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David M, Achtenhagen A, Bamberg C, Bormann C, Felderhoff-Müser U, Groth S, Hänel K, König K, Korell M, Michl S, Redler S, Schleußner E, Seyler H, Wallwiener M, Wallwiener S. Abortion in the First Trimester. Guideline of the DGGG (S2k-Level, AWMF Registry No. 015-094, December 2022) - Part 1 with Recommendations on Care Structures, Information and Advice on Decision-Making, Measures Before Abortion and Medical Abortion. Geburtshilfe Frauenheilkd 2023; 83:1205-1220. [PMID: 37808261 PMCID: PMC10556879 DOI: 10.1055/a-2078-8118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/14/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose The aim was to develop evidence-based recommendations where possible. The guideline presents the medical principles and scientific evidence for indications, the counselling of affected women, performing terminations, the choice of method, and the care and monitoring of a terminated pregnancy up until week 12 + 0 of gestation p. c. Methods In accordance with the requirements for S2k-guidelines, the contents of the guideline were drafted following a systematic search of the literature by a representative interdisciplinary group of experts. Guideline authors held several formal meetings under the auspices of the German Society for Gynaecology and Obstetrics (DGGG) during which the contents of the guideline were finalised and agreed upon. Recommendations A total of 61 recommendations are provided, covering care structures, provision of information and counselling to support decision-making, the measures to be taken before terminating the pregnancy, and medical termination of the pregnancy.
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Affiliation(s)
- Matthias David
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Anne Achtenhagen
- donum vitae e. V., Beratungsstelle Kurfürstendamm, Berlin, Germany
| | - Christian Bamberg
- Klinik und Poliklinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ursula Felderhoff-Müser
- Klinik für Kinderheilkunde I Neonatologie, Päd. Intensivmedizin, Päd. Infektiologie, Neuropädiatrie Zentrum für Kinder- und Jugendmedizin, Essen, Germany
| | - Sylvia Groth
- Arbeitskreis Frauengesundheit in Medizin, Psychotherapie und Gesellschaft (AKF) e. V., Berlin, Germany
| | | | | | - Matthias Korell
- Klinik für Gynäkologie und Geburtshilfe mit Brustzentrum am Johanna-Etienne-Krankenhaus, Neuss, Germany
| | - Susanne Michl
- Institut für Geschichte der Medizin und Ethik in der Medizin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Silke Redler
- Institut für Humangenetik, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Ekkehard Schleußner
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Germany
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David M, Achtenhagen A, Bamberg C, Bormann C, Felderhoff-Müser U, Groth S, Hänel K, König K, Korell M, Michl S, Redler S, Schleußner E, Seyler H, Wallwiener M, Wallwiener S. Abortion in the First Trimester. Guideline of the DGGG (S2k-Level, AWMF Registry No. 015-094, December 2022) - Part 2 with Recommendations for Surgical Termination of Pregnancy and Follow-up Care After Termination of Pregnancy. Geburtshilfe Frauenheilkd 2023; 83:1221-1234. [PMID: 37808257 PMCID: PMC10556860 DOI: 10.1055/a-2078-9346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 04/14/2023] [Indexed: 10/10/2023] Open
Abstract
Purpose The aim was to develop evidence-based recommendations where possible. The guideline presents the medical principles and scientific evidence for indications, counselling of affected persons, performing terminations, the choice of method, and the care and monitoring of a terminated pregnancy up until week 12 + 0 of gestation p. c. Methods In accordance with the requirements for an S2k-guideline, the contents of the guideline were drafted following a systematic search of the literature by a representative interdisciplinary group of experts. Guideline authors held several formal meetings under the auspices of the German Society for Gynaecology and Obstetrics (DGGG) during which the contents of the guideline were finalised and agreed upon. Recommendations The guideline provides recommendations on the surgical termination of pregnancy and follow-up care after termination of pregnancy.
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Affiliation(s)
- Matthias David
- Charité – Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Anne Achtenhagen
- donum vitae e. V., Beratungsstelle Kurfürstendamm, Berlin, Germany
| | - Christian Bamberg
- Klinik und Poliklinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | | | - Ursula Felderhoff-Müser
- Klinik für Kinderheilkunde I Neonatologie, Päd. Intensivmedizin, Päd. Infektiologie, Neuropädiatrie Zentrum für Kinder- und Jugendmedizin, Essen, Germany
| | - Sylvia Groth
- Arbeitskreis Frauengesundheit in Medizin, Psychotherapie und Gesellschaft (AKF) e. V., Berlin, Germany
| | | | | | - Matthias Korell
- Klinik für Gynäkologie und Geburtshilfe mit Brustzentrum am Johanna-Etienne-Krankenhaus, Neuss, Germany
| | - Susanne Michl
- Institut für Geschichte der Medizin und Ethik in der Medizin, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Silke Redler
- Institut für Humangenetik, Medizinische Fakultät und Universitätsklinikum Düsseldorf, Heinrich-Heine-Universität Düsseldorf, Düsseldorf, Germany
| | - Ekkehard Schleußner
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Friedrich-Schiller-Universität, Jena, Germany
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Bamberg C, Diehl W, Diemert A, Sehner S, Hecher K. Differentiation between TTTS Stages I vs II and III vs IV does not affect probability of double survival after laser therapy. Ultrasound Obstet Gynecol 2021; 58:201-206. [PMID: 32959919 DOI: 10.1002/uog.23131] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/17/2020] [Accepted: 09/11/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To compare the perinatal outcome of monochorionic twin pregnancies with twin-twin transfusion syndrome (TTTS), according to the disease severity, defined using Quintero staging, after treatment with fetoscopic laser surgery. METHODS This was a single-center study of 1020 consecutive cases with severe TTTS, which were treated with fetoscopic laser surgery. During the study period from January 1995 to March 2013, the participants were included at a mean ± SD gestational age of 20.8 ± 2.2 weeks. Perinatal survival analysis, including the rates of double survival and survival of at least one fetus, was undertaken according to the Quintero staging system. For blockwise comparisons of data, the whole population was divided into five chronologically consecutive study subgroups of 200 patients in each of the first four subgroups and 220 in the last one. RESULTS For the entire study population with known outcome (n = 1019), the rate of pregnancy with double fetal survival was 69.0% (127/184) in Stage-I, 71.4% (257/360) in Stage-II, 55.4% (236/426) in Stage-III and 51.0% (25/49) in Stage-IV TTTS cases. At least one twin survived in 91.3% (168/184) of pregnancies with Stage-I, 89.7% (323/360) of those with Stage-II, 83.1% (354/426) of those with Stage-III and 77.6% (38/49) of those with Stage-IV TTTS. The rates of double survival and survival of at least one fetus were both significantly higher in Stage-II TTTS compared with those in Stage-III TTTS cases (P < 0.001 and P = 0.011, respectively). Survival rates between pregnancies with Stage-I vs Stage-II TTTS and between those with Stage-III vs Stage-IV TTTS were not significantly different. Therefore, we combined pregnancies with Stage-I or Stage-II TTTS, and those with Stage-III or Stage-IV TTTS. The double survival rate was 70.6% (384/544) in combined Stage-I and Stage-II vs 54.9% (261/475) in combined Stage-III and Stage-IV TTTS cases (P < 0.001). At least one twin survived in 90.3% (491/544) of pregnancies with Stage-I or Stage-II TTTS vs 82.5% (392/475) in those with Stage-III or Stage-IV TTTS (P < 0.001). The double survival rate increased between the first and the last consecutive study subgroups from 59.8% (55/92) to 75.0% (96/128) (adjusted odds ratio (aOR)linear trend , 1.26 (95% CI, 1.01-1.56); P = 0.037) in pregnancies with Stage-I or Stage-II TTTS and from 41.7% (45/108) to 62.0% (57/92) (aORlinear trend , 1.21 (95% CI, 0.98-1.50); P = 0.082) in those with Stage-III or Stage-IV TTTS. Double survival rate was the lowest for Stage-III cases in which the donor twin was affected by severely abnormal Doppler findings (45.4% (64/141)). CONCLUSIONS Double survival and survival of at least one fetus in monochorionic twin pregnancies with TTTS were related significantly to Quintero stage. However, our data show that the differentiation between Stages I vs II and Stages III vs IV does not have any significant prognostic implication for perinatal survival. