (88.9 versus 76.1%; P = 0.03). Safety was comparable between the groups. There were no statistical differences in maternal, fetal or neonatal adverse events between the early and standard atosiban arms. CONCLUSIONS: The use of atosiban was effective for the delay of preterm labour and presented no safety concerns irrespective of the time it was administered.

Adolescent↗
PubMed2005

Cost effectiveness of a screen-and-treat program for asymptomatic vaginal infections in pregnancy: towards a significant reduction in the costs of prematurity.

OBJECTIVE: The purpose of this investigation was to determine the cost-saving potential of a simple screen-and-treat program for vaginal infection, which has previously been shown to lead to a reduction of 50% in the rate of preterm births. STUDY DESIGN: To determine the potential cost savings, we compared the direct costs of preterm delivery of infants with a birth weight below 1900g with the costs of the screen-and-treat program. We used a cut-off birth weight of 1900g because, in our population, all infants with a birth weight below 1900g were transferred to the neonatal intensive care unit. The direct costs associated with preterm delivery were defined to include the costs of the initial hospitalization of both mother and infant and the costs of outpatient follow-up throughout the first 6 years of life of the former preterm infant. The costs of the screen-and-treat program were defined to include the costs of the screening examination and the resulting costs of antimicrobial treatment and follow-up. All calculations were based on health-economic data obtained in the metropolitan area of Vienna, Austria. RESULTS: The number of preterm infants with a birth weight below 1900g was 12 (0.5%) in the intervention group (N=2058) and 29 (1.3%) in the control group (N=2097). The direct costs per preterm birth were found to amount to EUR (euro) 60262. Overall, the expected total savings in direct costs achieved by the screen-and-treat program and the ensuing 50% reduction in the number preterm births with a birth weight below 1900g amounted to more than euro 11 million. The costs of screening and treatment were found to amount to merely 7% of the direct costs saved as a result of the screen-and-treat program. CONCLUSION: A simple preterm prevention program, consisting of screening and antimicrobial treatment and follow-up of women with asymptomatic vaginal infection, leads not only to a significant reduction in the rate of preterm births but also to substantial savings in the direct costs associated with prematurity.

Adult↗
PubMed2005

Tissue-specific and ubiquitous basic helix-loop-helix transcription factors in human placental trophoblasts.

Tissue-specific class B basic helix-loop-helix (bHLH) transcription factors, dimerising with ubiquitously produced class A bHLH proteins, play a major role in murine trophoblast development. Here, we investigated expression patterns of class A and B bHLH factors in the human placenta and different trophoblast culture systems. Semi-quantitative RT-PCR and RNase protection assay revealed expression of the tissue-restricted factors Hash-2, I-mfa and Stra13 in placentae of early and late pregnancy, in purified villous trophoblasts as well as in invasive trophoblasts isolated from first trimester villous explant cultures. Accordingly, RNA in situ hybridisation localised Hash-2, I-mfa and Stra13 to the trophoblast epithelium, cell columns and extravillous trophoblasts invading maternal decidua. Villous stromal cells in situ and cultivated placental fibroblasts also produced I-mfa and Stra13 but failed to express Hash-2. The widely expressed class A proteins, E12/E47 were absent from all placental cell types while ITF-2 was restricted to placental stromal cells of early and late gestation. In contrast, HEB was identified in all trophoblast cell types using RT-PCR, Western blotting and immunohistochemistry. The negative HLH-regulators Id-1 and Id-2 lacking the DNA-binding domain, were detected in villous stromal cells and different cytotrophoblast subtypes but were absent from the syncytium. The data suggest that a complex interplay of activators (Hash-2, HEB) and repressors (Stra13, I-mfa) could be involved in extravillous trophoblast differentiation whereas downregulation of Id proteins could play a role in syncytialisation.

Adult↗
PubMed2005

Invasive trophoblasts generate regulatory collagen XVIII cleavage products.

