Fetal Urine Production in Late Pregnancy

Objective. Hourly fetal urine production rate (HFUPR) was studied in relation to both gestational age and the onset of spontaneous labor in normal term human pregnancies. Methods. Serial volume measurements were obtained from longitudinal ultrasound images of the fetal bladder at 1–5-minute intervals, and HFUPR was subsequently calculated. A total of 178 adequate bladder-filling cycles were recorded in 112 women, and the amniotic fluid index (AFI) was assessed. Results. HFUPR did not change significantly between 37 and 42 weeks' gestation. However, HFUPR decreased during the last 14 days prior to the onset of spontaneous labor (P < 0.005). No significant correlation was found between HFUPR and AFI, neither when measured at the same time nor when HFUPR and AFI were measured at various intervals in time. Conclusion. HFUPR falls before and in relation to the time of onset of labor rather than in relation to gestational age

Prediction of fetal lung immaturity using gestational age, patient characteristics and fetal lung maturity tests: a probabilistic approach

Objectives: The lecithin/sphingomyelin (L/S) ratio and the lamellar body count (LBC) can be used to predict respiratory distress syndrome (RDS). Design: We performed a retrospective cohort study among consecutive women who underwent amniotic fluid sampling for the assessment of fetal lung maturity. Logistic regression was used to construct models for the prediction of RDS in three gestational age categories, with models based on clinical characteristics only, clinical characteristics and the LBC, and on clinical characteristics and L/S ratio. Results: When amniotic fluid was collected <30 weeks, the specificity of the LBC was 30% and the sensitivity 100%. Addition of the L/S ratio increased the specifity to 60%, for a sensitivity of 100%. When amniocentesis was performed between 30 and 33 weeks, addition of the L/S ratio only marginally improved the performance of the LBC. Conclusions: At a gestational age <30 weeks, the L/S ratio has additional value over the LBC. Above 30 weeks of gestation, single use of the LBC seems sufficient.L. D. E. Wijnberger, M. de Kleine, H. A. M. Voorbij, B. Arabin, H. W. Bruinse, G. H. A. Visser, P. M. M. Bossuyt, B. W. J. Mo

Progesterone for the prevention of preterm birth in women with multiple pregnancies: the AMPHIA trial

Contains fulltext : 53264.pdf (publisher's version ) (Open Access)BACKGROUND: 15% of multiple pregnancies ends in a preterm delivery, which can lead to mortality and severe long term neonatal morbidity. At present, no generally accepted strategy for the prevention of preterm birth in multiple pregnancies exists. Prophylactic administration of 17-alpha hydroxyprogesterone caproate (17OHPC) has proven to be effective in the prevention of preterm birth in women with singleton pregnancies with a previous preterm delivery. At present, there are no data on the effectiveness of progesterone in the prevention of preterm birth in multiple pregnancies. METHODS/DESIGN: We aim to investigate the hypothesis that 17OHPC will reduce the incidence of the composite neonatal morbidity of neonates by reducing the early preterm birth rate in multiple pregnancies. Women with a multiple pregnancy at a gestational age between 15 and 20 weeks of gestation will be entered in a placebo-controlled, double blinded randomised study comparing weekly 250 mg 17OHPC intramuscular injections from 16-20 weeks up to 36 weeks of gestation versus placebo. At study entry, cervical length will be measured. The primary outcome is composite bad neonatal condition (perinatal death or severe morbidity). Secondary outcome measures are time to delivery, preterm birth rate before 32 and 37 weeks, days of admission in neonatal intensive care unit, maternal morbidity, maternal admission days for preterm labour and costs. We need to include 660 women to indicate a reduction in bad neonatal outcome from 15% to 8%. Analysis will be by intention to treat. We will also analyse whether the treatment effect is dependent on cervical length. DISCUSSION: This trial will provide evidence as to whether or not 17OHPC-treatment is an effective means of preventing bad neonatal outcome due to preterm birth in multiple pregnancies. TRIAL REGISTRATION: Current Controlled Trials ISRCTN40512715

Is there an association between depressive and urinary symptoms during and after pregnancy?

