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Abdel Hamid AS, El Zeneiny H, Fathy A, Nawara M. A pilot study to compare propranolol and misoprostol versus misoprostol and placebo for induction of labor in primigravidae; a randomized, single-blinded, placebo-controlled trial. BMC Pregnancy Childbirth 2023; 23:226. [PMID: 37016326 PMCID: PMC10071722 DOI: 10.1186/s12884-023-05537-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 03/22/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND The Induction of labor is the most common obstetric procedure in daily practice. Introducing propranolol as a new drug to augment the action of prostaglandins will help in the induction process and decrease CS rates. Several researchers have used propranolol in the augmentation of labor. AIM This pilot study compares propranolol and misoprostol versus misoprostol alone for labor induction in primigravids. METHODS This is a Randomized clinical trial, single-blinded, placebo-controlled trial at Ain Shams University Maternity hospital. This study included 128 pregnant full-term primigravid women candidates for labor induction, randomized into two groups. All candidates underwent labor induction with 25 µg of vaginal misoprostol. Group I received 20 mg of oral propranolol tablets, while group II received sugary pills as a placebo. Candidates who responded successfully to induction were assessed for possible augmentation of labor by amniotomy or oxytocin infusion. The Primary outcome was induction to delivery interval, while the secondary outcomes were the duration of the latent phase, mode of delivery, and APGAR score of the neonate. RESULTS The induction-delivery time was (11.8 ± 8.1 h. vs. 12.6 ± 8.9 h., P value = 0.027) and the duration of the latent phase of labor (7.9 ± 5.6 h. vs. 9.2 ± 6.03 h., P value = 0.017) were significantly shorter in the group of misoprostol and propranolol compared to the group of misoprostol and placebo. There was no statistically significant difference between both groups' mode of delivery, indications for cesarean section, misoprostol, and oxytocin doses, or neonatal outcome. (P value > 0.05). CONCLUSION Propranolol, when used with misoprostol for induction of labor, results in augmentation of action of misoprostol and a significantly shorter induction-delivery interval. TRIAL REGISTRATION We retrospectively registered this trial in clinicaltrial.gov on 01/09/2020 (NCT04533841). https://clinicaltrials.gov/ct2/show/NCT04533841.
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Affiliation(s)
- Ahmed Sherif Abdel Hamid
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Abbaseyya Square, Cairo, Egypt.
| | - Hazem El Zeneiny
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Abbaseyya Square, Cairo, Egypt
| | - Ahmed Fathy
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Abbaseyya Square, Cairo, Egypt
| | - Maii Nawara
- Department of Obstetrics & Gynecology, Faculty of Medicine, Ain Shams University, Abbaseyya Square, Cairo, Egypt
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Anzeljc V, Mujezinović F. A Randomised Controlled Trial Comparing Induction of Labour with the Propess Vaginal System to the Prostin Vaginal Tablet in Premature Rupture of Membranes at Term. J Clin Med 2022; 12:jcm12010174. [PMID: 36614975 PMCID: PMC9821379 DOI: 10.3390/jcm12010174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/28/2022] Open
Abstract
Aim: To compare the perinatal outcome and delivery intervals after the induction of labour with the Prostin vaginal tablet versus the Propess vaginal system in pregnant women with term-PROM. Design: One centre paralleled randomised controlled trial with a computer-generated table to allocate treatments. Setting: University Medical Centre in Slovenia. Participants: A total of 205 singleton healthy pregnant women with term-PROM. Intervention: Induction of labour with the Propess vaginal system (intervention group) versus Prostin tablets (control group). Main outcomes: The rate of failed inductions, complications in labour, time intervals between the PROM, induction, the beginning of the active phase, and delivery. Results: A total of 104 patients received Prostin, and 101 patients received Propess. Induction failure rates in the Prostin and the Propess groups were 8/104 (7.7%) and 5/101 (5.0%), respectively (p = 0.80). Delivery abnormalities were uncommon and comparable across the groups. The rates of caesarean sections in the Prostin and Propess groups were 4/96 (4.2%) and 6/96 (6.3%), respectively. The delivery intervals were comparable across the groups. Conclusions: In term-PROM pregnancies, the Propess vaginal system is a safe and effective option for inducing labour.
