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Objective: to explore pregnant women's experiences with the recently implemented screening for gestational diabetes mellitus (GDM). Design: qualitative study. Setting: Rhine-Neckar Metropolitan region, Germany. Participants: 20 pregnant women aged 27-41 years (mean: 32.6 years) who were at least in gestational week 29, i.e., those who should have already been screened for GDM. Measurements and findings: semi-structured interviews with open-ended questions were conducted via telephone between November 2013 and February 2014. All interviews were audiotaped, transcribed verbatim and subsequently analyzed using qualitative content analysis according to Mayring. The screening was seen as an important instrument to detect GDM and thus to prevent possible health problems in both mother and child. Some deviations from the recommended screening procedure were reported in the interviews, e.g., collecting capillary blood instead of venous blood during an oral glucose tolerance test (OGTT); offering an OGTT without a prior glucose challenge test (GCT); conducting a GCT after an overnight fast. Two women had to actively ask for the screening to be done. One woman reported that her gynaecologist advised her against the screening. Conclusion and implication for practice: this qualitative study reflects the women's experiences with the new screening for GDM. Our findings show that two years after the introduction of universal GDM screening in Germany the screening procedure does not always seem to meet the standards of the German maternity guidelines. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To define the changes in cervical light-induced fluorescence (LIF), an index of cross-linked collagen, after the use of locally applied prostaglandin preparations for labor induction at term and the correlation between LIF and Bishop-Score. Study design: The characteristic LIF of cervical collagen was measured from the surface of the cervix using a specially designed instrument (collascope) in 41 gravidas undergoing labor induction at term by prostaglandins. LIF and Bishop-Score were obtained directly before and 4h after the administration of prostaglandin. Paired Student''s t-test, Wilcoxon Signed Rank test, Linear Regression, Spearman correlation and Fisher Exact test were used as appropriate. Results: Cervical LIF decreased significantly after prostaglandin application (0.982±0.04 [before] to 0.885±0.037 [after], p =0.025). The decrease in LIF correlated with the initial LIF before PG-application (r =0.61). The Bishop-Score increased in all 41 patients. No correlation was found between LIF versus Bishop-Score. Conclusions: Cervical application of prostaglandins decreases the amount of cross-linked collagen as measured by LIF. This effect was observed only in patients with a prior high cross-linked collagen. [Copyright &y& Elsevier]

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. [ABSTRACT FROM AUTHOR]

Objective: To investigate the content of tumor necrosis factor α, interleukin-1β, interleukin-6 and interleukin-8 messenger ribonucleic acid (mRNA) in the lower uterine segment during term parturition. Study design: mRNA extracts from the lower uterine segment obtained from 53 women undergoing non-elective caesarean section at term were analyzed by semi-quantitative reverse transcriptase polymerase chain reaction. The patients were grouped according to cervical dilatation (less than 2 cm, n=18; 2 to less than 4 cm, n=13; 4–6 cm, n=7; more than 6 cm, n=15) at the time of caesarean section. Results: Interleukin-1β and interleukin-8 mRNA-contents at more than 6 cm cervical dilation were significantly higher than at less than 2 cm. The levels of interleukin-6 were already significantly increased in the 4–6 cm group, while the tumor necrosis factor α ribonucleic acid content did not change during parturition. Conclusion: The process of cervical dilatation during parturition at term is associated with an increased expression of interleukin-1β, interleukin-6 and interleukin-8 mRNA in the lower uterine segment. These findings support the theory that the activation of the inflammatory network plays an important role in the progress of cervical dilatation. [Copyright &y& Elsevier]