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- C Bamberg
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - W Diehl
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - S Sehner
- Department of Medical Biometry and Epidemiology, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
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Bamberg C, Deindl P, Hecher K. Twin Anemia-Polycythemia Sequence (Zwillings-Anämie-Polyzythämie-Sequenz). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/a-0864-4710] [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: 10/24/2022] Open
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Tavares de Sousa M, Glosemeyer P, Diemert A, Bamberg C, Hecher K. First-trimester intervention in twin reversed arterial perfusion sequence. Ultrasound Obstet Gynecol 2020; 55:47-49. [PMID: 31486133 DOI: 10.1002/uog.20860] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 08/16/2019] [Accepted: 08/20/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To report the outcome of monochorionic twins with twin reversed arterial perfusion (TRAP) sequence following interstitial laser therapy in the first trimester. METHODS This was a retrospective cohort study of all consecutive cases of TRAP that underwent interstitial laser therapy at ≤ 14 + 3 weeks' gestation between January 2014 and April 2016. Interstitial laser treatment was performed under ultrasound guidance using a 400-nm Nd:YAG laser fiber. Hospital records were reviewed to ascertain perinatal survival and morbidity. RESULTS Twelve monochorionic twin pregnancies underwent interstitial laser treatment of the umbilical artery of the acardiac fetus, at a median gestational age of 13 + 5 (interquartile range (IQR), 13 + 4 to 14 + 0) weeks. In all cases, one treatment was sufficient to achieve complete interruption of the perfusion of the acardiac twin. There were no procedure-related complications during or within 48 h after the procedure. In one (8.3%) case, intrauterine death of the pump twin occurred 2 weeks after the intervention. All other cases (91.7%) resulted in a live birth at a median gestational age of 39 + 6 (IQR, 37 + 1 to 41 + 2) weeks and with a median birth weight of 3370 (IQR, 2980-3480) g. No neonatal mortality or serious morbidity occurred. CONCLUSIONS Our results support the use of interstitial laser therapy in the first trimester of pregnancy complicated by TRAP sequence, showing a live birth rate of 92%. The results of a randomized controlled trial, evaluating early vs late intervention in pregnancy with TRAP sequence, are awaited. © 2019 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of the International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Glosemeyer
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - C Bamberg
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bamberg C, Hecher K. Zwillingstransfusionssyndrom. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/a-0787-2256] [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: 10/25/2022] Open
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Bamberg C, Diemert A, Glosemeyer P, Tavares de Sousa M, Hecher K. Discordance of umbilical coiling index between recipients and donors in twin-twin transfusion syndrome. Placenta 2019; 76:19-22. [PMID: 30803710 DOI: 10.1016/j.placenta.2019.01.013] [Citation(s) in RCA: 4] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 01/04/2019] [Accepted: 01/15/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION To compare the intertwin umbilical cord coiling in twin-twin transfusion syndrome (TTTS) before fetoscopic laser treatment and to correlate these with Doppler findings in both twins. METHODS We performed a prospective study using three-dimensional (3D) ultrasound with color Doppler imaging of the umbilical cord in TTTS. Coiling index was measured as a reciprocal value of one complete vascular coil. Ultrasound hypocoiling was thus defined as < 0.2 coils/cm and hypercoiling as > 0.6 coils/cm, respectively. Umbilical artery pulsatility index (PI) and peak systolic velocity, middle cerebral artery peak systolic velocity and ductus venosus PI of flow-velocity waveformes of both twins were measured. RESULTS We included 65 women in the study. The average gestational age was 21.1 ± 2.7 weeks. In 65 recipients and 56 donors coiling index could be quantified. The median (interquartile range) coiling index of recipient twins was significantly higher than of donors, 0.55 (0.41-0.68) vs. 0.26 (0.2-0.5); P < 0.0001. The proportions of abnormal intertwin coiling were significantly (P = 0.0015) different. Out of 65 recipient with coiling indices evaluation, 1 (1.5%) showed hypocoiled and 27 (41.5%) hypercoiled cords. In contrast, 27 donor twins (48.2%) showed hypocoiled and 5 (8.9%) hypercoiled umbilical cords. There were no significant correlations between the fetal Doppler values and coiling indices. DISCUSSION Evaluation of umbilical cord coiling index using 3D color Doppler in both twins complicated by TTTS is feasible in both, donors and recipients. Coiling indices differ significantly between recipient and donor twins and do not correlate with Doppler findings.
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Affiliation(s)
- Christian Bamberg
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter Glosemeyer
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manuela Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Abstract
Twin-to-twin transfusion syndrome (TTTS) is a serious complication that affects 10-15% of monochorionic multiple pregnancies. Communicating placental vessels on the chorionic plate between the donor and recipient twin are responsible for the imbalance of blood flow. There is evidence for the superiority of fetoscopic laser ablation over serial amnioreductions regarding survival and neurological outcome for stages II-IV TTTS. However, the optimal management of stage I is still debated. The "Solomon" technique showed a significant reduction in recurrent TTTS and post laser twin anemia-polycythemia sequence (TAPS) in comparison to the selective laser method without improvement in perinatal mortality or neonatal morbidity. Survival rates after fetoscopic laser surgery have significantly increased over the last 25 years. High volume centers report up to 70% double survival and at least one survivor in >90%. Long-term neurodevelopmental impairment occurs in about 10% of children after laser surgery. In this review we discuss the optimal management, innovations in laser technique, long-term neurodevelopmental outcome, and future aspects of TTTS treatment.
