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Klinische, laborchemische und sonografische Methoden erlauben die fruhe und zuverlassige Diagnose und Beurteilung einer Fruhschwangerschaft. Die serielle Bestimmung des humanen Choriongonadotropins (hCG) gestattet eine Unterscheidung zwischen intakter und gestorter Implantation. Mit der transvaginalen Sonografie konnen Informationen uber den Implantationsort, die Vitalitat des Embryos und das Vorliegen einer Mehrlingsschwangerschaft gewonnen werden. Zudem ermoglicht die sonografische Beurteilung eine weitgehend zuverlassige Bestimmung des Gestationsalters. Unter dem Begriff „Abort“ wird im deutschsprachigen Raum ein (nichtartifizieller) Verlust der Schwangerschaft vor Eintritt der Lebensfahigkeit des Kindes verstanden. Von Bedeutung ist hierbei die Unterscheidung zwischen sporadischen und habituellen Aborten, wobei ein habituelles Abortgeschehen bei 3 oder mehr aufeinanderfolgenden Fehlgeburten vorliegt. Im ersten Kapitelteil wird auf die klinischen Stadien und die vielfaltigen Ursachen von sporadischen Aborten eingegangen, wahrendem der zweite Kapitelteil die habituellen Aborte und ihre Risikofaktoren behandelt.

Fast alle Schwangeren machen sich Gedanken darum, ob es ihrem ungeborenen Kind gut geht. Oft ist die Sorge vor einer Fruhgeburt gros. Doch die Risikofaktoren sind bekannt, und eine gute Betreuung beim Gynakologen kann einer Fruhgeburt oftmals vorbeugen.

Klinische, laborchemische und sonographische Methoden erlauben die fruhe und zuverlassige Diagnose und Beurteilung einer intakten Schwangerschaft (z. B. serielle HCG-Bestimmungen) und von Schwangerschaftsrisiken. Mit der transvaginalen Sonographie konnen Informationen uber den Implantationsort, die Vitalitat des Embryos und das Vorliegen einer Mehrlingsschwangerschaft gewonnen und das Gestationsalter zuverlassig bestimmt werden.

Objective. We report the case of a 46-year-old woman presenting with acute chest pain in the 20th week of a twin pregnancy after oocyte donation. Case report. The Patient's medical history comprised several cardiovascular risk factors, such as hypertension, obesity, hypercholesterolemia, smoking, and a positive family history. After diagnosis of myocardial infarction, coronary catheterization and stenting was performed. Ten weeks later, Cesarean was indicated because of severe superimposed preeclampsia with lung edema. Mother and babies recovered uneventfully. Conclusion. In respect to increasing rates of higher maternal age and obesity during pregnancy, more attention to maternal health is required, particularly in programs for assisted reproductive techniques.

In preeclampsia and hemolysis, elevated liver enzymes and low platelet (HELLP) syndrome, impaired trophoblast invasion and excessive fibrin deposition in the placental intervillous space is associated with fetal compromise. However, little information is available whether modulation of placental protease expression – potentially causing impaired trophoblast invasion – is associated with the HELLP syndrome. Total RNA and protein were extracted from placental tissue from 11 females with HELLP syndrome and 8 controls matched for gestational age. mRNA expression of matrix metalloprotease (MMP) -2 and -9, tissue inhibitors of metalloprotease (TIMP) -1, -2, and -3, and urokinase-type plasminogen activator receptor (uPAR) was determined by Northern blotting. Protein expression of MMP-2 and -9, and TIMP-1 and -2 was detected by Western blotting and that of uPA, uPAR, and plasminogen activator inhibitor (PAI) -1 by ELISA. In patients with HELLP syndrome, mRNA expression of MMP-2 and TIMP-2 was decreased, whereas TIMP-1 and -3 levels were unchanged. MMP-9 and uPAR mRNA was undetectable in both groups. Protein expression of all investigated proteolytic factors remained unchanged. Our findings at the mRNA level suggest a decrease in matrix remodeling in placentae from patients with HELLP syndrome compared with control pregnancies, although this is not supported at the protein level.

