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Wowra K, Hegel E, Scharf A, Grünberger A, Rosenthal K. Life Cycle Assessment for Early‐Stage Bioprocess Development: Current State and Future Perspective. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- K. Wowra
- DECHEMA e. V Biotechnology Theodor-Heuss-Allee 25 60486 Frankfurt Germany
| | - E. Hegel
- DECHEMA e. V Biotechnology Theodor-Heuss-Allee 25 60486 Frankfurt Germany
| | - A. Scharf
- DECHEMA e. V Biotechnology Theodor-Heuss-Allee 25 60486 Frankfurt Germany
| | - A. Grünberger
- Bielefeld University Multiscale Bioengineering, Faculty of Technology Universitätsstr. 25 33615 Bielefeld Germany
| | - K. Rosenthal
- TU Dortmund University Chair for Bioprocess Engineering, Department of Biochemical and Chemical Engineering Emil-Figge-Str. 66 44227 Dortmund Germany
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Scharf A, Margraf NG, Tode J, Jensen-Kondering U. Multiple retinal aneurysms in probable cerebral amyloid angiopathy. J Neurol Sci 2021; 430:120005. [PMID: 34619621 DOI: 10.1016/j.jns.2021.120005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 09/21/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Amelie Scharf
- Department of Ophthalmology, UKSH Campus Kiel, Germany
| | | | - Jan Tode
- Department for Ophthalmology, Hannover Medical School (MHH), Hanover, Germany
| | - Ulf Jensen-Kondering
- Department of Radiology and Neuroradiology, UKSH Campus Kiel, Germany; Institute of Neuroradiology, UKSH Campus Lübeck, Germany.
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Scharf A, Barfield J, Shepherd M, Herickhoff L. 136 GameteGuard in maturation medium improves bovine embryo quality and quantity. Reprod Fertil Dev 2021. [DOI: 10.1071/rdv33n2ab136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The number of invitro-produced (IVP) bovine embryos generated in the United States increased 11% from 2017 to 2018, demonstrating a demand for new technology to rapidly and efficiently improve herd genetics. Unfortunately, embryo production on a per oocyte basis remains low, limiting the number of high-quality commercial embryos available for transfer or freezing. Reactive oxygen species (ROS) are a major contributor to low embryo production rates of invitro gametes and are especially problematic in maturation media. This is due to high numbers of mitochondria in the bovine oocyte producing ROS exacerbated by the invitro environment. GameteGuard® is an organic plant-based additive that provides protection against reactive oxygen species. The aims of this research were to evaluate the effects of GameteGuard addition to invitro bovine embryo production media to (1) mitigate the impact of ROS on oocyte maturation and competence, and (2) increase the production of high-quality embryos in our IVP system. Four rounds of invitro embryo production (Colorado State University protocol and media) with or without maturation medium supplemented with GameteGuard were performed (n=1175 total oocytes). Oocytes were aspirated from abattoir ovaries; those with homogeneous ooplasm and multiple layers of even cumulus cells were matured using control (n=585) or GameteGuard-supplemented (n=590) maturation medium. Oocytes were fertilized with frozen/thawed semen from proven IVF bulls (n=4) and then cultured in a two-step media system to Day 7. Blastocysts were evaluated on Day 7 according to IETS embryo grading standards. A subset of 80 blastocysts were fixed and stained after grading using an In Situ Cell Death Detection Kit (Fluorescein; Millipore Sigma) and Hoechst 33342 (Invitrogen) as apoptotic and counter-stains, respectively. Stained blastocysts were assessed by immunofluorescence microscopy to obtain the percentage of apoptotic cells and total cell count. Because multiple bulls were used, a linear mixed model was required for data analysis. Treatment was considered the fixed effect and bulls as a random effect to determine the impact of the treatment on stage and quality of blastocysts. Cleavage rates were not different (P>0.5) but GameteGuard supplementation of maturation medium resulted in a 22% increase in grade-1 embryos per total blastocysts produced (P<0.01; n=79/106 control vs. n=120/137 GameteGuard grade 1 blastocysts). Additionally, the percent of grade 2 and 3 embryos per total blastocysts decreased, (P<0.01; 27%, n=27/106 control and 11%, n=14/137 GameteGuard grade 2 and 3 blastocysts), suggesting that supplementation with GameteGuard promoted development of better-quality embryos overall. The percentage of apoptotic cells was also significantly higher in control blastocysts compared with treated blastocysts (P<0.02; 11.4%, n=38 control and 12.8%, n=42 GameteGuard). GameteGuard supplementation of the maturation medium significantly increased the production of high-quality IVP bovine embryos, thereby providing potential marketable gain for embryo producers.
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Cossais F, Schaeffer E, Heinzel S, Zimmermann J, Niesler B, Röth R, Rappold G, Scharf A, Zorenkov D, Lange C, Barrenschee M, Margraf NG, Ellrichmann M, Berg D, Böttner M, Wedel T. Expression Profiling of Rectal Biopsies Suggests Altered Enteric Neuropathological Traits in Parkinson's Disease Patients. J Parkinsons Dis 2020; 11:171-176. [PMID: 33337386 DOI: 10.3233/jpd-202258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Still little is known about the nature of the gastrointestinal pathological alterations occurring in Parkinson's disease (PD). Here, we used multiplexed mRNA profiling to measure the expression of a panel of 770 genes related to neuropathological processes in deep submucosal rectal biopsies of PD patients and healthy controls. Altered enteric neuropathological traits based on the expression of 22 genes related to neuroglial and mitochondrial functions, vesicle trafficking and inflammation was observed in 9 out of 12 PD patients in comparison to healthy controls. These results provide new evidences that intestinal neuropathological alterations may occur in a large proportion of PD patients.
