Prävention von Frühgeburten

Zusammenfassung: Die Frühgeburt stellt heute, obwohl große Fortschritte im medizinisch-technischen Bereich gemacht wurden, immer noch eine Hauptursache der perinatalen Mortalität und Morbidität dar. Trotz intensiver Bemühungen im therapeutischen Bereich ist die Rate der Frühgeburten in den westlichen Ländern stabil oder - wie in den USA - sogar ansteigend. Präventive Maßnahmen rücken deswegen immer stärker in den Blickpunkt. In der vorliegenden Übersichtsarbeit werden basierend auf randomisierten oder Beobachtungsstudien die aktuellen Strategien zur Prävention diskutiert. Nach den derzeit vorliegenden Metaanalysen wird die perinatale Morbidität durch präventive Maßnahmen nicht verbessert, wohl aber das Gestationsalter verlängert. Was dies an Vorteilen für das Neugeborene bringt, bleibt zu kläre

Biomarker development for presymptomatic molecular diagnosis of preeclampsia: Feasible, useful or even unnecessary?

The past decade saw the advent of a number of promising biomarkers to detect pregnancies at risk for preeclampsia (PE), the foremost being those associated with an imbalance of angiogenic factors. In late pregnancy, these are useful for the detection of imminent cases of PE, while earlier they were more predictive for early- than late-onset PE. This suggests that there may be fundamental differences between the underlying pathology of these two PE forms. Therefore, it is possible that such a biological premise may limit the development of biomarkers that will permit the efficacious detection of both early- and late-onset PE via an analysis of first-trimester maternal blood samples. Consequently, a significant increase in our understanding of the underlying pathology of PE, using a variety of approaches ranging from systems biology to animal models, will be necessary in order to overcome this obstacle. © Informa UK, Ltd

Water birth: is the water an additional reservoir for group B streptococcus?

Objective: Water birth became popular in the last years, despite the fact that many questions like the risk of infection for the newborn remain unanswered. Group B streptococcal (GBS) infections in the newborn remain a challenge in obstetrics and neonatology. Method: We conducted a prospective trial to study the impact of water birth on the colonization rate of the bath water and, more importantly, the GBS-colonization rate of the newborn. Result: After water birth the bath water was significantly more often colonized with GBS than after immersion followed by a delivery in bed. The newborns, however, showed no difference in GBS colonization and there was even a trend towards less GBS colonization of the newborn after a water delivery. Conclusion: Regarding GBS colonization of the newborn during water birth there might be a wash out effect, which protects the children during the deliver

From Linear Optical Quantum Computing to Heisenberg-Limited Interferometry

The working principles of linear optical quantum computing are based on photodetection, namely, projective measurements. The use of photodetection can provide efficient nonlinear interactions between photons at the single-photon level, which is technically problematic otherwise. We report an application of such a technique to prepare quantum correlations as an important resource for Heisenberg-limited optical interferometry, where the sensitivity of phase measurements can be improved beyond the usual shot-noise limit. Furthermore, using such nonlinearities, optical quantum nondemolition measurements can now be carried out at the single-photon level.Comment: 10 pages, 5 figures; Submitted to a Special Issue of J. Opt. B on "Fluctuations and Noise in Photonics and Quantum Optics" (Herman Haus Memorial Issue); v2: minor change

Simultaneous quantitative assessment of circulating cell-free mitochondrial and nuclear DNA by multiplex real-time PCR

Quantification of circulating nucleic acids in plasma and serum could be used as a non-invasive diagnostic tool for monitoring a wide variety of diseases and conditions. We describe here a rapid, simple and accurate multiplex real-time PCR method for direct synchronized analysis of circulating cell-free (ccf) mitochondrial (mtDNA) and nuclear (nDNA) DNA in plasma and serum samples. The method is based on one-step multiplex real-time PCR using a FAM-labeled MGB probe and primers to amplify the mtDNA sequence of the ATP 8 gene, and a VIC-labeled MGB probe and primers to amplify the nDNA sequence of the glycerinaldehyde-3-phosphate-dehydrogenase (GAPDH) gene, in plasma and serum samples simultaneously. The efficiencies of the multiplex assays were measured in serial dilutions. Based on the simulation of the PCR reaction kinetics, the relative quantities of ccf mtDNA were calculated using a very simple equation. Using our optimised real-time PCR conditions, close to 100% efficiency was obtained from the two assays. The two assays performed in the dilution series showed very good and reproducible correlation to each other. This optimised multiplex real-time PCR protocol can be widely used for synchronized quantification of mtDNA and nDNA in different samples, with a very high rate of efficiency

