[Stillbirths in the Obstetrical Departments of Berlin from 2013 to 2014]. / Totgeburten der Jahre 2013 und 2014 in den Berliner Kliniken.

Objective: Review of anonymous data of all stillbirths in all 19 obstetrical departments in Berlin from 2013-2014 with the goal to develop strategies for prevention of stillbirths (≥500 g birth weight). Results: There were a total of 401 stillbirths,178 after fetocide or pregnancy termination and 223 were spontaneous stillbirths. Of this group an anatomical diagnosis from the autopsy was documented in 21 cases. When compared to live births, spontaneous stillbirths were significantly more likely to have intrauterine growth restriction (birth weight under the 10th percentile), a mother≥35 years of age, and a mother from a foreign country. Conclusions: In order to establish efficient strategies of stillbirth prevention, it is important to develop a uniform methodology for collecting stillbirth data on the mother, baby and placenta, and to develop a local or national registry of these data.

Prophylactic tranexamic acid in parturients at low risk for post-partum haemorrhage: systematic review and meta-analysis.

Tranexamic acid is effective in reducing blood loss during various types of surgery and after trauma. No compelling evidence has yet been presented for post-partum haemorrhage. A systematic literature search of relevant databases was performed to identify trials that assessed blood loss and transfusion incidence after tranexamic acid administration for post-partum haemorrhage. The random effects model was used for meta-analysis. Risk ratios (RRs) and weighted mean differences (WMDs) were calculated with 95% confidence intervals (CIs). Seven trials with a low risk of bias comparing tranexamic acid vs. placebo with a total of 1760 parturients were included in our systematic review and meta-analysis. Blood loss was significantly lower after tranexamic acid use (WMD -140.29 ml, 95% CI -189.64 to -90.93 ml; P<0.00001). Tranexamic acid reduced the risk for blood transfusions (RR 0.34, 95% CI 0.20-0.60, P=0.0001). The incidence of transfusions in the placebo group varied between 1.4% and 33%. When omitting the two trials with the highest incidence of transfusions, the RR was no longer significant. Additional uterotonics were necessary in the placebo groups; gastrointestinal adverse events were more common after tranexamic acid use. Only four cases of thrombosis were found, two each in the tranexamic acid and control groups. Tranexamic acid effectively reduced post-partum blood loss; the effect on the incidence of blood transfusions requires further studies. Only few trials observed adverse events including thromboembolic complications and seizures.

[Pharmacological prevention disease with vitamin D--epidemiological evidence using the example of complications during pregnancy and birth]. / Medikamentöse Krankheitsprävention mit Vitamin D--Epidemiologische Evidenz am Beispiel von Komplika-tionen im Verlauf der Schwangerschaft und bei der Geburt.

National and international epidemiological studies have shown that relevant segments of populations are - especially in the winter period - vitamin D deficient and for the entire year vitamin D intake is far too low. This also applies to pregnant women. In January 2012 the German Nutrition Society has increased the intake recommendations for vitamin D by a factor of 4. It is suggested that a sufficient supply with vitamin D has high preventive potentials with respect to several chronic diseases and will potentially reduce the incidence of preterm birth. This paper considers the evidence of associations between vitamin D deficiency and adverse pregnancy outcomes. Based on the current epidemiological knowledge which is, however, sparse there is very low evidence that vitamin D deficiency is a relevant risk factor for adverse pregnancy outcomes. This makes it even more difficult to give rationale answers to emerging questions with respect to supplementation, dosage and vitamin D diagnostic measures. An observational study with 2 or 3 large obstetric clinics should be undertaken to clarify the central question without delay.

[Non-invasive genetic prenatal testing--an ethical discourse]. / Non-invasive Genetische Pränatale Testung--ein ethischer Diskurs.

The non-invasive genetic prenatal testing (NIPT) provides better diagnostic results for the autosomal aneuploidies and decreases the rate of invasive diagnostic methods. With NIPT the possibility for a real screening method is given while posing a lot of ethical questions which have to be answered by the scientific and public communities.

Relationship between fetal head station established using an open magnetic resonance imaging scanner and the angle of progression determined by transperineal ultrasound.

