Background: Estimation of fetal weight through ultrasound or clinically, is important in the management of pregnant women. In low resource settings, where ultrasound is scarce, determination of the superior clinical method between Johnson’s rule and palpation method is of significant value. Objective: The objective of this study was to determine the best clinical method in estimating fetal weight in term parturients in a tertiary government hospital. 140 term mothers with singleton pregnancies in cephalic presentation were included in this study. Methodology: Fetal weight was estimated using both palpation method and Johnson’s rule and compared to the actual fetal weight. Effects of body mass index (BMI), cervical dilatation, and engagement on the accuracy of both methods were evaluated using one-way ANOVA and test of proportions. The accuracy of both methods were calculated by mean absolute error and bias. Bland-Altman analysis was used to see limits of agreement and the mean difference between estimated fetal weight to actual birthweight. Results: Mean estimated fetal weight (EFW) was 2846.39 ± 427.29g by Johnson’s and 2904.29 ± 372.79g by palpation with a mean actual birthweight of 3028.30 ± 441.52g. Using paired t-test, no significant differences were found in EFW by the two methods and actual birthweight. Palpation had more estimates that differed from actual by < 100 grams at 41.43% compared to 16.43% for Johnson’s with p < 0.001. Lower bias (7.11%) was seen in palpation compared to Johnson’s (12.09%) and with more precise estimates. Conclusion Palpation method is more accurate and reliable than Johnson’s rule. Clinical palpation is easy, cost effective, simple and should be considered as a diagnostic tool for fetal weight estimation especially in rural areas. The effect modifiers are cervical dilation for palpation and engagement for Johnson’s. BMI has no effect in accuracy of estimates in both methods.
Fetal Weight ; Fetus ; Prenatal Care ; Palpation ; Research Design ; Health Services

To date, the use of red blood cells (RBCs) produced from stem cells in vitro has not proved practical for routine transfusion. However, the perpetual and widespread shortage of blood products, problems related to transfusion-transmitted infections, and new emerging pathogens elicit an increasing demand for artificial blood. Worldwide efforts to achieve the goal of RBC production through stem cell research have received vast attention; however, problems with large-scale production and cost effectiveness have yet to prove practical usefulness. Some progress has been made, though, as cord blood stem cells and embryonic stem cells have shown an ability to differentiate and proliferate, and induced pluripotent stem cells have been shown to be an unlimited source for RBC production. However, transfusion of stem cell-derived RBCs still presents a number of challenges to overcome. This paper will summarize an up to date account of research and advances in stem cell-derived RBCs, delineate our laboratory protocol in producing RBCs from cord blood, and introduce the technological developments and limitations to current RBC production practices.
Blood Substitutes ; Cost-Benefit Analysis ; Embryonic Stem Cells ; Erythrocytes* ; Fetal Blood ; Induced Pluripotent Stem Cells ; Stem Cell Research ; Stem Cells*