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Affiliation(s)
- François Cossais
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Eva Schaeffer
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Sebastian Heinzel
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Jessica Zimmermann
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Beate Niesler
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Ralph Röth
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany
| | - Gudrun Rappold
- Department of Human Molecular Genetics, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,nCounter Core Facility, Institute of Human Genetics, Heidelberg University Hospital, Heidelberg, Germany.,Interdisciplinary Center for Neurosciences (IZN), Heidelberg University, Heidelberg, Germany
| | - Amelie Scharf
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Dmitri Zorenkov
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Christina Lange
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | | | - Nils G Margraf
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Mark Ellrichmann
- Interdisciplinary Endoscopy, Medical Department I, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Daniela Berg
- Department of Neurology, University Hospital Schleswig-Holstein, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Martina Böttner
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
| | - Thilo Wedel
- Institute of Anatomy, Christian-Albrechts-University of Kiel, Kiel, Germany
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Forner DM, Scharf A. Schwangerschaft nach der Enukleation von fast 100 Myomen. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Staboulidou I, Bock N, Günter HH, Steinborn A, Gebauer G, Scharf A. Analyse des Nackentransparenz (NT-)Screeningkonzepts an der Frauenklinik der MHH: Eine prospektive Follow-up-Studie. Z Geburtshilfe Neonatol 2015; 219:147. [DOI: 10.1055/s-0035-1549868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - N. Bock
- Universitäts-Frauenklinik Göttingen, Göttingen
| | - H.-H. Günter
- Frauenklinik der Med. Hochschule Hannover, Hannover
| | - A. Steinborn
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - G. Gebauer
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - A. Scharf
- Frauenklinik der Med. Hochschule Hannover, Hannover
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Schmidt P, Hörmansdörfer C, Elsässer M, Scharf A, Hillemanns P, von Kaisenberg CS. Erratum: Pitfalls of Ultrasonographic Yolk Sac Measurement. Ultraschall Med 2011; 32:e202. [PMID: 22179805 DOI: 10.1055/s-0031-1282063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- P Schmidt
- Frauenarztpraxis Bahnhofstraße, Wolfenbüttel
| | - C Hörmansdörfer
- Abteilung für Allgemein- und Visceralchirurgie, Klinikum Oldenburg gGmbH
| | - M Elsässer
- Abteilung für Gynäkologie und Geburtshilfe, Universität Heidelberg
| | - A Scharf
- Praxis für Pränatalmedizin, Darmstadt
| | - P Hillemanns
- Abteilung für Gynäkologie und Geburtshilfe, Medizinische Hochschule Hannover
| | - C S von Kaisenberg
- Abteilung für Gynäkologie und Geburtshilfe, Medizinische Hochschule Hannover
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Schmidt P, Hörmansdörfer C, Elsässer M, Scharf A, Hillemanns P, von Kaisenberg CS. Pitfalls of ultrasonographic yolk sac measurement. Ultraschall Med 2011; 32 Suppl 2:E147-E150. [PMID: 21877319 DOI: 10.1055/s-0031-1281648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Novel aneuploidy screening has been suggested for measuring the yolk sac during very early pregnancy. However, in a pilot study the measured diameters differed up to 29 % from the overall average. The aim of this study was to analyze the impact of image magnification on yolk sac measurement. MATERIALS AND METHODS From November 3, 2009 to July 28, 2010, 119 yolk sac measurements were performed. During each examination, each yolk sac was examined once with standard image magnification and once by live scan zoom. RESULTS The measurement values were 5 % smaller in the standard image. The mean relative ratio (RR), median RR, and standard deviation (SD) were 0.951, 0.950, and 0.103 mm, respectively (95 % CI 0.744 to 1.158 mm). Regarding absolute differences, the mean, median, and standard deviation were -0.222 mm, -0.220 mm, and 0.473 mm, respectively, (95 % CI -1.169 to + 0.725 mm). With standard zoom (magnified images), the SD was 1.142 mm (1.099 mm). CONCLUSION Five criteria should be regarded for optimal image settings: image magnification during live scan, optimal gain setting, enhanced gamma level, median section plane, and out-to-out caliper placement.
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Affiliation(s)
- P Schmidt
- Frauenarztpraxis Bahnhofstraße, Wolfenbüttel.
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Kleinsorge F, Smetanay K, Rom J, Hörmannsdörfer C, Scharf A, Schmidt P. Prospektive Testleistungsbewertung des Ersttrimester Screenings in Deutschland bei Risikoberechnung über http://www.firsttrimester.net. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1271803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kleinsorge F, Smetanay K, Rom J, Hörmansdörfer C, Hörmannsdörfer C, Scharf A, Schmidt P. [Prospective performance evaluation of first trimester screenings in Germany for risk calculation through http://www.firsttrimester.net]. Z Geburtshilfe Neonatol 2011; 214:239-42. [PMID: 21207324 DOI: 10.1055/s-0030-1265199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND In 2008, 2 351 first trimester screenings were calculated by a newly developed internet database ( http:// www.firsttrimester.net ) to evaluate the risk for the presence of Down's syndrome. MATERIAL AND METHODS All data were evaluated by the conventional first trimester screening according to Nicolaides (FTS), based on the previous JOY Software, and by the advanced first trimester screening (AFS). After receiving the feedback of the karyotype as well as the rates of the correct positives, correct negatives, false positives, false negatives, the sensitivity and specificity were calculated and compared. RESULTS Overall 255 cases were investigated which were analysed by both methods. These included 2 cases of Down's syndrome and one case of trisomy 18. The FTS and the AFS had a sensitivity of 100%. The specificity was 88.5% for the FTS and 93.0% for the AFS. CONCLUSION As already shown in former studies, the higher specificity of the AFS is a result of a reduction of the false positive rate (28 to 17 cases). As a consequence of the AFS with a detection rate of 100% the rate of further invasive diagnostics in pregnant women is decreased by having 39% fewer positive tested women.
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Affiliation(s)
- F Kleinsorge
- Universitätsfrauenklinik Heidelberg, Vosstrasse 9, Heidelberg.
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Rom J, von Minckwitz G, Marmé F, Ataseven B, Kozian D, Sievert M, Schlehe B, Schuetz F, Scharf A, Kaufmann M, Sohn C, Schneeweiss A. Phase I study of apoptosis gene modulation with oblimersen within preoperative chemotherapy in patients with primary breast cancer. Ann Oncol 2009; 20:1829-35. [PMID: 19605509 DOI: 10.1093/annonc/mdp208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Expression of the Bcl-2 protein confers resistance to chemotherapy-mediated apoptotic signals in patients with breast cancer. We investigated effects of Bcl-2 down-regulation by the Bcl-2 antisense oligodeoxynucleotide oblimersen in breast tumor biopsies. Oblimersen targets Bcl-2 messenger RNA (mRNA), down-regulates Bcl-2 protein translation and enhances antitumor effects of subtherapeutic chemotherapy doses. Within a phase I trial, we administered escalating doses of oblimersen (3, 5 or 7 mg/kg/day) as continuous infusion on days 1-7 in combination with standard-dose docetaxel (Taxotere), Adriamycin and cyclophosphamide (TAC) on day 5 as preoperative chemotherapy in 28 patients with T2-4 tumors. Effects of oblimersen were evaluated in tumor biopsies and peripheral blood mononuclear cells (PBMCs) 4 days after start of oblimersen and before TAC treatment by quantitative microfluidic real-time PCR. Read-outs consisted in measurement of Bcl-2 mRNA modulations and of 18 putative predictive markers. Two of 13 patients showed a diminution of Bcl-2 transcripts after 4 days of treatment with oblimersen 5 mg/kg/day. PBMCs could not be evaluated as a surrogate tissue because no qualified RNA could be isolated. Nevertheless, we demonstrated feasibility to process clinical samples and to obtain good quality RNA from tumor biopsies and indicated the potential of oblimersen to lower Bcl-2 mRNA in breast cancer.
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Affiliation(s)
- J Rom
- Department of Gynecology and Obstetrics, University of Heidelberg, Germany.
