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Pohl M, Greimel P, Klaritsch P, Csapó B, Simonis H, Schneditz D. Feasibility of continuous intra-uterine pressure measurements during amnioreduction in twin-to-twin transfusion syndrome therapy. Placenta 2023; 142:147-153. [PMID: 37801953 DOI: 10.1016/j.placenta.2023.09.003] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 08/29/2023] [Accepted: 09/04/2023] [Indexed: 10/08/2023]
Abstract
INTRODUCTION This work explores the feasibility of simultaneous and continuous intra-abdominal, intra-uterine, and arterial blood pressure measurements to examine the hemodynamic perturbation expected during therapeutic amnioreduction and to better understand the protective role of the placenta during that treatment. METHODS Patients with twin-to-twin transfusion syndrome were treated with fetoscopic laser ablation followed by amnioreduction. Intra-abdominal, intra-uterine, and mean arterial pressures were simultaneously recorded during amnioreduction performed in steps of 200 mL. Placental thickness and uterine dimensions were measured before and after amnioreduction by ultrasonography. RESULTS Useful pressure recordings were obtained between volume reduction steps and short hands-off periods in four studies. Median amnioreduction volume was 1400 mL corresponding to a median uterine volume reduction of 1121 mL. Mean intra-uterine pressure significantly fell from 24.8 to 13.6 mmHg (p = 0.011) and intra-abdominal pressure significantly decreased from 13.4 to 9.2 mmHg after amnioreduction (p = 0.015). Uterine pressure recordings revealed transient contractions (A, in mmHg) following individual amnioreduction steps, which increased with fractional amnioreduction (F, no dimension) (A = 17.23*F + 11.81; r = 0.50, p = 0.001). DISCUSSION Simultaneous and continuous measurement of intra-abdominal, intra-uterine, and arterial blood pressures during amnioreduction is feasible. The dynamics reveal transient uterine contractions reaching levels comparable to those seen during childbirth which seem to oppose impending maternal hypovolemia by placental steal at the expense of temporarily reducing placental perfusion pressure and underline the importance of uterine and placental interaction.
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Affiliation(s)
- Maximilian Pohl
- Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010, Graz, Austria
| | - Patrick Greimel
- Research Unit for Fetal Medicine, Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Philipp Klaritsch
- Research Unit for Fetal Medicine, Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Bence Csapó
- Research Unit for Fetal Medicine, Division of Obstetrics, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Holger Simonis
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, 8036, Graz, Austria
| | - Daniel Schneditz
- Otto Loewi Research Center, Medical University of Graz, Neue Stiftingtalstrasse 6, 8010, Graz, Austria.
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Nonn O, Bonstingl L, Sallinger K, Neuper L, Fuchs J, Gauster M, Huppertz B, Brislinger D, El-Heliebi A, Fluhr H, Kampelmühler E, Klaritsch P. Maternal COVID-19 causing intrauterine foetal demise with microthrombotic placental insufficiency: a case report. BMC Pregnancy Childbirth 2023; 23:653. [PMID: 37689629 PMCID: PMC10492311 DOI: 10.1186/s12884-023-05942-6] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Accepted: 08/21/2023] [Indexed: 09/11/2023] Open
Abstract
BACKGROUND Pregnant women have an increased risk of getting infected with SARS-CoV-2 and are more prone to severe illness. Data on foetal demise in affected pregnancies and its underlying aetiology is scarce and pathomechanisms remain largely unclear. CASE Herein we present the case of a pregnant woman with COVID-19 and intrauterine foetal demise. She had no previous obstetric or gynaecological history, and presented with mild symptoms at 34 + 3 weeks and no signs of foetal distress. At 35 + 6 weeks intrauterine foetal death was diagnosed. In the placental histopathology evaluation, we found inter- and perivillous fibrin depositions including viral particles in areas of degraded placental anatomy without presence of viral entry receptors and SARS-CoV-2 infection of the placenta. CONCLUSION This case demonstrates that maternal SARS-CoV-2 infection in the third trimester may lead to an unfavourable outcome for the foetus due to placental fibrin deposition in maternal COVID-19 disease possibly via a thrombogenic microenvironment, even when the foetus itself is not infected.
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Affiliation(s)
- Olivia Nonn
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Berlin, Germany.
- Experimental and Clinical Research Centre, Max Delbrück Center for Molecular Medicine in the Helmholtz Association and Charité Universitätsmedizin Berlin, Berlin, Germany.
- Max Delbrück Center for Molecular Medicine in the Helmholtz Association (MDC), Berlin, Germany.
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria.
| | - Lilli Bonstingl
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Katja Sallinger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
| | - Lena Neuper
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Julia Fuchs
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Division of Medical Physics and Biophysics, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Martin Gauster
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Berthold Huppertz
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Dagmar Brislinger
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Amin El-Heliebi
- Division of Cell Biology, Histology and Embryology, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Center for Biomarker Research in Medicine (CBmed), Graz, Austria
- BioTechMed, Graz, Austria
| | - Herbert Fluhr
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Eva Kampelmühler
- Diagnostic and Research Institute of Pathology, Diagnostic and Research Center for Molecular Biomedicine, Medical University of Graz, Graz, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
- Research Unit for Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
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Grab D, Merz E, Eichhorn KH, Tutschek B, Kagan KO, Heling KS, Faber R, Klaritsch P, Rempen A, Kähler C, Henrich W, Manegold-Brauer G, Helmy S, Hoopmann M. Basic Gynecologic Ultrasound Examination (Level I): DEGUM, ÖGUM, and SGUM Recommendations. Ultraschall Med 2023. [PMID: 35705173 DOI: 10.1055/a-1851-5157.10.1055/a-1851-515] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Ultrasound has become an essential diagnostic tool in gynecology, and every practicing gynecologist must be able to differentiate normal from pathologic findings, such as benign or malignant pelvic masses, adnexal torsion, pelvic inflammation disease, endometriosis, ectopic pregnancies, and congenital uterine malformations at least on a basic level. A standardized approach to the correct settings of the ultrasound system, the indications for gynecologic ultrasound investigations, and the sonographic appearance of normal anatomy and common pathologic findings in the standard planes are important prerequisites for safe and confident clinical management of gynecologic patients. Based on current publications and different national and international guidelines, updated DEGUM, ÖGUM, and SGUM recommendations for the performance of basic gynecologic ultrasound examinations were established.