A pregnancy is considered postterm if it is beyond 294 days (42 complete weeks). Several investigators have demonstrated that postterm pregnancy may be accompanied by a rise in perinatal morbidity and/or mortality. Abnormalities such as meconium staining, cringenital anomalies, intrauterine growth retardation, postmaturity syndrome, fetal asphyxia have been reported in some cases of reduced amniotic fluid volume (oligohyramnios) which is commonly observed in postterm pregnancies. Amniotic fluid volume has been shown to decrease significantly as gestational age advances beyond term. Oligohydramnios has particular relevance to postterm pregnancies. Poor perinatal outcomes of oligohydramnios on postterm pregnancy have been reported by several authors. To date, however, the relationship between oligohydramnios in pastterm pregnancy and fetal outcome is debatable. The purpose of this clinical study was to evaluate the relationship between oligohydr- amnios and perinatal outcome in 64 cases of postterm pregnancies. Amniotic fluid index(AFI) values were measured semiweekly in 64 good dated, uncomplicated singleton pregnancies. AFI values were categorized into 2 groups. The group 1; patients whose final AFI value was above 5.0 cm; Group 2, patients whose AFI value fell below 5.0 cm. Adverse fetal outcome was defined by the presence of meconium staining, fetal heart rate decelerations, cesarean delivery for fetal distress, low Apgar score at 1 and 5 minutes, neonatal intensive care unit admission, and perinatal mortality. The fetal outcome was compared group 1 with group 2 and results obtained were as follows: 1. The incidence of oligohydramnios in postterm pregnancy was 54.7 %. The average diminution of amniotic fluid index was from 8.2 1.8 cm to 5.6+2.2 cm/week. 2. The incidence of meconium-staining in amniotic fluid was 40.6 % (Group 1: 20.7 %, Group 2: 57.1 %) and showed statistically significant difference between the two groups(p= 0.003). 3. The incidence of Apgar score less than 7 was 23.4% in 1 minute (Group 1: 13.8 %, Group 2: 31.4 %) and 4.7 % in 5 minutes(Group 1: 3.4%, Group 2: 5.7 %), respectively and showed no statistically significant difference between the two groups (p=0.140, p=1.000). 4. I'he incidence of cesarean delivery due to fetal distress was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). 5. The incidence of admission to NICU was 12.5 % (Group 1: 6.9%, Group 2: 17.1 %) and showed no statistically significant difference between the two groups (p=0.275). Adverse fetal outcome was not uniformly observed in postterm pregnancies with oligohydramnios. Amniotic fluid index in oligohydramnios group as a single independent guide was not enough to predict fetal outcomes in postterm pregnancy without specific pathologic condition of fetus.
Amniotic Fluid* ; Apgar Score ; Asphyxia ; Deceleration ; Female ; Fetal Distress ; Fetal Growth Retardation ; Fetus ; Gestational Age ; Heart Rate, Fetal ; Humans ; Incidence ; Infant, Newborn ; Intensive Care, Neonatal ; Meconium ; Mortality ; Oligohydramnios ; Perinatal Mortality ; Pregnancy* ; Research Personnel

The use of high throughput screening (HTS) in drug development is principally for the selection new drug candidates or screening of chemical toxicants. This system minimizes the experimental environment and allows for the screening of candidates at the same time. Umbilical cordderived stem cells have some of the characteristics of fetal stem cell and have several advantages such as the ease with which they can be obtained and lack of ethical issues. To establish a HTS system, optimized conditions that mimic typical cell culture conditions in a minimal space such as 96 well plates are needed for stem cell growth. We have thus established a novel HTS system using human umbilical cord derived-mesenchymal stem cells (hUC-MSCs). To determine the optimal cell number, hUC-MSCs were serially diluted and seeded at 750, 500, 200 and 100 cells per well on 96 well plates. The maintenance efficiencies of these dilutions were compared for 3, 7, 9, and 14 days. The fetal bovine serum (FBS) concentration (20, 10, 5 and 1%) and the cell numbers (750, 500 and 200 cells/well) were compared for 3, 5 and 7 days. In addition, we evaluated the optimal conditions for cell cycle block. These four independent optimization experiments were conducted using an MTT assay. In the results, the optimal conditions for a HTS system using hUC-MSCs were determined to be 300 cell/well cultured for 8 days with 1 or 5% FBS. In addition, we demonstrated that the optimal conditions for a cell cycle block in this culture system are 48 hours in the absence of FBS. In addition, we selected four types of novel small molecule candidates using our HTS system which demonstrates the feasibility if using hUC-MSCs for this type of screen. Moreover, the four candidate compounds can be tested for stem cell research application.
Cell Count ; Cell Culture Techniques ; Cell Cycle ; Fetal Stem Cells ; Humans ; Hydrazines ; Mass Screening ; Mesenchymal Stromal Cells ; Seeds ; Stem Cell Research ; Stem Cells ; Umbilical Cord