OBJECTIVE: We investigated the correlation between the angle of progression measured by transperineal ultrasound and fetal head station measured by open magnetic resonance imaging (MRI), the gold standard, in pregnant women at full term. METHODS: Thirty-one pregnant women at full term with a fetus in the occipitoanterior position were enrolled. First, the distance between the leading part of the skull and the interspinal plane was obtained using an open MRI system with the patient in a supine position. Immediately after MRI, the angle of progression was obtained by transperineal ultrasound without changing the woman's posture. RESULTS: There was a significant correlation between the angle of progression determined by transperineal sonography and the distance between the presenting fetal part and the level of the maternal ischial spines (y = - 0.51x + 60.8, r(2) = 0.38, P < 0.001). None of the fetal heads was engaged at the time of MRI and ultrasound examinations. CONCLUSIONS: The present study demonstrated a predictable relationship between the angle of progression obtained by transperineal ultrasound and the traditional scale used to quantify fetal head descent. Based on our results, station 0 would correspond to a 120° angle of progression. However, this correlation is based on statistical assumptions only and has to be proven in future studies.

Measurement of fetal head descent using the 'angle of progression' on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise.

OBJECTIVES: To assess whether ultrasound experience or fetal head station affects the reliability of measurement of fetal head descent using the angle of progression on intrapartum ultrasound images obtained by a single experienced operator, and to determine reliability of measurements when images were acquired by different operators with variable ultrasound experience. METHODS: One experienced obstetrician performed 44 transperineal ultrasound examinations of women at term and in prolonged second stage of labor with the fetus in the occipitoanterior position. Three midwives without ultrasound experience, three obstetricians with < 5 years' experience and three obstetricians with > 10 years' experience measured fetal head descent based on the angle of progression in the images obtained. The angle of progression was measured by two obstetricians in independent ultrasound examinations of 24 laboring women at term with the fetus in the cephalic position to allow assessment of the reliability of image acquisition. Intraclass correlation coefficients (ICCs) with 95% confidence interval (CI) were used to evaluate interobserver reliability and Bland-Altman analysis was used to assess interobserver agreement. RESULTS: In total, 444 measurements were performed and compared. Interobserver reliability with respect to offline image analysis was substantial (overall ICC, 0.72; 95% CI, 0.63-0.81). ICCs were 0.82 (95% CI, 0.70-0.89), 0.81 (95% CI, 0.71-0.88) and 0.61 (95% CI, 0.43-074) for observers with > 10 years', < 5 years' and no ultrasound experience, respectively. There were no significant differences between ICCs among observer groups according to ultrasound experience. Fetal head station did not affect reliability. Bland-Altman analysis indicated reasonable agreement between measurements obtained by two different operators with > 10 years' and < 5 years' ultrasound experience (bias, -1.09 degrees ; 95% limits of agreement, -8.76 to 6.58). The reliability of measurement of the angle of progression following separate image acquisition by two experienced operators was similar to the reliability of offline image analysis (ICC, 0.86; 95% CI, 0.70-0.93). CONCLUSIONS: Measurement of the angle of progression on transperineal ultrasound imaging is reliable regardless of fetal head station or the clinician's level of ultrasound experience.

Uterine compression sutures for preserving fertility in severe postpartum haemorrhage: an overview 13 years after the first description.

We performed a systematic review of the current literature on efficacy, complications and impact on future pregnancies of uterine compression sutures (UCS) applied in cases of severe postpartum haemorrhage (PPH) in women who wish to preserve fertility. Publications related to UCS from their initial description 03/1996-07/2009, were identified using PubMed and EMBASE. Numerous case series have demonstrated the high efficiency of UCS against PPH. When performed correctly, they are associated with a low complications rate. A higher risk of uterine ischaemia seems to be caused when combined with vessel ligation. No negative impact on fertility has been reported. Uncomplicated future pregnancies occur within a range of 1-3 years. UCS appear safe, simple to learn and preserve future reproductive potential. They should be considered prior to definite measures like hysterectomy in severe PPH. Long-term follow-up is recommended when additional combined vessel ligation is performed due to the potential risk of ischaemic necrosis.

[Management of dichorionic twin delivery at term with cephalic-presenting first twin - a monocentric retrospective cohort study]. / Geburtsleitung bei dichorialen Zwillingen am Termin bei vorangehendem Zwilling in Schädellage - eine monozentrische retrospektive Kohortenstudie.