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Affiliation(s)
- Veronika Anzeljc
- Department of Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Correspondence:
| | - Faris Mujezinović
- Department of Perinatology, University Medical Centre Maribor, Ljubljanska 5, 2000 Maribor, Slovenia
- Faculty of Medicine, University of Maribor, Taborska 8, 2000 Maribor, Slovenia
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Use of Vaginal Dinoprostone (PGE 2) in Patients with Premature Rupture of Membranes (PROM) Undergoing Induction of Labor: A Comparative Study. J Clin Med 2022; 11:jcm11082217. [PMID: 35456318 PMCID: PMC9031152 DOI: 10.3390/jcm11082217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose: To evaluate the effect and safety of vaginal dinoprostone in pregnant women with PROM who undergo induction of labor (IoL). Materials and Methods: Prospective observational study conducted at La Mancha Centro hospital from 1 February 2019, to 30 August 2020. Obstetric and neonatal variables of 94 pregnant women with PROM who underwent IoL with vaginal dinoprostone were analyzed, and the results were compared with 330 patients without PROM who also underwent IoL. Bivariate and multivariate analyses were performed using binary and multiple linear regression. Results: A total of 424 women were included in this study. A greater response to cervical ripening (Bishop score > 6) with PGE2 was observed in the PROM group (odds ratio (OR) 2.73, 95% confidence interval (CI) 1.50−4.99, p = 0.001), as well as a shorter total duration of IoL (mean difference (MD) 2823.37 min (min), 95% CI 1257.30−4389.43, p < 0.001). Cesarean sections were performed in 28.7% (n = 27) of patients in the PROM group vs. 34.2% (n = 113) of patients in the non-PROM group, with no significant differences (OR 0.87%, 95% CI 0.47−1.60, p = 0.652). There were no significant differences in changes in the cardiotocographic record (CTG), postpartum hemorrhage (PPH), uterine rupture, or adverse neonatal outcomes between the two groups. Conclusions: The use of vaginal dinoprostone in pregnant women undergoing IoL with PROM is safe for the mother and the fetus, shortens the total delivery time, and does not increase the risk of cesarean section compared with pregnant women undergoing IoL without PROM.
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Bolnga JW, Mola GDL, Totona C, Ao P, Lufele E, Laman M. Safety and efficacy of an oral misoprostol standard-dose regimen vs a low-dose regimen for induction of labour in Papua New Guinean women: An open-label randomised controlled trial. Aust N Z J Obstet Gynaecol 2021; 61:554-562. [PMID: 33734433 DOI: 10.1111/ajo.13331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 02/18/2021] [Indexed: 01/15/2023]
Abstract
BACKGROUND Oral misoprostol is widely used for induction of labour (IOL) in developing countries because of its many advantages. However, limited data exist concerning its safety and efficacy when lower doses are used. AIM To determine the safety and efficacy of a low-dose oral misoprostol regimen (commencing at 12 μg) compared to a standard-dose regimen (commencing at 25 μg) in Papua New Guinea (PNG) women undergoing IOL. MATERIALS AND METHODS This was an open-label non-inferiority randomised controlled trial conducted at a provincial hospital in PNG. Women with singleton pregnancies ≥36 weeks with cephalic presentation and a Bishops score of <6, requiring IOL were enrolled. Both regimens were incremented second-hourly to a maximum required dose within 24 h or until commencement of labour. The primary outcome was the proportion of women who delivered within 24 h of drug administration without any severe adverse events. RESULTS Of the 262 women induced (130 standard-dose vs 132 low-dose), rates of successful induction were high for both regimens (120/130 (92%) vs 118/132 (89%); P = 0.52). Fourteen women (11%) in the standard-dose regimen and 20 (15%) in the low-dose regimen had severe adverse events. There was no significant difference in the safety profile of the two regimens (106/130 (82%) vs 98/132 (74%); P = 0.18). The induction-to-delivery time was significantly shorter in the standard-dose arm (15.2 ± 8.7 h vs 18.0 ± 9.1 h; P = 0.01). CONCLUSION The standard-dose regimen for IOL has greater efficacy in reducing induction-to-delivery time compared to the low-dose regimen. There was no significant difference in the number of adverse events between the two regimens.