Previous studies have shown that e-cigarettes are perceived as being less harmful than tobacco cigarettes by pregnant women and might be used to quit smoking during pregnancy. Our aim was to further explore and characterise perceived threats, benefits and barriers of e-cigarette use during pregnancy. Our ST udy on E -cigarettes and P regnancy (STEP) was, among others, based on a netnographic approach of analysing existing threads in German-speaking online discussion forums dealing with perceived threats and benefits of e-cigarette use during pregnancy. For the analysis, we used an inductive-deductive qualitative content analysis. Based on 25 online discussion threads containing 1552 posts, we identified perceived threats, perceived benefits and perceived barriers to e-cigarette use during pregnancy, among others, as main themes. Subthemes identified within the main theme perceived threats were severe nicotine related health risks, potential health risks of additional ingredients, relative risks and lack of knowledge and research studies. As perceived benefits , we identified possibility and facilitation of smoking cessation, harm reduction and financial benefits. Perceived barriers were lack of satisfaction and social stigma. Our qualitative results suggest that the perception of the health threats related to e-cigarette use during pregnancy varies according to the nicotine content and the perception of relative risks compared with tobacco cigarettes. In addition to this, risk perception is defined through further health and non-health related barriers and benefits (e.g. suitability of e-cigarettes as a smoking cessation aid, social stigma). [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Objectives: Current international guidelines recommend tocolytic treatment by at least 48 h to complete fetal lung maturation and to ensure in-utero transfer to a perinatal center before 34 weeks of gestation in patients with threatened preterm birth. According to the results of former surveys, significant differences between daily clinical practice patterns and evidence-based guideline recommendations regarding tocolytic treatment have been demonstrated. We compared data from a nation-wide survey on the practice of initial tocolysis with recommendations from the current German Guideline 015/025 "Prevention and Treatment of Preterm Birth".Study Design: 632 obstetric units in Germany received a link to an online questionnaire between January 20th and March 31st 2020, which was developed according to national and international recommendations and guidelines. Collected data was descriptively analyzed by performing measures of frequency.Results: The response rate was 19%; 51 (42.5%) of the respondents consider CTG tracing with ≥ 4 contractions within 20 min, 49 (40.8%) cervical length measurement of ≤ 25 mm and 13 (10.9%) subjective contractions as the most significant decision-making criteria for tocolysis; 47 (39.2%) of obstetric units initiate tocolysis earliest at 23 + 0, 34 (28.3%) at 22 + 0, 26 (21.7%) at 23 + 5 and 13 (10.8%) at 24 + 0 weeks of gestation; 104 (86.7%) stop tocolysis latest at the 34 + 0 weeks of gestation, 42 (35.0%) obstetric units administer antenatal corticosteroids at 23 + 5, 16 (13.3%) at 22 + 0, and 13 (10.8%) at 24 + 0 weeks of gestation. Calcium channel blockers are the first-line tocolytic drug used by 59 (49.1%) of the obstetric units, followed by intravenous betamimetics as bolus (n = 26, 21.7%) and atosiban (n = 20, 16.7%). Severe side-effects were observed by 105 (70%) of the respondents in association with the use of betamimetics, 14 (9.3%) with the use of nifedipine and 30 (20.0%) with nitroglycerine patches. The German guideline was considered the most important decision-making support by 78 (65%) of the obstetric units, followed by hospital specific SOPs/algorithms (n = 31, 25.8%).Conclusion: Our survey highlights a considerable discrepancy between evidence-based guideline recommendations and daily clinical practice. [ABSTRACT FROM AUTHOR]

Objective: To study if spontaneous contractions augmented by proteinase-activated receptor-2 (PAR-2)-activating peptide serine-leucine-isoleucine-glycine-arginine-leucine (SLIGRL) involve coactivation of membrane chemoceptors and are associated with expression of PAR-2 mRNA in non-pregnant and pregnant rat myometrium.Materials and Methods: Non-pregnant, mid-pregnant, and late pregnant rat uterine horn and small intestine segments were snap-frozen in liquid nitrogen to determine PAR-2 mRNA levels by real time polymerase chain reaction (PCR). Uterine rings were used for isometric tension recording. Effect of SLIGRL (0.1 mM) on spontaneous contractions before and after exposure to ibuprofen (cyclooxygenase inhibitor, 1.0 microM), SQ-29548 (thromboxane A(2) receptor inhibitor, 1.0 microM), ketotifen (histamine 1 receptor inhibitor, 10 microM), WEB-2170BS (platelet-activating factor (PAF) receptor inhibitor, 10 microM), atropine (muscarinic receptor inhibitor, 0.1 microM), or ketanserin (serotonin receptor inhibitor, 10 microM) were compared. Paired t-test and one-way ANOVA followed by Dunnett's or Newman-Keuls post hoc tests were used for statistical analysis when appropriate.Significance: P<0.05.Results: The agents did not significantly affect time-associated decay in spontaneous contractile activity in any group of the tissues. Activation of spontaneous contractions induced by SLIGRL in non-pregnant rat myometrium did not involve coactivation of membrane chemoceptors, while in mid-pregnant rat myometrium coactivation of prostanoid, histamine, and serotonin receptors and in late pregnant rat myometrium coactivation of thromboxane receptors was noted. Expression of PAR-2 mRNA was similar in non-pregnant, mid-pregnant, and late pregnant rat myometrium.Conclusions: Expression of PAR-2 in rat myometrium is not dependent on gestational age. Stimulation of PAR-2 is associated with production/release of cyclooxygenase pathway product(s) activating thromboxane/prostaglandin H2 receptors, partial involvement of histamine H1 receptors and serotonin receptors in midpregnancy and thromboxane A2/prostaglandin H2 receptors in late pregnancy. [ABSTRACT FROM AUTHOR]

