Changes in Heart Rate, Heart Rate Variability, Breathing Rate, and Skin Temperature throughout Pregnancy and the Impact of Emotions—A Longitudinal Evaluation Using a Sensor Bracelet

(1) Background: Basic vital signs change during normal pregnancy as they reflect the adaptation of maternal physiology. Electronic wearables like fitness bracelets have the potential to provide vital signs continuously in the home environment of pregnant women. (2) Methods: We performed a prospective observational study from November 2019 to November 2020 including healthy pregnant women, who recorded their wrist skin temperature, heart rate, heart rate variability, and breathing rate using an electronic wearable. In addition, eight emotions were assessed weekly using five-point Likert scales. Descriptive statistics and a multivariate model were applied to correlate the physiological parameters with maternal emotions. (3) Results: We analyzed data from 23 women using the electronic wearable during pregnancy. We calculated standard curves for each physiological parameter, which partially differed from the literature. We showed a significant association of several emotions like feeling stressed, tired, or happy with the course of physiological parameters. (4) Conclusions: Our data indicate that electronic wearables are helpful for closely observing vital signs in pregnancy and to establish modern curves for the physiological course of these parameters. In addition to physiological adaptation mechanisms and pregnancy disorders, emotions have the potential to influence the course of physiological parameters in pregnancy

Antibiotic Use During Pregnancy and Childbirth: Prospective Observational Study on Prevalence, Indications, and Prescribing Patterns in a German Tertiary Center

Introduction Antibiotics are powerful drugs to prevent and treat perinatal infections. Overuse of antibiotics leads to antibiotic resistance, has potential side effects and influences the maternal and neonatal microbiome. Patients and Methods We performed a prospective observational study on the prevalence, indications, and prescribing patterns of antibiotics during pregnancy and childbirth. We included women who had given birth after 23+0 weeks of gestation at a single tertiary center in Germany from January 2020 to March 2021. Descriptive statistics and binomial regression were performed to analyze the factors influencing the prescription of antibiotics. Results We included 522 postpartum women into our study. 337 (64.6%) were exposed to antibiotics during pregnancy and/or childbirth. 115 women received antibiotics during pregnancy, 291 during birth. Most antibiotics during pregnancy were prescribed for urinary tract infections (UTIs) (56.0%). Most prescriptions were issued by obstetrics and gynecology physicians (65.8%), followed by hospitals (16.7%) and family medicine physicians (8.8%). Most antibiotics during childbirth were given for a cesarean section (64.3%), followed by preterm rupture of membranes (41.2%). 95.3% of women who had a preterm birth were exposed to antibiotics. In logistic regression models, lower gestational age at birth, higher maternal body-mass-index and smoking were independently associated with antibiotic use during pregnancy and childbirth. Conclusion We found a high rate of antibiotic exposure during pregnancy and childbirth. Our results imply an urgent need for antibiotic stewardship programs in perinatal medicine as well as further research on the effects of perinatal antibiotic exposure on microbiome development and childhood health. // Einleitung Antibiotika sind potente Medikamente, die verschrieben werden, um perinatale Infektionen zu verhindern oder zu behandeln. Der übermäßige Einsatz von Antibiotika führt zur Antibiotikaresistenz, ist potenziell mit Nebenwirkungen behaftet und hat zudem Auswirkungen auf das mütterliche und neonatale Mikrobiom. Patientinnen und Methoden Wir führten eine prospektive Beobachtungsstudie durch, um die Prävalenz, die Indikationen und die Verschreibungsmuster für Antibiotika während der Schwangerschaft und der Geburt zu untersuchen. Eingeschlossen wurden Frauen, die nach 23+0 Schwangerschaftswochen zwischen Januar 2020 and März 2021 in einem deutschen universitären Perinatalzentrum Level I entbanden. Es wurden eine deskriptive statistische Analyse sowie binomiale Regressionsanalysen durchgeführt, um Faktoren, welche die Verschreibung von Antibiotika beeinflussen, zu identifizieren. Ergebnisse Insgesamt wurden 522 Frauen nach der Entbindung eingeschlossen. 337 (64,6%) erhielten Antibiotika während der Schwangerschaft und/oder der Geburt. 115 Frauen erhielten Antibiotika während der Schwangerschaft und 291 Frauen erhielten sie während der Geburt. Die meisten Antibiotika wurden während der Schwangerschaft zur Behandlung von Harnwegsinfektionen verschrieben (56,0%). Die meisten Verschreibungen wurden von Frauenärzten ausgestellt (65,8%), gefolgt von Krankenhäusern (16,7%) und Hausärzten (8,8%). Die meisten während der Geburt verabreichten Antibiotika wurden wegen eines Kaiserschnitts (64,3%) verschrieben; an zweiter Stelle war die Verschreibung wegen vorzeitigen Blasensprungs (41,2%). 95,3% der Frauen, die eine Frühgeburt hatten, wurden mit Antibiotika behandelt. In den Regressionsmodellen war ein niedriges Gestationsalter bei der Entbindung, ein hoher mütterlicher Body-Mass-Index und Rauchen unabhängig voneinander mit dem Einsatz von Antibiotika während der Schwangerschaft und der Geburt assoziiert. Schlussfolgerung Unsere Studie zeigt eine hohe Antibiotikaexposition von Frauen während Schwangerschaft und Geburt. Die Ergebnisse weisen darauf hin, dass ein Antibiotic-Stewardship-Programm in der Perinatalmedizin dringend nötig ist. Weitere Studien zu den Auswirkungen einer perinatalen Antibiotikaexposition auf die frühe Entwicklung des menschlichen Mikrobioms sowie auf die Gesundheit von Kindern werden benötigt

