MIP1β, IL-4, IL-8, IL-10 and proIL-1β might be potential singular biomarkers in diagnosing intrauterine inflammation. The combinations of elevated levels of IL-17/GROα, MIP1β/IL-15 and histone/IL-10 are new potentially advantageous biomarker combinations.

Die Autoren sind Mitglieder einer Arbeitsgruppe, die sich am 8. 11. 2007 erstmals und danach mehrfach traf, um unter Federführung von Prof. Dr. J. W. Dudenhausen "die Bedeutung des Eisenstoffwechsels und Möglichkeiten der Eisensubstitution in Schwangerschaft und Wochenbett" zu diskutieren und Vorschläge für Leitlinien zu erarbeiten. Die Arbeitsgruppe hat für diese Empfehlungen einschlägige wissenschaftliche Arbeiten zusammengetragen, sorgfältig evaluiert und weitere Experten konsultiert (z. B. Prof. Dr. Nils Milman, Kopenhagen, PD Dr. Peter Nielsen, Hamburg). Die inhaltlichen Schwerpunkte waren: Verbreitung, gesundheitliche Bedeutung, Diagnostik, Zusammenfassung ! Zur Erarbeitung fundierter Empfehlungen für die Prophylaxe und Therapie von Eisenmangel und Anämie in der Geburtsmedizin wurde ein Adhoc-Arbeitskreis (Geburtsmedizin, Pädiatrie, Psychiatrie, Pharmakologie) gebildet, der die einschlägige Literatur kritisch bewerten und auf dieser Grundlage strukturierte Handlungsanweisungen entwickeln sollte. Obwohl nicht alle Fälle einer Anämie in der Schwangerschaft auf einen Eisenmangel zurückzuführen sind, lässt sich an ihrer großen Verbreitung die Gesundheitsbelastung der Frauen durch Eisenmangel erkennen: Weltweit leiden 42 % der Schwangeren an einer Anämie, in Europa sind es 25 %. Niedrige bis erschöpfte Eisenreserven schon zu Beginn der Schwangerschaft haben die meisten Frauen, selbst in Europa. Eisenmangel und vor allem Anämie beeinträchtigen die Gesundheit und Lebensqualität der Frauen. Der für die Schwangerschaft erforderliche Eisenbedarf von über 1000 mg lässt sich nicht allein durch die Ernährung decken, Eisensupplemente sind erforderlich. Nach der Entbindung hängt das Wiederauffüllen der Eisenspeicher nicht nur von den präpartalen Eisenreserven, sondern v. a. davon ab, ob der peripartale Blutverlust ausgeglichen werden kann. Die postpartale Erholung kann durch orale und intravenöse Eisentherapie oder in schweren Fällen durch Bluttransfusion wesentlich verbessert werden. Es wurde ein Stufenplan entwickelt, der mit gerin-gem diagnostischen Aufwand den Prophylaxeund Therapiebedarf feststellt, nach dem in der Schwangerschaft und im Wochenbett verfahren werden sollte.

Sir: Few data on cerebral haemodynamics in the early neonatal period have been published. Therefore we read with interest the article by Hayashi and coworkers [2] on Doppler sonographic measurements of cerebral blood flow velocities during the first 90 h of life. In this study data were grouped into six classes according to time of examination, class 1 including measurements from 0-3 h after birth. From previous publications and our own experience we would like to add some points not considered in this study.Cerebral blood flow velocities correlate strongly with blood pH and with pCO2 [3, 4,6]. Blood gas analysis was not performed in Hayashi's patients and the normal Apgar scores do not rule out significant changes in umbilical and capillary heel blood gases [1]. Furthermore, cerebral blood flow velocities have been shown to depend on the behavioural state of the neonates [5], which was also not considered in Hayashi's study.We have recently evaluated quantitative blood flow velocities in the anterior cerebral artery of 19 mature newborns delivered from breech presentation either vaginally (n = 10) or by caesarean section (n = 9). Colour Doppler and pulsed Doppler sonography were performed several times during the first 5 rain of life and in 3-to 10-min intervals during the next 20-30 min (Hewlett Packard 1000 Sonos, 5-MHz transducer).To determine systolic and mean flow velocity (Vmean and Vmax) only measurements with at least three similar Doppler curves were considered. Diastolic flow velocity (Vmin) was not reproducible by this technique because Vmi~ fluctuates rapidly during the cardiopulmonary adaptation phase. Apgar scores, umbilical cord blood pH, capillary blood gas analysis and blood pressure 5 rain after birth were also recorded. Mean values for V~ean and vmax were 35 _+ 13 cm/s and 58 + 16 cm/s immediately after birth and 20 + 6 cm/s and 40 + 10 cm/s at 20 rain. In eight of ten neonates delivered vaginally and in nine of ten neonates delivered by caesarean section v ...... and Vm~• decreased by almost 60% within the first 20 min of life. The remaining neonates showed marked increases of v ...... and v .... (Figs. 1,2). Extremely high cerebral blood flow velocities were observed immediately after birth in two infants delivered by caesarean section (Vma~ 110cm/s and 95cm/s; Vmean 60cm/s and 59cm/s). These high cerebral blood flow velocities did not correlate with umbilical and capillary blood pH (7.28 and 7.30) or the Agpar score at 1 rain (3 and 9), but in both cases delivery of the head was mechanically more difficult than in the other infants, including those delivered vaginally. Our data show that the most significant changes in cerebral blood flow velocities occur during the first 30 min of life. There seems to be a correlation between cerebral blood flow velocities and mechanical factors during delivery.It would be interesting if Hayashi and coworkers could provide information on the precise time of their measurements in the first group, on the Apgar scores at 1 and 5 min, the pCO2 levels and t...

BackgroundVariations in cytokine and immune mediator expression patterns in amniotic fluid due to gestational age, maternal age and fetal gender were investigated.FindingsAmniotic fluid samples were obtained from 192 women, 82 with a mid-trimester amniocentesis (median gestational age 17 weeks) and 110 with a caesarean section not in labor (median gestational age 39 weeks). Amniotic fluid was screened by commercial ELISAs for the TH1/TH2/TH17 cytokines and immune mediators IL-1 beta, IL-2, IL-4, IL-6, IL-8, IL-10, IL-12, IL-15, IL-17, TNF alpha, GRO-alpha, MIP1alpha, MIP1beta, Histone, and IP10. Analysis was by Bonferroni correction for multiple comparisons. None of the 15 examined cytokines revealed any differences in expression patterns regarding fetal gender. Significant differences were found in IL-4, IL-10, IL-12, TNF- alpha, GRO-alpha and MIP1-beta with respect to gestational age and in GRO-alpha regarding maternal age.ConclusionCytokines utilized as biomarkers in the diagnosis of intrauterine infections are not influenced in their expression pattern by fetal gender but may vary with respect to maternal age and gestational age.

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