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Affiliation(s)
- Dieter Grab
- Obstetrics and Gynecology, University of Ulm, Germany
| | - Eberhard Merz
- Frankfurt, Center for Ultrasound and Prenatal Medicine, Frankfurt/Main, Germany
| | | | | | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University of Tuebingen, Germany
| | - Kai-Sven Heling
- Berlin, Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - Renaldo Faber
- Leipzig, Center of Prenatal Medicine, Leipzig, Germany
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University Graz, Austria
| | - Andreas Rempen
- Department of Gynecology and Obstetrics, Diakonieklinik, Schwäbisch Hall, Germany
| | | | - Wolfgang Henrich
- Obstetrics, Charité University Hospital Berlin - Virchow Hospital Campus, Berlin, Germany
| | | | - Samir Helmy
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Markus Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
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Grab D, Merz E, Eichhorn KH, Tutschek B, Kagan KO, Heling KS, Faber R, Klaritsch P, Rempen A, Kähler C, Henrich W, Manegold-Brauer G, Helmy S, Hoopmann M. Basic Gynecologic Ultrasound Examination (Level I): DEGUM, ÖGUM, and SGUM Recommendations. Ultraschall Med 2023; 44:151-161. [PMID: 35705173 DOI: 10.1055/a-1851-5157] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Ultrasound has become an essential diagnostic tool in gynecology, and every practicing gynecologist must be able to differentiate normal from pathologic findings, such as benign or malignant pelvic masses, adnexal torsion, pelvic inflammation disease, endometriosis, ectopic pregnancies, and congenital uterine malformations at least on a basic level. A standardized approach to the correct settings of the ultrasound system, the indications for gynecologic ultrasound investigations, and the sonographic appearance of normal anatomy and common pathologic findings in the standard planes are important prerequisites for safe and confident clinical management of gynecologic patients. Based on current publications and different national and international guidelines, updated DEGUM, ÖGUM, and SGUM recommendations for the performance of basic gynecologic ultrasound examinations were established.
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Affiliation(s)
- Dieter Grab
- Obstetrics and Gynecology, University of Ulm, Germany
| | - Eberhard Merz
- Frankfurt, Center for Ultrasound and Prenatal Medicine, Frankfurt/Main, Germany
| | | | | | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University of Tuebingen, Germany
| | - Kai-Sven Heling
- Berlin, Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - Renaldo Faber
- Leipzig, Center of Prenatal Medicine, Leipzig, Germany
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University Graz, Austria
| | - Andreas Rempen
- Department of Gynecology and Obstetrics, Diakonieklinik, Schwäbisch Hall, Germany
| | | | - Wolfgang Henrich
- Obstetrics, Charité University Hospital Berlin - Virchow Hospital Campus, Berlin, Germany
| | | | - Samir Helmy
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Markus Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
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Semrl N, Barth M, Feigl S, Hochstätter R, Oreskovic I, Fluhr H, Klaritsch P, Speicher I, Kollmann M. Birth of monozygotic dichorionic twins after a single blastocyst embryo transfer: a case report of genetic determination of zygosity. F S Rep 2023. [DOI: 10.1016/j.xfre.2023.03.002] [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: 03/09/2023] Open
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Mylrea-Foley B, Wolf H, Stampalija T, Lees C, Arabin B, Berger A, Bergman E, Bhide A, Bilardo CM, Breeze AC, Brodszki J, Calda P, Cetin I, Cesari E, Derks J, Ebbing C, Ferrazzi E, Ganzevoort W, Frusca T, Gordijn SJ, Gyselaers W, Hecher K, Klaritsch P, Krofta L, Lindgren P, Lobmaier SM, Marlow N, Maruotti GM, Mecacci F, Myklestad K, Napolitano R, Prefumo F, Raio L, Richter J, Sande RK, Thornton J, Valensise H, Visser GHA, Wee L. Longitudinal Doppler Assessments in Late Preterm Fetal Growth Restriction. Ultraschall Med 2023; 44:56-67. [PMID: 34768305 DOI: 10.1055/a-1511-8293] [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: 06/13/2023]
Abstract
PURPOSE To assess the longitudinal variation of the ratio of umbilical and cerebral artery pulsatility index (UCR) in late preterm fetal growth restriction (FGR). MATERIALS AND METHODS A prospective European multicenter observational study included women with a singleton pregnancy, 32+ 0-36+ 6, at risk of FGR (estimated fetal weight [EFW] or abdominal circumference [AC] < 10th percentile, abnormal arterial Doppler or fall in AC from 20-week scan of > 40 percentile points). The primary outcome was a composite of abnormal condition at birth or major neonatal morbidity. UCR was categorized as normal (< 0.9) or abnormal (≥ 0.9). UCR was assessed by gestational age at measurement interval to delivery, and by individual linear regression coefficient in women with two or more measurements. RESULTS 856 women had 2770 measurements; 696 (81 %) had more than one measurement (median 3 (IQR 2-4). At inclusion, 63 (7 %) a UCR ≥ 0.9. These delivered earlier and had a lower birth weight and higher incidence of adverse outcome (30 % vs. 9 %, relative risk 3.2; 95 %CI 2.1-5.0) than women with a normal UCR at inclusion. Repeated measurements after an abnormal UCR at inclusion were abnormal again in 67 % (95 %CI 55-80), but after a normal UCR the chance of finding an abnormal UCR was 6 % (95 %CI 5-7 %). The risk of composite adverse outcome was similar using the first or subsequent UCR values. CONCLUSION An abnormal UCR is likely to be abnormal again at a later measurement, while after a normal UCR the chance of an abnormal UCR is 5-7 % when repeated weekly. Repeated measurements do not predict outcome better than the first measurement, most likely due to the most compromised fetuses being delivered after an abnormal UCR.