Endostatin, the C-terminal proteolytic fragment of the noncollagenous domain 1 (NC1) of the basement membrane protein collagen XVIII, inhibits cell proliferation and migration. Placental and decidual expression of the peptide suggested a role in angiogenesis and/or extravillous trophoblast differentiation. Here, we demonstrate that supernatants of trophoblastic SGHPL-5 cells, purified first trimester villous trophoblasts and villous explant cultures contain proteases which in vitro cleave 20kDa endostatin from purified, recombinant NC1 domains. However, supernatants of decidual and villous fibroblasts failed to generate the 20kDa endostatin fragment. Moreover, we show that recombinant endostatin inhibits invasion of SGHPL-5 cells through Matrigel invasion chambers. Since mesenchymal cells but not trophoblasts produce collagen XVIII we suspect that invasive trophoblasts may produce endostatin upon contacting the extracellular matrix deposited by decidual stromal cells. Generation of endostatin through trophoblast-derived proteases could play a role in the regulation of trophoblast invasiveness.

Cell Differentiation↗
PubMed2004

Expression pattern of collagen XVIII and its cleavage product, the angiogenesis inhibitor endostatin, at the fetal-maternal interface.

Endostatin, the C-terminal fragment of the basement membrane protein collagen XVIII regulates epithelial cell migration and impairs tumour growth by inhibiting angiogenesis. Here, we investigated the expression pattern of collagen XVIII/endostatin in human placental and decidual tissues of various ages of gestation as well as in primary villous cytotrophoblasts, trophoblast cell lines, and villous explant cultures differentiating along the invasive pathway. RT-PCR analysis revealed production of collagen XVIII mRNA in total placenta and decidua of early and late pregnancy and in SGHPL-5 and HTR-8/Svneo cells. Collagen XVIII transcripts were absent from purified extravillous trophoblasts and syncytialising trophoblast cultures. Accordingly, an antibody against a protein domain common to different collagen XVIII isoforms detected the 180 kDa protein in villous and decidual tissue and cultivated placental fibroblasts but not in the different isolated trophoblast cell types. Immunohistochemical analyses localised collagen XVIII to villous basement membranes and to the endothelium as well as to placental and decidual stromal cells. Interestingly, expression of various forms of endostatin (20 and 26 kDa) was detected in placenta and decidua using Western blot analyses. Moreover, supplementation of recombinant endostatin increased MMP-2 expression in villous explant cultures and SGHPL-5 cells suggesting that the inhibitor may modulate extravillous trophoblast differentiation.

Adult↗
PubMed2003

Review of clinical experience with atosiban and the Tractocile Efficacy Assessment Survey in Europe (TREASURE) study protocol.

A phase IV multinational, multicentre study has been designed--the Tractocile Efficacy Assessment Survey in Europe (TREASURE). The aim is to assess atosiban in the clinical setting, which is associated with fewer restrictions than in phase III trials. Atosiban is to be compared with 'usual care' in women eligible for treatment, and will also be evaluated as deferred or immediate treatment in women who have not yet fulfilled the diagnostic criteria for pre-term labour. Exploring the use of atosiban beyond the normal indications may allow the identification of additional subpopulations of women who will benefit from early treatment. TREASURE will offer data on new diagnostic tools, investigate respiratory distress syndrome according to severity and record the use of antenatal steroids. It is hoped that additional information concerning the subtle differences in clinical practice will broaden our understanding of how to manage pre-term labour and offer the chance to revise treatment guidelines.

Female↗
PubMed2002

Continuous vs interrupted sutures for single-layer closure of uterine incision at cesarean section.

In a non-randomized cohort study, we compared continuous with interrupted sutures for the closure of the lower uterine segment at cesarean section. Eighty-two women, who underwent cesarean section at the Department of Obstetrics at the University Hospital of Vienna between January and May 2000, were included in the study. Thirty-eight patients had single-layer closure of the lower uterine segment and 43 patients had closure with interrupted sutures. There were significant differences in total operating-time (32 min vs 40 min, P=0.001) and in the pre- and postoperative maternal hemoglobin (DeltaHb 0.6 g/dl vs 1.1 g/dl, P<0.01), but there was no significant difference in sonographically diagnosed hematomas (32% vs 21%, P=0.27). No woman had fever, the median hospitalization time was 6 days, and there were no re-admissions. In both groups, the median need for analgesics was 150 mg diclofenac ( P=0.22). Continuous single-layer closure of the lower uterine segment at cesarean section saves operating time, reduces blood loss, and introduces less foreign material into the wound.