OBJECTIVE: To assess neonatal outcome and delivery mode in dichorionic twin delivery at term with a cephalic-presenting first twin. METHODS: A retrospective cohort study of 308 twin deliveries after 37 completed weeks of gestation with a cephalic-presenting first twin undertaken in one perinatal center with active management of second twin delivery. The neonatal outcome was measured by the Apgar score, the umbilical artery pH and the transfer into the neonatal unit. RESULTS: In the whole group, 57% were vaginally delivered and 43% needed a Cesarean delivery. The planned vaginal delivery group contained 71% while the planned elective Cesarean delivery group contained 29%. In the planned vaginal delivery group 80% were delivered vaginally, in 15% an emergency Cesarean was necessary, 5% had a vaginal delivery of the first twin followed by Cesarean delivery of the second twin. The neonatal outcome of the second twin shows a higher risk. There are significant differences in the rates of the second twin having lower rates of the umbilical artery pH >7.20 in the group of planned vaginal delivery. The higher risks are compensated in the group of planned elective Cesarean delivery. CONCLUSIONS: Planned vaginal delivery of dichorionic twins at term and active second-stage management is associated with lower rate of normal neonatal outcome. These risks should be considered in prenatal informed consent discussions with the pregnant woman.

Technical performance of lactate biosensors and a test-strip device during labour.

INTRODUCTION: Lactate in fetal blood has a high diagnostic power to detect fetal compromise due to hypoxia, as lactate allows an estimation of duration and intensity of metabolic acidemia. Biosensor technology allows an instantaneous diagnosis of fetal compromise in the delivery room. The goal of the current investigation is to define the preanalytical and analytical biases of this technology under routine conditions in a labour ward in comparison to test-strip technology, which allows measurement of lactate alone. MATERIAL AND METHODS: Three lactate biosensors (RapidLab 865, Siemens Medical Solutions Diagnostics, Bad Nauheim, Germany; Radiometer ABL625 and ABL 700, Radiometer Copenhagen, Denmark) and one test-strip device (Lactate Pro, Oxford Instruments, UK) were evaluated regarding precision in serial and repetitive measurements in over 1350 samples of fetal whole blood. The coefficient of variation (CV) and the standard deviation (SD) were calculated. The average value of all three biosensors was defined as an artificial reference value (refval). Blood tonometry was performed in order to test the quality of respiratory parameters and to simulate conditions of fetal hypoxia (pO (2): 10 and 20 mmHg). RESULTS: The precision of serial measurements of all biosensors indicated a coefficient of variation (CV) between 1.55 and 3.16% with an SD from 0.042 to 0.053 mmol/L. The test-strip device (Lactate Pro) mounted to 0.117 mmol/L and 3.99% (SD, CV). When compared to our reference value (refval) ABL 625 showed the closest correlation of -0.1%, while Siemens RapidLab 865 showed an overestimation of +8.9%, ABL700 an underestimation of -6.2% and Lactate Pro of -3.7%. CONCLUSION: For routine use all tested biosensors show sufficient precision. The test-strip device shows a slightly higher standard deviation. A direct comparison of measured lactate values from the various devices needs to be interpreted with caution as each method detects different lactate concentrations. Furthermore, the 40 min process of tonometry led to an increase of SD and coefficient of variation in all devices. This results in the important preanalytical finding that the precision of replicated measurements worsens significantly with time. The clinician should be aware of the type of analyser used and of preanalytical biases before making clinical decisions on the basis of lactate values.

Transperineal ultrasound imaging in prolonged second stage of labor with occipitoanterior presenting fetuses: how well does the 'angle of progression' predict the mode of delivery?

OBJECTIVES: To compare the angle of progression on transperineal ultrasound imaging between different modes of delivery in prolonged second stage of labor with occipitoanterior fetal position. METHODS: We prospectively evaluated 41 women at term (>or= 37 weeks) with failure to progress in the second stage of labor. Only cases with occipitoanterior fetal position were included in the final analysis. These cases were classified into three groups: Cesarean section for failure to progress, vacuum extraction for failure to progress, and spontaneous delivery following prolonged second stage of labor. Transperineal ultrasound examination was performed just before digital examination and subsequent delivery. The angle between a line placed through the midline of the pubic symphysis and a line running from the inferior apex of the symphysis tangentially to the fetal skull (the so-called 'angle of progression') was measured offline by an observer blinded to the mode of delivery. RESULTS: There were 26 cases with occipitoanterior fetal position (Cesarean section, n = 5; vacuum extraction, n = 16; spontaneous delivery, n = 5). Logistic regression analysis showed a strong relationship between the angle of progression and the need for Cesarean delivery (R(2) measure of fit = 55%, likelihood ratio chi-square P < 0.0001). When the angle of progression was 120 degrees , the fitted probability of either an easy and successful vacuum extraction or spontaneous vaginal delivery was 90%. CONCLUSIONS: This is the first report to document a strong relationship between an objective ultrasound marker (angle of progression) and the mode of delivery following prolonged second stage of labor with occipitoanterior fetal position. A predictive model using this parameter would allow better decision making regarding operative delivery for obstructed labor.