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Schmidt P, Hörmansdörfer C, Golatta M, Scharf A. Analysis of the distribution shift of detected aneuploidies by age independent first trimester screening. Arch Gynecol Obstet 2009; 281:393-9. [DOI: 10.1007/s00404-009-1137-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2009] [Accepted: 05/19/2009] [Indexed: 11/30/2022]
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Rom J, von Minckwitz G, Marme F, Sievert M, Kozian D, Schuetz F, Scharf A, Kaufmann M, Sohn C, Schneeweiss A. Phase I study of apoptosis gene modulation with oblimersen within preoperative chemotherapy in patients with primary breast cancer. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e11576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e11576 Background: The expression of the Bcl-2 protein confers resistance to chemotherapy mediated apoptotic signals in patients with breast cancer. The development of chemo sensitizing drugs may result in new treatment options. We investigated the effects of Bcl-2 down-regulation by the Bcl-2 antisense oligodeoxynucleotide oblimersen in breast tumor biopsies. Oblimersen targets Bcl-2 mRNA, thereby down regulates Bcl-2 protein translation, and enhances the antitumor effects of sub therapeutic doses of docetaxel. Methods: Within a phase I trial we administered escalating doses of oblimersen (3/5/7mg/kg/day) as continuous infusion on day 1–7 in combination with standard dosed docetaxel, doxorubicin, cyclophosphamide (TAC) on day 5 as preoperative chemotherapy in 28 patients with T2–4 breast cancers. Effects of oblimersen were evaluated in tumor biopsies and peripheral blood mononuclear cells (PBMCs) 4 days after start of oblimersen continuous infusion and before TAC treatment by quantitative microfluidic real-time polymerase chain reaction (RT-PCR). Read-outs consisted in measurement of Bcl-2 mRNA modulations and of 18 other putative predictive markers. Results: Two out of 13 patients showed a diminution of Bcl-2 transcripts after 4 days of treatment with oblimersen 5 mg/kg/day. PBMCs could not be evaluated as a surrogate tissue, because no qualified RNA could be isolated. Conclusions: Nevertheless, we demonstrated the feasibility to process clinical samples and to obtain good quality RNA from tumor biopsies, and indicated the potential of oblimersen to lower Bcl-2 mRNA in breast cancer. No significant financial relationships to disclose.
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Affiliation(s)
- J. Rom
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
| | - G. von Minckwitz
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
| | - F. Marme
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
| | - M. Sievert
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
| | - D. Kozian
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
| | - F. Schuetz
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
| | - A. Scharf
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
| | - M. Kaufmann
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
| | - C. Sohn
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
| | - A. Schneeweiss
- University Women's Hospital of Heidelberg, Heidelberg, Germany; University of Frankfurt, Frankfurt, Germany; Sanofi-Aventis GmbH, Berllin, Germany
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Hörmansdörfer C, Schmidt P, Golatta M, Vaske B, Hillemanns P, Scharf A. Impact of the maternal age on first trimester screening for chromosomal aberrations of the fetus – Analysis of 15,228 datasets. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hörmansdörfer C, Schmidt P, Hillemanns P, Golatta M, Scharf A. Does the exclusion of maternal background risk in calculation software PRC, PIA and JOY improve First Trimester Screening (FTS)? Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Lautmann K, Staboulidou I, Wüstemann M, Günter H, Scharf A, Hillemanns P. Heterotopic pregnancy: simultaneous intrauterine and ectopic pregnancy following IVF treatment with the birth of a healthy child. Ultraschall Med 2009; 30:71-73. [PMID: 17926256 DOI: 10.1055/s-2007-963214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Although spontaneous simultaneous intrauterine and ectopic pregnancy was an extremely rare event in the past, it is increasingly being diagnosed since the rate of assisted reproduction technique (ART) gestations increased. Due to the serious consequences, delayed diagnosis should be prevented in order to salvage the viable intrauterine fetus and avoid maternal morbidity and mortality. This case report demonstrates that the pitfalls of the diagnosis of heterotopic pregnancy make early diagnosis difficult and the prevention of heterotopic pregnancies by single embryo transfer should be continuously discussed. The role of high resolution ultrasound scans and the importance of close monitoring of early pregnancies following ART are emphasized because early diagnosis of heterotopic pregnancy results in a similar perinatal outcome as singleton pregnancies.
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Affiliation(s)
- K Lautmann
- Frauenklinik, Medizinische Hochschule Hannover, Hannover.
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Staboulidou I, Wüstemann M, Vaske B, Scharf A, Hillemanns P, Schmidt P. Interobserver variability of the measurement of fetal nasal bone length between 11+0 and 13+6 gestation weeks among experienced and inexperienced sonographers. Ultraschall Med 2009; 30:42-46. [PMID: 18773384 DOI: 10.1055/s-2008-1027402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Examination of fetal nasal bone (NB) by ultrasound between 11 + 0 and 13 + 6 gestation weeks has been proposed as an additional tool in the detection of trisomy 21 and therefore its application and implementation are used in a broad range. The study aimed at evaluating the interobserver feasibility of the measurement of fetal nasal bone length in comparison with experienced and inexperienced sonographers. MATERIALS AND METHODS The study population was comprised of women who chose to have first trimester screening (FTS) at the Fetal Medicine Unit of the University Medical School of Hannover. Two experienced (> 400 FTS examinations, sonographer 1 and 2) and one inexperienced sonographer (95 FTS examinations, sonographer 3) were asked to measure the nasal bone length consecutively and independently of each other. Statistical analysis was performed for any differences and variations in the results. RESULTS The fetal profile was examined in 220 cases. The median nasal bone length by sonographer one was 2.4 cm, sonographer two 2.4 cm and sonographer three 2 cm. The differences between the results of sonographer 1 and 3 as well 2 and 3 were statistically significant. There were no significant variations between the results of sonographer 1 and 2. There was also no significant difference in the results concerning nuchal translucency and crown-rump length among the three examiners. CONCLUSION The uncertainty and the difficulties of an inexperienced examiner with the presenting of the nasal bone, as shown by published data sets as well as by the variability of the measurement results of this study, with all the consequences in the risk calculation and counseling show that this tool should only be implemented by experienced and quality-controlled sonographers with a minimum amount of examinations. Because of its major impact in risk calculation and the importance of the nasal bone as a sonographic marker, documentation of the sonographer's skills is mandatory for the use of the nasal bones as an additional sonographic marker in first trimester screening.
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Affiliation(s)
- I Staboulidou
- University Medical School of Hannover, Department of Obstetrics and Gynecology, Hannover.
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Hörmansdörfer C, Scharf A, Golatta M, Vaske B, Corral A, Hillemanns P, Schmidt P. Comparison of Prenatal Risk Calculation (PRC) with PIA Fetal Database software in first-trimester screening for fetal aneuploidy. Ultrasound Obstet Gynecol 2009; 33:147-151. [PMID: 19009535 DOI: 10.1002/uog.6250] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVES In February 2007 new software, Prenatal Risk Calculation (PRC), for calculating the risk of fetal aneuploidy was introduced in Germany. Our aim was to investigate its test performance and compare it with that of the PIA Fetal Database (PIA) software developed and used by The Fetal Medicine Foundation. METHODS Between 31 August 1999 and 30 June 2004 at the Women's Hospital of the Medical University of Hanover in Germany, 3120 singleton pregnancies underwent combined first-trimester screening at 11 + 0 to 13 + 6 weeks of gestation. Calculation of risk for fetal aneuploidy was computed prospectively using the PIA software. In a subsequent retrospective analysis, we recalculated risks for the 2653 of these datasets with known fetal outcome using the PRC software and compared the results. RESULTS Of the 2653 datasets analyzed, 17 were cases of aneuploidy. At a cut-off of 1 : 230, for the detection of fetal aneuploidy, the respective sensitivity, false-positive rate and positive predictive value were 70.6%, 4.1% and 9.9% for PRC and 76.5%, 2.9% and 14.6% for PIA. At a cut-off of 1 : 300, the equivalent values were 70.6%, 5.6% and 7.5% for PRC and 76.5%, 4.0% and 11.0% for PIA. The differences in test performance between the two types of software were highly significant (P < 0.0001). DISCUSSION The test performance of PRC was inferior to that of PIA, the sensitivity for detection of fetal aneuploidy being lower and the false-positive rate higher. Had PRC been employed prospectively in our study, 40% more women examined would have been offered unnecessarily an invasive procedure for fetal karyotyping.