Adult↗
PubMed2002

The effect of epidural analgesia on the occurrence of obstetric lacerations and on the neonatal outcome during spontaneous vaginal delivery.

The aim of this study was to determine if epidural analgesia is associated with increased risk of obstetric lacerations during spontaneous vaginal delivery. Furthermore we assessed the effect of epidural analgesia on maternal and neonatal parameters. This multicenter study consisted of an analysis of data from the delivery databases of the University Hospital of Vienna and the Semmelweis Women's Hospital Vienna. This study was restricted to a sample that included all women with uncomplicated pregnancy, a gestational age >37(th) weeks and a pregnancy with cephalic presentation. Epidural analgesia was set during the first stage of labour. Techniques and management styles of epidural analgesia were the same in both hospitals. No statistically significant association was found between epidural analgesia and the occurrence of perineal tears (p=0.83), vaginal (p=0.37) or labial trauma (p=0.11). Furthermore the results demonstrated a statistically significant higher rate of primiparous women using epidural analgesia (p=0.001). A statistically significant prolonged second stage of labour was observed in women undergoing epidural analgesia (p=0.0001). Episiotomy was statistically significant more frequent in women requiring epidural analgesia (p=0.0001). Women who were treated with epidural analgesia were more likely to have labour augmented with oxytocin (p=0.001). No statistically significant differences in neonatal outcomes determined by APGAR score (p=0.84) and cord pH (p=0.23) were observed between the two groups. Women undergoing epidural analgesia demonstrated a prolonged second stage of labour, a higher rate of episiotomy and an increased use of oxytocin to augment labour. Some of these adverse effects might be caused by the higher rate of primiparous women using epidural analgesia. However, epidural analgesia showed no evidence of a detrimental effect on the integrity of the birth-canal in spontaneous vaginal delivery. In our opinion it is a save and effective method of pain relief during labour.

Analgesia, Epidural↗
PubMed2002

Postpartum bleeding and von Willebrand's disease.

We calculated the decreases in hemoglobin levels between the day of delivery and postpartum day 3 in all 3565 deliveries of the year 1997. Fourteen patients had a drop in hemoglobin level of more than 8% and were included in the study. Ten women without excessive bleeding served as a control group. In all women tested, plasma von willebrand factor antigen (vWF:Ag) correlated well with factor VIII:C activity, and both were within normal limits, so that we were able to exclude the presence of type I von willebrand's disease (vWD I). Two women in the excessive bleeding group were found to have an isolated decrease in coagulation factor activity. In one patient, factor XI:C and XII:C activities were reduced to 46% and 53% respectively, and APTT was prolonged to 48.5 seconds. In the other, factor VII:C activity had dropped to 69%, and Normotest results were only 62%. Ten of the 14 patients and 1 woman of the control group were diagnosed as having mild anemia. We conclude that investigations for vWD I should only be done in women with a previous history of abnormal bleeding.

Adult↗
PubMed2002

[Elective cesarean section--delivery mode of the future or social misconception?].

Over the past 20 years, the rate of Cesarean section has undergone a marked increase on a global level and it appears unlikely that this trend will be reversed in the near future. This fact has also raised a number of questions regarding the growing preference for elective Cesarean section following a complication-free pregnancy and in the absence of medical indications. Both, the mortality rate of carefully prepared procedures of this kind, as well as the attending morbidity rate, have been successfully reduced in recent years owing to improvements in section technique, causing certain of the maternal and fetal risks accompanying vaginal delivery to come under closer scrutiny than before. The potential damage to the perineum during birth--and the impairment of the parturient's sexuality this may cause--in conjunction with the fact that vaginal delivery continues to expose the infant to certain risks which cannot be ruled out entirely, has made the choice between vaginal delivery and Cesarean section increasingly difficult. The argument most frequently cited in favour of vaginal delivery concerns the unimpaired birth experience it offers. Many women, however, do not consider this a high priority. In keeping with the greater importance currently being assigned to patients' preferences, the authors support the view that the parturient herself should be enabled to decide what level of risk is acceptable to her, including stating her preference for a delivery by Cesarean section. It cannot be stressed enough that, in this context, comprehensive information and rigorous documentation are indispensable requirements.