[Early health promotion and prevention at the beginning of the 20th and 21st centuries. Data and thoughts on the 100th anniversary of the opening of the Empress Auguste Victoria House in Berlin]. / Frühe Gesundheitsförderung und Prävention am Beginn des 20. und des 21. Jahrhunderts. Daten und Gedanken zum 100. Jahrestag der Eröff nung des Kaiserin Auguste Victoria Hauses zu Berlin.

In June 1909, The Empress Auguste Victoria House in Berlin was opened. This first institute for preventive paediatrics had the objective to overcome infant mortality in Germany. This objective was attained. Since then, an unprecedented decrease of mortality in all age groups occurred as well as a doubling of life expectancy. With this "retreat of death", our concepts of health changed fundamentally, and a new spectrum of diseases emerged. This article discusses some mile stones of this change, and explains why we find more illness despite the great improvement in the field of health. The "new diseases" amenable to early prevention are presented in a table. To make disease prevention successful requires the participation of the individual. Therefore, it is important to know the demand to make a good programme effective in the population. Empirical results of a nationwide representative study on the demand by expecting and young parents for preventive consultation are presented. Anticipatory guidance of young parents is a modern approach to health promotion and disease prevention. A controlled trial shows that this approach improved knowledge, behaviour, health risk indicators, health, and development during the first two years after delivery. Future studies should focus on long term effects of early health promotion.

[Survey on breast-feeding initiation and potential impact factors in hospitals and birth centres in Berlin]. / Untersuchung in Berliner Geburtskliniken und Geburtshäusern über den Stillbeginn und mögliche Einflussfaktoren.

AIMS: The aim of this study was to collect information on and to evaluate the impact of the timing of first suckling and breast-feeding initiation in Berlin and to assess the practicability and acceptance of using a short questionnaire to collect breast-feeding data in hospitals and birth centres. METHODS: A three-month observational study was conducted in 19 maternity units and 4 birth centres, using a short questionnaire to collect quantitative data on the timing of first suckling and breast-feeding from mother-child pairs on the day of discharge. RESULTS: The data indicate a breast-feeding rate of 96.1% at discharge. Infants born in birth centres were more frequently put to their mother's breast within the first hour after birth (p<0.05), and were more frequently mainly (p<0.05) or exclusively (p<0.01) breast-fed at discharge than infants born in hospitals. Hospitals' breast-feeding policies (i.e., following the 'ten steps to successful breast-feeding') were not associated with a higher prevalence of early first suckling and any breast-feeding at discharge, but rather with exclusivity of breastfeeding (p<0.001). CONCLUSIONS: Breast-feeding initiation rates are satisfactorily high in Berlin. Rates of early first suckling and (exclusive) initial breast-feeding are highest in birth centres. No consistent association was found between hospitals' breast-feeding policy and initial breast-feeding variables. The questionnaire was well accepted and is deemed suitable for monitoring purposes.

Intrauterine growth restriction in a rodent model and developmental programming of the metabolic syndrome: a critical appraisal of the experimental evidence.

Research on intrauterine growth restriction (IUGR) and subsequent development of obesity, type 2 diabetes and the metabolic syndrome is rapidly expanding, and potential implications for primary prevention are considerable. We have critically appraised one of the experimental animal models frequently used as mimic of human fetal growth restriction, which involves bilateral ligation of the uterine artery in rats (Lig). Our experimental study showed that Lig performed on day 17 of pregnancy neither leads to IUGR nor to neonatal catch-up growth, an important pathogenetic co-factor in humans. Meta-analysis of the literature revealed domination by studies in which Lig pups with IUGR were actively selected. Accordingly, publication bias is evident (p=0.007). Altered placental perfusion--the main cause of IUGR in humans in Western countries--neither led to IUGR nor to neonatal catch-up growth in Lig offspring, i.e., to none of the etiological factors of the human 'small baby syndrome'. Appropriate and reproducible rodent models of IUGR through decreased placental flow remain to be established to uncover the pathophysiological basis of the 'small baby syndrome'. This may lead to new strategies of primary prevention of diabetes, obesity, and the metabolic syndrome.