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Affiliation(s)
- C Hörmansdörfer
- Department of Obstetrics and Gynaecology, Medical University of Hanover, Hanover, Germany.
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Schmidt P, Dormeier J, Hörmansdörfer C, Golatta M, Scharf A, Hillemanns P. Vorstellung einer neuen Methodik zur Visualisierung typischer Befundkonstellationen für euploide und aneuploide Feten – Common Bubbles im AFS–3D-Verfahren. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Elsässer M, Stoiber B, Maul H, Staboulidou I, Scharf A, Sohn C, Schmidt P. Aneurysma der Vena galeni in der 22. SSW – Verlauf und Prognose eines ausgeprägten Aneurysmas der Vena galeni in der 22. SSW. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Golatta M, Hörmansdörfer C, Elsässer M, Scharf A, Sohn C, Schmidt P. Herausrechnung des maternalen Alters aus den Risikokalkulationsergebnissen der PIA, PRC und Joy-Software. – Ist eine Reduzierung der Falschpositivrate im Rahmen des Downsyndromscreenings möglich? Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Lenz FP, Scharf A, Sohn C, Rom J. Evaluierung einer deutschen Version des P-QOL Fragebogens bei Senkungszuständen. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Hörmansdörfer C, Scharf A, Golatta M, Vaske B, Hillemanns P, Schmidt P. Preliminary analysis of the new ‘Prenatal Risk Calculation (PRC)’ software. Arch Gynecol Obstet 2008; 279:511-5. [DOI: 10.1007/s00404-008-0743-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 07/15/2008] [Indexed: 11/28/2022]
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Schmidt P, Hörmansdörfer C, Oehler K, Härtel H, Hillemanns P, Scharf A. Dreidimensionale Scatterplotanalyse zur Risikoeinschätzung für fetale Aneuploidien. Z Geburtshilfe Neonatol 2008; 212:127-35. [DOI: 10.1055/s-2008-1004708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rom J, von Minckwitz G, Eiermann W, Sievert M, Schlehe B, Marmé F, Schuetz F, Scharf A, Eichbaum M, Sinn HP, Kaufmann M, Sohn C, Schneeweiss A. Oblimersen combined with docetaxel, adriamycin and cyclophosphamide as neo-adjuvant systemic treatment in primary breast cancer: final results of a multicentric phase I study. Ann Oncol 2008; 19:1698-705. [PMID: 18477581 DOI: 10.1093/annonc/mdn280] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Combining the Bcl-2 down-regulator oblimersen with cytotoxic treatment leads to synergistic antitumor effects in preclinical trials. This multicentric phase I study was carried out to evaluate maximum tolerated dose (MTD), safety and preliminary efficacy of oblimersen in combination with docetaxel, adriamycin and cyclophosphamide as neo-adjuvant systemic treatment (NST) in primary breast cancer (PBC). METHODS Previously untreated patients with PBC T2-4a-c N0-3 M0 received one cycle of docetaxel 75 mg/m(2), adriamycin 50 mg/m(2) and cyclophosphamide 500 mg/m(2) administered on day 5 combined with escalating doses of oblimersen as a 24-h continuous infusion on days 1-7 followed by five cycles of combination of docetaxel, adriamycin and cyclophosphamide (TAC) without oblimersen every 3 weeks. Prophylactic antibiotic therapy and granulocyte colony-stimulating factor administration were used in all six cycles. Blood serum samples were taken throughout the treatment period for pharmacokinetic analysis. RESULTS Twenty-eight patients were enrolled (median age, 50 years; ductal-invasive histology, 68%; tumorsize 2-5 cm, 61%; grade 3, 43%; hormone receptor negative, 36%; Her2 positive 18%) and received oblimersen in a dose of 3 mg/kg/day (cohort I, nine patients), 5 mg/kg/day (cohort II, nine patients) and 7 mg/kg/day (cohort III, 10 patients) respectively. No dose-limiting toxicity occurred. Following oblimersen combined with TAC, the most severe toxicity was neutropenia [National Cancer Institute-Common Toxicity Criteria (NCI-CTC) grades 1-2/3/4] which developed in 0/0/56% of patients (cohort I), 11/0/56% of patients (cohort II) and 20/20/50% of patients (cohort III). No febrile neutropenia occurred. Most common adverse events (all NCI-CTC grade < or = 2) were fatigue, nausea, alopecia, headache and flue-like symptoms observed in 78% (cohort I), 89% (cohort II) and 90% (cohort III) of patients. With increasing dose of oblimersen, a higher incidence of grade IV leukopenia and neutropenia was noted. At the MTD of 7 mg/kg/day of oblimersen, serious adverse events occurred in 40% of the patients. CONCLUSION Oblimersen up to a dose of 7 mg/kg/day administered as a 24-h infusion on days 1-7 can be safely administered in combination with standard TAC on day 5 as NST in patients with PBC. The safety and preliminary efficacy warrants further evaluation of oblimersen in combination with every cycle of the TAC regimen in a randomized trial.
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Affiliation(s)
- J Rom
- Department of Gynecology and Obstetrics, University of Heidelberg, Heidelberg, Germany.