Cesarean Section↗
PubMed2002

[Multiple pregnancy].

The incidence of multiple pregnancies has increased considerably over the past 20 years in the western world. The number of twin pregnancies has increased by approximately 25% and the rate of triplet and higher order multiple pregnancies has more than doubled. This is due to the use of ovarian hyperstimulation and assisted reproduction techniques, and to the increasing maternal age. Multiple pregnancy can be considered as the most important adverse outcome of infertility treatment. The main determinant for outcome and management of multiple pregnancies is the chorionicity. This can be determined by ultrasound until 14 weeks of gestation. Twenty percent of all twin pregnancies are monochorionic, and 15% of these develop severe twin to twin transfusion syndrome, which is best treated by LASER separation of the communicating blood vessels. Obstetric complications associated with multiple gestation also occur more frequently in monochorionic twins. They include increased incidence of preterm labor, intrauterine growth restriction and assisted or surgical delivery. Neonatal problems include low birthweight and increased prevalence of congenital malformations. Overall, there has been a decrease in neonatal mortality of twins and triplets over the past 10 years, which is mainly due to the enormous advances in neonatal intensive care.

Cross-Sectional Studies↗
PubMed2001

Acupuncture for cervical ripening and induction of labor at term--a randomized controlled trial.

OBJECTIVE: The aim of this study was to evaluate whether acupuncture at term can influence cervical ripening, induce labor and thus reduce the need for postdates induction. METHODS: On the estimated date of confinement (EDC) women were prospectively randomized to an acupuncture group (AG) or a control group (CG). Data of 45 women were evaluated (AG, n = 25; CG, n = 20). Inclusion criteria were as follows: confirmed EDC, uncomplicated course of pregnancy, singleton pregnancy in cephalic presentation. Exclusion criteria were as follows: cervical dilation > 3 cm, active labor, premature rupture of membranes, previous cesarean section, pathologies in mother or fetus. Women were examined at 2-day intervals. The cervical length was measured with vaginal ultrasonography, cervical mucus was obtained for a fetal Fibronectin test and the cervical status was assessed according to the Bishop score. In the AG, the points Hegu (Large Intestine 4) and Sanyinjiao (Spleen 6) were pierced on both sides every second day. If women were not delivered 10 days after EDC, labor was induced by administering vaginal prostaglandin tablets. RESULTS: The cervical length in the AG was shorter than that in the CG on day 6 and day 8 after EDC (P = 0.04 for both). In the AG the time period from the first positive Fibronectin test to delivery was 2.3 days, while that in the CG was 4.2 days (P = 0.08). The time period from EDC to delivery was on average 5.0 days in the AG and 7.9 days in the CG (P = 0.03). Labor was induced in 20% of women in the AG (n = 5) and in 35% in the CG (n = 7) (P = 0.3). Overall duration of labor, and first and second stage of labor were not different in the two groups. In 56% of women who underwent acupuncture (n = 14) and in 65% of controls (n = 13), Oxytocin was used to augment labor. (P = 0.54). CONCLUSION: Acupuncture at points LI4 and SP 6 supports cervical ripening at term and can shorten the time interval between the EDC and the actual time of delivery.

Acupuncture Points↗
PubMed2001

Perineal lacerations during spontaneous vaginal delivery.