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Affiliation(s)
- Bronacha Mylrea-Foley
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
| | - Hans Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - Christoph Lees
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, UK
- Queen Charlotte's and Chelsea Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, location VUMC, Amsterdam, The Netherlands
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Center (Location AMC), University of Amsterdam, Amsterdam, The Netherlands
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium, Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | | | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata, University, Policlinico Casilino Hospital, Rome, Italy
| | - G H A Visser
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
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Bayr H, Greimel P, Klaritsch P. Das „Sunglass Sign“: Ein neues sonografisches Zeichen zur frühen und sicheren Diagnosestellung der Eileiterschwangerschaft. Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1750238] [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: 10/17/2022] Open
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8
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Mylrea-Foley B, Thornton JG, Mullins E, Marlow N, Hecher K, Ammari C, Arabin B, Berger A, Bergman E, Bhide A, Bilardo C, Binder J, Breeze A, Brodszki J, Calda P, Cannings-John R, Černý A, Cesari E, Cetin I, Dall'Asta A, Diemert A, Ebbing C, Eggebø T, Fantasia I, Ferrazzi E, Frusca T, Ghi T, Goodier J, Greimel P, Gyselaers W, Hassan W, Von Kaisenberg C, Kholin A, Klaritsch P, Krofta L, Lindgren P, Lobmaier S, Marsal K, Maruotti GM, Mecacci F, Myklestad K, Napolitano R, Ostermayer E, Papageorghiou A, Potter C, Prefumo F, Raio L, Richter J, Sande RK, Schlembach D, Schleußner E, Stampalija T, Thilaganathan B, Townson J, Valensise H, Visser GHA, Wee L, Wolf H, Lees CC. Perinatal and 2-year neurodevelopmental outcome in late preterm fetal compromise: the TRUFFLE 2 randomised trial protocol. BMJ Open 2022; 12:e055543. [PMID: 35428631 PMCID: PMC9014041 DOI: 10.1136/bmjopen-2021-055543] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION Following the detection of fetal growth restriction, there is no consensus about the criteria that should trigger delivery in the late preterm period. The consequences of inappropriate early or late delivery are potentially important yet practice varies widely around the world, with abnormal findings from fetal heart rate monitoring invariably leading to delivery. Indices derived from fetal cerebral Doppler examination may guide such decisions although there are few studies in this area. We propose a randomised, controlled trial to establish the optimum method of timing delivery between 32 weeks and 36 weeks 6 days of gestation. We hypothesise that delivery on evidence of cerebral blood flow redistribution reduces a composite of perinatal poor outcome, death and short-term hypoxia-related morbidity, with no worsening of neurodevelopmental outcome at 2 years. METHODS AND ANALYSIS Women with non-anomalous singleton pregnancies 32+0 to 36+6 weeks of gestation in whom the estimated fetal weight or abdominal circumference is <10th percentile or has decreased by 50 percentiles since 18-32 weeks will be included for observational data collection. Participants will be randomised if cerebral blood flow redistribution is identified, based on umbilical to middle cerebral artery pulsatility index ratio values. Computerised cardiotocography (cCTG) must show normal fetal heart rate short term variation (≥4.5 msec) and absence of decelerations at randomisation. Randomisation will be 1:1 to immediate delivery or delayed delivery (based on cCTG abnormalities or other worsening fetal condition). The primary outcome is poor condition at birth and/or fetal or neonatal death and/or major neonatal morbidity, the secondary non-inferiority outcome is 2-year infant general health and neurodevelopmental outcome based on the Parent Report of Children's Abilities-Revised questionnaire. ETHICS AND DISSEMINATION The Study Coordination Centre has obtained approval from London-Riverside Research Ethics Committee (REC) and Health Regulatory Authority (HRA). Publication will be in line with NIHR Open Access policy. TRIAL REGISTRATION NUMBER Main sponsor: Imperial College London, Reference: 19QC5491. Funders: NIHR HTA, Reference: 127 976. Study coordination centre: Imperial College Healthcare NHS Trust, Du Cane Road, London, W12 0HS with Centre for Trials Research, College of Biomedical & Life Sciences, Cardiff University. IRAS Project ID: 266 400. REC reference: 20/LO/0031. ISRCTN registry: 76 016 200.
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Affiliation(s)
- Bronacha Mylrea-Foley
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Jim G Thornton
- Department of Obstetrics and Gynaecology, University of Nottingham, City hospital, Nottingham, UK
| | - Edward Mullins
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Neil Marlow
- Elizabeth Garrett Anderson Institute for Women's Health University College London, London, UK
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christina Ammari
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Birgit Arabin
- Department of Obstetrics Charite, Humboldt University of Berlin, Berlin, Germany
| | - Astrid Berger
- Department of Gynecology and Obstetrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Eva Bergman
- Department of Women’s and Children’s Health, Uppsala University, Uppsala, Sweden
| | - Amarnath Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Caterina Bilardo
- Department of Obstetrics Amsterdam, Vrije Universiteit Amsterdam, Noord-Holland, The Netherlands
| | - Julia Binder
- Department of Obstetrics and Fetomaternal Medicine, Medical University of Vienna, Vienna, Austria
| | - Andrew Breeze
- Fetal medicine Unit, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jana Brodszki
- Department of Obstetrics and Gynecology, Lund Skanes universitetssjukhus Lund, Skåne, Sweden
| | - Pavel Calda
- Department of Obstetrics and Gynaecology, Charles University, Praha, Czech Republic
| | | | - Andrej Černý
- Department of Obstetrics & Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Elena Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, University of Milan, Milan, Italy
| | - Irene Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Hospital, University of Milan, Milan, Italy
| | | | - Anke Diemert
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | | | | | - Ilaria Fantasia
- Unit of Fetal Medicine and Prenatal Diagnosis, RCCS materno infantile Burlo Garofolo Dipartimento di Pediatria, Trieste, Italy
| | - Enrico Ferrazzi
- Department of Clinical Sciences and Community Health, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, ltaly
| | | | - Tullio Ghi
- Department of Obstetrics & Gynecology, University of Parma, Parma, Italy
| | - Jenny Goodier
- Institute for Reproductive and Developmental Biology, Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Patrick Greimel
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Wilfried Gyselaers
- Department of Obstetrics and Gynecology, Hospital Oost-Limburg, Genk, Belgium
| | - Wassim Hassan
- Obstetrics & Gynaecology, East Suffolk and North Essex NHS Foundation Trust, Colchester Hospital, Colchester, UK
| | | | - Alexey Kholin
- National Medical Research Center for Obstetrics, Gynecology & Perinatology, Moscow, Russia
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Medical University of Graz, Graz, Austria
| | - Ladislav Krofta
- Institute for Care of Mother and Child, Prague, Czech Republic
| | - Peter Lindgren
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention & Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Silvia Lobmaier
