The small baby is a major challenge of modern obstetrics. Not only is low birth weight the most important factor associated with perinatal mortality but there are also dangers of short and long term mental or physical handicap in survivors. General management includes treatment of maternal disease, cessation of substance abuse, good nutrition and institution of bed rest. Although not of proven benefit, bed rest may maximize uterine blood flow. In any case, antenatal testing should be instituted. Because the task of the obstetrician is to deliver the baby in the best possible condition, which is possible only if the baby at risk has been recognized during the antenatal period, the place of intrapartum monitoring and the use of cesarean section in the management of the small baby are questions of everyday relevance to the practicing obstetrician. Delivery should be in a hospital capable of dealing with the various neonatal morbidities associated with growth restriction, including asphyxia, sepsis and malformations. Minimizing hypoxic episodes during labor and delivery, as well as optimizing neonatal care for these infants, will likely produce the healthiest outcome.
Asphyxia ; Bed Rest ; Cesarean Section ; Female ; Fetal Growth Retardation ; Humans ; Hypogonadism ; Infant ; Infant, Low Birth Weight ; Infant, Newborn ; Mitochondrial Diseases ; Obstetrics ; Ophthalmoplegia ; Perinatal Mortality ; Pregnancy ; Premature Birth ; Sepsis ; Substance-Related Disorders ; Survivors

Excretory-secretory products (ESP) of T. vaginalis have been shown to inhibit sperm motility, viability, and functional integrity, leading to a decreased fertilization rate in vitro. This study investigated whether T. vaginalis induce apoptosis and ultrastructural changes of sperm using flow cytometry and electron microscopy. Incubation of sperm with T. vaginalis ESP increased phosphatidylserine externalization and DNA fragmentation, and decreased mitochondrial membrane potential. Transmission electron microscopy of sperm incubated with ESP revealed abnormal features such as distorted heads, broken necks, and acrosomes exocytosis. This is the first report that demonstrates a direct impact of T. vaginalis ESP on sperm apoptosis and architecture in vitro.

Lactobacillus species in the female genital tract are thought to act as a barrier to infection. Several studies have demonstrated that lactobacilli can adhere to vaginal epithelial cells. However, little is known about how the adherence of lactobacilli to vaginal epithelial cells affects the acidity, cell viability, or proliferation of the lactobacilli themselves or those of vaginal epithelial cells. Lactobacillus acidophilus was co-cultured with immortalized human vaginal epithelial cells (MS74 cell line), and the growth of L. acidophilus and the acidity of the culture medium were measured. MS74 cell density and viability were also assessed by counting cell numbers and observing the cell attachment state. L. acidophilus showed exponential growth for the first 6 hr until 9 hr, and the pH was maintained close to 4.0-5.0 at 24 hr after culture, consistent with previous studies. The growth curve of L. acidophilus or the pH values were relatively unaffected by co-culture with MS74 cells, confirming that L. acidophilus maintains a low pH in the presence of MS74 cells. This co-culture model could therefore potentially be used to mimic vaginal conditions for future in vitro studies. On the other hand, MS74 cells co-cultured with L. acidophilus more firmly attached to the culture plate, and a higher number of cells were present compared to cells cultured in the absence of L. acidophilus. These results indicate that L. acidophilus increases MS74 cell proliferation and viability, suggesting that lactobacilli may contribute to the healthy environment for vaginal epithelial cells.
Cell Adhesion ; Cell Line ; Cell Survival ; Coculture Techniques ; Culture Media/chemistry ; Epithelial Cells/*microbiology/*physiology ; Female ; Humans ; Hydrogen-Ion Concentration ; Lactobacillus acidophilus/growth & development/metabolism/*physiology ; Time Factors