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Affiliation(s)
- John W Bolnga
- Department of Obstetrics and Gynaecology, Modilon Hospital, Madang, Papua New Guinea.,Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Glen D L Mola
- Department of Obstetrics and Gynaecology, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Catherine Totona
- Department of Obstetrics and Gynaecology, Modilon Hospital, Madang, Papua New Guinea
| | - Paula Ao
- Department of Obstetrics and Gynaecology, Modilon Hospital, Madang, Papua New Guinea
| | - Elvin Lufele
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
| | - Moses Laman
- Papua New Guinea Institute of Medical Research, Madang, Papua New Guinea
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Pretscher J, Weiss C, Dammer U, Stumpfe F, Faschingbauer F, Beckmann MW, Kehl S. Influence of Preeclampsia on Induction of Labor at Term: A Cohort Study. In Vivo 2021; 34:1195-1200. [PMID: 32354909 DOI: 10.21873/invivo.11892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Revised: 01/22/2020] [Accepted: 01/27/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Even though vaginal delivery is a feasible option in patients with preeclampsia, the cesarean section rate in those patients is high. The aim of this study was to evaluate the influence of preeclampsia on induction of labor at term. PATIENTS AND METHODS This historical cohort study analyzed inductions of labor in women at term having preeclampsia versus women who were induced due to other reasons. The primary outcome measure was the cesarean section rate. RESULTS The cesarean section rate was higher in the preeclampsia group for both nulliparous and multiparous women after induction of labor but failed to reach statistical significane. The induction-to-delivery interval was longer in nulliparous women and the rate of vaginal birth within 48 h was lower in the nulliparous patiens with preeclampsia. However, the impact of preeclampsia on the cesarean section rate was not significant in the multivariable analysis following adjustment for BMI and parity. CONCLUSION Preeclampsia at term did not influence the cesarean section rate in nulliparous and parous women when labor was induced.
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Affiliation(s)
- Jutta Pretscher
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany
| | - Ulf Dammer
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian Stumpfe
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Florian Faschingbauer
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
| | - Sven Kehl
- Department of Obstetrics and Gynecology, Erlangen University Hospital, Erlangen, Germany
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Wegener S, Koenigbauer JT, Laesser C, Metz M, Pech L, Kummer J, Daut J, Jarchau U, Wegener V, Hellmeyer L. Do we need a 200 μg misoprostol vaginal insert? A retrospective cohort study comparing the misoprostol vaginal insert to oral misoprostol. J Obstet Gynaecol Res 2020; 46:851-857. [PMID: 32363787 DOI: 10.1111/jog.14230] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/07/2020] [Accepted: 02/24/2020] [Indexed: 11/28/2022]
Abstract
AIM The misoprostol vaginal insert (MVI) was reported to be more effective than dinoprostone but discussed critically because of high rates of fetal heart rate changes due to uterine tachysystole. The aim of this study was to investigate the outcome of induced labor using the MVI compared to off-label orally-administered misoprostol (OM). METHODS Retrospective study including a total of 401 patients with singleton pregnancies in whom labor was induced at ≥36 0/7 gestational weeks with MVI (203) or OM (198). Primary outcomes were the time from induction to delivery, vaginal delivery in 24 h and the mode of delivery and the neonatal outcome. RESULTS Median time until any delivery was 833 min (645-1278) for MVI and 1076.5 min (698-1686.3) for OM group; 83.7% of the patients in the MVI group gave birth within 24 h versus 63.6% in the OM group. The MVI group needed significantly less pre-delivery oxytocin (29%). Tachysystole (6.4%) and pathological CTG (30.5%) occurred at a significantly higher frequency in the MVI group. The cesarean section rate was significantly higher in the MVI group amounting to 21.7% versus 14.6% in the OM group (P < 0.05). Neonatal outcome did not differ between the groups. CONCLUSION The MVI might be an option if you are in need for an approved and faster method to induce labor. Although we observed a significantly higher rate of fetal heart rate changes and cesarean sections in the MVI group this did not affect the neonatal outcome.