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Karel Marsal
- Obstetrics and Gynaecology, Faculty of Medicine, Lunds Universitet, Lund, Sweden
| | - Giuseppe M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, Federico II University Hospital, Napoli, Italy
| | - Federico Mecacci
- High Risk Pregnancy Unit, University Hospital Careggi, Firenze, Italy
| | - Kirsti Myklestad
- Department of Obstetrics, Children's and Women's Health, St Olavs Hospital University Hospital, Trondheim, Norway
| | - Raffaele Napolitano
- Elizabeth Garrett Anderson Institute for Women's Health University College London, London, UK
| | - Eva Ostermayer
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Aris Papageorghiou
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK,Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Claire Potter
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Federico Prefumo
- Department of Obstetrics and Gynaecology, Università degli Studi di Brescia, Brescia, Italy
| | - Luigi Raio
- Department of Obstetrics and Gynaecology, University of Bern, Bern, Switzerland
| | - Jute Richter
- Department of Gynecology and Obstetrics, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ragnar Kvie Sande
- Department of Obstetrics and Gynaecology, Stavanger University Hospital, Stavanger, Norway
| | - Dietmar Schlembach
- Vivantes Network for Health, Clinicum Neukoelln, Clinic for Obstetric Medicine, Berlin, Germany
| | | | - Tamara Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, RCCS materno infantile Burlo Garofolo Dipartimento di Pediatria, Trieste, Italy
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, UK,Molecular & Clinical Sciences Research Institute, St George’s, University of London, London, UK
| | - Julia Townson
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Herbert Valensise
- Division of Obstetrics and Gynaecology Policlinico Casilino, Roma, Italy
| | - Gerard HA Visser
- Department of Obstetrics, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Ling Wee
- Obstetrics And Gynaecology, Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - Hans Wolf
- Department of Obstetrics and Gynaecology, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - Christoph C Lees
- Imperial College London, Obstetrics and Gynaecology, Queen Charlotte's & Chelsea Hospital London, London, UK
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9
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Fischer T, Helmer H, Klaritsch P, Fazelnia C, Bogner G, Hillerer KM, Wohlmuth C, Jaksch-Bogensperger H. Diagnosis and Therapy of Iron Deficiency Anemia During Pregnancy: Recommendation of the Austrian Society for Gynecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd 2022; 82:392-399. [PMID: 35392071 PMCID: PMC8983107 DOI: 10.1055/a-1710-3387] [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: 11/24/2021] [Accepted: 11/30/2021] [Indexed: 10/25/2022] Open
Abstract
This overview analyzes the data on the controversial therapy of iron substitution during pregnancy, the diagnosis of iron deficiency anemia and the indication-related therapy, and is the first recommendation issued by the OEGGG on the appropriate therapy. The effects of anemia during pregnancy on postnatal outcomes have been intensively investigated with heterogeneous results. A final scientific conclusion with regards to the "optimal" maternal hemoglobin level is limited by the heterogeneous results of various studies, many of which were conducted in emerging nations (with different dietary habits and structural differences in the respective healthcare systems). The current literature even suggests that there may be a connection between both decreased and increased maternal serum hemoglobin concentrations and unfavorable short-term and long-term neonatal outcomes. In Austria, 67 percent of pregnant women take pharmacological supplements or use a variety of dietary supplements. Clinically, the prevalence of maternal anemia is often overestimated, leading to overtreatment of pregnant women (iron substitution without a medical indication). To obtain a differential diagnosis, a workup of the indications for treatment should be carried out prior to initiating any form of iron substitution during pregnancy. If treatment is medically indicated, oral iron substitution is usually sufficient. Because of the restricted approval and potential side effects, medical indications for intravenous iron substitution should be limited. Intravenous iron substitution without a prior detailed diagnostic workup is an off-label use and should only be used in very limited cases, and women should be advised accordingly.
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Affiliation(s)
- Thorsten Fischer
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Austria
| | - Hanns Helmer
- Leitliniengruppe der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe, Univ.-Klinik f. Frauenheilkunde, Medizinische Universität Wien, Wien, Austria
| | - Philipp Klaritsch
- Abteilung für Geburtshilfe, Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - Claudius Fazelnia
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Austria
| | - Gerhard Bogner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Austria
| | - Katharina M Hillerer
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Austria
| | - Christoph Wohlmuth
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Austria
| | - Heidi Jaksch-Bogensperger
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Paracelsus Medizinische Universität Salzburg (PMU), Salzburg, Austria
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10
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Hoopmann M, Tutschek B, Merz E, Eichhorn KH, Kagan KO, Heling KS, Faber R, Rempen A, Kaehler C, Manegold-Brauer G, Helmy S, Klaritsch P, Grab D. Quality Requirements for gynecological ultrasound examinations of DEGUM level II - Recommendations of the Sections/Working Groups Gynecology and Obstetrics of DEGUM, ÖGUM and SGUM. Ultraschall Med 2022; 43:146-158. [PMID: 34749404 DOI: 10.1055/a-1663-6322] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Gynecological sonography is the central and most frequently used technical examination method used by gynecologists. Its focus is on the clarification of masses of the uterus and the adnexa, fertility diagnosis, clarification of bleeding disorders and chronic and acute pelvic problems, pelvic floor and incontinence diagnosis as well as the differential diagnosis of disturbed early pregnancy. The indication for diagnostic and therapeutic interventions, preoperative planning and postoperative controls are largely based on the findings of gynecological sonography. These examinations are particularly dependent on the experience of the examiner.Based on the proven multi-stage concept of obstetric diagnostics, gynecological sonography should primarily be performed by an experienced and specialized examiner in patients for whom the initial gynecological examinations have not yet led to a sufficient assessment of the findings. So that the expert status required for this has an objective basis, the Gynecology and Obstetrics Section of DEGUM in cooperation with ÖGUM and SGUM implemented the option of acquiring DEGUM Level II for gynecological sonography. The effectiveness of the care in the multi-level concept depends on the quality of the ultrasound examination at level I. Quality requirements for the basic examination and the differentiation between the basic and further examination have therefore already been defined by DEGUM/ÖGUM. The present work is intended to set out quality requirements for gynecological sonography of DEGUM level II and for the correspondingly certified gynecologists.Common pathologies from gynecological sonography and requirements for imaging and documentation are described.
