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Objective: To describe the use of gauze covered with chitosan, a potent hemostatic agent derived from chitin, in the treatment of postpartum hemorrhage (PPH)., Study Design: Patients suffering from postpartum hemorrhage were treated by uterine packing with chitosan-covered gauze, either through the hysterotomy in case of cesarean delivery or transvaginally, for up to 24 hours., Results: Chitosan-covered gauze was used in 19 cases of postpartum hemorrhage due to uterine atony, placenta accreta/increta, or anticoagulation, including 5 severe cases where a hysterectomy seemed inevitable otherwise. In all but one case, the bleeding stopped and further interventions were avoided. Over comparable periods of time (18 months) and births (3822 vs 4077) before and after the introduction of the chitosan gauze in our clinic, the rate of peripartum hysterectomies was reduced by 75% (8 vs 2; odds ratio, 4.27; P = .044)., Conclusion: Chitosan-covered gauze is a viable option in the treatment of (severe) postpartum hemorrhage. It is easy to use and requires no special training. It can be used after both vaginal and cesarean deliveries, and there are no adverse side effects. Furthermore, it is very inexpensive compared with other treatment options, making it suitable for use also in low resource-countries, where the death toll due to postpartum hemorrhage is especially high., (Copyright © 2013 Mosby, Inc. All rights reserved.)

Background: Gestational diabetes and preeclampsia are leading causes of complications during pregnancy., Aims: The aims of this study were to quantify the probability that both diseases occur together, to evaluate commonality of risk factor profiles, and to clarify the connection between gestational diabetes and preeclampsia in combination with the maternal body mass index., Study Design: We analysed data of the German Perinatal Quality Registry 2006, an annual full inventory of all hospital births in Germany., Subjects: The Registry contains the complete national birth cohort of 668,085 newborn infants and 647,392 mothers from 896 German obstetric clinics., Outcome Measures: Each case of gestational diabetes or preeclampsia that was identified during pregnancy by a gynaecologist or in the hospital was fully registered., Results: The prevalence of GDM was 2.32% and that of PE was 2.31%, resulting in 0.09% of all pregnant women being diagnosed with both diseases. GDM was found to be an independent risk factor for PE. Increased maternal age, nulliparity, and multiple gestation pregnancies could be identified as common risk factors for both diseases, while increased pre-pregnancy body mass index was found to be the most important predictor for both diseases., Conclusions: As PE and GDM share similar risk factors, identification of high-risk groups by simultaneous screening methods seems to be reasonable for prevention of complications. Further studies will be needed to investigate possible pathophysiological pathways increased body mass index has on the induction of both diseases., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Cheap and simple interventions that are intended to minimize postpartum hemorrhage are of major public health concern. We report a case of postpartum hemorrhage in which conservative interventions had failed. The use of a chitosan-covered gauze that originally was developed for combat trauma allowed us to achieve hemostasis, and a seemingly inevitable hysterectomy was avoided., (Copyright © 2012 Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to determine whether optical methods can estimate cervix function during pregnancy and whether progestins modify this process., Study Design: Photos of the external cervix of timed-pregnant rats were taken every other day from day 13 until postpartum day 5 after daily treatments with vehicle (controls) or progestin treatments (progesterone, subcutaneously or vaginally; 17-alpha-hydroxyprogesterone caproate [17P] and RU-486 subcutaneously, once on day 16). The surface area of the cervix was estimated from photos., Results: The surface area of cervix increases throughout pregnancy and reverses after delivery in controls. In the progesterone subcutaneously or 17P subcutaneously groups, increases in surface area are lower (17P group until day 19 only; P < .05). Vaginal progesterone does not prevent surface area increases. Only the progesterone subcutaneously blocked delivery. RU-486 increases the surface area of the cervix (P < .05) during preterm delivery., Conclusion: An optical method is useful for quantitative assessment of the cervix and evaluation of agents that modify cervical function., (Copyright © 2011 Mosby, Inc. All rights reserved.)