BACKGROUND: The aim of the study was to assess the frequency of perineal lacerations during normal spontaneous vaginal delivery and to evaluate potential risk factors. METHODS: The study is based on an analysis of data from the obstetric database of the University Hospital of Vienna and the Semmelweis Women's Hospital Vienna, from February 1999 through to July 1999. Women with vaginal deliveries, uncomplicated pregnancies, uncomplicated first and second stage of labor, gestational age > 37 weeks and pregnancies with cephalic presentation were included. RESULTS: Of 1009 women, 36.2% had perineal lacerations (18.1% had first-degree, 15.2% second-degree, and 2.9% third-degree perineal tears). Univariate logistic regression models showed that only low parity (p = 0.004), the absence of episiotomy (p = 0.0001), and a large head diameter of the infant (p = 0.005) increased the risk for perineal laceration. After adjustment in multivariate analysis, low parity (p = 0.0001), the absence of episiotomy (p = 0.0001) and a large head diameter (p = 0.0004) remained independent risk factors for perineal laceration. Additionally, advanced age of the mother was associated with an increased risk of perineal laceration (p = 0.03). When analyzing the probability for third-degree perineal tears, a strong association with primiparity (p = 0.01), the use of episiotomy (p = 0.0001), a prolonged second stage of labor (p = 0.0001), a large head diameter of the infant (p = 0.01) and the use of oxytocin (p = 0.008) was found. CONCLUSIONS: Primiparous women who are being delivered of a large child are at a greater risk for severe perineal lacerations. In the study population episiotomy did not appear to protect against severe perineal lacerations.

Adolescent↗
PubMed2001

Serum levels of adhesion molecules in women with pregnancy-induced hypertension.

In a matched pair study, we investigated the serum levels of intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), platelet endothelial cell adhesion moleculae-1 (PECAM-1) and P-selectin in 40 nulliparous patients with pregnancy-induced hypertension (PIH) and in 40 normotensive pregnant controls by using an enzyme-linked immunosorbent assay (ELISA). Multivariate logistic regression models were used to analyze the influence of elevated serum levels of adhesion molecules on the occurrence of PIH and on the association with the severe form of the disease. The median serum levels of ICAM-1, VCAM-1 and PECAM-1 were significantly elevated in women with PIH compared to controls (296 and 222 ng/ml, p = 0.003, 633 and 505 ng/ml, p = 0.02 and 7.7 and 6.6 ng/ml, p < 0.0001, respectively), whereas the differences of the median serum levels of P-selectin were not significantly between groups. In a multivariate logistic regression model, the serum levels of ICAM-1 and PECAM-1 revealed a significant influence on the occurrence of PIH versus healthy pregnant women (p = 0.04 and p = 0.006, respectively), whereas VCAM-1 and P-selectin serum levels were not associated with the occurrence of pregnancy-induced hypertension (p = 0.3 and p = 0.2, respectively). In a multivariate logistic regression model, the serum levels of PECAM-1 were associated with severe disease (p = 0.002). Our data indicate that the expression of ICAM-1 and PECAM-1 is upregulated in patients with pregnancy-induced hypertension. Elevated serum levels of PECAM-1 were associated with the development of severe disease.

Adult↗
PubMed2001

[Non-closure of peritoneum at cesarean section. Results from repeat cesarean sections].

OBJECTIVES: A number of publications advocate the short-term advantages of peritoneal nonclosure at cesarean section. However, currently there are no hard data available about long-term results and the repeat cesareans. MATERIAL AND METHODS: The study group of this retrospective analysis consisted of 30 women who underwent a repeat cesarean delivery, after a previous cesarean without closure of the visceral and parietal peritoneum. The control group (n = 31) had undergone peritoneal closure at the primary operation. All cesareans were performed at the same institution between 04/01/1997 and 12/31/1998 (first operation), and 01/01/1999 and 06/30/2000 (repeat operation). RESULTS: The mean operation time was 38.9 (+/- 11.6) minutes in the study group and 44.2 (+/- 13.6) minutes in controls (p = 0.05). The mean incision-delivery time was 6.7 (+/- 3.2) minutes in the study group and 9.1 (+/- 3.9) minutes in controls (p < 0.01). No difference in intraoperative blood loss was observed between the two groups. In each cohort one case with significant intraabdominal adhesions was observed. CONCLUSION: Our results indicate that nonclosure of the peritoneum at primary cesarean section does not promote intraabdominal adhesions. This appears to be beneficial for the repeat cesareans.

Abdomen↗