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Aim: This is the first report of a randomized trial of cerclage on pure cervical shortening without vaginosis or cervicitis. The objective of our multicenter randomized controlled trial was to assess the benefits of ultrasoundindicated cervical cerclage in the mid-trimester to prevent preterm birth in women who have no signs of infection or inflammation of the lower genital tract. Material and Methods: Women with a short cervical length < 25 mm between 16 and 26 weeks of gestation were randomly assigned to receive a Shirodkar cerclage, McDonald cerclage, or bedrest (no cerclage). Before being randomly assigned to one of the three groups, all women were screened for infection/inflammation of the lower genital tract; those with positive results were excluded from the study. The ratio of preterm delivery as a primary end-point was evaluated in the groups. Results: A total of 106 singleton patients with a short cervical length were assessed for study eligibility; 106 patients were randomized to the three treatment options. Ultimately, 98 patients (in the Shirodkar [n = 34], McDonald [n = 34] and bedrest [n = 30] groups) were analyzed. No differences in preterm delivery or perinatal outcomes were found between the three groups. Significantly fewer patients in the Shirodkar group required hospitalization for treatment of threatened preterm labor when compared to patients in the bedrest group. Conclusion: For women with a short cervical length < 25 mm between 16 and 26 weeks of gestation, Shirodkar cerclage might be considered to reduce the occurrence of threatened preterm labor.

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Previously, this group reported on a system of extrauterine incubation of a goat fetus, in which the fetus is surrounded by artificial amniotic fluid and connected to the circuit with an ECMO (extracorporeal membrane oxygenator) by the umbilical arteries and veins. The following is a summary of recent progress using an improved method of catheterization and a new system that included a dialyzer within the circuit. Nine goat fetuses were used in this experiment. Six goats were successfully incubated; the duration of their incubation was 146.5 2 61.3 h (mean * SD). The longest one was 236 h. Slowly progressive circulatory depression was thought to be the main cause of fetal death. Marked tendencies to bleeding and water retention were not observed in any cases. Stable serum electrolyte levels were maintained.

A high-performance liquid chromatographic method for simultaneous determination of free catecholamines, their basic metabolites and serotonin in human urine was developed. The compounds were separated on a precolumn of cation-exchange resin and a mixed-mode (C18/cation-exchange) column and determined by an eight-channel electrochemical detector. By this method, free norepinephrine (NE), epinephrine (E), dopamine (DA), normetanephrine (NMN), metanephrine (MN), 3-methoxy-tyramine (3-MT) and serotonin (5-HT) were determined in 40 min with inter-assay precision of 1.9, 3.2, 1.2, 1.6, 1.6, 5.5 and 3.2%, respectively. Detection limits were between 0.05 (E) and 0.3 (3-MT) pmol. The mean values of analytical recovery for NE, E, DA, NMN, MN, 3-MT, 5-HT were 99, 104, 104, 99, 102, 109 and 99%, respectively.

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Fetal cardiovascular responses to an altered intrauterine environment of increased myometrial contractures induced by oxytocin (OT) pulses to the ewe over the final 50 days of gestation were studied in chronically instrumented sheep. Ewes received saline (Cntl) or long-term OT treatment (LTOT, 600 microU x kg(-1) x min(-1) in 5-min pulses every 20 min) from 96 days gestational age. Fetal baroreflex responses to sodium nitroprusside (SNP) and phenylephrine (PE) were studied at 133 days gestation. OT increased contractures in LTOT ewes. Fetal blood pressure (FBP) was higher, and fetal heart rate (FHR) and slope of daily change in FBP and FHR were lower in LTOT fetuses. Fetal SNP-induced hypotension resulted in a narrow R-R interval variation range in LTOT fetuses; Cntl fetuses showed early breakdown in compensation. Baroreflex response slope during PE-induced fetal hypertension was lower in LTOT than in Cntl fetuses. Although the cortisol-to-ACTH ratio was lower in LTOT fetuses, fetal plasma ACTH and cortisol changes were similar in control and LTOT fetuses. We hypothesize that contracture-induced alterations in the intrauterine environment accelerate fetal cardiovascular development through mild hypoxemia, repetitive fetal pituitary-adrenal stimulation, and/or physical stimulation.