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Affiliation(s)
- Silke Wegener
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Josefine T Koenigbauer
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Claudia Laesser
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Melanie Metz
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Luisa Pech
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Julia Kummer
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Julia Daut
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Ute Jarchau
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | - Viktor Wegener
- Department of Anesthesiology and Operative Intensive Care Medicine (CCM, CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Lars Hellmeyer
- Department of Obstetrics and Gynecology, Vivantes Klinikum im Friedrichshain, Berlin, Germany
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Puhl A, Weiss C, Schneid A, Zahn E, Kraft K, Pretscher J, Faschingbauer F, Beckmann MW, Kehl S. [Does Induction of Labor for Preterm Premature Rupture of Membranes at 34 Weeks of Gestation Increase the Risk for Cesarean Section?]. Z Geburtshilfe Neonatol 2020; 224:269-274. [PMID: 32120446 DOI: 10.1055/a-1110-1132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE Induction of labor at 34 weeks of gestation is often linked to increased risk for cesarean section. Recently, the PPROMT trial demonstrated a higher cesarean section rate when labor was induced for preterm premature rupture of membranes (PPROM). The purpose of this study was therefore to evaluate the success rate of induction of labor for PPROM at 34 and 35 weeks of gestation in comparison with a higher gestational age. MATERIAL AND METHODS In this historic cohort study, cases with labor inductions for PPROM ≥ 34 weeks of gestation were included. Induction of labor at 34 and 35 weeks of gestation (group 1) were compared with those performed at 36 weeks (group 2) and 37 weeks (group 3). Induction of labor was started 12 to 24 hours after (preterm) premature rupture of membranes. Antibiotics were given routinely. The primary outcome was the rate of cesarean section. RESULTS There were significantly more cesarean sections in group 3 in comparison with group 2 (7 vs. 25%, p=0.0136). However, univariable and multiple logistic regression analysis of the primary outcome measure showed that there was no impact of the group affiliation on cesarean section rate. Significant parameters influencing the risk of cesarean section were body mass index and Bishop score. CONCLUSION Induction of labor for PPROM at 34 weeks of gestation is not associated with an increased rate of cesarean section.
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Affiliation(s)
- Alexander Puhl
- Frauenklinik, Klinikverbund Kempten-Oberallgäu gGmbH, Kempten
| | - Christel Weiss
- Medizinische Statistik, Biomathematik und Informationsverarbeitung, Universitätsmedizin Mannheim, Universität Heidelberg, Mannheim
| | - Anna Schneid
- Frauenklinik, Klinikverbund Kempten-Oberallgäu gGmbH, Kempten
| | - Eva Zahn
- Frauenklinik, Klinikverbund Kempten-Oberallgäu gGmbH, Kempten
| | | | - Jutta Pretscher
- Gynäkologie und Geburtshilfe, Universitätsklinikum Erlangen Frauenklinik, Erlangen
| | | | | | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen
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Wang X, Zhang X, Liu Y, Jiang T, Dai Y, Gong Y, Li Q, Wang X. Effect of premature rupture of membranes on time to delivery and outcomes in full-term pregnancies with vaginal dinoprostone-induced labour. Arch Gynecol Obstet 2019; 301:369-374. [PMID: 31776709 DOI: 10.1007/s00404-019-05351-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 10/15/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this study was to assess the effect of premature rupture of membranes (PROM) in full-term pregnancies with dinoprostone-induced labour. PATIENTS AND METHODS This historical cohort study analysed 2166 full-term pregnancies with dinoprostone-induced labour between 1 August 2016 and 30 April 2018. A group that underwent induction of labour for PROM (PROM group) was compared to a group that underwent labour induction for other indications (no-PROM group). Time to delivery and perinatal outcome were compared between the two groups. RESULTS A total of 2166 pregnancies (662 PROM and 1504 no-PROM) were included. The two groups demonstrated no significant differences except in biparietal diameter and gestational age (P < 0.001). The caesarean section delivery rate in the PROM group was significantly lower than in the non-PROM group (26.89 vs. 33.58%, P < 0.0001). In the PROM group, the induction-to-delivery time was shorter (P < 0.0001) and the rates of vaginal birth within 24 h (P < 0.0001) and 48 h (P < 0.0001) were higher than those in the control group. The incidence rate of amniotic fluid contamination in the PROM group was significantly lower than that in the non-PROM group (19.18 vs. 25.20%, P = 0.002). CONCLUSION PROM significantly affects perinatal outcome in Chinese women who undergo dinoprostone-induced labour, especially the caesarean delivery rate and the induction-to-delivery time.
