No abstract

Purpose This is an official interdisciplinary guideline, published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (OEGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline was developed for use in German-speaking countries and is backed by the German Society of Anaesthesiology and Intensive Medicine (DGAI), the Society of Thrombosis and Haemostasis Research (GTH) and the German Association of Midwives. The aim is to provide a consensus-based overview of the diagnosis and management of peripartum bleeding obtained from an evaluation of the relevant literature. Methods This S2k guideline was developed from the structured consensus of representative members of the various professional associations and professions commissioned by the Guideline Commission of the DGGG. Recommendations The guideline encompasses recommendations on definitions, risk stratification, prevention and management.

DM affects the length of gestation and incidence of spontaneous preterm birth.

Chorionic gonadotropin (CG) is indispensable for human pregnancy because it controls implantation, decidualization, and placental development. However, its particular role in the differentiation process of invasive trophoblasts has not been fully unraveled. Here we demonstrate that the hormone promotes trophoblast invasion and migration in different trophoblast model systems. RT-PCR and Western blot analyses revealed expression of the LH/CG receptor in trophoblast cell lines and different trophoblast primary cultures. In vitro, CG increased migration and invasion of trophoblastic SGHPL-5 cells through uncoated and Matrigel-coated transwells, respectively. The hormone also increased migration of first-trimester villous explant cultures on collagen I. Proliferation of the trophoblast cell line and villous explant cultures measured by cumulative cell numbers and in situ 5-bromo-2'-deoxyuridine labeling, respectively, was unaffected by CG. Addition of the hormone activated ERK-1/2 and AKT in SGHPL-5 cells and pure, extravillous trophoblasts. Inhibition of MAPK kinase/ERK and phosphatidylinositide 3-kinase/AKT blocked phosphorylation of the kinases and attenuated CG-dependent invasion of SGHPL-5 cells. Similarly, the inhibitors decreased hormone-stimulated migration in villous explant cultures. Western blot analyses and gelatin zymography suggested that CG increased matrix metalloproteinase (MMP)-2 protein levels and activity in both culture systems. Inhibition of ERK or AKT diminished CG-induced MMP-2 expression. In summary, the data demonstrate that CG promotes trophoblast invasion and migration through activation of ERK and AKT signaling involving their downstream effector MMP-2. Because the increase of CG during the first trimester of pregnancy correlates with rising trophoblast motility, the hormone could be a critical regulator of the early invasion process.

The binding of [3H]oxytocin ([3H]-OT) and [3H]arginine vasopressin ([ 3H]-AVP) by bovine endometrial and myometrial membrane preparations obtained on days 0, 7, 14, 17, and 21 after estrus or mating was investigated. [3H]OT was bound with higher affinity than [3H]AVP by both tissues; the mean dissociation constants (KdS) were 0.95 x 10(-9) M and 1.56 x 10(-9) M for OT and AVP, respectively, P less than 0.0001, with no significant variations in the KdS during the cycle. The concentration of [3H]OT binding sites was on the average 50% higher than [3H]AVP across the cycle in both tissues. Endometrial receptor levels varied significantly during the cycle; it was lowest on days 7 and 14, rose significantly on day 17, and peaked on day 21. Myometrial receptor levels decreased from levels at estrus on days 7 and 14, but the changes were not significant. The ratio between endometrial and myometrial receptor concentrations changed from about 10 at estrus to less than 1 in the luteal phase. In early pregnancy, the receptor levels did not differ from nonpregnant levels on days 7 and 14, but on day 17 the endometrial receptor concentrations were significantly lower, and on day 21 those in both tissues were significantly lower. The endometrial OT and AVP receptor concentrations were inversely correlated with plasma progesterone levels (P = 0.005) with no correlation to plasma estradiol, whereas the myometrial receptor concentrations showed no correlation to plasma progesterone but an inverse correlation with plasma estradiol (P = 0.004). We conclude that the endometrial OT and AVP receptor concentrations are more tightly controlled by progesterone than myometrium, and that the bovine conceptus suppresses endometrial OT and AVP receptor concentrations in the preattachment stage either by a local action on the endometrium or indirectly via an antiluteolytic effect.

COVID-19 is placing considerable strain on healthcare systems. Disaster and military medicine specialists were involved in the outbreak in Italy, after many units were overwhelmed. Health providers were caught off guard and personnel was unprepared to face this unprecedented threat. Local decisions accelerated the rate of the spread. Many countries declared a state of emergency and lockdown to contain the exponential transmission of the disease. The purpose of this review is to suggest quick key points of strategies to implement in obstetric units without delay to respond to the oncoming wave, based on experience and feedback from the field. It is essential in an emergency situation to understand what is at stake and prepare maternity wards in the best possible way.

Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). Recommendations Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.

Bacterial and viral infections cause high rates of morbidity and mortality in premature newborns. In the setting of viral infection, pDCs play a key role as strong producers of IFN-α upon TLR9 activation. We analyzed pDC frequency, phenotype, morphology, and function in CB of preterm and term newborns in comparison with adults. Whereas all age groups show similar pDC numbers, BDCA-2, CD123, and TLR9 levels, the expression of BDCA-4 and capacity to produce IFN-α upon TLR9 challenge were decreased significantly in preterm neonates. Furthermore, we show by means of electron microscopy that pDCs from preterm newborns exhibit a distinct, "immature" morphology. Taken together, these findings suggest decreased functionality of pDCs in the premature newborn. The reduced capacity to produce IFN-α is likely to render such infants more susceptible to viral infections.