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Staboulidou I, Wüstemann M, Schmidt P, Günter HH, Hillemanns P, Scharf A. [Influence of circadian rhythm on fetal and maternal Doppler parameters--is a diurnal variation detectable?]. Z Geburtshilfe Neonatol 2008; 212:47-52. [PMID: 18432556 DOI: 10.1055/s-2008-1004638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Doppler sonography is an established method in fetal medicine. Up to now a possible circadian rhythm of fetal and maternal Doppler parameters has only been insufficiently characterized and documented. This survey aimed at evaluating the significance of Doppler parameters with regard to diurnal variations. We have analyzed whether or not a circadian rhythm of fetal and maternal Doppler parameters is detectable. MATERIAL AND METHODS A non-selected collective of 100 patients with a singleton pregnancy between the 20th and 39th week of gestation was examined with Doppler sonography at the Medical School of Hannover. Besides the Doppler sonography, which was performed at three fixed times a day, the maternal blood pressure was examined each time. Outcome parameters were resistance index (RI), pulsatility index (PI) and the maximum velocity (V (max)) of the A. umbilicalis, A. cerebri media and the Aa. uterinae as well as the maternal blood pressure. RESULTS There were no significant differences for the RI, PI and V (max) of the Aa. uterinae for the whole collective, nor for the subgroups of maternal hypertonia, preeclampsia, notching and fetal growth restriction (IUGR). There were also no significant diurnal variations of the Doppler parameters for the fetal vessels. In particular, there were no differences in the measured Doppler parameters in comparison to the collective with unremarkable gravidity. In some subgroups statistical significance could be achieved, but due to the minor variations, no clinical importance has to be considered. CONCLUSION A circadian rhythm of the Doppler parameters could not be confirmed in the examined collective. The time of the applied Doppler sonography on physiological conditions might represent a factor which does not affect the validity of the Doppler sonographic results. As a consequence a single Doppler examination at a freely chosen time seems to be sufficient to obtain a correct assessment of fetal and maternal blood perfusion. Further studies on larger collectives are necessary to evaluate the clinical importance of a possible circadian rhythm, especially in fetuses with pathological Doppler values.
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Affiliation(s)
- I Staboulidou
- Medizinische Hochschule Hannover, Abteilung für Gynäkologie und Geburtshilfe.
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Golatta M, Hörmansdörfer C, Scharf A, Sohn C, Schmidt P. Mathematische Umformung der Risikokalkulationsergebnisse aus der PRC-Software unter Ausschluss des mütterlichen Alters zeigt Verbesserung für das Downsyndromscreening. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1075746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Schmidt P, Staboulidou I, Elsässer M, Vaske B, Hillemanns P, Scharf A. How Imprecise May the Measurement of Fetal Nuchal Translucency Be without Worsening First-Trimester Screening? Fetal Diagn Ther 2008; 24:291-5. [DOI: 10.1159/000158520] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 07/16/2007] [Indexed: 11/19/2022]
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Hörmansdörfer C, Schmidt P, Hillemanns P, Scharf A. Die pränatale Detektion der Trisomien 13, 18 und 21: Vergleich des Advanced First Trimester Screenings (AFS)® mit dem Ersttrimester-Screening nach Nicolaides. Z Geburtshilfe Neonatol 2007; 211:243-9. [DOI: 10.1055/s-2007-981361] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Kessel S, Staboulidou I, Oehler K, Hillemanns P, Scharf A, Günter HH. [Gestational diabetes under clinical conditions in aspired normoglycemia: investigation for correlation of blood glucose daily profiles and fetometric ultrasound parameters]. Z Geburtshilfe Neonatol 2007; 211:185-90. [PMID: 17960516 DOI: 10.1055/s-2007-981328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND One of the therapeutic aims in gestational diabetes (GDM) is to prevent the development of fetal hypertrophy by adaptation of maternal glycemic control. Relating to this context, maternal blood glucose daily profiles and fetal biometry ultrasound parameters were analysed for a possible correlation. A special focus was given to the question as to whether a latency period exists for this possible connection. PATIENTS AND METHODS 152 pregnancies affected by GDM, without fetal malformations or aneuploidies, were enrolled. Altogether, 746 ultrasound examinations consisting of 7 fetometric parameters each and 1 288 blood glucose daily profiles originating from the 20 (th) to 40 (th) gestational week were systematically investigated for interrelation by correlation and multiple regression analysis. RESULTS No robust, constant correlation between the analysed parameters could be observed. However, marked differences between latency periods were noticed. Blood glucose parameters, which revealed significant regressions with fetal abdominal circumference, had an average time lag of 6.2 +/- 2.5 weeks, whereas the latency period for head circumference averaged 2.4 +/- 1.2 weeks. The overall small-for-gestational-age (SGA) rate was 20 %, pregnant women with a body mass index > 30 kg / m (2) revealed the highest rate of 28 %. CONCLUSIONS Therapeutic intervention depending on sonographically detected hypertrophy must be considered as being delayed. The currently valid therapeutic criteria including intended normoglycemia and regular fetometric ultrasound controls cannot prevent markedly high SGA rates, especially among obese women, in adequately treated GDM.
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Affiliation(s)
- S Kessel
- Abteilung I für Geburtshilfe, Pränatalmedizin und allg. Gynäkologie, Frauenklinik der Med. Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover
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Goebel JC, Soergel P, Pruggmayer M, Mühlhaus K, Stuhrmann M, Scharf A. Prenatal diagnosis of the Rhesus D fetal blood type on amniotic fluid in daily practice. Arch Gynecol Obstet 2007; 277:155-60. [PMID: 17701192 DOI: 10.1007/s00404-007-0437-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2007] [Accepted: 07/30/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To retrospectively examine the diagnostic accuracy of prenatal RhD blood type genotyping on amniotic fluid, using a combination of two polymerase chain reaction (PCR) methods in daily practice. METHODS Amniotic fluid was obtained from women undergoing amniocentesis. Two PCR protocols were carried out in two different laboratories. We obtained the postnatal serological RhD status. In cases with differing prenatal and postnatal test results, we investigated the possible error source by different methods. Sensitivity, specificity and the predictive values were calculated. RESULTS Prenatal RhD genotyping was applied in 1,640 cases, of which the postnatal serologic RhD status was obtained in 927. No discordance between both PCR methods occurred. In nine out of 927 cases differing results between PCR and serologic status were encountered. The sensitivity was 99.5%, the specificity 98.6%, and both positive and negative predictive values 99.1%. CONCLUSION Prenatal diagnosis of the fetal RhD blood type with PCR from amniotic fluid is highly accurate in daily practice and associated with a minimal sensitivity of 99.5% and a minimal specificity of 98.6%.