Endovascular trophoblast invasion, spiral artery remodelling and uteroplacental haemodynamics in a transgenic rat model of pre-eclampsia.

The aim of the present study was to evaluate the depth of endovascular trophoblast invasion and associated remodelling of spiral arteries in a transgenic model of pre-eclampsia in the rat, a species showing a comparable deep invasion during normal pregnancy as the human. Pre-eclamptic (PE) transgenic rats (TGR) (hAngiotensinogen female x hRenin male) and non-PE reversely mated (RM) TGR rats were compared to normal Sprague-Dawley rats (C). Day 18 implantation sites were collected and the presence of endovascular trophoblast, fibrinoid, endothelial and smooth muscle cells were evaluated in spiral arteries in three parallel layers in the mesometrial triangle using an image analysis system (KS-400). In a separate group of animals peak-systolic and end-diastolic velocities were measured by Doppler in uterine and arcuate arteries, and the resistance indices (RI) were calculated. In PE and RM rats, the entire mesometrial triangle contained significantly more endovascular trophoblast and vascular fibrinoid deposits than the C group. No difference was found between the groups in the overall amount of smooth muscle surrounding the lumen, but in the PE and RM groups significantly more muscle was present in parts of the contours covered by trophoblast. There was significantly less CD31-positive endothelium in the total lumen contours of the PE and RM groups than in the C group, but in parts of the contours covered by trophoblast more residual endothelium was present in both TGR groups. Comparison of the three layers indicated deeper invasion in both the PE and RM groups than in the C group. By Doppler analysis of the proximal uterine artery the RI was found to be significantly lower in the PE and the RM group than in the C group. In the arcuate artery, the RI was significantly lower in the PE group as compared to the RM and C groups. We conclude that in this transgenic PE rat model there is deeper endovascular invasion of spiral arteries and decreased RI of uterine arteries at day 18 of pregnancy.

Prenatal sonographic and MRI findings in a pregnancy complicated by uterine sacculation: case report and review of the literature.

Approximately 15% of women have a retroverted uterus prior to pregnancy, and retroversion occurs in 11% of women in the first trimester of pregnancy. However, the uterus usually moves to an upward position before 14 weeks' gestation. Incarceration and sacculation of a retroverted uterus occur in 1 in 3000 pregnancies and are difficult to diagnose. They have often been missed until shortly before delivery and can lead to serious obstetric emergencies such as labor dystocia, uterine rupture, retained placenta and uncontrollable postpartum hemorrhage. Performing a Cesarean section without correct diagnosis may cause difficulties in identifying the bladder and the cervix, and therefore in opening the lower uterine segment. This leads to bladder injuries, vaginal transsection and trans- or supracervical hysterectomy. Early diagnosis and detailed scanning are crucial for the obstetric management and operative approach.We report a case of an incarcerated uterus in a patient presenting at 24 weeks' gestation with severe bilateral flank and lower abdominal pain. The symptoms were misdiagnosed as appendicitis. Digital examination revealed a ventralized vaginal axis. The cervix was not palpable. The clinical course, and two- and three-dimensional ultrasound and magnetic resonance imaging findings, are presented. The delivery was performed by midline laparotomy Cesarean section. The management for different gestational ages and a review of the literature are discussed.

Patients with preeclampsia develop agonistic autoantibodies against the angiotensin AT1 receptor.

Immune mechanisms and the renin-angiotensin system are implicated in preeclampsia. We investigated 25 preeclamptic patients and compared them with 12 normotensive pregnant women and 10 pregnant patients with essential hypertension. Antibodies were detected by the chronotropic responses to AT1 receptor-mediated stimulation of cultured neonatal rat cardiomyocytes coupled with receptor-specific antagonists. Immunoglobulin from all preeclamptic patients stimulated the AT1 receptor, whereas immunoglobulin from controls had no effect. The increased autoimmune activity decreased after delivery. Affinity-column purification and anti-human IgG and IgM antibody exposure implicated an IgG antibody directed at the AT1 receptor. Peptides corresponding to sites on the AT1 receptor's second extracellular loop abolished the stimulatory effect. Western blotting with purified patient IgG and a commercially obtained AT1 receptor antibody produced bands of identical molecular weight. Furthermore, confocal microscopy of vascular smooth muscle cells showed colocalization of purified patient IgG and AT1 receptor antibody. The protein kinase C (PKC) inhibitor calphostin C prevented the stimulatory effect. Our results suggest that preeclamptic patients develop stimulatory autoantibodies against the second extracellular AT1 receptor loop. The effect appears to be PKC-mediated. These novel autoantibodies may participate in the angiotensin II-induced vascular lesions in these patients.