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Affiliation(s)
- Christian Bamberg
- University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Fetal Medicine, Hamburg, Germany.
| | - Kurt Hecher
- University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Fetal Medicine, Hamburg, Germany
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Pasura L, Schwickert A, Henrich W, Bamberg C. Sonographische Evaluation des unteren Uterinsegments in einer Folgeschwangerschaft nach einfacher- oder doppelter Uterusverschlusstechnik bei der Sectio caesarea. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671164] [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: 10/28/2022] Open
Affiliation(s)
- L Pasura
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - A Schwickert
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - W Henrich
- Charité Universitätsmedizin, Klinik für Geburtsmedizin, Berlin, Deutschland
| | - C Bamberg
- Universitätsklinikum Hamburg-Eppendorf, Zentrum für Geburtshilfe, Kinder- und Jugendmedizin Klinik und Poliklinik für Geburtshilfe und Pränatalmedizin, Hamburg, Deutschland
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Faensen A, Lehmann H, Metze B, Berns M, Hinkson L, Henrich W, Bührer C, Bamberg C. Differential association of prenatal blood flow patterns with death and neurodevelopmental retardation in preterm infants with intrauterine growth restriction. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671137] [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: 10/28/2022] Open
Affiliation(s)
- A Faensen
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - H Lehmann
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - B Metze
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Neonatologie, Berlin, Deutschland
| | - M Berns
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Neonatologie, Berlin, Deutschland
| | - L Hinkson
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - W Henrich
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Geburtsmedizin, Berlin, Deutschland
| | - C Bührer
- Charité – Universitätsmedizin Berlin, Charité Centrum Frauen-, Kinder- & Jugendmedizin mit Perinatalzentrum & Humangenetik CC 17, Neonatologie, Berlin, Deutschland
| | - C Bamberg
- UKE, Geburtsmedizin, Hamburg, Deutschland
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Bamberg C, Diemert A, Glosemeyer P, Hecher K. Quantified discordant placental echogenicity in twin anemia-polycythemia sequence (TAPS) and middle cerebral artery peak systolic velocity. Ultrasound Obstet Gynecol 2018; 52:373-377. [PMID: 28557152 DOI: 10.1002/uog.17535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Revised: 05/03/2017] [Accepted: 03/07/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To quantify sonographic placental echogenicity in twin anemia-polycythemia sequence (TAPS) and to correlate it with middle cerebral artery peak systolic velocity (MCA-PSV) measurements. METHODS We performed a retrospective search for consecutive TAPS cases between 16 and 36 weeks of gestation (MCA-PSV > 1.5 multiples of the median (MoM) in the anemic donor and < 1.0 MoM in the polycythemic recipient) in our database of monochorionic twin gestations from January 2007 until December 2016. In cases for which ultrasound images showing the donor's and the recipient's part of the placenta were available, echogenicity for both twins was quantified by image processing. MCA-PSV Doppler values of both fetuses were correlated to their respective placental echogenicity. Placental thickness of both twins was also measured. RESULTS Of 756 cases with MCA-PSV measurements identified from the database, 36 (4.8%) had TAPS; of these, 23 had TAPS combined with twin-twin transfusion syndrome and 13 showed isolated TAPS. Placental echogenicity could be quantified in 28 pregnancies. Mean ± SD placental echogenicity of donor twins was significantly higher than that of recipients (138.7 ± 22.8 vs 77.9 ± 37.0; P < 0.0001). Furthermore, a significant positive correlation was found between placental echogenicity and MCA-PSV MoM (R = 0.67, P < 0.0001). Mean placental thickness of donor twins (n = 20) was significantly higher than that of recipients (49.3 mm ± 13.4 vs 25.4 mm ± 10.1; P < 0.0001). CONCLUSIONS Echogenicity of the placental share in recipient and donor twins with TAPS correlates with MCA-PSV values. Quantification of sonographic placental echogenicity may help to determine the severity of TAPS in monochorionic twins. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- C Bamberg
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - P Glosemeyer
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Bamberg C, Dudenhausen JW, Bujak V, Rodekamp E, Brauer M, Hinkson L, Kalache K, Henrich W. A Prospective Randomized Clinical Trial of Single vs. Double Layer Closure of Hysterotomy at the Time of Cesarean Delivery: The Effect on Uterine Scar Thickness. Ultraschall Med 2018; 39:343-351. [PMID: 27626240 DOI: 10.1055/s-0042-112223] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE We undertook a randomized clinical trial to examine the outcome of a single vs. a double layer uterine closure using ultrasound to assess uterine scar thickness. MATERIALS AND METHODS Participating women were allocated to one of three uterotomy suture techniques: continuous single layer unlocked suturing, continuous locked single layer suturing, or double layer suturing. Transvaginal ultrasound of uterine scar thickness was performed 6 weeks and 6 - 24 months after Cesarean delivery. Sonographers were blinded to the closure technique. RESULTS An "intent-to-treat" and "as treated" ANOVA analysis included 435 patients (n = 149 single layer unlocked suturing, n = 157 single layer locked suturing, and n = 129 double layer suturing). 6 weeks postpartum, the median scar thickness did not differ among the three groups: 10.0 (8.5 - 12.3 mm) single layer unlocked vs. 10.1 (8.2 - 12.7 mm) single layer locked vs. 10.8 (8.1 - 12.8 mm) double layer; (p = 0.84). At the time of the second follow-up, the uterine scar was not significantly (p = 0.06) thicker if the uterus had been closed with a double layer closure 7.3 (5.7 - 9.1 mm), compared to single layer unlocked 6.4 (5.0 - 8.8 mm) or locked suturing techniques 6.8 (5.2 - 8.7 mm). Women who underwent primary or elective Cesarean delivery showed a significantly (p = 0.03, p = 0.02, "as treated") increased median scar thickness after double layer closure vs. single layer unlocked suture. CONCLUSION A double layer closure of the hysterotomy is associated with a thicker myometrium scar only in primary or elective Cesarean delivery patients.
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Affiliation(s)
- Christian Bamberg
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
| | | | - Verena Bujak
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
| | - Elke Rodekamp
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
| | - Martin Brauer
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
| | - Larry Hinkson
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
| | - Karim Kalache
- Maternal-Fetal Medicine, Obstetrics & Gynecology Department, Sidra Medical and Research Center, Doha, Qatar
| | - Wolfgang Henrich
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
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Affiliation(s)
- Christian Bamberg
- Department of Obstetrics; Charité-University Medical Center; Berlin Germany
| | - Larry Hinkson
- Department of Obstetrics; Charité-University Medical Center; Berlin Germany
| | - Wolfgang Henrich
- Department of Obstetrics; Charité-University Medical Center; Berlin Germany
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Vitezica I, von Heymann C, Henrich W, Bamberg C. Caesarean delivery during dual antiplatelet therapy after acute myocardial infarction and stenting. Case Reports in Perinatal Medicine 2017. [DOI: 10.1515/crpm-2017-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Cardiac disease is the leading cause of maternal mortality during pregnancy in high-resource countries.
Case
A 31-year-old woman had an ST-elevated myocardial infarction (STEMI) at 16 gestational weeks. The patient received three coronary drug-eluting stents followed by dual antiplatelet therapy (DAPT) with aspirin and clopidogrel. An elective caesarean delivery was performed under general anesthesia at 37+1 gestational weeks. Due to subnormal response to clopidogrel, administration was paused only 24 h perioperatively without bridging with tirofiban because of the slightly increased risk of stent thrombosis in clopidogrel nonresponders. There was no postoperative bleeding.