Background: Metastatic melanoma during pregnancy represents a life-threatening situation not only for the mother but also for the fetus due to aggressive therapy and potential maternal-fetal metastasis. Case Report: We report the case of a 37-year-old woman with advanced metastatic malignant melanoma during her first pregnancy, with a review of the literature. In this case, a tight and primarily interdisciplinary obstetrical and dermatological case management enabled the delivery of a small but healthy premature infant in the 29th week of gestation by planned Cesarean section. However, due to progressive disease, the mother died only 10 weeks after the delivery of the baby. Conclusion: Sufficient perinatal and oncologic experience provided, diagnostic and surgical interventions as well as radiotherapy and chemotherapy in metastatic melanoma disease are feasible and relatively safe even during pregnancy.

In order to investigate the effect of different immunosuppressive regimens and the time interval between transplantation and pregnancy on long-term outcome, we performed a case-control study in pregnant renal allograft recipients. Eighty-one pregnancies of kidney transplanted recipients were identified [cyclosporine (CYA): n = 40; azathioprine (AZA): n = 41]. Controls were matched with respect to important prognostic factors. Posttransplant follow-up was 91.3 +/- 5 months. Graft and patient survival were similar in both groups and there was no apparent effect of immunosuppression. A total of 28 recipients (33%) delivered within 2 years and 6 (8%) subjects within 1 year after transplantation, but these short transplantation-to-pregnancy intervals had no apparent adverse effect on long-term outcome. In contrast to AZA-treated patients, CYA-treated patients experienced an increase in serum creatinine postpartum (1.15 +/- 0.2 mg/dL vs. 1.61 +/- 0.1 mg/dL; p0.05). Whole blood CYA levels decreased transiently during pregnancy from 115.9 +/- 8 ng/mL to 80.7 +/- 7 ng/mL leading to a gradual increase in drug dose from 240 +/- 14 mg/day to 324 +/- 21 mg/day (p0.05). Following delivery, there was an increase in CYA concentrations to 173 +/- 5.4 ng/mL, requiring rapid dose tapering to baseline of 246 +/- 15 mg/day. Pregnancies in renal recipients do not affect long-term patient and graft survival, independent of the immunosuppression. No detrimental effect of short transplantation-to-pregnancy intervals on long-term graft function was detected.

The number of women with congenital heart disease reaching reproductive age has increased due to therapeutic advances. The aim of this study was to examine obstetric and cardiac problems during pregnancy after Mustard/Senning repair for transposition of the great arteries.Sixty pregnancies in 34 women from 3 centers were studied. The women were interviewed, and their records reviewed for clinical status and diagnostic evaluation. Age range was 16-34 years during first pregnancy, and all were in a low functional class. There were 11 miscarriages and 5 abortions. Of 44 successful pregnancies, 20 were vaginal deliveries and 24, cesarean sections. A total of 25% were delivered prematurely. Thirteen babies had birth weight

Background: Breast cancer in men is rare and requires therapy concepts including health considerations different from those in female patients. Case Report: We report on a 64-year-old male patient with metastatic breast cancer in the lung and cervical lymph nodes. Upon metastasis, initial adjuvant endocrine therapy with tamoxifen was changed to anastrozole. After 1 year of treatment, the patient was found to have rising prostatespecific antigen (PSA) levels, and diagnostic workup confirmed the diagnosis of early prostate cancer. Because of simultaneous progressive disease of metastatic breast cancer, chemotherapy with 6 cycles of docetaxel was administered resulting in a partial remission of both tumor types. The patient is currently treated with an endocrine combination therapy of fulvestrant, goserelin, and bicalutamide. He is in good clinical condition, and tumor markers for both tumor types are stable. Conclusion: Elevated PSA levels under therapy with aromatase inhibitors have been described in individual cases but always warrant a careful diagnostic workup to exclude prostate cancer as an important differential diagnosis. Genetic counseling has to be taken into consideration in the case of male breast cancer as well as in the case of coincidence of different tumor types, such as breast and prostate cancer, due to the possibility of e.g. BRCA mutations in these patients.