OBJECTIVES: The purpose of this study is to establish animal model of extracorporeal membrane oxygenation (ECMO) system that uses membreane type oxygenator and circulation circuit of umbilical artery and vein. Blood gas and hemodynamic changes in the fetal goat undergoing ECMO were also evaluated. METHODS: Total 15 pregnant goat had been used to perform extrauterine fetal incubation using ECMO through umbilical artery and vein. Cesarean-section was performed to pregnant goat (35 kg) of 120-130 days of gestation to insert catheters (8 Fr) into the umbilical artery and vein. The tip of inserted catheter's the other end was connected with the circuit system including membrane type oxygenator (Polystan) and roller pump. A total of 300 ml of blood was drawn from donor nonpregnant goat and primed into circuit on the day of surgery. The goat fetus was immersed in a chamber filled with artificial amniotic fluid to monitor blood flow dynamics and blood gas was analyzed. RESULTS: The ECMO system using umbilical cord in the extrauterine incubation of fetal goat was developed and maximum survival of goat fetus was 34.5 hrs (mean survival was 856.6+/-688 min). Oxygen tension (PO2) in umbilical artery and vein were 20.53+/-2.54 mmHg, 31.03+/-13.03 mmHg and oxygen saturation (SO2) in umbilical artery and vein were 46.61+/-18.14 mmHg, 71.56+/-15.39 mmHg. Mean blood flow was 176+/-62 ml/min/kg. CONCLUSION: We suggest that our experimental model as an extrauterine fetal research could be a reasonable method in future advanced studies. However, longterm survival of extrauterine fetus needs more suitable hemodynamic and blood gas condition supported by further researches.
Amniotic Fluid ; Catheters ; Extracorporeal Membrane Oxygenation* ; Female ; Fetal Research ; Fetus ; Goats* ; Hemodynamics* ; Humans ; Membranes ; Models, Animal ; Models, Theoretical ; Oxygen ; Oxygenators ; Pregnancy ; Tissue Donors ; Umbilical Arteries* ; Umbilical Cord ; Veins*

Translational medicine is an emerging idea in current medical research area. Typically, for the purpose of bridging the gap between basic and clinical research, it not only emphasizes the urgency and necessity to break the traditional working formats, including single subject centered research team and limited cooperation among different scientific groups, but also highlights a more close and frequent interaction between basic scientist and clinician. In order to reach this goal, the theory and method of systems biology should be employed. This paper mainly focused on a central issue that how to carry out an investigation on early clinical diagnosis of xenobiotic-induced intrauterine growth retardation (IUGR) by using research concept of translational medicine and method of systems biology. Briefly, a hypothesis of common mechanism of IUGR was first proposed and subsequent validation was performed via integrating--omics (e.g. genomics, proteomics, cytomics, metabonomics/metabolomics) and molecular biology techniques. Metabonomics was further utilized to explore IUGR biomarker and establish preliminary forecasting model by bioinformatics and computational biology, which is available for early diagnosis of IUGR and make a complement to current evaluation criteria.
Biomarkers ; analysis ; Computational Biology ; Early Diagnosis ; Female ; Fetal Growth Retardation ; chemically induced ; diagnosis ; metabolism ; Genomics ; Humans ; Metabolomics ; Pregnancy ; Proteomics ; Systems Biology ; Translational Medical Research ; Xenobiotics ; toxicity