Conclusions
There is a lack of evidence-based guidelines regarding the management of acute myocardial infarction (AMI) during pregnancy; thus, delivery should be performed in a tertiary center with a multidisciplinary approach.
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Bamberg C, Hinkson L, Dudenhausen JW, Bujak V, Kalache KD, Henrich W. Longitudinal transvaginal ultrasound evaluation of cesarean scar niche incidence and depth in the first two years after single- or double-layer uterotomy closure: a randomized controlled trial. Acta Obstet Gynecol Scand 2017; 96:1484-1489. [DOI: 10.1111/aogs.13213] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 08/15/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Christian Bamberg
- Department of Obstetrics; Charité-University Medical Center; Berlin Germany
| | - Larry Hinkson
- Department of Obstetrics; Charité-University Medical Center; Berlin Germany
| | | | - Verena Bujak
- Department of Obstetrics; Charité-University Medical Center; Berlin Germany
| | - Karim D. Kalache
- Department of Obstetrics; Charité-University Medical Center; Berlin Germany
| | - Wolfgang Henrich
- Department of Obstetrics; Charité-University Medical Center; Berlin Germany
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Sindhwani N, Bamberg C, Famaey N, Callewaert G, Dudenhausen JW, Teichgräber U, Deprest J. In vivo evidence of significant levator ani muscle stretch on MR images of a live childbirth. Am J Obstet Gynecol 2017; 217:194.e1-194.e8. [PMID: 28412085 DOI: 10.1016/j.ajog.2017.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Revised: 03/25/2017] [Accepted: 04/05/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Vaginal childbirth is believed to be a significant risk factor for the development of pelvic floor dysfunction later in life. Previous studies have explored the use of medical imaging and simulations of childbirth to determine the stretch in the levator ani muscle. A report in 2012 has recorded magnetic resonance images of a live childbirth of a 24 year old woman giving birth vaginally for the second time, using a 1.0 Tesla open, high-field scanner. Our objective was to determine the stretch ratios in the levator muscle using these magnetic resonance images of live childbirth. STUDY DESIGN Three-dimensional magnetic resonance image sequences were obtained to visualize coronal and axial planes before and after the childbirth. These images were obtained before the expulsion phase without pushing and were used to reconstruct the levator muscle and the fetal head in 3 dimensions. The fetal head was approximated to be an ellipsoid, and it is assumed that its middle section is visible in dynamic magnetic resonance images. Assuming incompressibility, the full deformation field of the fetal head is then calculated. Real-time cine magnetic resonance images were acquired for the during the expulsion phase, occurring over 2 contractions in the midsagittal plane. The levator muscle stretch is estimated using a custom program. The program calculates points of contact between the fetal head ellipsoid and the levator ani muscle model as the head descends down the birth canal and moves them orthogonal to its surface. Circumferential stretch was calculated to represent the extension needed to allow the passage of the fetal head. RESULTS Starting from a position in the preexpulsion phase, the levator muscle experiences a maximum circumferential stretch of 248% on the posterior-medial portion of the levator ani muscle, as shown in previously published finite element simulations. However, the maximal stretch was notably less than that predicted by finite element models. This is because our baseline 3-dimensional model of the levator muscle is created from images taken shortly before expulsion and thus is already in a stretched state. Furthermore, the finite element models are created from images of a healthy nulliparous woman, while this study uses images from a para 2 woman. CONCLUSION This study is the first attempt to estimate the stretch in levator ani muscle using magnetic resonance images of a live childbirth. The stretch was significant and the locations corroborate with previous findings of finite element models.
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Bamberg C, Hinkson L, Henrich W. Authors' Response to the Letter to the Editor: Single- vs. Double-Layer Closure of Hysterotomy at the Time of Cesarean Delivery. Ultraschall Med 2017; 38:449. [PMID: 28614855 DOI: 10.1055/s-0043-113080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Christian Bamberg
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
| | - Larry Hinkson
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
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Kaufner L, Henkelmann A, von Heymann C, Feldheiser A, Mickley L, Niepraschk-von Dollen K, Grittner U, Henrich W, Bamberg C. Can prepartum thromboelastometry-derived parameters and fibrinogen levels really predict postpartum hemorrhage? J Perinat Med 2017; 45:427-435. [PMID: 27442353 DOI: 10.1515/jpm-2016-0009] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/19/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Decreased postpartum rotational thromboelastometric parameters of coagulation (ROTEM®) and fibrinogen levels have been associated with postpartum hemorrhage (PPH). However, the predictive power of prepartum ROTEM® parameters and fibrinogen levels (Fbgpre) for PPH remains unknown. METHODS This prospective observational pilot study included 217 healthy pregnant women. Maximum clot firmness (FIBTEM-MCF), fibrinogen levels and standard coagulation parameters were measured upon admission to the delivery room for labor and within 1 h after vaginal delivery. Blood loss was measured with a calibrated collecting drape during the third stage of labor. PPH was defined as blood loss ≥500 mL. Predictors for bleeding were identified via receiver operating characteristic analyses and bivariate and multivariate regression analyses. RESULTS Women with and without PPH did not differ in median FIBTEM-MCF [23 mm (25th percentile 20 mm, 75th percentile 26 mm) vs. 23 mm (19 mm, 26 mm), respectively; P=0.710] or mean Fbgpre (4.57±0.77 g/L vs. 4.45±0.86 g/L, respectively; P=0.431). Blood loss and prepartum coagulation parameters were not correlated (FIBTEM-MCF, rs=-0.055, P=0.431; Fbgpre, rs=-0.017, P=0.810). The areas under the curves (predictive power for PPH) for FIBTEM-MCF and Fbgpre and were 0.52 (0.41-0.64, P=0.699) and 0.53 [95% confidence interval (95% CI) 0.40-0.65, P=0.644], respectively. Neither FIBTEM-MCF nor Fbgpre was associated with PPH. However, primiparity [odds ratio (OR) 4.27, 95% CI 1.32-13.80, P=0.015) and urgent cesarean section (2.77, 1.00-7.67, P=0.050) were independent predictors of PPH. CONCLUSIONS ROTEM® parameters, Fbgpre and postpartum blood loss were not associated, nor did these factors predict PPH. Sufficiently powered prospective studies are needed to confirm these results.