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Affiliation(s)
- Markus Hoopmann
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | | | - Eberhard Merz
- Centre for Ultrasound and Prenatal Medicine, Frankfurt/Main, Germany
| | | | - Karl Oliver Kagan
- Department of Obstetrics and Gynaecology, University of Tübingen, Tübingen, Germany
| | - Kai-Sven Heling
- Praxis, Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - Renaldo Faber
- Leipzig, Center of Prenatal Medicine, Leipzig, Germany
| | - Andreas Rempen
- Frauenklinik, Evangelisches Diakoniekrankenhaus, Schwäbisch-Hall, Germany
| | | | | | - Samir Helmy
- Department of Obstetrics and Gynecology, Medical University of Vienna, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University Graz, Austria
| | - Dieter Grab
- Department of Obstetrics and Gynecology, University of Ulm, Germany
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11
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Feigl S, Obermayer-Pietsch B, Klaritsch P, Pregartner G, Herzog SA, Lerchbaum E, Trummer C, Pilz S, Kollmann M. Impact of Thyroid Function on Pregnancy and Neonatal Outcome in Women with and without PCOS. Biomedicines 2022; 10:biomedicines10040750. [PMID: 35453500 PMCID: PMC9025948 DOI: 10.3390/biomedicines10040750] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 03/18/2022] [Accepted: 03/21/2022] [Indexed: 02/01/2023] Open
Abstract
Background: Women with polycystic ovary syndrome (PCOS) are more prone to autoimmune thyroiditis, and both disorders lead to subfertility and pregnancy-related complications. The aim of this study was to investigate whether mothers with and without PCOS and their offspring have comparable thyroid parameters at term and how thyroid parameters are associated with perinatal outcome in this population. Methods: This cross-sectional observational study was performed in a single academic tertiary hospital in Austria. Seventy-nine pregnant women with PCOS and 354 pregnant women without PCOS were included. Blood samples were taken from the mother and cord blood at birth. Primary outcome parameters were maternal and neonatal thyroid parameters at delivery. Secondary outcome parameters were the composite complication rate per woman and per neonate. Results: Thyroid dysfunction was more prevalent among PCOS women (p < 0.001). At time of birth, free triiodothyronine (fT3) levels were significantly lower in PCOS than in non-PCOS women (p = 0.005). PCOS women and their neonates had significantly higher thyreoperoxidase antibody (TPO-AB) levels (p = 0.001). Women with elevated TPO-AB had a significantly higher prevalence of hypothyroidism (p < 0.001). There was a significant positive correlation between maternal and neonatal free thyroxine, fT3 and TPO-AB levels. There were no significant differences in thyroid parameters between women or neonates with or without complications. Conclusions: Our results demonstrate a higher prevalence of thyroid dysfunction and autoimmunity in PCOS women, supporting a common etiology of both disorders. We were not able to show an association between complication rate and thyroid parameters.
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Affiliation(s)
- Sarah Feigl
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (S.F.); (P.K.)
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.O.-P.); (E.L.); (C.T.); (S.P.)
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (S.F.); (P.K.)
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation (IMI), Medical University of Graz, 8036 Graz, Austria; (G.P.); (S.A.H.)
| | - Sereina Annik Herzog
- Institute for Medical Informatics, Statistics and Documentation (IMI), Medical University of Graz, 8036 Graz, Austria; (G.P.); (S.A.H.)
| | - Elisabeth Lerchbaum
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.O.-P.); (E.L.); (C.T.); (S.P.)
| | - Christian Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.O.-P.); (E.L.); (C.T.); (S.P.)
| | - Stefan Pilz
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.O.-P.); (E.L.); (C.T.); (S.P.)
| | - Martina Kollmann
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (S.F.); (P.K.)
- Correspondence:
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12
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Pomar L, Ochoa J, Cabet S, Huisman TAGM, Paladini D, Klaritsch P, Galmiche A, Prayer F, Gacio S, Haratz K, Malinger G, Van Mieghem T, Baud D, Bromley B, Lebon S, Dubruc E, Vial Y, Guibaud L. Prenatal diagnosis of Aicardi syndrome based on a suggestive imaging pattern: A multicenter case-series. Prenat Diagn 2022; 42:484-494. [PMID: 34984691 PMCID: PMC9302986 DOI: 10.1002/pd.6085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 11/18/2021] [Revised: 12/28/2021] [Accepted: 12/30/2021] [Indexed: 12/02/2022]
Abstract
Objectives To characterize a suggestive prenatal imaging pattern of Aicardi syndrome using ultrasound and MR imaging. Methods Based on a retrospective international series of Aicardi syndrome cases from tertiary centers encountered over a 20‐year period (2000–2020), we investigated the frequencies of the imaging features in order to characterize an imaging pattern highly suggestive of the diagnosis. Results Among 20 cases included, arachnoid cysts associated with a distortion of the interhemispheric fissure were constantly encountered associated with complete or partial agenesis of the corpus callosum (19/20, 95%). This triad in the presence of other CNS disorganization, such as polymicrogyria (16/17, 94%), heterotopias (15/17, 88%), ventriculomegaly (14/20, 70%), cerebral asymmetry [14/20, 70%]) and less frequently extra‐CNS anomaly (ocular anomalies [7/11, 64%], costal/vertebral segmentation defect [4/20, 20%]) represent a highly suggestive pattern of Aicardi syndrome in a female patient. Conclusion Despite absence of genetic test to confirm prenatal diagnosis of AS, this combination of CNS and extra‐CNS fetal findings allows delineation of a characteristic imaging pattern of AS, especially when facing dysgenesis of the corpus callosum.