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Affiliation(s)
- J C Goebel
- Institute of Human Genetics, Hannover Medical School, Hannover, Germany
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Schmidt P, Hörmansdörfer C, Hillemanns P, Scharf A. Vorstellung einer neuen Computersoftware für das Advanced Firsttrimester Screening. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-988641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Schmidt P, Hörmansdörfer C, Hillemanns P, Elsässer M, Scharf A. Fallbericht eines Ersttrimester-Screenings mit klassischem Algorithmus nach Nicolaides und mit Advanced Firsttrimester Screening. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-988642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kessel S, Staboulidou I, Oehler K, Hillemanns P, Scharf A, Günter HH. Der Gestationsdiabetes unter klinischen Bedingungen bei angestrebter Normoglykämie: Detaillierter Verlauf fetometrischer Parameter zwischen der 20. und 40. Schwangerschaftswoche. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Freerksen N, Maul H, Scharf A, Schmidt P, Koch L, Sohn C. Aktuelle Therapiekonzepte. Vorzeitige Wehentätigkeit und ihre medikamentöse Behandlung. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Günter HH, Scharf A, Hillemanns P, Wenzlaff P, Maul H. [Pregnancies without prenatal care--which women are potentially affected, what are the inherent fetal risks?]. Z Geburtshilfe Neonatol 2007; 211:27-32. [PMID: 17327989 DOI: 10.1055/s-2006-942204] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND In the past decades prenatal care has lead to a reduction in maternal and fetal-neonatal morbidity and mortality. However, the number of examinations that should be recommended - especially in low-risk pregnancies - is still unclear. OBJECTIVE Women not taking part in prenatal care resemble a subgroup of pregnant women at risk. The objective of this study was to define characteristic parameters based on patient's history and clinical outcome and which maternal and fetal-neonatal morbidity has to be taken into account. PATIENTS AND METHODS From 913 255 data sets of the Perinatal Registry Lower Saxony, Germany, between 1987 and 1999 n = 2 208 pregnancies (0.24 %) were documented as 'not taken part in prenatal care', while n = 163 143 pregnancies were identified as having undergone optimal prenatal care according to the recommendations. Both groups were compared regarding pregnancy associated and obstetrical parameters. Data are given as odds ratio (OR) and 95 % confidence interval (CI) for pregnancies without any prenatal care vs. pregnancies with standard prenatal care. RESULTS History of still birth: OR 1.750 (1.175 - 2.609), p < 0.05; mother single: 7.271 (6.603 - 8.006), p < 0.01; maternal age < 18 yrs: 9.904 (7.771 - 12.624), p < 0.01; maternal age > 40 yrs: 3.781 (2.900 - 4.907), p < 0.01; German vs. other origin: 0.214 (0.196 - 0.234), p < 0.01; preterm birth: 2.667 (2.380 - 2.989), p < 0.01; cesarean section: 0.728 (0.644 - 0.823), p < 0.05; birth weight < 5 %: 2.552 (2.140 - 2.943), p < 0.01; APGAR at 1 min < 3: 5.463 (4.521 - 6.602), p < 0.01; umbilical artery pH < 7.0: 2.941 (1.753 - 4.932), p < 0.01; neonatal intubation: 3.945 (3.244 - 4.797), p > 0.01; still birth: 6.089 (4.731 - 7.838), p < 0.01; death post partum: 4.444 (3.008 - 6.567), p < 0.01. CONCLUSION Pregnant women not taking part in prenatal care are younger or older, more frequently foreigners, and present characteristics of a lower socioeconomic status. These pregnancies are associated with a very high potential of neonatal morbidity. From a both medical and economic point of view, it appears to be reasonable to specifically look after those women before or during pregnancy.
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Affiliation(s)
- H H Günter
- Zentrum Frauenheilkunde der Medizinischen Hochschule Hannover, Abt. I, Frauenheilkunde und Geburtshilfe.
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Tzialidou I, Oehler K, Scharf A, Staboulidou I, Westhoff-Bleck M, Hillemanns P, Günter HH. [Marfan syndrome in pregnancy: presentation of four cases and discussion]. Z Geburtshilfe Neonatol 2007; 211:36-41. [PMID: 17327991 DOI: 10.1055/s-2007-960544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The coincidence of Marfan syndrome and pregnancy means a high risk for mother and child, as it is associated with cardiovascular and obstetric complications. We report our experience of four pregnancies with the Marfan syndrome. The course of pregnancy, the peripartum management and both the maternal and neonatal outcomes of four pregnant women with the Marfan syndrome, who were treated in our department between 1995 and 2005, were retrospectively analysed. The pregnancies of two women were complicated by premature rupture of membranes (36 (th) gestational week) and premature uterine contractions with cervical incompetence (30 (th) gestational week), respectively. One patient developed class 3 (NYHA) heart failure in the 3 (rd) trimenon. Two out of four women had mild cardiovascular disease and could deliver vaginally. In the other two cases a primary Caesarean section was performed at the 36 (th) week of gestation because of severe cardiovascular morbidity. No patient had a progressive aortic dilatation, dissection or rupture. The neonatal outcome was uneventful in all cases. Three newborns underwent a genetic evaluation for the Marfan syndrome, in two of them mutations in the fibrillin 1 gene were detected. Women with the Marfan syndrome should be counselled pre-conception and observed by an interdisciplinary team during pregnancy. If the aortic root diameter is < 40 mm, without progression in pregnancy, and in the absence of severe valve insufficiency, then pregnancy is in most cases well tolerated and vaginal delivery can be performed.
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MESH Headings
- Adult
- Aortic Dissection/diagnosis
- Aortic Dissection/genetics
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/genetics
- Cesarean Section
- DNA Mutational Analysis
- Female
- Fetal Membranes, Premature Rupture/diagnosis
- Fibrillin-1
- Fibrillins
- Genetic Counseling
- Genetic Testing
- Heart Failure/diagnosis
- Heart Failure/genetics
- Humans
- Infant, Newborn
- Marfan Syndrome/diagnosis
- Marfan Syndrome/genetics
- Microfilament Proteins/genetics
- Obstetric Labor Complications/diagnosis
- Obstetric Labor Complications/genetics
- Obstetric Labor, Premature/diagnosis
- Obstetric Labor, Premature/genetics
- Pregnancy
- Pregnancy Complications/diagnosis
- Pregnancy Complications/genetics
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/genetics
- Pregnancy Trimester, Third
- Pregnancy, High-Risk
- Retrospective Studies
- Uterine Cervical Incompetence/diagnosis
- Uterine Cervical Incompetence/genetics
- Vacuum Extraction, Obstetrical
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Affiliation(s)
- I Tzialidou
- Medizinische Hochschule Hannover, Zentrum Frauenheilkunde, Abteilung I: Frauenheilkunde und Geburtshilfe.
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Schmidt P, Staboulidou I, Soergel P, Hillemanns P, Scharf A. Individualized growth charts for ultrasound measurements can significantly improve fetal monitoring. Arch Gynecol Obstet 2007; 276:315-21. [PMID: 17375314 DOI: 10.1007/s00404-007-0355-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE For monitoring pregnancies it is useful to reduce unnecessary examinations due to wrongfully assumed growth retardation in cases with a small fetal growth potential. It also makes sense to improve the detection of objectively retardated children in order to a disproportionately high growth potential. It was the aim of this study to modify the standard growth charts for ultrasound parameters according to parental influences to better display the individual growth potential. MATERIAL AND METHODS In a prospective trial 1,390 ultrasound measurements of 174 completed pregnancies were observed. For all patients a standard questionnaire was conducted in which possible predictors for fetal growth were collected. Customizing the growth charts had been achieved by (1) calculating the general impact of parental factors on the ultrasound measurement values, (2) plotting the individual growth charts for each pregnancy and (3) analyzing the difference of every observed measurement from either unchanged normal values or customized growth charts. RESULTS The obtained biparietal diameter measurements all in all are 291 mm closer to the individualized charts than to the unmodified charts. The total improvement of all thoracal diameter measurements was found to be 294 mm, the summarized advancement of all abdomen circumference values was 1,005 mm and the femur length measurements are 296 mm nearer to customized charts. All results were statistically significant. DISCUSSION This is the first time the impact of several predictors on ultrasound growth charts had been analyzed. While other working groups have demonstrated the benefit of customizing the fetal weight and length, this concept had never been carried forward onto the growth charts for ultrasound values. The method to adjust the common mean values by so called 'modifiers' is derived from the mathematical concept of the sequential first-trimester screening for Down's syndrome. For customizing growth charts this approach seems to be useful as well. The feasability and the statistical benefit of customizing ultrasound growth charts has been demonstrated in this work. A larger study seems to be promising and should be performed. Further improvements could be obtained by using normal growth charts which were derived from the examined cohort.