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Bamberg C, Deprest J, Sindhwani N, Teichgräberg U, Güttler F, Dudenhausen JW, Kalache KD, Henrich W. Evaluating fetal head dimension changes during labor using open magnetic resonance imaging. J Perinat Med 2017; 45:305-308. [PMID: 27219097 DOI: 10.1515/jpm-2016-0005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/18/2016] [Indexed: 11/15/2022]
Abstract
AIM Fetal skull molding is important for the adaptation of the head to the birth canal during vaginal delivery. Importantly, the fetal head must rotate around the maternal symphysis pubis. The goals of this analysis were to observe a human birth in real-time using an open magnetic resonance imaging (MRI) scanner and describe the fetal head configuration during expulsion. METHODS Real-time cinematic MRI series (TSE single-shot sequence, TR 1600 ms, TE 150 ms) were acquired from the midsagittal plane of the maternal pelvis during the active second stage of labor at 37 weeks of gestation. Frame-by-frame analyses were performed to measure the frontooccipital diameter (FOD) and distance from the vertex to the base of the fetal skull. RESULTS During vaginal delivery in an occiput anterior position, the initial FOD was 10.3 cm. When expulsion began, the fetal skull was deformed and elongated, with the FOD increasing to 10.8 cm and 11.2 cm at crowning. In contrast, the distance from the vertex to the base of the skull was reduced from 6.4 cm to 5.6 cm at expulsion. CONCLUSIONS Fetal head molding is the change in the fetal head due to the forces of labor. The biomechanics of this process are poorly understood. Our visualization of the normal mechanism of late second-stage labor shows that MRI technology can for the first time help define the changes in the diameters of the fetal head during active labor.
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Affiliation(s)
| | - Jan Deprest
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven
| | - Nikhil Sindhwani
- Department of Obstetrics and Gynecology, University Hospital Leuven, Leuven
| | - Ulf Teichgräberg
- Department of Radiology, Charité-University Medical Center, Berlin
| | - Felix Güttler
- Department of Radiology, Charité-University Medical Center, Berlin
| | | | - Karim D Kalache
- Department of Obstetrics, Charité-University Medical Center, Berlin
| | - Wolfgang Henrich
- Department of Obstetrics, Charité-University Medical Center, Berlin
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Faensen AL, von Trebra MW, Freese F, Kreutz R, Bamberg C, Hinkson L, Rothermund L. Genetic low nephron number hypertension is associated with altered expression of key components of the renin-angiotensin system during nephrogenesis. J Perinat Med 2016; 44:705-9. [PMID: 26677883 DOI: 10.1515/jpm-2015-0159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Accepted: 11/02/2015] [Indexed: 02/02/2023]
Abstract
AIM This study investigates key components of the renin-angiotensin system (RAS) which play a central role in nephrogenesis and possibly in fetal programming of arterial hypertension in adult life. METHODS We compared a genetic rat model with inborn nephron deficit, the Munich Wistar Fromter rat (MWF), to normotensive Wistar rats during nephrogenesis at day 19 of fetal development (E19) and at postnatal day 7 (D7). RESULTS At E19 renal mRNA of angiotensin II type 1a (AT1a) (-50%, P<0.05) and type 1b (AT1b) (-55%, P<0.05) receptors were significantly decreased and renal mRNA expression of angiotensin II type 2 (AT2) receptor was fivefold increased in MWF (n=8) as compared to Wistar rats (n=8). At D7 renal mRNA expression of AT1a (-42%, P<0.05) remained lower in MWF (n=8) as compared to Wistar (n=7). Renal mRNA expression of AT2 (-30%, P>0.05) decreased in MWF (n=8) to about the level of the Wistar control (n=6). CONCLUSIONS Altered fetal expression of key molecules of the renin-angiotensin system in MWF indicates a possible role in genetic low nephron number hypertension.
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Bamberg C, Niepraschk-von Dollen K, Mickley L, Henkelmann A, Hinkson L, Kaufner L, von Heymann C, Henrich W, Pauly F. Evaluation of measured postpartum blood loss after vaginal delivery using a collector bag in relation to postpartum hemorrhage management strategies: a prospective observational study. J Perinat Med 2016; 44:433-9. [PMID: 26353161 DOI: 10.1515/jpm-2015-0200] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 08/10/2015] [Indexed: 11/15/2022]
Abstract
AIM To evaluate the incidence of postpartum hemorrhage (PPH) and severe PPH via routine use of a pelvic drape to objectively measure blood loss after vaginal delivery in connection with PPH management. METHODS This prospective observational study was undertaken at the obstetrical department of the Charité University Hospital from December 2011 to May 2013 and evaluated an unselected cohort of planned vaginal deliveries (n=1019 live singletons at term). A calibrated collecting drape was used to meassure blood loss in the third stage of labor. PPH and severe PPH were defined as blood loss ≥500 mL and ≥1000 mL, respectively. Maternal hemoglobin content was evaluated at admission to delivery and at the first day after childbirth. RESULTS During the study period, 809 vaginal deliveries were analysed. Direct measurement revealed a median blood loss of 250 mL. The incidences of PPH and severe PPH were 15% and 3%, respectively. Mean maternal hemoglobin content at admission was 11.9±1.1 g/dL, with a mean decrease of 1.0±1.1 g/dL. Blood loss measured after vaginal delivery correlated significantly with maternal hemoglobin decrease. CONCLUSIONS This study suggests that PPH incidence may be higher than indicated by population-based data. Underbuttocks drapes are simple, objective bedside tools to diagnose PPH. Blood loss should be quantified systematically if PPH is suspected.
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Hartenstein S, Bamberg C, Proquitté H, Metze B, Bührer C, Schmitz T. Birth weight-related percentiles of brain ventricular system as a tool for assessment of posthemorrhagic hydrocephalus and ventricular enlargement. J Perinat Med 2016; 44:179-85. [PMID: 26378487 DOI: 10.1515/jpm-2015-0085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/12/2015] [Indexed: 11/15/2022]
Abstract
Besides remarkable improvements of neonatal medical therapy, neurological morbidity remains a major concern in preterm infants. In particular, intracranial hemorrhage is a severe complication strongly correlated to poor neurological outcome. For early clinical assessment of intracranial hemorrhage and its impact on the ventricular system, cranial sonography is an important bedside diagnostic tool. Reference values of ventricular sizes are available in relation to gestational age (GA). So far, it has not been demonstrated that ventricular size values are also reliable in relation to birth weight (BW). In this study, we performed cranial ultrasonography in 250 preterm and term newborn infants. Measurements of the intracranial ventricular system by cranial ultrasound examination were performed within 72 h after birth. We determined ventricular index, anterior horn width, width of the third ventricle, width and length of the fourth ventricle for statistical analysis in relation to BW and GA. GA ranged from 23 weeks, 3 days to 42 weeks, 1 day (mean: 33 weeks), BW ranged from 345 to 5620 g (mean: 2146 g). Ventricular index and fourth ventricle width revealed a significant correlation to birth weight with r=0.75, each. A significant correlation to birth weight was also obtained for width and length of the third ventricle (r=0.55 and 0.47, respectively). Correlations obtained for ventricular measures in relation to GA were similar to those referring to BW. In preterm and term infants, ventricular sizes in relation to BW seem reliable for assessment and monitoring of ventricular pathologies, i.e. after intracranial hemorrhage.