Fetal Microchimeric Cells in Blood of Women with an Autoimmune Thyroid Disease

CONTEXT: Hashimoto's thyroiditis (HT) and Graves' disease (GD), two autoimmune thyroid diseases (AITD), occur more frequently in women than in men and show an increased incidence in the years following parturition. Persisting fetal cells could play a role in the development of these diseases. OBJECTIVE: Aim of this study was to detect and characterize fetal cells in blood of postpartum women with and without an AITD. PARTICIPANTS: Eleven patients with an AITD and ten healthy volunteers, all given birth to a son maximum 5 years before analysis, and three women who never had been pregnant, were included. None of them had any other disease of the thyroid which could interfere with the results obtained. METHODS: Fluorescence in situ hybridization (FISH) and repeated FISH were used to count the number of male fetal cells. Furthermore, the fetal cells were further characterized. RESULTS: In patients with HT, 7 to 11 fetal cells per 1.000.000 maternal cells were detected, compared to 14 to 29 fetal cells in patients with GD (p=0.0061). In patients with HT, mainly fetal CD8(+) T cells were found, while in patients with GD, fetal B and CD4(+) T cells were detected. In healthy volunteers with son, 0 to 5 fetal cells were observed, which was significantly less than the number observed in patients (p<0,05). In women who never had been pregnant, no male cells were detected. CONCLUSION: This study shows a clear association between fetal microchimeric cells and autoimmune thyroid diseases

Photon wave functions, wave-packet quantization of light, and coherence theory

The monochromatic Dirac and polychromatic Titulaer-Glauber quantized field theories (QFTs) of electromagnetism are derived from a photon-energy wave function in much the same way that one derives QFT for electrons, that is, by quantization of a single-particle wave function. The photon wave function and its equation of motion are established from the Einstein energy-momentum-mass relation, assuming a local energy density. This yields a theory of photon wave mechanics (PWM). The proper Lorentz-invariant single-photon scalar product is found to be non-local in coordinate space, and is shown to correspond to orthogonalization of the Titulaer-Glauber wave-packet modes. The wave functions of PWM and mode functions of QFT are shown to be equivalent, evolving via identical equations of motion, and completely describe photonic states. We generalize PWM to two or more photons, and show how to switch between the PWM and QFT viewpoints. The second-order coherence tensors of classical coherence theory and the two-photon wave functions are shown to propagate equivalently. We give examples of beam-like states, which can be used as photon wave functions in PWM, or modes in QFT. We propose a practical mode converter based on spectral filtering to convert between wave packets and their corresponding biorthogonal dual wave packets.Comment: 34 pages, 3 figures, minor correction

A cohort evaluation on arterial stiffness and hypertensive disorders in pregnancy

10.1186/1471-2393-12-160BMC Pregnancy and Childbirth12-BPCM

External validation of prognostic models to predict stillbirth using the International Prediction of Pregnancy Complications (IPPIC) Network database: an individual participant data meta-analysis

Objective Stillbirth is a potentially preventable complication of pregnancy. Identifying women at high risk of stillbirth can guide decisions on the need for closer surveillance and timing of delivery in order to prevent fetal death. Prognostic models have been developed to predict the risk of stillbirth, but none has yet been validated externally. In this study, we externally validated published prediction models for stillbirth using individual participant data (IPD) meta-analysis to assess their predictive performance. Methods MEDLINE, EMBASE, DH-DATA and AMED databases were searched from inception to December 2020 to identify studies reporting stillbirth prediction models. Studies that developed or updated prediction models for stillbirth for use at any time during pregnancy were included. IPD from cohorts within the International Prediction of Pregnancy Complications (IPPIC) Network were used to validate externally the identified prediction models whose individual variables were available in the IPD. The risk of bias of the models and cohorts was assessed using the Prediction study Risk Of Bias ASsessment Tool (PROBAST). The discriminative performance of the models was evaluated using the C-statistic, and calibration was assessed using calibration plots, calibration slope and calibration-in-the-large. Performance measures were estimated separately in each cohort, as well as summarized across cohorts using random-effects meta-analysis. Clinical utility was assessed using net benefit. Results Seventeen studies reporting the development of 40 prognostic models for stillbirth were identified. None of the models had been previously validated externally, and the full model equation was reported for only one-fifth (20%, 8/40) of the models. External validation was possible for three of these models, using IPD from 19 cohorts (491 201 pregnant women) within the IPPIC Network database. Based on evaluation of the model development studies, all three models had an overall high risk of bias, according to PROBAST. In the IPD meta-analysis, the models had summary C-statistics ranging from 0.53 to 0.65 and summary calibration slopes ranging from 0.40 to 0.88, with risk predictions that were generally too extreme compared with the observed risks. The models had little to no clinical utility, as assessed by net benefit. However, there remained uncertainty in the performance of some models due to small available sample sizes. Conclusions The three validated stillbirth prediction models showed generally poor and uncertain predictive performance in new data, with limited evidence to support their clinical application. The findings suggest methodological shortcomings in their development, including overfitting. Further research is needed to further validate these and other models, identify stronger prognostic factors and develop more robust prediction models. (c) 2021 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.Peer reviewe