Lebensbedrohliche Infektionen in der Schwangerschaft

Die Sepsis als klinische Manifestation einer lebensbedrohlichen Infektion gehört weltweit zu den häufigsten maternalen Todesursachen im Rahmen von Schwangerschaft und Geburt. Das rasche Erkennen sowie der Beginn einer antibiotischen Therapie und Volumensubstitution sind entscheidend in der Therapie. Bei persistierender Hypotonie sollten Vasopressoren zum Einsatz kommen. Eine engmaschige fetomaternale Überwachung ist wichtig. Bei einer Chorioamnionitis ist die Entbindung indiziert. Eine Sepsis ist keine Kontraindikation für die Steroidgabe zur fetalen Lungenreifungsinduktion. Die Definition der Sepsis und deren Therapie entspricht in der Schwangerschaft den Kriterien bei Nichtschwangeren. Die Beurteilung der Organdysfunktion kann mittels SOFA(„sequential organ failure assessment“)-Score ermittelt werden. Die häufigsten Ursachen für eine Sepsis in der Schwangerschaft sind eine Chorioamnionitis, eine Pyelonephritis mit Urosepsis und ein exazerbierter Infekt der Atemwege. Gerade Schwangere sind aufgrund der veränderten Atem- und Lungenphysiologie prädisponiert für schwere Verläufe. Eine Sepsis im Rahmen einer Appendizitis ist selten, kann dennoch auftreten, da die Diagnose der Appendizitis in der Schwangerschaft meist verzögert gestellt wird und Perforationen deshalb häufiger vorkommen. Bei Fieber und einer entsprechenden Anamnese (z. B. Reisen) muss auch an bei uns seltenere Krankheiten, wie z. B. Malaria, gedacht werden. // Sepsis as a clinical manifestation of a life-threatening infection is one of the leading causes worldwide of maternal mortality in pregnancy and childbirth. The rapid recognition of sepsis and initiation of treatment with intravenous fluids and antibiotic therapy is crucial in the management of sepsis. Vasopressors should be administered in cases of persisting hypotension. A close fetomaternal surveillance is crucial. A chorioamnionitis is an indication for delivery. Administration of steroids for induction of fetal lung maturation is not contraindicated in cases of sepsis. The definition of sepsis and its management are similar to those in nonpregnant individuals. The sequential organ failure assessment (SOFA) score is used for assessment of organ dysfunction. The most frequent causes of sepsis in pregnancy are chorioamnionitis, pyelonephritis and an exacerbated respiratory tract infection. Pregnant women are particularly prone to severe disease progression due to immunological and adaptive changes in respiratory physiology during pregnancy. Appendicitis-related sepsis is rare; however, as the diagnosis of appendicitis in pregnancy is often delayed perforation occurs more frequently and then leads to sepsis. Diseases that are rare in Germany (for example malaria) need to be considered in patients with fever and an appropriate history (e.g., travelling)

Low-Molecular Weight Heparin Increases Circulating sFlt-1 Levels and Enhances Urinary Elimination

Rationale: Preeclampsia is a devastating medical complication of pregnancy which leads to maternal and fetal morbidity and mortality. While the etiology of preeclampsia is unclear, human and animal studies suggest that excessive circulating levels of soluble fms-like tyrosine-kinase-1 (sFlt-1), an alternatively spliced variant of VEGF-receptor1, contribute to the signs and symptoms of preeclampsia. Since sFlt-1 binds to heparin and heparan sulfate proteoglycans, we hypothesized that the anticoagulant heparin, which is often used in pregnancy, may interfere with the levels, distribution and elimination of sFlt-1 in vivo. Objective: We systematically determined serum and urine levels of angiogenic factors in preeclamptic women before and after administration of low molecular weight heparin and further characterized the interaction with heparin in biochemical studies. Methods and Results: Serum and urine samples were used to measure sFlt-1 levels before and after heparin administration. Serum levels of sFlt-1 increased by 25% after heparin administration in pregnant women. The magnitude of the increase in circulating sFlt-1 correlated with initial sFlt-1 serum levels. Urinary sFlt-1 levels were also elevated following heparin administration and levels of elimination were dependent on the underlying integrity of the glomerular filtration barrier. Biochemical binding studies employing cation exchange chromatography revealed that heparin bound sFlt-1 had decreased affinity to negatively charged surfaces when compared to sFlt-1 alone. Conclusion: Low molecular weight heparin administration increased circulating sFlt1 levels and enhanced renal elimination. We provide evidence that both effects may be due to heparin binding to sFlt1 and masking the positive charges on sFlt1 protein