Depressive symptoms and urinary symptoms are both highly prevalent in pregnancy. In the general population, an association is reported between urinary symptoms and depressive symptoms. The association of depressive and urinary symptoms has not yet been assessed in pregnancy. In this study, we assessed (1) the prevalence of depressive symptoms, over-active bladder (OAB) syndrome, urge urinary incontinence (UUI) and stress urinary incontinence (SUI) during and after pregnancy using the Center for Epidemiologic Studies Depression Scale (CES-D) and the Urogenital Distress Inventory (UDI) and (2) the association of depressive symptoms with urinary incontinence and over-active bladder syndrome during and after pregnancy, controlling for confounding socioeconomic, psychosocial, behavioural and biomedical factors in a cohort of healthy nulliparous women. Our data show a significant increase in prevalence of depressive symptoms, UUI, SUI and OAB during pregnancy and a significant reduction in prevalence of depressive symptoms, SUI and OAB after childbirth. UUI prevalence did not significantly decrease after childbirth. In univariate analysis, urinary incontinence and the OAB syndrome were significantly associated with a CES-D score indicative of a possible clinical depression at 36 weeks gestation. However, after adjusting for possible confounding factors, only the OAB syndrome remained significantly associated (OR 4.4 [1.8–10.5]). No association was found between depressive and urinary symptoms at 1 year post-partum. Only OAB was independently associated with depressive symptoms during pregnancy. Possible explanations for this association are discussed

Maternal TLR4 and NOD2 Gene Variants, Pro-Inflammatory Phenotype and Susceptibility to Early-Onset Preeclampsia and HELLP Syndrome

Background: Altered maternal inflammatory responses play a role in the development of preeclampsia and the hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome. We examined whether allelic variants of the innate immune receptors toli-like receptor 4 (TLR4) and nucleotide-binding oligomerization domain (NOD2), that impair the inflammatory response to endotexin are related to preeclampsia and HELLP syndrome. Methods and Finding: We determined five common mutations in TLR4 (D299G and T399I and NOD2 (R70W, G908R and L1007fs) in 340 primiparous women with a histo

Ondernemer leert liefst buiten de klas : Wageningen Universiteit brengt competenties in beeld : special toekomst

Wetenschappers van Wageningen Universiteit onderzochten de competenties van een groep ondernemers uit de glastuinbouw. Ze bekeken hierbij hoe de ondernemer in de praktijk leert, dus buiten regeliere studie o

Progesteron ter preventie van vroeggeboorte

English title: Progesterone for prevention of preterm delivery: only in trial settingSinds de ontdekking van progesteron wordt onderzocht of toediening van exogeen progesteron vroeggeboorte kan voorkomen. In 2003 werden 2 trials gepubliceerd die een positief effect lieten zien van progesteron bij de preventie van herhaalde vroeggeboorte. Recentere gegevens ondersteunen deze bevindingen echter niet. Bij meerlingzwangerschappen lijkt het gebruik van progesteron het aantal vroeggeboortes niet te verminderen. De resultaten van progesteron bij vrouwen met een asymptomatische korte cervix zijn veelbelovend, maar in deze groep moet meer onderzoek gedaan worden. = Since the discovery of progesterone researchers have studied whether administration of exogenous progesterone can prevent preterm birth. Two trials were published in 2003 that showed a positive effect of progesterone with regard to the prevention of recurrent preterm birth. However, more recent data do not support these findings. In multiple pregnancies the use of progesterone does not seem to reduce the number of preterm births. The results in pregnant women with asymptomatic shortening of the cervix are promising, although more research is needed in this group.Arianne C. Lim, Ben Willem J. Mol en Hein W. Bruins