[Harvest of Stem Cells from Umbilical Cord Blood: Relevance of Perinatal Factors for the Quality of Umbilical Cord Transplant Units]. / Gewinnung von Stammzellen aus Nabelschnurblut: Relevanz peripartaler Faktoren für die Qualität von Transplantaten.

INTRODUCTION: Umbilical cord blood (UCB) contains hematopoietic stem cells with therapeutic potential and unique cellular properties. Due to the limited number of stem cells in the UCB (surrogate marker total nucleated cells, TNC), only one in five donations is suitable for transplantation. The aim of this study was to investigate whether predictive factors exist for a TNC count above the 99th percentile. MATERIAL AND METHODS: Retrospective data analysis of the 100 largest donations from 2,299 registered UCB units. Differences between maternal, fetal, and obstetric factors were analyzed and compared with a standardized cohort of 731 registered UCB units. RESULTS: maternal age and BMI in the Top100 cohort were higher compared with the comparative cohort (32 vs. 31 years, p=0.007; 30 kg/m2 vs. 29 kg/m2, p=0.024). There were significantly more P1 (76.0 vs. 62.8%, p=0.013) and women with gestational diabetes (5.00 vs. 1.65%, p=0.044). The gestational week, birth weight, the proportion of vaginal-operative deliveries and secondary caesarean sections were higher in the Top100 cohort (40+4 vs. 40+1 wks, p=0.002), (3700 vs. 3450 g, p<0.001), (53.0 vs. 22.7%, p<0.001) (10 vs. 6.2%, p=0.014). CONCLUSION: For a successful transplant, the amount of TNC in the UCB unit is crucial. Vaginal-operative deliveries, secondary caesarean sections, and a birth weight above 3700 g are favorable with regard to stem cell content. In cases with a complicated course of delivery, collection should not be neglected once the mother and child are safely cared for.

Antenatal predictors of stem cell content for successful umbilical cord blood donation.

PURPOSE: The most important HLA-independent factor for the selection of cord blood units (CBU) for hematopoietic stem cell transplantation is the total nucleated cell (TNC) count over 150 × 107 as a surrogate marker for stem cell content. The purpose of this prospective study was to define prenatal clinical predictors for TNC count that would help to identify successful CBU donors before the onset of active labor. METHODS: This was a prospective analysis of 594 CBUs, collected from all eligible term singleton pregnancies at Basel University Hospital between 4/2015 and 9/2016 analyzing several maternal and fetal factors. The impact of these factors on TNC count (< 150 × 107 cells vs. ≥ 150 × 107 cells) of the CBUs was modeled in a multivariate analysis. RESULTS: A total of 114 (19.2%) CBUs had a TNC count of ≥ 150 × 107. In a ROC analysis there was no significant difference between the AUC of all prenatal factors (AUC 0.62) and estimated fetal birth weight by ultrasound alone (AUC 0.62). For women planning a trial of labor a recruitment cut-off at an estimated birth weight of 3300 g would allow 72.6% of all donors with sufficient TNC count to be recruited and 22.8% of all collected CBUs would have a sufficient TNC count for banking. For women planning for elective CS a cut-off of 3400 g would allow 71.4% of all donors with sufficient TNC count to be recruited and 22.7% of all collected CBUs would have sufficient TNC count for banking. CONCLUSION: The estimated fetal birth weight within 2 weeks of delivery by ultrasound as single parameter can be considered at the time of recruitment to estimate the chances of a successful CBU donation.

Antenatal psychobiological predictors of psychological response to childbirth.

BACKGROUND: Several psychological and obstetric predictors of a negative childbirth experience and traumatic response to delivery have been identified. However, the influence of antepartum physiological stress parameters has not been elucidated. OBJECTIVE: The study includes an exploratory analysis of the associations of fear of delivery, antenatal basal and reactive activity of the hypothalamic-pituitary-adrenal axis, and obstetric outcomes, with childbirth experience and posttraumatic avoidance in the postpartum period. DESIGN: This was a prospective study with two antenatal measurements and a final assessment during the first week postpartum. An experimental condition with a standardized stressor (Trier Social Stress Test) was included in the design to study psychobiological stress response as a predictor of traumatic birth and posttraumatic avoidance. RESULTS: Linear regression analyses show independent associations of fear of delivery and more pronounced antenatal cortisol awakening response with a more negative childbirth experience. Fear of delivery was mediated by state anxiety after stress exposure, which, together with cortisol awakening response, explained 16% of the variance in the outcome of a more negative childbirth experience. Finally, antenatal fear of delivery and a negative childbirth experience both predicted higher avoidance scores during the first week postpartum. CONCLUSIONS: The associations found in this study can improve identification during pregnancy of women at risk for negative psychological response to childbirth. For these women, the provision of supportive care during pregnancy should be evaluated.

Safety and acceptance of "Vibwife", a new moving mattress to support mobilization during labor: Result of a clinical study.

OBJECTIVE: To examine the safety and acceptance "Vibwife", a new moving mattress to support mobilization of pregnant women during labor. DESIGN: The study was a prospective medical device clinical study without a control group. The study was designed in intervention phases, with safety evaluation by a safety review board after each intervention phase. SETTING: The study took place at the University Hospital of Basel, Switzerland. PARTICIPANTS: 50 women were included with a low risk singleton pregnancy > 37th weeks during the first stage of labor. INTERVENTION: Evaluation of the safety and acceptance of women, midwives and physicians during the first stage of labor. The intervention was carried out in 3 phases. In the first phase five women in labor used the device for 10 minutes, the next 10 women for 20 minutes, and finally the next 35 women for 30 minutes. MEASUREMENTS: Measurement included capturing Adverse Events (AEs) (including Adverse Device Effects (ADEs)), Serious Adverse Events (SAEs) and recording vital parameters before, during, and after intervention, as well as CTG before and after intervention. Acceptance by women, midwives and physicians was measured by questionnaires with a 4-point Likert scale and pain intensity by a discrete Visual Analogue Scale (VAS) from 0-10. FINDINGS: No SAE occurred during the trial. A total of 32 AEs occurred in 25 women during the intervention or in the 30 minutes follow-up. The most frequently observed AEs were modification of blood pressure and CTG abnormalities. None of the 32 AEs led to sequels of any kind. The relationship between AEs occurrence and the use of the medical device was viewed as certain in 2 cases (6.2%), possible or likely in 8 cases (25%), and unlikely or unrelated in 22 cases (68, 7%). Overall, women, midwives and physicians reported high satisfaction with their use of the device. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The medical device "Vibwife" was judged as safe for women. Acceptance among women and health personnel was good. Considering the potential benefits of mobilization during labor, this new medical device could be a very interesting adjunct to other obstetrical tools. Particularly, women whose mobility is restrained by epidural anesthesia while giving birth could be very suitable candidates. To answer the question of efficacy, a randomized-controlled trial is required.