Low-Molecular Weight Heparin Increases Circulating sFlt-1 Levels and Enhances Urinary Elimination

Rationale: Preeclampsia is a devastating medical complication of pregnancy which leads to maternal and fetal morbidity and mortality. While the etiology of preeclampsia is unclear, human and animal studies suggest that excessive circulating levels of soluble fms-like tyrosine-kinase-1 (sFlt-1), an alternatively spliced variant of VEGF-receptor1, contribute to the signs and symptoms of preeclampsia. Since sFlt-1 binds to heparin and heparan sulfate proteoglycans, we hypothesized that the anticoagulant heparin, which is often used in pregnancy, may interfere with the levels, distribution and elimination of sFlt-1 in vivo. Objective: We systematically determined serum and urine levels of angiogenic factors in preeclamptic women before and after administration of low molecular weight heparin and further characterized the interaction with heparin in biochemical studies. Methods and Results: Serum and urine samples were used to measure sFlt-1 levels before and after heparin administration. Serum levels of sFlt-1 increased by 25% after heparin administration in pregnant women. The magnitude of the increase in circulating sFlt-1 correlated with initial sFlt-1 serum levels. Urinary sFlt-1 levels were also elevated following heparin administration and levels of elimination were dependent on the underlying integrity of the glomerular filtration barrier. Biochemical binding studies employing cation exchange chromatography revealed that heparin bound sFlt-1 had decreased affinity to negatively charged surfaces when compared to sFlt-1 alone. Conclusion: Low molecular weight heparin administration increased circulating sFlt1 levels and enhanced renal elimination. We provide evidence that both effects may be due to heparin binding to sFlt1 and masking the positive charges on sFlt1 protein

Heterogenous use of misoprostol for induction of labour: results of an online survey among midwives in German-speaking countries

Purpose!#!This online survey looked at the experiences and general perceptions of midwives concerning induction of labour and the specific use of misoprostol.!##!Methods!#!We published an online questionnaire with 24 questions in German on midwives' experiences and perceptions of different methods of induction of labour.!##!Results!#!The online survey was answered by 412 midwives between February 2016 and February 2017. At least 20% of the 24 questions were answered in 333 questionnaires, which were included in this analysis. Oral misoprostol was the most common induction method for primipara and for women with a previous vaginal birth and an unfavourable cervix. Apart from alternative methods for induction of labour like castor oil and complementary/alternative methods, oral misoprostol was the preferred method of induction of labour by midwives. Midwives described a wide range of dosage schedules concerning application intervals, starting doses, and the maximum daily dose of misoprostol. Approximately 50% of the participants of this study described prescriptions of more than 200 µg misoprostol daily for induction of labour.!##!Conclusion!#!Misoprostol is widely used in Germany and was one of the three preferred methods of induction of labour among midwives in our study next to castor oil and complementary/alternative methods. The preparation and dosage of misoprostol vary significantly among hospitals and do not adhere to international guidelines. Midwives voiced their concerns about inconsistent indications and heterogenous use of different methods and dosages of induction. They wished for more patience with late-term pregnancies and individualized shared decision-making between pregnant women and obstetricians

Timing of antenatal steroid administration for imminent preterm birth: results of a prospective observational study in Germany

Purpose: To evaluate the timing of antenatal steroid administration and associated medical interventions in women with imminent preterm birth. Methods: We performed a prospective observational study at a single tertiary center in Germany from September 2018 to August 2019. We included pregnant women who received antenatal steroids for imminent preterm birth and evaluated the interval from administration to birth. 120 women with antenatal steroid application were included into our analysis. Descriptive statistics were performed to analyze factors influencing the timing of antenatal steroids and to evaluate additional medical interventions which women with imminent preterm birth experience. Results: Of the 120 women included into our study, 35.8% gave birth before 34/0 weeks and 64.2% before 37/0 weeks of gestation. Only 25/120 women (20.8%) delivered within the optimal time window of 1-7 days after antenatal steroid application. 5/120 women (4.2%) only received one dose of antenatal steroids before birth and 3/120 (2.5%) gave birth within 8 to 14 days after antenatal steroids. Most women gave birth more than 14 days after steroid application (72.5%, 87/120). Women with preeclampsia (60%), PPROM (31%), and FGR (30%) had the highest rates of delivery within the optimal time window. Women of all timing groups received additional interventions and medications like antibiotics, tocolytics, or anticoagulation. Conclusion: Our observational data indicate that most pregnant women do not give birth within 7 days after the administration of antenatal steroids. The timing was best for preterm birth due to preeclampsia, PPROM, and FGR. Especially for women with symptoms of preterm labor and bleeding placenta previa, antenatal steroids should be indicated more restrictively to improve neonatal outcome and reduce untimely and unnecessary interventions. Keywords: Antenatal steroids; Corticosteroids; Prediction; Preterm birth; Respiratory distress syndrome