Objective: The purpose of this study was to evaluate cervical changes and delivery at term during pregnancy in rats after various progestin treatments., Study Design: Pregnant rats were treated by various routes and vehicles with progesterone, 17-alpha-hydroxyprogesterone caproate (17P), R5020, and RU-486. Delivery time was determined and cervical ripening was assessed in vivo by collagen light-induced fluorescence., Results: The cervix is rigid in the progesterone injection, 17P, and vaginal R5020 groups vs controls. Vaginal progesterone had no effect. RU-486 treatment softened the cervix during preterm delivery. Only subcutaneous injected progesterone, R5020 (subcutaneous and vaginal), and topical progesterone in sesame and fish oil inhibits delivery. Delivery is not changed by subcutaneous injection of 17P, vaginal progesterone, oral progesterone, and topical progesterone in Replens (Crinone; Columbia Labs, Livingston, NJ)., Conclusion: Inhibition of cervical ripening and delivery by progestins depends on many factors that include their properties, the route of administration, and the vehicle. This study suggests reasons that the present treatments for preterm labor are not efficacious., (Copyright (c) 2010 Mosby, Inc. All rights reserved.)

Objectives: Smoking during pregnancy greatly increases the risk of adverse fetal outcomes. This study was conducted to investigate the prevalence of smoking during pregnancy and to identify social, behavioural and preventable perinatal risk factors., Study Design: This study was based on a national registry, acquired in the 2005 German Perinatal Quality Survey, which contains data on 99.31% of deliveries in Germany., Methods: The database draws on prenatal and perinatal data on 668,085 newborns and 647,392 mothers at 917 maternity clinics. Bivariate methods and multiple logistic regression analyses were used., Results: Thirteen percent of pregnant women smoked at least one cigarette per day after becoming aware of their pregnancy. Median cigarette consumption among pregnant smokers was 10 cigarettes per day. The prevalence of smoking was higher than average among women of low socio-economic status (20%), women without a partner (23%) and pregnant women under 20 years of age (34%). Multiparous women and women suffering from psychosocial stress smoked more than the respective reference groups. In addition, pregnant smokers displayed major deficits in terms of prenatal care., Conclusions: This study identified risk groups with above-average smoking prevalence during pregnancy. These risk groups are key target populations for preventive measures.

Objective: The purpose of this study was to determine whether the platelet-activating factor antagonist WEB-2170 inhibits preterm cervical ripening induced by lipopolysaccharide or by antiprogestin RU 486., Study Design: Timed-pregnant rats were killed on day 16 after treatment with (1) WEB-2170, lipopolysaccharide, lipopolysaccharide plus WEB-2170, or vehicle control and (2) with WEB-2170, RU 486, RU 486 plus WEB-2170, or vehicle control. Cervical ripening was assessed by light-induced fluorescence and resistance to stretch. Statistics were assessed by 1-way analysis of variance followed by Tukey-test (P <.05)., Results: Light-induced fluorescence and resistance to stretch were significantly lower in the lipopolysaccharide-treated and in the RU486-treated animals compared with vehicle control (lipopolysaccharide:light-induced fluorescence, 7.0+/-0.6 vs 12.8+/-0.8 [P=.001]; resistance to stretch, 0.41+/-0.03 N/mm vs 0.54+/-0.04 N/mm [P <.05]; RU486:light-induced fluorescence, 9.6+/-0.6 vs 11.7+/-0.6 [P <.05]; resistance to stretch, 0.28+/-0.06 N/mm vs 0.61+/-0.02 N/mm [P <.001]). Compared with vehicle control, WEB-2170 alone did not alter cervical light-induced fluorescence or resistance to stretch. Although WEB-2170 significantly blocked cervical ripening after lipopolysaccharide administration (light-induced fluorescence, 11.3+/-1.3 [P <.05]; resistance to stretch, 0.61+/-0.04 [P <.01]), WEB-2170 did not inhibit the RU 486-induced cervical ripening., Conclusion: Although infection-related cervical ripening is inhibited by platelet-activating factor antagonists, the physiologic process of cervical ripening appears to be unaffected. Platelet-activating factor inhibition may be of clinical value in the infection-related pathologic processes that are responsible for premature cervical ripening.