What is already known about this topic?
Aicardi syndrome (AS) is a rare developmental encephalopathy, characterized by the classic triad of infantile spasms, agenesis of the corpus callosum, and chorioretinal lacunae As the genetic etiology of AS is unknown and its classic triad cannot be extrapolated to prenatal diagnosis, to establish a prenatal imaging pattern is of major interest
What does this study add?
We confirmed and completed a prenatal imaging pattern highly suggestive of AS, based on the most frequent features encountered in a large series: arachnoid cysts associated with a distortion of the interhemispheric fissure, agenesis of the corpus callosum, cortical malformations and heterotopias, and less frequently extra‐CNS anomaly (ocular anomalies, costal/vertebral segmentation defect)
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Affiliation(s)
- Léo Pomar
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.,School of Health Sciences (HESAV), University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - José Ochoa
- Diagnus SA, Prenatal Diagnosis and Fetal Medicine Centre, Córdoba, Argentina
| | - Sara Cabet
- Pediatric and Fœtal Imaging, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
| | - Thierry A G M Huisman
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, USA
| | - Dario Paladini
- Fetal Medicine and Surgery Unit, Gaslini Children's Hospital, Genoa, Italy
| | - Philipp Klaritsch
- Research Unit for Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Aurore Galmiche
- Ultrasound and Fetal Medicine, Department of Obstetrics, Hospital of Niort, Niort, France
| | - Florian Prayer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Sebastián Gacio
- Division of Pediatric Neurology, Hospital of Children Ricardo Gutiérrez, Ciudad Autónoma de Buenos Aires, Argentina
| | - Karina Haratz
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Gustavo Malinger
- Division of Ultrasound in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Tim Van Mieghem
- Fetal Medicine Unit, Department of Obstetrics and Gynecology, Mount Sinai Hospital and University of Toronto, Toronto, Ontario, Canada
| | - David Baud
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Bryann Bromley
- Department of Obstetrics & Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Sébastien Lebon
- Pediatric Neurology Unit, Department of Pediatrics, Lausanne University Hospital, Lausanne, Switzerland
| | - Estelle Dubruc
- Institute of Pathology, Lausanne University Hospital, Lausanne, Switzerland
| | - Yvan Vial
- Ultrasound and Fetal Medicine, Department Woman-Mother-Child, Lausanne University Hospital and Lausanne University, Lausanne, Switzerland
| | - Laurent Guibaud
- Pediatric and Fœtal Imaging, Hôpital Femme Mère Enfant, Hospices Civils de Lyon, Université Claude Bernard Lyon 1, Lyon, France
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13
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Zeisler H, Dietrich W, Heinzl F, Klaritsch P, Humpel V, Moertl M, Obruca C, Wimazal F, Ramoni A, Tiechl J, Wentzel‐Schwarz E. Prevalence of iron deficiency in pregnant women: A prospective cross-sectional Austrian study. Food Sci Nutr 2021; 9:6559-6565. [PMID: 34925785 PMCID: PMC8645778 DOI: 10.1002/fsn3.2588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 09/02/2021] [Accepted: 09/03/2021] [Indexed: 12/01/2022] Open
Abstract
The aim of the study was to determine, for the first time, in a prospective cross-sectional multicenter study, the prevalence of iron deficiency (ID) in an Austrian pregnant population. A cohort of 425 pregnant women was classified into four groups of different weeks of gestation. Group 1 was monitored longitudinally, while groups 2-4, iron status, were sampled only once. Evaluation of the prevalence of ID was performed by comparing the diagnostic criteria of the WHO to the cutoff proposed by Achebe MM and Gafter-Gvili A (Achebe) and the Austrian Nutrition Report (ANR). In comparison with the ANR, the prevalence of ID was lower in group 1 and higher in groups 2-4 (17.2% vs. 12.17%, 25.84%, 35.29%, and 41.76%, respectively) (p-values < .01 except group 1). According to WHO, the prevalence in group 1 was 12.17% at inclusion, 2 months later 31.7%, and further 2 months later 65.71%, respectively. According to Achebe, the number of cases doubled; for group 1, the number of cases rose from 13 to 42 (115 patients total); for groups 2-4, we observed an increase from 112 to 230 (340 patients total). This study reported a prevalence of around 12% at the beginning of pregnancy, which increased during pregnancy up to 65%. ID can have a massive impact on quality of life, justifying screening, as iron deficiency would be easy to diagnose and treat.