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Bamberg C, Bujak V, Rodekamp E, Hinkson L, Kalache K, Henrich W. Longitudinale transvaginale sonographische Evaluation bezüglich Narben Pouch nach einschichtiger und zweischichtiger Uterusnaht bei Sectio caesarea – eine prospektiv randomisierte Studie. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566460] [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: 10/22/2022]
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Vitezica I, Heymann CV, Kaufner L, Koch C, Blaschke F, Dörner T, Berns M, Henrich W, Bamberg C. Sectio cesarea unter dualer Plättchenhemmung nach akutem Myokardinfarkt und Stenting im 2. Trimenon. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566720] [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: 10/22/2022]
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Pauly F, Bamberg C, Niepraschk von Dollen K, Mickley L, Henrich W. Der präpartale maternale Fibrinogenwert ist ein Prädiktor für das Auftreten peripartaler Blutungen. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0034-1375714] [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]
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Lehmann D, Schubert K, Joshi PR, Hardy SA, Tuppen HAL, Baty K, Blakely EL, Bamberg C, Zierz S, Deschauer M, Taylor RW. Pathogenic mitochondrial mt-tRNA(Ala) variants are uniquely associated with isolated myopathy. Eur J Hum Genet 2015; 23:1735-8. [PMID: 25873012 PMCID: PMC4519577 DOI: 10.1038/ejhg.2015.73] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 03/12/2015] [Indexed: 11/09/2022] Open
Abstract
Pathogenic mitochondrial DNA (mtDNA) point mutations are associated with a wide range of clinical phenotypes, often involving multiple organ systems. We report two patients with isolated myopathy owing to novel mt-tRNA(Ala) variants. Muscle biopsy revealed extensive histopathological findings including cytochrome c oxidase (COX)-deficient fibres. Pyrosequencing confirmed mtDNA heteroplasmy for both mutations (m.5631G>A and m.5610G>A) whilst single-muscle fibre segregation studies (revealing statistically significant higher mutation loads in COX-deficient fibres than in COX-positive fibres), hierarchical mutation segregation within patient tissues and decreased steady-state mt-tRNA(Ala) levels all provide compelling evidence of pathogenicity. Interestingly, both patients showed very high-mutation levels in all tissues, inferring that the threshold for impairment of oxidative phosphorylation, as evidenced by COX deficiency, appears to be extremely high for these mt-tRNA(Ala) variants. Previously described mt-tRNA(Ala) mutations are also associated with a pure myopathic phenotype and demonstrate very high mtDNA heteroplasmy thresholds, inferring at least some genotype:phenotype correlation for mutations within this particular mt-tRNA gene.
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Affiliation(s)
- Diana Lehmann
- Department of Neurology, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Kathrin Schubert
- Department of Neurology, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Pushpa R Joshi
- Department of Neurology, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Steven A Hardy
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Helen A L Tuppen
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Karen Baty
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | - Emma L Blakely
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
| | | | - Stephan Zierz
- Department of Neurology, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Marcus Deschauer
- Department of Neurology, University of Halle-Wittenberg, Halle (Saale), Germany
| | - Robert W Taylor
- Wellcome Trust Centre for Mitochondrial Research, Institute of Neuroscience, The Medical School, Newcastle University, Framlington Place, Newcastle upon Tyne, UK
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Noirez P, Thomasson R, Bamberg C, Djemai H, Desgorces F, Karim Z, Luquet S, Magnan C, Toussaint JF, Denis R. P052: Métabolisme énergétique, performance et récupération post-exercice dans un modèle murin (HFE-/-) de surcharge en fer. NUTR CLIN METAB 2014. [DOI: 10.1016/s0985-0562(14)70695-8] [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: 10/24/2022]
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Pauly F, Bamberg C, Niepraschk von Dollen K, Mickley L, Henkelmann A, Henrich W. Der präpartale maternale Fibrinogenwert ist ein Prädiktor für das Auftreten peripartaler Blutungen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388035] [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: 10/24/2022] Open
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Pauly F, Bamberg C, Niepraschk von Dollen K, Mickley L, Henrich W. Der präpartale maternale Fibrinogenwert ist ein Prädiktor für das Auftreten peripartaler Blutungen. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1376478] [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: 10/25/2022] Open
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Cuerva MJ, Bamberg C, Tobias P, Gil MM, De La Calle M, Bartha JL. Use of intrapartum ultrasound in the prediction of complicated operative forceps delivery of fetuses in non-occiput posterior position. Ultrasound Obstet Gynecol 2014; 43:687-692. [PMID: 24265172 DOI: 10.1002/uog.13256] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Revised: 11/09/2013] [Accepted: 11/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To evaluate the hypothesis that intrapartum ultrasound (ITU) measurements, including the angle of progression (AOP), progression distance (PD) and head direction (HD), can predict complicated forceps delivery in non-occiput posterior deliveries. METHODS In this prospective observational study, a single operator performed ITU on 30 patients with an indication for operative forceps delivery. Managing obstetricians were blinded to the results. ITU was performed just before blade application, between contractions and concurrently with contractions and active pushing. Forceps delivery was classified as complicated when one or more of the following situations occurred: three or more tractions; a subjective impression of a difficult or failed application; a third-degree or higher perineal tear; significant bleeding during the episiotomy repair; major tear; significant traumatic neonatal lesion. RESULTS Twenty-one forceps deliveries were classified as uncomplicated and nine were complicated. The strongest predictor of a complicated forceps delivery, calculated using the area under the receiver-operating characteristics curve (AUC), was the AOP between contractions (AOP1) (AUC = 98.9%). The best cut-off for predicting a difficult forceps delivery was an AOP1 of 138° (sensitivity = 85.7%, specificity = 100%). The best predictive model included both the AOP1 and the HD during a contraction with active pushing (HD2). CONCLUSION The sonographic parameters AOP and HD can be used to predict complicated operative forceps delivery in fetuses in non-occiput posterior position.
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Affiliation(s)
- M J Cuerva
- Department of Obstetrics, La Paz University Hospital, Madrid, Spain
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Bamberg C, Hinkson L, Longardt AC, Rothe K, Horn D, Henrich W. Three-dimensional ultrasound of massive macroglossia in a fetus with Beckwith-Wiedemann syndrome. Case Reports in Perinatal Medicine 2014. [DOI: 10.1515/crpm-2013-0068] [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: 11/15/2022]
Abstract
Abstract
We present the prenatal ultrasound findings of massive macroglossia in a fetus with prenatally diagnosed Beckwith-Wiedemann syndrome. Three-dimensional surface mode ultrasound was utilized for enhanced visualization of the macroglossia.