BACKGROUND/OBJECTIVES: The study was conducted to evaluate the effects of dietary leucine supplementation on mitochondrial biogenesis and energy metabolism in the liver of normal birth weight (NBW) and intrauterine growth-retarded (IUGR) weanling piglets. MATERIALS/METHODS: A total of sixteen pairs of NBW and IUGR piglets from sixteen sows were selected according to their birth weight. At postnatal day 14, all piglets were weaned and fed either a control diet or a leucine-supplemented diet for 21 d. Thereafter, a 2 × 2 factorial experimental design was used. Each treatment consisted of eight replications with one piglet per replication. RESULTS: Compared with NBW piglets, IUGR piglets had a decreased (P < 0.05) hepatic adenosine triphosphate (ATP) content. Also, IUGR piglets exhibited reductions (P < 0.05) in the activities of hepatic mitochondrial pyruvate dehydrogenase (PDH), citrate synthase (CS), α-ketoglutarate dehydrogenase (α-KGDH), malate dehydrogenase (MDH), and complexes I and V, along with decreases (P < 0.05) in the concentration of mitochondrial DNA (mtDNA) and the protein expression of hepatic peroxisome proliferator-activated receptor-γ coactivator 1α (PGC-1α). Dietary leucine supplementation increased (P < 0.05) the content of ATP, and the activities of CS, α-KGDH, MDH, and complex V in the liver of piglets. Furthermore, compared to those fed a control diet, piglets given a leucine-supplemented diet exhibited increases (P < 0.05) in the mtDNA content and in the mRNA expressions of sirtuin 1, PGC-1α, nuclear respiratory factor 1, mitochondrial transcription factor A, and ATP synthase, H+ transporting, mitochondrial F1 complex, β polypeptide in liver. CONCLUSIONS: Dietary leucine supplementation may exert beneficial effects on mitochondrial biogenesis and energy metabolism in NBW and IUGR weanling piglets.
Adenosine Triphosphate ; Birth Weight* ; Citrate (si)-Synthase ; Diet ; DNA, Mitochondrial ; Energy Metabolism* ; Fetal Growth Retardation ; Leucine* ; Liver ; Malate Dehydrogenase ; Nuclear Respiratory Factor 1 ; Organelle Biogenesis* ; Oxidoreductases ; Parturition* ; Peroxisomes ; Pyruvic Acid ; Research Design ; RNA, Messenger ; Sirtuin 1 ; Transcription Factors

Intrauterine respiratory movements were speculated from the ancient time, and numerous studies were carried out both in human and animal experiments. Results of these studies suggested that intrauterine respiratory movement exist regularly and there is free flow of amniotic fluid into fetal lung during the fetal life. Amniotic fluid contains desqumated epithelial cells, lanugo, and vernix caseosa. Thus, when the amniotic fluid is aspirated, these amniotic debris will also be aspirated. The effort of aspiration of amniotic debris were also studied by many investigators, and their report indicated that in normal gestation with normal delivery, aspiration of amniotic debris are minimal and gives no significant effect to neonatal infant. However, if the amniotic fluid contains excessive debris, by vigorous fetal movement due to intrauterine anoxia, a large amount of amniotic debris will be aspirate to cause disturbance in neonatal respiration. Demonstration of amniotic debris in the lung is carried out by the identification of desquamated epithelial cells or lipid which is present in vernix caseosa in alveolar lumen. Based on these observations, present study is planned to investigate the amount and distribution pattern of lipids in neonatally dead infant lung to correlate with aspiration of amniotic fluid to clinical data and coexisting pulmonary and systemic diseases. From the autopsy cases performed during January, 1973 and March, 1976, 26 cases of neonatal autopsies aged less than 10 days after the birth were subjected for the studies. From each case, sections of the lung were examined for the presence of amined for the presence of amniotic debris and pulmonary diseases after routine paraffin embedding and hematoxylin-eosin stain. For the demonstration of fat, frozen sections of lung tissue from each case were stained with oil red-O, and the amount and distribution of fat in the lung were recorded. The correlation of amount and distribution of fat with age of infants, gestation period, body weight, types of pulmonary and systemic diseaases were made and following results are obtained. RESULTS AND SUMMARY: 1. Fat is present frequently in the lungs of neonatally dead infants, and distributed widely in bronchioles, alveolar ducts, alveolar lumen, and alveolar wall. 2. As. The infant age is younger, less than 2 days, the larger amount and the wider distribution of the fat are noted. 3. The amount of fat was parallel to the amount of amniotic debris judged by desquamated epithelial cells in the alveolar lumina. 4. The most common associated diseases were congenital anomaly, prematurity, and respiratory distress syndrome.
Amniotic Fluid ; Animal Experimentation ; Anoxia ; Autopsy ; Body Weight ; Bronchioles ; Epithelial Cells ; Female ; Fetal Movement ; Frozen Sections ; Hair ; Humans ; Infant ; Lung Diseases ; Lung* ; Paraffin Embedding ; Parturition ; Pregnancy ; Research Personnel ; Respiration ; Vernix Caseosa