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Affiliation(s)
- Harald Zeisler
- Department of Obstetrics and GynaecologyMedical University ViennaViennaAustria
| | - Wolf Dietrich
- Department of Obstetrics and GynaecologyKarl Landsteiner University of Health SciencesUniversity Hospital TullnTullnAustria
| | - Florian Heinzl
- Department of Obstetrics and GynaecologyMedical University ViennaViennaAustria
| | - Philipp Klaritsch
- Department of Obstetrics and GynaecologyMedical University GrazGrazAustria
| | - Victoria Humpel
- Department of Obstetrics and GynaecologyMedical University GrazGrazAustria
| | - Manfred Moertl
- Department of Gynecology and ObstetricsPerinatal Center, Klagenfurt am WörtherseeKlagenfurtAustria
| | - Christian Obruca
- Department of Obstetrics and GynaecologyKarl Landsteiner University of Health SciencesUniversity Hospital TullnTullnAustria
| | - Friedrich Wimazal
- Department of Obstetrics and GynaecologyMedical University ViennaViennaAustria
| | - Angela Ramoni
- Department of Obstetrics and GynaecologyMedical University InnsbruckInnsbruckAustria
| | - Johanna Tiechl
- Department of Obstetrics and GynaecologyMedical University InnsbruckInnsbruckAustria
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14
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von Kaisenberg C, Klaritsch P, Ochsenbein-Kölble N, Hodel ME, Nothacker M, Hecher K. Screening, Management and Delivery in Twin Pregnancy. Ultraschall Med 2021; 42:367-378. [PMID: 33017845 DOI: 10.1055/a-1248-8896] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The following AWMF guideline (DGGG/AGG & DEGUM responsible) deals with the diagnosis, screening and management of twins as well as the timing and mode of birth.Twin pregnancies can be classified as dichorionic diamniotic (DC DA), monochorionic diamniotic (MC DA) and monochorionic monoamniotic (MC MA) which are always monochorionic.Twin pregnancies can be concordant (both twins are affected) or discordant (only one twin is affected) for chromosomal defects, malformations, growth restriction and hemodynamic disorders.Chorionicity is the prognostically most significant parameter. Monochorial twins have significantly higher risks of intrauterine morbidity and mortality compared to dichorial twins.In particular, general aspects of twin pregnancies such as dating, determination of chorionicity and amnionicity, the labeling of twin fetuses and the perinatal switch phenomenon are discussed.Routine monitoring of MC and DC twin pregnancies with ultrasound at 11-13+ 6 weeks of gestation for chromosomal defects, invasive prenatal diagnosis, first-trimester NT or CRL discrepancies, early diagnosis of fetal anatomical defects, and management of twins with abnormalities, including selective fetocide, is described.Second trimester screening and management for preterm birth, intrauterine selective growth restriction (sFGR), classification of monochorial twins with sFGR, and management of the surviving twin after the death of the co-twin are described.Complications exclusively affecting MC twins include Twin to Twin Transfusion Syndrome (TTTS) with the important topics screening, prognosis, complications of laser therapy, timing of delivery, risks for brain abnormalities and delayed neurological development, Twin Anemia-Polycythemia Sequence (TAPS) and Twin Reversed Arterial Perfusion (TRAP) Sequence. This also includes MC MA twins as well as conjoined twins.Finally, the birth mode and time for DC and MC twin pregnancies are described.The information is summarized in 62 recommendations for action, 4 tables and 8 illustrations with comprehensive background texts.The guideline is an international guideline adaptation (ISUOG, NICE) as well as a systematic literature search and is up-to-date.
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Affiliation(s)
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University Graz, Austria
| | | | | | - Monika Nothacker
- AWMF-Institut für Medizinisches Wissensmanagement (AWMF-IMWi), University of Marburg, Germany
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Hospital Hamburg-Eppendorf, Hamburg, Germany
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15
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Gasparella P, Singer G, Spendel S, Nagy E, Eder HG, Klaritsch P, Till H, Haxhija EQ. Nasal glial heterotopia: A rare interdisciplinary surgical challenge in newborns. Pediatr Med Chir 2021; 43. [PMID: 33876893 DOI: 10.4081/pmc.2021.240] [Citation(s) in RCA: 2] [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] [Received: 09/02/2020] [Accepted: 03/19/2021] [Indexed: 11/22/2022] Open
Abstract
Nasal Glioma (NG) represents a rare congenital abnormality of the neonate, which can be associated with skull defects or even a direct communication to the central nervous system. MRI serves valuable information for differentiation from encephalocele, dermoid cyst and congenital hemangioma. Complete resection remains the treatment of choice. We present two cases of NG, which were both suspected during prenatal ultrasound and MRI. In the first case, postnatal MRI showed a transcranial continuity. Mass excision was performed and the defect was covered by a glabellar flap allowing a good cosmetic result. Postnatal MRI excluded a trans-glabellar communication in the second case. After surgical excision, the resulting skin defect was covered with a full thickness skin graft harvested from the right groin. In cases of NGs complete resection and cosmetic appealing results can be achieved and might necessitate a multidisciplinary approach.
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Affiliation(s)
| | | | - Stephan Spendel
- Division of Plastic, Aesthetic and Reconstructive Surgery, Department of Surgery.
| | - Eszter Nagy
- Division of Pediatric Radiology, Department of Radiology.
| | | | - Philipp Klaritsch
- Department of Gynecology and Obstetrics, Medical University of Graz, Graz.
| | - Holger Till
- Department of Pediatric and Adolescent Surgery.
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16
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Kollmann M, Obermayer-Pietsch B, Lerchbaum E, Feigl S, Hochstätter R, Pregartner G, Trummer C, Klaritsch P. Vitamin D Concentrations at Term Do Not Differ in Newborns and Their Mothers with and without Polycystic Ovary Syndrome. J Clin Med 2021; 10:jcm10030537. [PMID: 33540556 PMCID: PMC7867163 DOI: 10.3390/jcm10030537] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 01/13/2021] [Accepted: 01/27/2021] [Indexed: 12/02/2022] Open
Abstract
Studies suggest that non-pregnant women with polycystic ovary syndrome (PCOS) may be at elevated risk of 25 hydroxyvitamin D (25(OH)D) deficiency. Furthermore, there is evidence suggesting that 25(OH)D may also play an important role during pregnancy. Data regarding 25(OH)D deficiency during pregnancy in PCOS patients and its association with perinatal outcome is scarce. The aim of the study was to investigate whether mothers with and without PCOS have different 25(OH)D levels at term, how maternal 25(OH)D levels are reflected in their offspring, and if 25(OH)D levels are associated with an adverse perinatal outcome. Therefore, we performed a cross-sectional observational study and included 79 women with PCOS according to the ESHRE/ASRM 2003 definition and 354 women without PCOS and an ongoing pregnancy ≥ 37 + 0 weeks of gestation who gave birth in our institution between March 2013 and December 2015. Maternal serum and cord blood 25(OH)D levels were analyzed at the day of delivery. Maternal 25(OH)D levels did not differ significantly in women with PCOS and without PCOS (p = 0.998), nor did the 25(OH)D levels of their respective offspring (p = 0.692). 25(OH)D deficiency (<20 ng/mL) was found in 26.9% and 22.5% of women with and without PCOS (p = 0.430). There was a strong positive correlation between maternal and neonatal 25(OH)D levels in both investigated groups (r ≥ 0.79, p < 0.001). Linear regression estimates of cord blood 25(OH)D levels are about 77% of serum 25(OH)D concentrations of the mother. Compared to healthy controls, the risk for maternal complications was increased in PCOS women (48% vs. 65%; p = 0.009), while there was no significant difference in neonatal complications (22% and 22%; p = 1.0). However, 25(OH)D levels were similar between mothers and infants with and without perinatal complications. Although the share of women and infants with 25(OH)D deficiency was high in women with PCOS and without PCOS, it seems that the incidence of adverse perinatal outcome was not affected. The long-term consequences for mothers and infants with a 25(OH)D deficiency have to be investigated in future studies.