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Affiliation(s)
- Xiaoyan Wang
- Chongqing Health Center for Women and Children, No. 120 LongShan Road, Yubei District, Chongqing, 401147, China
| | - Xiaoyan Zhang
- Chongqing Health Center for Women and Children, No. 120 LongShan Road, Yubei District, Chongqing, 401147, China
| | - Yiran Liu
- Chongqing Health Center for Women and Children, No. 120 LongShan Road, Yubei District, Chongqing, 401147, China
| | - Tingting Jiang
- Chongqing Health Center for Women and Children, No. 120 LongShan Road, Yubei District, Chongqing, 401147, China
| | - Yang Dai
- Chongqing Health Center for Women and Children, No. 120 LongShan Road, Yubei District, Chongqing, 401147, China
| | - Yangyang Gong
- Chongqing Health Center for Women and Children, No. 120 LongShan Road, Yubei District, Chongqing, 401147, China
| | - Qin Li
- Chongqing Health Center for Women and Children, No. 120 LongShan Road, Yubei District, Chongqing, 401147, China
| | - Xueyan Wang
- Chongqing Health Center for Women and Children, No. 120 LongShan Road, Yubei District, Chongqing, 401147, China.
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Kehl S, Born T, Weiss C, Faschingbauer F, Pretscher J, Beckmann MW, Sütterlin M, Dammer U. Induction of labour with sequential double-balloon catheter and oral misoprostol versus oral misoprostol alone in obese women. Eur J Obstet Gynecol Reprod Biol X 2019; 3:100034. [PMID: 31403122 PMCID: PMC6687443 DOI: 10.1016/j.eurox.2019.100034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 04/29/2019] [Indexed: 11/28/2022] Open
Abstract
Objective To evaluate the efficacy of induction of labour in obese women using sequential double-balloon catheter and oral misoprostol in comparison with oral misoprostol alone. Study design In this cohort study, 400 pregnant women with BMI higher than 35 kg/m2 undergoing labour induction at term were included. Induction of labour with a double-balloon catheter and, if necessary, sequential oral misoprostol (n = 216) was compared to oral misoprostol alone (n = 184). The primary outcome measure was the caesarean section rate. Secondary outcome parameters were, among others, the induction-to-delivery-interval, the rate of vaginal delivery within 24 and 48 h as well as fetal outcome parameters. Results The caesarean section rate was significantly lower in the group with sequential use of double-balloon catheter and oral misoprostol (27.6% versus 37.5%, p = 0.0345). After stratification for parity this reduction was seen especially in nulliparous (38.6% versus 56.9%, p = 0.0039). The rate of abnormal CTG was significantly lower as well (19.9% versus 30.4%, p = 0.0150), particularly in nulliparous (25.9% versus 40.4%, p = 0.0138). Uni- and multivariable analyzes showed that the caesarean section rate was significantly influenced by the method of induction of labour (p = 0.0026), parity (p < 0.0001) and Bishop score (p = 0.0425). Conclusion In obese women, induction of labour with sequential use of double-balloon catheter and oral misoprostol is associated with significantly more normal vaginal deliveries and less caesarean sections.
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Affiliation(s)
- Sven Kehl
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
| | - Tilman Born
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
| | - Christel Weiss
- Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, Heidelberg University, Germany
| | | | - Jutta Pretscher
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
| | - Matthias W Beckmann
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
| | - Marc Sütterlin
- Department of Obstetrics and Gynaecology, University Medical Centre Mannheim, Heidelberg University, Germany
| | - Ulf Dammer
- Department of Obstetrics and Gynaecology, Erlangen University Hospital, Germany
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