Abstract: 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 &y& Elsevier]

Objective: The significant role of direct contact between hematopoietic progenitor cells (HPC) and the cellular microenvironment for maintaining “stemness” has been demonstrated. Human mesenchymal stem cell (MSC) feeder layers represent a surrogate model for this interaction. Specific adhesion molecules are responsible for this cell−cell contact. Methods: To define cell−cell contact between HPC and MSC, we have studied adhesive interaction of various fractions of HPC by using a novel assay based on gravitational force upon inversion. Adherent and nonadherent cells were separated and further analyzed with regard to gene expression and long-term hematopoietic culture initiating cell (LTC-IC) frequency. Results: HPC subsets with higher self-renewing capacity demonstrated significantly higher adherence to human MSC (CD34+ vs CD34−, CD34+/CD38− vs CD34+/CD38+, slow dividing fraction vs fast dividing fraction). LTC-IC frequency was significantly higher in the adherent fraction than in the nonadherent fraction. Furthermore, genes coding for adhesion proteins and extracellular matrix were higher expressed in the adherent subsets of CD34+ cells (fibronectin 1, cadherin 11, vascular cell adhesion molecule-1, connexin 43, integrin β-like 1, and TGFBI). Conclusion: In this study we have demonstrated that primitive subsets of HPC have higher affinity to human MSC. The essential role of specific junction proteins for stabilization of cell−cell contact is indicated by their significant higher expression. [Copyright &y& Elsevier]

Abstract: To understand cervical ripening and especially the pathophysiology of cervical insufficiency, it is important to know the cervical composition: the cervix is dominated by fibrous connective tissue, consisting predominantly of Type I collagen (70%). Despite many studies of the cervix, we still rely upon relatively crude methods for clinical evaluation of the cervix. If the amount of cervical collagen plays a role in cervical insufficiency and in success of or length of induction of labor, then measurements of cervical collagen may provide an objective means of establishing the diagnosis or prognosis. We have established and reported a non-invasive means, called Collascope, to measure collagen cross-linking using light-induced fluorescence (LIF), and which is specifically designed to assess cervical ripening, and functions by measuring the natural fluorescence of non-soluble collagen in the cervix. Studies conducted in animals and humans in a variety of settings indicate that cervical function can be successfully monitored using the Collascope during pregnancy: LIF correlates negatively with gestational age and positively with time-to-delivery interval, and is predictive of delivery within 24h. Additionally LIF is significantly lower in women with cervical insufficiency. We suggest that the Collascope might be useful to better define management in cases of spontaneous preterm or induced term cervical ripening. From our studies and others, it is clear that in forecasting (pre-)term cervical ripening, the capability of the technologies and bioassays that have been generally accepted into clinical practice are limited. Any devices shown to be superior to the clinically accepted tests currently used should be quite useful for clinicians. The Collascope offers an objective measurement of both the function and state of the cervix, by directly measuring collagen cross-linking using LIF. [Copyright &y& Elsevier]

Abstract: At present, there is no effective treatment for preterm labor. The most obvious reason for this anomaly is that there is no objective manner in which to evaluate the progression of pregnancy through steps leading to labor, either at term or preterm. Understanding the physiology of the uterus during term and preterm parturition is important for developing methods to control uterine function and is essential to solving clinical problems related to labor. Several techniques have been adopted to monitor and/or to diagnose labor. Unfortunately they are either subjective or indirect and do not provide an accurate prediction especially for preterm labor. Uterine electromyography (EMG) may provide more objective, highly accurate, and clinically useful information. This may be especially important in clinical scenarios such as prediction of preterm labor, differentiation between true and false labor, and management of labor augmentation, labor induction or tocolysis. Thereby EMG would enable clinicians to apply much better treatment for pregnant patients. [Copyright &y& Elsevier]