Recording of fetal heart rate via CTG monitoring has been routinely performed as an important part of antenatal and subpartum care for several decades. The current guidelines of the FIGO (ref1) recommend a normal range of the fetal heart rate from 110 to 150 bpm. However, there is no agreement in the medical community whether this is the correct range (ref2). We aim to address this question by computerized analysis (ref 3) of a high quality database (HQDb, ref 4) of about one billion electronically registered fetal heart rate measurements from about 10,000 pregnancies in three medical centres over seven years. In the present paper, we lay out a detailed analysis plan for this evidence-based project in the vein of the validation policy of the Sylvia Lawry Centre for Multiple Sclerosis Research (ref 5) with a split of the database into an exploratory part and a part reserved for validation. We will perform the analysis and the validation after publication of this plan in order to reduce the probability of publishing false positive research findings (ref 6-7).

Apoptosis of placental trophoblast cells has become the subject of intensive research. Recently, a monoclonal antibody (M30) directed against a neo-epitope of cytokeratin 18, that is formed after cleavage of this cytoskeletal protein by caspases, was shown to be of advantage over other tests for the detection of trophoblast cell apoptosis. In the present study, we describe a method for the enrichment of highly pure villous trophoblast cells based on the proteolytic digestion of placental tissue, density gradient separation of dissected cells, and immunoelimination of contaminating, non-trophoblast cells employing an antibody to the HLA class I antigen. The high purity (94-99%) of the trophoblast cell preparation was shown by antibody staining for cytokeratin 7 and absence of vimentin. Furthermore, we demonstrate that after a simple permeabilization and fixation step with 90% methanol and using the M30 CytoDeath, FITC-conjugated antibody, apoptotic trophoblast cells could be distinguished from non-apoptotic cells by flow cytofluorometry in a highly quantitative and sensitive fashion. Our protocol is an improvement over previously used methods such as immunocytochemistry as it allows to differentiate rapidly between competent and apoptotic trophoblast cells by the quantitative method of flow cytofluorometry.

Objective: To investigate whether the activity of the three mitogen-activated protein kinases (Jun aminoterminal kinase, extracellular regulated kinase, and p38) is altered in placental tissue of women with preeclampsia and hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome. Methods: Placental activity (measured by immunoprecipitation-kinase assay) and protein expression (measured by western blot) of Jun aminoterminal kinase, extracellular regulated kinase, and p38 mitogen-activated protein kinase were measured in four groups of eight women each with preeclampsia, HELLP syndrome, and normal vaginal or cesarean deliveries. To further characterize the Jun aminoterminal kinase signal transduction pathway, phosphorylation of c-Jun, a downstream effector of Jun aminoterminal kinase– mitogen-activated protein kinase, was analyzed by western blotting, and the activity of Rac1, an upstream activator of the Jun aminoterminal kinase signaling pathway, was determined by pull-down assay. Results: The activity of Jun aminoterminal kinase was significantly lower in placentas of women with preeclampsia or HELLP syndrome compared with those who had normal vaginal or cesarean delivery, whereas levels of Jun aminoterminal kinase protein expression were similar. Phosphorylation of the transcription factor c-Jun and Rac1 activity also were significantly lower in women with preeclampsia and HELLP than in controls. p38 mitogen-activated protein kinase activity was significantly higher in women with preeclampsia than with HELLP syndrome. There was no change in extracellular regulated kinase activity or protein expression between subgroups. Conclusion: In placentas of women with preeclampsia or HELLP syndrome, a Rac1-Jun aminoterminal kinase-c-Jun-dependent signal transduction pathway was downregulated.