OBJECTIVE: The impact of maternal stress on pregnancy outcome has been a focus of research and cortisol is known as a biomarker of psychological stress. The aim of this study is to evaluate the relationship between salivary cortisol levels and pregnancy outcomes prospectively. METHODS: The subjects of this study were healthy pregnant women who collected morning samples of saliva (10~12 AM) at 10~13, 20~23 weeks of gestation, and postpartum 2 days between April 2007 to March 2008. Saliva was collected with commercial collector, Salivette(R), and cortisol level was analyzed by enzyme immunoassay. They also underwent ultrasonographic examination of umbilical and uterine artery Doppler between 20~23 weeks of gestation. Statistical analysis was assessed between salivary cortisol levels and pregnancy outcomes, including Doppler findings. RESULTS: A total 39 pregnant women collected salivary cortisol as indicated. They showed increase in cortisol level in 2nd trimester compared to 1st trimester, which decreased after delivery. Salivary cortisol level was not associated with maternal age, parity, occupation, body mass index, blood pressure, delivery mode, fetal sex, and fetal weight. However higher cortisol level was associated with lower resistance index of uterine artery, even there was no statistical significance. CONCLUSION: Our data could not show any association between salivary cortisol levels and pregnancy outcomes. Although this study presents a number of methodological and conceptual challenges, this does not necessarily preclude the use of salivary cortisol measures, but rather point to the importance of careful research design.
Blood Pressure ; Body Mass Index ; Female ; Fetal Weight ; Humans ; Hydrocortisone ; Immunoenzyme Techniques ; Maternal Age ; Occupations ; Parity ; Postpartum Period ; Pregnancy ; Pregnancy Outcome ; Pregnant Women ; Research Design ; Saliva ; Stress, Psychological ; Uterine Artery

Endothelial progenitor cells (EPCs) have been reported to possess the capacity to colonize vascular grafts and hold promise for therapeutic neovascularization. However, limited quantities of EPCs have been the major factor impeding effective research on vasculoangiogenesis. In this study, cytokine and culture conditions necessary for the provision of large quantities of endothelial cells (ECs) were investigated. Cord blood was collected from 18 normal full-term deliveries and CD34+ cells were isolated by MACS system (Miltenyi Biotech, Bergish-Gladbach, Germany). To evaluate the effect of cytokines, CD34+ cells were cultured with various cytokine combinations, such as stem cell factor (SCF), flt3-ligand (FL), and thrombopoietin (TPO) with vascular endothelial growth factor (VEGF), interleukin-1beta, fibroblast growth factor-basic (FGF-b) as basic cytokines. The quantities of non-adherent and adherent cells were the greatest with SCF, FL and TPO. The addition of TPO to all other cytokines significantly increased the number of non-adherent and adherent cells (p< 0.05, Wilcoxon rank sum test). After four weeks of culture, adherent cells expressed endothelial specific markers such as KDR, CD31 and CD62E. Typical morphology of ECs was observed during culture, such as cord-like structure and cobblestone appearance, suggesting that the adherent cells were consistent with ECs. In this study, the experimental conditions that optimize the production of ECs for therapeutic neovascularization were described. And it was possibly suggested that TPO plays a major role in differentiation from EPCs to ECs.
Antigens, CD34/analysis ; Cell Differentiation/drug effects ; Cell Division/drug effects ; *Cell Separation ; Cells, Cultured ; Cytokines/pharmacology ; *Endothelial Cells/immunology ; Fetal Blood/*cytology ; Fetus ; Flow Cytometry ; Humans ; Research Support, Non-U.S. Gov't ; *Stem Cells/*immunology ; Thrombopoietin/pharmacology