Objectives: This study was undertaken to evaluate the effect of proteinase-activated receptor-2 (PAR-2) activation on the contractility of uterine tissues from term pregnant rats and the role of mast cells and prostaglandins in such an effect., Study Design: Uterine rings from pregnant (day 20-21) Sprague-Dawley rats were used for isometric tension recording in organ chamber experiments (Krebs solution, 5% carbon dioxide in air, 37 degrees C, pH approximately 7.4). Responses to the PAR-2 activating peptide SLIGRL (serine-leucine-isoleucine-glycine-arginine-leucine), and to the inactive reverse peptide LRGILS (leucine-arginine-glycine-isoleucine-leucine-serine) were determined after pretreatments with compound 48/80, cromolyn, S[+]-chlorpheniramine maleate, cimetidine, combinations of histamine (H) receptor antagonists with cromolyn or ibuprofen and compared with vehicle., Results: SLIGRL significantly augmented contractility of uterine tissues, and this response was not inhibited by compound 48/80, cromolyn, and ibuprofen, as well as by H(1)- and H(2)-receptor antagonists, alone or in combination with cromolyn., Conclusion: PAR-2 activation augments uterine contractility in tissues obtained from term pregnant rats, and this effect is independent of mast cell activation or cyclo-oxygenase pathway products.

Objective: The purpose of this study was to investigate gestational changes of cervical light-induced fluorescence, an index of cross-linked collagen, and the relationship between light-induced fluorescence and the time-to-delivery interval., Study Design: Fifty patients were included in one of two groups. (1) Twenty-one healthy pregnant women without signs of labor underwent repeated cervical light-induced fluorescence measurement during the last trimester. (2) Light-induced fluorescence was measured in 29 patients with signs of labor, and the time from measurement to delivery was noted. Cervical light-induced fluorescence was obtained noninvasively with a prototype instrument that was designed specifically for this purpose. Spearman correlation and the Student t test and receiver-operator characteristics analysis were performed (P <.05)., Results: Light-induced fluorescence correlated negatively with gestational age and positively with time-to-delivery interval, was significantly lower in patients who were delivered <24 hours compared with those patients who were delivered >24 hours later, and was predictive of delivery within 24 hours., Conclusion: Cervical light-induced fluorescence decreases significantly as gestational age increases. Light-induced fluorescence may be a useful tool to identify patients in whom delivery is imminent.

Objective: The purpose of this study was to determine the effect of locally applied platelet-activating factor on cervical ripening and leukocyte infiltration., Study Design: Timed-pregnant rats were treated vaginally twice each day on days 14 and 15 of gestation with platelet-activating factor 5 x 10(-8) mol/L (low-dose), 5 x 10(-7) mol/L (high-dose), or solvent and were killed on day 16. Cervical ripening was assessed by cervical resistance-to-stretch and light-induced autofluorescence of cross-linked collagen. Longitudinal sections of the cervix were hematoxylin and eosin stained, and the number of polymorphonuclear leukocytes in eight high-power fields was determined., Results: Cervical resistance-to-stretch and light-induced autofluorescence were decreased in rats that were treated with high-dose platelet-activating factor compared with controls (0.4375 +/- 0.0126 N/mm vs 0.5528 +/- 0.0294 N/mm, and 2.739 +/- 0.150 N/mm vs 3.475 +/- 0.236 N/mm; P <.05). High-dose platelet-activating factor led to infiltration with polymorphonuclear leukocytes compared with control (22.1 +/- 5.2 vs 2.1 +/- 1.3 cells/8 high-power fields, P <.05)., Conclusion: Local platelet-activating factor application induces cervical ripening accompanied by stromal polymorphonuclear leukocyte infiltration. Platelet-activating factor may play a major role in parturition under physiologic and pathologic conditions.

Objective: Understanding the physiology of the uterus and cervix during term and preterm parturition is crucial for developing methods to control their function and is essential to solving clinical problems related to labor. To date, only crude, inaccurate, and subjective methods are used to assess changes in uterine and cervical function in pregnancy., Methods: In the past several years, we have developed noninvasive methods to quantitatively evaluate the uterus and cervix based on recording of uterine electrical signals from the abdominal surface (uterine electromyography) and measurement of light-induced fluorescence (LIF) of cervical collagen (Collascope), respectively. Both methods are rapid and allow immediate assessment of uterine contractility and cervical ripening., Results: Studies in animals and humans indicated that uterine and cervical performance can be monitored successfully during pregnancy using those approaches and that these techniques can be used during labor to better define management in a variety of conditions associated with labor., Conclusion: The potential benefits of the proposed instrumentation and methods include reducing the rate of preterm delivery, improving maternal and perinatal outcome, monitoring treatment, decreasing cesarean rate and providing research methods to understand uterine and cervical function.