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Affiliation(s)
- Christian Bamberg
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
| | - Larry Hinkson
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
| | | | - Karin Rothe
- Department of Pediatric Surgery, Charité-University Medical Center, Berlin, Germany
| | - Denise Horn
- Department of Human Genetics, Charité-University Medical Center, Berlin, Germany
| | - Wolfgang Henrich
- Department of Obstetrics, Charité-University Medical Center, Berlin, Germany
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Weißhaupt K, Bamberg C, Schönborn I, Henrich W. Spontane Re-Uterusruptur im 2. Trimenon nach laparoskopischer Salpingektomie und Myomenukleation. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361325] [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: 10/26/2022]
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Tucher EV, Siedentopf N, Siedentopf JP, Weichert A, Bamberg C, Dückelmann A, Henrich W. Inkarzerationen und Sacculationen bei Retroflexio uteri. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361307] [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: 10/26/2022]
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Fazeli S, Bamberg C, Brauer M, Mayer B, Salama A, Hüsemann D, Hinkson L, Henrich W. Perinatales Management bei fetaler Anämie durch irreguläre Antikörper: 2 Fälle schwerer fetaler Anämie bei Alloimmunisierung durch Anti-cellano- Antikörper und Anti-Rh 17- Antikörper. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361472] [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: 10/26/2022]
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Bamberg C, Pauly F, Niepraschk-von Dollen K, Mickley L, Henkelmann A, Kaufner L, Henrich W. Bestimmung des maternalen Faktor XIII Spiegels im Blutplasma zur Abschätzung des Blutungsrisikos unter der Geburt. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361200] [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: 10/26/2022]
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Pauly F, Bamberg C, Mickley L, Niepraschk-von Dollen K, Henkelmann A, Henrich W. Der präpartale maternale Fibrinogenwert ist ein Prädiktor für das Auftreten peripartaler Blutungen. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361312] [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: 10/26/2022]
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Bamberg C, Brauer M, Hinkson L, Longardt AC, Rothe K, Horn D, Bührer C, Henrich W. Dreidimensionale Ultraschall Darstellung einer schweren Makroglossie bei einem Feten mit Beckwith-Wiedemann-Syndrom. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361254] [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: 10/26/2022]
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Freese AL, Wehland M, Freese F, Kreutz R, Schulz A, Bamberg C, Rothermund L. Genetic Low Nephron Number Hypertension is Associated with Altered Expression of the Renin-Angiotensin System (RAS) During Nephrogenesis. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361199] [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: 10/26/2022]
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Golic M, Hinkson L, Bamberg C, Rodekamp E, Brauer M, Sarioglu N, Henrich W. Vasa praevia: risk-adapted modification of the conventional management--a retrospective study. Ultraschall Med 2013; 34:368-376. [PMID: 23023454 DOI: 10.1055/s-0032-1313167] [Citation(s) in RCA: 2] [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: 06/01/2023]
Abstract
PURPOSE Undiagnosed vasa praevia carries an imminent risk of fetal death and increases with IVF. When diagnosed, the question arises as to whether the conventional prenatal management of routine steroid administration for fetal lung maturation and elective caesarean section in week 35 is generally justified in face of the risks involved. We present a retrospective study of a risk-adapted modification of the conventional management of vasa praevia. MATERIAL AND METHODS We analysed 11 years of records involving 18 cases of antenatally diagnosed vasa praevia at our perinatal centre. Each case was managed by a risk-adapted modification of the conventional treatment where both, the steroid administration and the timing of delivery, were dependent on the patient history and clinical signs for preterm birth. RESULTS There were no lethal fetal, neonatal, or maternal complications. The earliest caesarean section took place at 34 weeks 1 day, the latest at 37 weeks 1 day, and in more than half of the cases at ≥ 36 weeks. CONCLUSION Steroid application is generally recommended for pregnancies before 34 weeks carrying a risk for preterm birth. Thus, retrospectively, none of our cases required steroid administration. This supports our protocol of not obligatorily administering steroids. Delaying the caesarean section up to two weeks beyond the conventionally recommended date of 35 weeks in 78% of our cases resulted in no complications. This justifies the suitability of determining the timing of delivery based on our individual patient assessment. In conclusion, the following recommendations for a risk-adapted management of vasa praevia can be made: 1. weekly evaluation of risk factors for preterm delivery; 2. steroid administration only at risk for preterm birth; 3. admission to hospital with full obstetric and neonatal care facilities between 32 and 34 weeks; 4. elective caesarean section between 35 and 37 weeks, risk-adapted.
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Affiliation(s)
- M Golic
- Klinik für Geburtsmedizin, Campus Virchow-Klinikum, Charité-Universitätsmedizin Berlin, Germany.
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Engels T, Frei C, Chekerov R, Bamberg C, Neitzel H, Henrich W, Verlohren S. Schwere Hypertonie und Proteinurie in 19+2 SSW bei Triploidie mit Plazentahypertrophie sowie alobärer Holoprosenzephalie. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347746] [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: 10/26/2022] Open
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Freese A, Wehland M, Freese F, Bamberg C, Kreutz R, Rothermund L. Genetic low nephron number hypertension is associated with altered expression of osteopontin and CD44 during nephrogenesis. J Perinat Med 2013; 41:295-9. [PMID: 23241663 DOI: 10.1515/jpm-2012-0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/06/2012] [Indexed: 11/15/2022]
Abstract
AIMS The study set out to investigate whether the osteopontin (OPN)-CD44-integrin-receptor-system is differently regulated during nephrogenesis in inborn nephron deficit, a major determinant of human primary hypertension and cardiovascular disease in adult life. METHODS We compared a genetic rat model with an inherited nephron deficit, the Munich-Wistar-Froemter rat (MWF), to normotensive Wistar rats during nephrogenesis at day 19 of fetal development (E19) and at postpartal day 7 (D7). RESULTS Renal OPN mRNA (-75%, P<0.05) and protein expression (-38%, P<0.05) were strongly decreased at E19 in MWF compared to Wistar. Renal mRNA-expression of CD44 was increased at E19 in MWF (+271%, P<0.05). At D7, renal OPN protein expression was increased (+115%, P<0.05) and renal mRNA-expression of CD44 remained elevated compared to Wistar control (+127%, P<0.05). CONCLUSIONS Altered fetal expression of the OPN-CD44-integrin-receptor-system in the MWF model points to a possible role in low nephron number hypertension and cardiovascular disease.
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Bolz N, Kalache KD, Proquitte H, Slowinski T, Hartung JP, Henrich W, Bamberg C. Value of Doppler sonography near term: can umbilical and uterine artery indices in low-risk pregnancies predict perinatal outcome? J Perinat Med 2013; 41:165-70. [PMID: 23096449 DOI: 10.1515/jpm-2012-0042] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2012] [Accepted: 08/14/2012] [Indexed: 11/15/2022]
Abstract
AIM The goal of this study was to evaluate the umbilical and uterine Doppler velocimetry waveforms for predicting the perinatal outcome of low-risk pregnancies at term. METHODS We prospectively recruited 514 women with low risk pregnancies and performed umbilical and uterine artery Doppler assessments between 37 and 41 weeks of gestation. Ultrasound measurements (completed in 365 patients) were correlated with the perinatal outcome. RESULTS The velocimetry waveforms of the umbilical artery were significantly associated with birthweight, placental weight, and postpartal umbilical artery pH. Low pH, placental weight, and birthweight were correlated with increasing pulsatility index (PI) and resistance index (RI). An umbilical artery PI > 1.2 and a uterine artery RI > 0.5 were associated with statistically higher rates of infants that were small for gestational age (SGA). Also, high cesarean delivery rates were correlated with an umbilical artery PI > 1.2. CONCLUSIONS In our low-risk pregnancies population, the elevated umbilical artery indices at term appeared to be associated with the higher rates of infants that were SGA and cesarean deliveries. The Doppler waveforms at term had low prognostic value for predicting neonatal acidosis or decreased Apgar scores.