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Affiliation(s)
- P Schmidt
- Department of Obstetrics and Gynecology, Medical University Hannover, Hannover, Germany.
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Günter HH, Scharf A, Hertel H, Hillemanns P, Wenzlaff P, Maul H. [Perinatal morbidity in pregnancies of women with preconceptional and gestational diabetes mellitus in comparison with pregnancies of non-diabetic women. Results of the perinatal registry of Lower Saxony, Germany]. Z Geburtshilfe Neonatol 2007; 210:200-7. [PMID: 17206554 DOI: 10.1055/s-2006-957073] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Pregnancies of women with glucose tolerance disorders are still associated with high maternal and perinatal morbidity. In the present population-based study, we investigated the fetal and neonatal risks and complications in pregnancies of women with preconceptional and gestational diabetes in comparison with pregnancies of non-diabetic women. METHODS A total of 913,255 pregnancies with 926,685 newborns documented by the Perinatal Registry of Lower Saxony, Germany, between 1987 and 1999 was retrospectively evaluated. In particular, the obstetric parameters of 3439 women with preconceptional diabetes mellitus (PDM, n = 3485 neonates), 4051 women with gestational diabetes mellitus (GDM, n = 4155 neonates) and 905,765 non-diabetic women (NDM, n = 919.053 neonates) were analysed. RESULTS The diabetes groups had a higher rate of preterm birth < 31st week of gestation (PDM vs. NDM odds ratio [OR] 2.341; GDM vs. NDM OR 1.483) and between the 32nd and 37th weeks of gestation (OR 3.688 and 2.418, respectively). The incidences of pathological cardiotocograms (OR 1.519 and 1.258, respectively) and acidosis as indication for operative delivery (OR 5,015 and 2,102, respectively) were increased in the diabetes groups. There was a higher prevalence of birth weight > 4500 g (OR 2.775 and 2.742, respectively) and >95. percentile (OR 4.268 and 3.610, respectively) in newborns of diabetic women. The higher rate of umbilical arterial pH < 7.00 (OR 2.481 and 1.195, respectively) as well as Apgar score at 1 minute <7 (OR 2.971 and 1.897, respectively) indicated a poorer neonatal outcome in pregnancies of women with diabetes mellitus. The frequency of necessary intubation of the infants was significantly higher in the diabetes group (OR 3.384 and 1.317, respectively). There also was an increased prevalence of intrauterine fetal death in pregnancies of diabetic women (OR 4.197 and 2.511, respectively). CONCLUSION Pregnancies of women with diabetes mellitus are still correlated with higher perinatal risks and complications. The neonatal morbidity in pregnancies with gestational diabetes mellitus was more similar to that of pregnancies with preconceptional diabetes mellitus than to the morbidity in the group of non-diabetic women. Changes of the parameters within the observation period were the same in all three groups and therefore cannot be attributed to a primary more intensive prenatal care of diabetic women.
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Affiliation(s)
- H H Günter
- Zentrum Frauenheilkunde der Medizinischen Hochschule Hannover, Abt. I: Frauenheilkunde und Geburtshilfe, Carl-Neuberg-Strasse 1, 30625 Hannover.
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Schmidt P, Garcea R, Parussis E, Staboulidou I, Scharf A. A rare case of massive ovarian edema in an uncomplicated singleton pregnancy. Ultraschall Med 2007; 28:71-4. [PMID: 16703489 DOI: 10.1055/s-2006-926648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Massive Ovarian Edema (MOE) is a rare cause of ovarian enlargement. Only 77 cases have been reported in the world literature so far, merely three of which were observed during pregnancy. Two of these showed additional pathological changes of the affected ovary (torsion) or were found in twin pregnancy. The patient presented on hand is therefore only the second report of MOE in an uncomplicated singleton pregnancy. In this case, a therapeutical resection of the affected ovary was performed at 16 + 4 weeks of gestation. The further course of the pregnancy was uncomplicated.
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Affiliation(s)
- P Schmidt
- Frauenarztpraxis Dr. Schmidt, Wolfenbüttel.
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Günter HH, Scharf A, Tzialidou I, Hillemanns P, Wenzlaff P, Maul H. [Hospitalization, type of obstetrical clinic and anamnestic risk profile of pregnant women with pregestational diabetes mellitus--results of the perinatal registry of Lower Saxony, Germany]. Zentralbl Gynakol 2007; 128:341-6. [PMID: 17213973 DOI: 10.1055/s-2006-955205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Obstetric and diabetic societies recommend an intensive care of pregnancies in women with pregestational diabetes, an early hospitalization in case of obstetric and internal complications as well as delivery in a perinatal center. OBJECTIVE To evaluate the number and duration of hospitalization of pregnant women with pregestational diabetes in comparison with non-diabetic women and further more the type of clinics in which both groups were delivered. We also investigated if there were any differences in anamnestic risk factors in correlation with the type of hospital. MATERIAL AND METHODS The data of the Perinatal Registry of Lower Saxony, Germany, between 1990 and 1999 were analyzed retrospectively. The pregnancies of 2 543 women with pregestational diabetes were compared with the pregnancies of 707 695 non-diabetic women. RESULTS There was at least one admission to hospital in 40 % of diabetic and 18.6 % of non diabetic women and more than one admission in 11.9 and 3.6 %, respectively (p < 0.001). The number and duration of hospitalization in both groups decreased significantly within the observation period. 57.7 % of all hospitals performed 1 to 4 and 11 % of the hospitals 5 to 9 deliveries of diabetic women per year. In the group of pregnant women with pregestational diabetes 45 % were delivered in clinics with 1 to 4 and 26.4 % in clinics with 5 to 9 deliveries of diabetic women per year. CONCLUSIONS A higher number and duration of hospitalization was observed in the diabetic group, but both decreased significantly in each group during the observation period. No significant trend for delivering diabetic women in specialized high-risk units could be detected.
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Affiliation(s)
- H H Günter
- Zentrum Frauenheilkunde der Medizinischen Hochschule Hannover, Abt. I: Frauenheilkunde und Geburtshilfe.