[Multiple roles and quality of life of mothers two years after the birth of the first child]. / Berufstätigkeit und Lebensqualität von Müttern zwei Jahre nach der Geburt des ersten Kindes.

TOPIC: We studied those characteristics of mothers that are related to occupational activity two years after the birth of the first child. Differences in the health-related quality of life between working mothers and mothers who are not working were also analysed, taking other parameters into account, in particular household income. METHODOLOGY: 311 mothers with a first child were given a questionnaire on the quality of life based on WHOQOL-BREF, on depression (also surveyed one year before for 139 mothers), on their work situation, socio-demography and other possible confounders. The probability of vocational activity was analysed using logistic regression and the influence of multiple roles on the quality of life was analysed using multiple linear regression. RESULTS: About 60% of mothers were not working two years after the birth of their first child, 25% were working part-time and 11% full time, with 4% in training or education. Working mothers were more likely to have a higher level of education (60% vs. 31%) and less likely to have a household income below the poverty line (13% vs. 47%). The results of the logistic regression showed that the odds ratio for being employed was six times higher for mothers with higher education than mothers with a lower level of education [OR 5.99; 95% confidence interval (CI) 2.58-13.91], whereas the odds ratio for mothers with additional children against those with only one child was 0.14; (95% CI 0.05-0.40), and for mothers with German nationality against those of other ethnicities the odds ratio was 2.37 (95% CI 1.12-5.04). Working mothers give more positive ratings than non-working mothers for their physical and mental quality of life (both p<0.01), their social relationships (p<0.05), as well as their global quality of life and their depression score (p<0.10). Even after adjusting for the depression score one year before working mothers reported less depression (p<0.05). The influence of income on the quality of life was low, except for the assessment of the quality of the environment, and this explains only a small part of the positive effect of the vocational activity. CONCLUSIONS: Vocational activity of mothers of two-year old children reduces the risk of poverty and additionally contributes to an improved physical and mental quality of life of the mother and also to improved social relationships.

[Perinatal risk in emergent surgery]. / Perinatales Risiko bei notfallchirurgischen Eingriffen.

During pregnancy, appendicitis, cholecystitis, choledocholithiasis, intestinal obstruction, and ulcers can lead to complaints and complications which occasion emergent surgery. The disease as such, its complications, the surgical intervention, and the anesthesia represent a risk for both mother and child. Risks arise particularly often due to the delay of diagnosis and therapy. Risk to the child depends on gestational week, fetal lung maturity, and oxygen supply.

Effects of maternal dexamethasone treatment early in pregnancy on glucocorticoid receptors in the ovine placenta.

The effects of endogenous cortisol on binucleate cells (BNCs), which promote fetal growth, may be mediated by glucocorticoid receptors (GRs), and exposure to dexamethasone (DEX) in early pregnancy stages of placental development might modify this response. In this article, we have investigated the expression of GR as a determinant of these responses. Pregnant ewes carrying singleton fetuses (n = 119) were randomized to control (2 mL saline/ewe) or DEX-treated groups (intramuscular injections of 0.14 mg/kg ewe weight per 12 hours) at 40 to 41 days of gestation (dG). Placental tissue was collected at 50, 100, 125, and 140 dG. Total glucocorticoid receptor protein (GRt) was increased significantly by DEX at 50 and 125 dG in females only, but decreased in males at 125 dG as compared to controls. Glucocorticoid receptor α (GRα) protein was not changed after DEX treatment. Three BNC phenotypes were detected regarding GRα expression (++, +-, --), DEX increased the proportion of (++) and decreased (--) BNC at 140 dG. Effects were sex- and cell type dependent, modifying the responsiveness of the placenta to endogenous cortisol. We speculate that 3 maturational stages of BNCs exist and that the overall activity of BNCs is determined by the distribution of these 3 cell types, which may become altered through early pregnancy exposure to elevated glucocorticoids.