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Affiliation(s)
- Nora Bolz
- Department of Obstetrics, Charité University Medical Center, Berlin, Germany
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Bamberg C, Hinkson L, Henrich W. Prenatal Detection and Consequences of Fetal Macrosomia. Fetal Diagn Ther 2013; 33:143-8. [DOI: 10.1159/000341813] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 07/06/2012] [Indexed: 11/19/2022]
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Fotopoulou C, Kyeyamwa S, Linder M, Thieme D, Hartenstein S, Klein O, Dudenhausen JW, Henrich W, Kalache KD, Bamberg C. Proteomic analysis of midtrimester amniotic fluid to identify novel biomarkers for preterm delivery. J Matern Fetal Neonatal Med 2012; 25:2488-93. [PMID: 22827563 DOI: 10.3109/14767058.2012.712565] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The aim of this study was to identify possible biomarkers for preterm delivery by analyzing midtrimester amniotic fluid. METHODS Thirty-two amniotic fluid samples were studied; 16 patients had a spontaneous preterm delivery and 16 patients delivered at term. The proteomic technique consisted of surface-enhanced laser desorption ionization time-of-flight (SELDI-TOF) using different types of solid chromatographic chips (Q10, CM10 and IMAC30). RESULTS Mass spectrometry tracings were obtained from the amniotic fluids of both patients who delivered preterm and patients who delivered at term. Seven potential markers were identified to be differentially expressed in patients who delivered preterm. CONCLUSIONS Proteomic analysis of amniotic fluid obtained in the midtrimester reveals the presence of a set of proteins in patients at risk for preterm delivery.
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Affiliation(s)
- Christina Fotopoulou
- Department of Gynecology, Berlin Centrum for Regenerative Therapies, Charité-University Hospital, Berlin, Germany
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Bamberg C, Fotopoulou C, Neissner P, Slowinski T, Dudenhausen JW, Proquitte H, Bührer C, Henrich W. Maternal characteristics and twin gestation outcomes over 10 years: impact of conception methods. Fertil Steril 2012; 98:95-101. [DOI: 10.1016/j.fertnstert.2012.04.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2011] [Revised: 04/10/2012] [Accepted: 04/10/2012] [Indexed: 10/28/2022]
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Bamberg C, Rademacher G, Güttler F, Teichgräber U, Cremer M, Bührer C, Spies C, Hinkson L, Henrich W, Kalache KD, Dudenhausen JW. Human birth observed in real-time open magnetic resonance imaging. Am J Obstet Gynecol 2012; 206:505.e1-6. [PMID: 22425409 DOI: 10.1016/j.ajog.2012.01.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/20/2011] [Accepted: 01/09/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Knowledge about the mechanism of labor is based on assumptions and radiographic studies performed decades ago. The goal of this study was to describe the relationship between the fetus and the pelvis as the fetus travels through the birth canal, using an open magnetic resonance imaging (MRI) scanner. STUDY DESIGN The design of the study used a real-time MRI series during delivery of the fetal head. RESULTS Delivery occurred by progressive head extension. However, extension was a very late movement that was observed when the occiput was in close contact with the inferior margin of the symphysis pubis, occurring simultaneously with gliding downward of the fetal head. CONCLUSION This observational study shows, for the first time, that birth can be analyzed with real-time MRI. MRI technology allows assessment of maternal and fetal anatomy during labor and delivery.
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Güttler FV, Heinrich A, Rump J, de Bucourt M, Schnackenburg B, Bamberg C, Hamm B, Teichgräber UK. Magnetic resonance imaging of the active second stage of labour: proof of principle. Eur Radiol 2012; 22:2020-6. [PMID: 22549105 DOI: 10.1007/s00330-012-2455-9] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Revised: 02/09/2012] [Accepted: 02/23/2012] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To prove that magnetic resonance imaging of foetal anatomy during the active second stage of vaginal delivery is feasible. MATERIALS AND METHODS Initially, five pregnant volunteers around the 30th week of gestation were examined in an open MRI. Based on the findings, one vaginal delivery was acquired under real-time imaging. To monitor the birth status during image acquisition, an MR-compatible wireless cardiotocography (CTG) system was built. Single-shot sequence parameters were optimised to compensate motion artefacts during labour. RESULTS Safety requirements to monitor the birth process under real-time MR imaging were met. High-resolution MR images were acquired immediately before and after delivery. In one patient, TSE single-shot cinematic sequences of the active second stage of labour were obtained. All sequences were adapted to tolerate movement of the mother and infant, as well as residual noise from the CTG. Furthermore, the MR imaging during labour showed only minor image artefacts. CONCLUSION CTG-monitored acquisition of MRI series during the active second stage of delivery is feasible. Image quality should allow various further studies to improve models for birth simulation as well as potential investigation of obstructed labour and obstetric complications.
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Affiliation(s)
- F V Güttler
- Department of Radiology, Charité University Hospital, Charitéplatz 1, 10117 Berlin, Germany.
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Güttler FV, Bamberg C, Heinrich A, Rump J, Schnackenburg B, de Bucourt M, Thomas A, Hamm B, Teichgräber U. Dokumentation der aktiven zweiten Phase der Geburt mittels MRT. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311320] [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: 10/28/2022]
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Bamberg C, Scheuermann S, Fotopoulou C, Slowinski T, Dückelmann AM, Teichgräber U, Streitparth F, Henrich W, Dudenhausen JW, Kalache KD. Angle of progression measurements of fetal head at term: a systematic comparison between open magnetic resonance imaging and transperineal ultrasound. Am J Obstet Gynecol 2012; 206:161.e1-5. [PMID: 22177192 DOI: 10.1016/j.ajog.2011.10.867] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [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: 04/18/2011] [Revised: 08/18/2011] [Accepted: 10/19/2011] [Indexed: 11/16/2022]
Abstract
OBJECTIVE During labor, transperineal sonography is increasingly used to evaluate fetal head descent. The aim of this study was to compare the angle of progression assessed by open magnetic resonance imaging (MRI) vs transperineal ultrasound. STUDY DESIGN A total of 31 pregnant women at term (>37 weeks), who were not in labor, underwent MRI in an open 1.0-T system. A midsagittal plane of the maternal pelvis was stored. Immediately after, without changing the supine position, a transperineal ultrasound was performed. The angle of progression was measured offline by transperineal ultrasound and MRI. RESULTS The angles of progression measured by transperineal ultrasound (mean, 79.05 degrees; SD 11.44) and MRI (mean, 80.48 degrees; SD 11.06) correlated significantly (P < .001). The intraclass correlation coefficient between the 2 methods was 0.89 (95% confidence interval, 0.78-0.94). CONCLUSION The angle of progression measurements obtained by transperineal ultrasound and open MRI showed very good agreement.
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Affiliation(s)
- Christian Bamberg
- Department of Obstetrics, Charité University Hospital, Berlin, Germany.
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Bamberg C, Fotopoulou C, Teichgraeber U, Henrich W, Dudenhausen JW, Kalache K. Die Bestimmung des Angle of progression am Termin: Ein Vergleich zwischen transperinealer Sonographie und offenen MRT. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293264] [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: 10/15/2022]
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