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Hörmansdörfer C, Schmidt P, Scharf A, Hillemanns P. Excluding Maternal Background Risk in First Trimester Screening – Analysis of a Novel Test Strategy. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Freerksen N, Sicking I, Beuter P, Scharf A, Sohn C, Maul H. Multimorbide Transplantationspatientin im Zustand nach Eizellspende in Osteuropa. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1002985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hörmansdörfer C, Scharf A, Staboulidou I, Hillemanns P, Schmidt P. Improved fetal monitoring through individualized growth charts for ultrasound measurements. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1003016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Hörmansdörfer C, Schmidt P, Scharf A, Hillemanns P. Age Indication or First Trimester Screening? – A Comparison of the Test performance and the Resulting Financial Consequences. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1003017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Staboulidou I, Steinborn A, Schmidt P, Günter HH, Hillemanns P, Scharf A. [References values for the fetal nasal bone in the first trimenon of pregnancy in a normal collective. A prospective study]. Z Geburtshilfe Neonatol 2006; 210:173-8. [PMID: 17099839 DOI: 10.1055/s-2006-951741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Examination of the fetal nasal bone by ultrasound between 11 and 14 weeks gestation has been proposed as an additional tool in the detection of trisomy 21. However, the variability in the identification and the normal length of the fetal nasal bone have not been investigated sufficiently as yet. The aim of this study was to evaluate this parameter and to establish normal ranges for nasal bone length. METHOD Ultrasound examinations were carried out in 122 fetuses at 9, 10, 11, 12 and 20 weeks gestation. On the scans, the fetal profile was examined for the possibility of identification of the nasal bone. Normal nasal bone length reference ranges were generated using prenatal measurements. RESULTS The fetal profile was successfully examined in all cases. The nasal bone could first be visualised at 9 weeks gestation. The identification of the fetal nasal bone in all cases was achieved at 12 weeks gestation. The median nasal bone length was 0.29 mm at 9 weeks gestation, 0.96 mm at 10 weeks gestation, 1.73 mm at 11 weeks gestation, 2.25 at 12 weeks gestation, and 6.18 mm at 20 weeks gestation. CONCLUSION The reference ranges for the measurement of the fetal nasal bone length are similar to the findings in the published literature. Only with a knowledge of reference ranges for nasal bone length in normal fetuses can conclusions be drawn about the presence/absence of the bone or the presence of a hypoplastic nasal bone. Further studies are necessary to confirm these results and to obtain larger datasets to assess nasal bone as a quantitative marker.
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Affiliation(s)
- I Staboulidou
- Frauenklinik der Medizinischen Hochschule Hannover, Hannover.
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Günter HH, Tzialidou I, Scharf A, Wenzlaff P, Maul H, Hillemanns P. Intrauteriner Tod des Feten bei präkonzeptionellem Diabetes, Gestationsdiabetes und Schwangerschaften ohne diabetische Stoffwechsellage. Ergebnisse der Perinatalstatistik Niedersachsen. Z Geburtshilfe Neonatol 2006; 210:193-9. [PMID: 17206553 DOI: 10.1055/s-2006-957072] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECT The prevalence of intrauterine fetal death as well as the relevant risk factors in pregnancies of women with preconceptional and gestational diabetes mellitus and non-diabetic women were investigated. METHODS The data of the Perinatal Registry of Lower Saxony between 1987 and 1999 for pregnancies of women with preconceptional diabetes mellitus (PDM, n = 3351), gestational diabetes mellitus (GDM, n = 3954) and women without diabetes mellitus (non-diabetic pregnancies, NDM, n = 887,779) were retrospectively analysed. RESULTS Intrauterine fetal death occurred in 46 women with PDM (1.35 %), 32 women with GDM (0.79 %) and 2756 non-diabetic women (0.31 %). The odds ratio (OR, 95 % CI) for PDM vs. NDM was 4.468 (3.332 - 5.992; p < 0.01) and for GDM vs. NDM it was 2.595 (1.829 - 3.682; p < 0.01). The percentage of death, which occurs before the 32nd week of gestation, was 13 % in pregnancies with PDM, 12.5 % in pregnancies with GDM and 27.7 % in non-diabetic pregnancies. 50 % of fetal deaths in the PDM group, 43.8 % of those in the GDM group and 39.3 % of those in the NDM group occurred after the 36th week of gestation. The percentages of dead fetuses who were under the 10th percentile of growth (small for gestational age, SGA), in pregnancies with PDM, GDM and NDM were 15.2 %, 6.3 %, and 28.7 %, respectively. The percentages of dead fetuses above the 90th percentile of growth (large for gestational age, LGA) were 41.3 % (PDM), 37.5 % (GDM), and 8.7 % (NDM), (p < 0.01 for PDM vs. NDM and for GDM vs. NDM). CONCLUSION The risk of intrauterine fetal death in pregnancies of diabetic women is still increased. It seems that especially the LGA fetuses of diabetic mothers and SGA fetuses of non-diabetic mothers are at greater risk of intrauterine death.
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Affiliation(s)
- H H Günter
- Zentrum Frauenheilkunde der Medizinischen Hochschule Hannover, Abt. I: Frauenheilkunde und Geburtshilfe, Carl-Neuberg-Strasse 1, 30625 Hannover.
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Staboulidou I, Schauer J, Rau GA, Hass R, Hollwitz B, Scharf A. Antenatal Ultrasonographic Appearance of Isolated Fetal Ascites. Fetal Diagn Ther 2006; 21:501-5. [PMID: 16969003 DOI: 10.1159/000095661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Accepted: 12/06/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Isolated fetal ascites can be caused by many heterogeneous disorders and is associated with a variety of conditions. Cloacal anomalies are rare abnormalities with a highly variable array of sonographic symptoms, which make them difficult to diagnose antenatally. We present a case with isolated fetal ascites without hydronephrosis caused by a cloacal malformation. CASE A 28-year-old woman, gravida 2, para 1, was referred to our unit at 18 weeks gestation with a hyperdense structure in the fetal liver. Cordocentesis revealed a normal karyotype and negative viral titers. Isolated fetal ascites occurred for the first time at 23 weeks gestation. Serial ultrasounds showed progressive fetal ascites with no hydronephrosis at any time and no other malformations apart from the previously diagnosed hyperechogenic liver structure. After the insertion of an abdomino-amniotic shunt, a temporary reduction of the sonographically detectable ascites could be achieved. Cesarean delivery was necessary due to a pathological CTG at 33 weeks of gestation. The baby was born with a markedly distended abdomen. Postnatal radiologic examination showed two fistulae between the cloaca and the notedly dilated vagina and the rectum respectively. At the age of 3 months a vaginoplasty was performed, which involved creating a correctly positioned vaginal opening, reconstruction of the urethra and rectum as well as occlusion of the two fistulae. CONCLUSION In view of the examinations, performed before and after delivery, it has to be assumed that fetal urine drained via the cloaca through the fallopian tubes into the abdomen. In contrast to usual appearance of cloacal malformations no hydronephrosis was detected and the kidney function was normal at all times. To our knowledge, this is the first published case of isolated fetal ascites without hydronephrosis caused by a cloacal malformation.
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Affiliation(s)
- I Staboulidou
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine and General Gynecology, Medical School of Hannover, Hannover, Germany.
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Günter H, Scharf A, Hertel H, Hillemanns P, Wenzlaff P, Maul H. Maternale Risiken und Komplikationen in Schwangerschaften präkonzeptioneller Diabetikerinnen und Gestationsdiabetikerinnen im Vergleich mit nicht diabetischen Schwangerschaften - Ergebnisse der Perinatalerhebung Niedersachsen. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-924690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Maul H, Scharf A, Baier P, Günter H, Sohn C. Aktuelle Therapiekonzepte. Intrauterine Wachstumsrestriktion (IUGR) und Schwangerschaftsfortsetzung. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-955933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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