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Affiliation(s)
- Martina Kollmann
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (S.F.); (R.H.); (P.K.)
- Correspondence:
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.O.-P.); (E.L.); (C.T.)
| | - Elisabeth Lerchbaum
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.O.-P.); (E.L.); (C.T.)
| | - Sarah Feigl
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (S.F.); (R.H.); (P.K.)
| | - Rüdiger Hochstätter
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (S.F.); (R.H.); (P.K.)
| | - Gudrun Pregartner
- Institute for Medical Informatics, Statistics and Documentation (IMI), Medical University of Graz, 8036 Graz, Austria;
| | - Christian Trummer
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria; (B.O.-P.); (E.L.); (C.T.)
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (S.F.); (R.H.); (P.K.)
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Tollenaar LS, Slaghekke F, Lewi L, Colmant C, Lanna M, Weingertner AS, Ryan G, Arévalo S, Klaritsch P, Tavares de Sousa M, Khalil A, Papanna R, Gardener GJ, Bevilacqua E, Kostyukov KV, Bahtiyar MO, Kilby MD, Tiblad E, Oepkes D, Lopriore E. Spontaneous twin anemia polycythemia sequence: diagnosis, management, and outcome in an international cohort of 249 cases. Am J Obstet Gynecol 2021; 224:213.e1-213.e11. [PMID: 32730900 DOI: 10.1016/j.ajog.2020.07.041] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 06/26/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Twin anemia polycythemia sequence is a chronic form of unbalanced fetofetal transfusion through minuscule placental anastomoses in monochorionic twins, leading to anemia in the donor and polycythemia in the recipient. Owing to the low incidence of twin anemia polycythemia sequence, data on diagnosis, management, and outcome are limited. OBJECTIVE This study aimed to investigate the diagnosis, management, and outcome in a large international cohort of spontaneous twin anemia polycythemia sequence. STUDY DESIGN Data from the international twin anemia polycythemia sequence registry, retrospectively collected between 2014 and 2019, were used for this study. A total of 17 fetal therapy centers contributed to the data collection. The primary outcomes were perinatal mortality and severe neonatal morbidity. Secondary outcomes included a risk factor analysis for perinatal mortality and severe neonatal morbidity. RESULTS A total of 249 cases of spontaneous twin anemia polycythemia sequence were included in this study, 219 (88%) of which were diagnosed antenatally and 30 (12%) postnatally. Twin anemia polycythemia sequence was diagnosed antenatally at a median gestational age of 23.7 weeks (interquartile range, 9.7-28.8; range, 15.1-35.3). Antenatal management included laser surgery in 39% (86 of 219), expectant management in 23% (51 of 219), delivery in 16% (34 of 219), intrauterine transfusion (with partial exchange transfusion) in 12% (26 of 219), selective feticide in 8% (18 of 219), and termination of pregnancy in 1% (3 of 219) of cases. Perinatal mortality rate was 15% (72 of 493) for the total group, 22% (54 of 243) for donors, and 7% (18 of 242) for recipients (P<.001). Severe neonatal morbidity occurred in 33% (141 of 432) of twins with twin anemia polycythemia sequence and was similar for donors (32%; 63 of 196) and recipients (33%; 75 of 228) (P=.628). Independent risk factors for spontaneous perinatal mortality were donor status (odds ratio, 3.8; 95% confidence interval, 1.9-7.5; P<.001), antenatal twin anemia polycythemia sequence stage (odds ratio, 6.3; 95% confidence interval, 1.4-27.8; P=.016 [stage 2]; odds ratio, 9.6; 95% confidence interval, 2.1-45.5; P=.005 [stage 3]; odds ratio, 20.9; 95% confidence interval, 3.0-146.4; P=.002 [stage 4]), and gestational age at birth (odds ratio, 0.8; 95% confidence interval, 0.7-0.9; P=.001). Independent risk factors for severe neonatal morbidity were antenatal twin anemia polycythemia sequence stage 4 (odds ratio, 7.9; 95% confidence interval, 1.4-43.3; P=.018) and gestational age at birth (odds ratio, 1.7; 95% confidence interval, 1.5-2.1, P<.001). CONCLUSION Spontaneous twin anemia polycythemia sequence can develop at any time in pregnancy from the beginning of the second trimester to the end of the third trimester. Management for twin anemia polycythemia sequence varies considerably, with laser surgery being the most frequent intervention. Perinatal mortality and severe neonatal morbidity were high, the former especially so in the donor twins.
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Torreiter PP, Macher S, Matzhold EM, Resch B, Klaritsch P, Körmöczi GF, Polin H, Neuhold L, Schönbacher M, Schlenke P, Wagner T. Ethical Issues and Management of Fetal Hemolytic Anemia Caused by Anti-Rh17 in a Multipara with Rare -D- Phenotype. Transfus Med Hemother 2021; 48:183-187. [PMID: 34177424 DOI: 10.1159/000513124] [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: 07/12/2020] [Accepted: 11/17/2020] [Indexed: 11/19/2022] Open
Abstract
Background The development of allo-anti-Rh17 (anti-Hr0) in a -D- phenotype whose red blood cells (RBCs) lack CcEe antigens is most likely triggered by transfusion, transplantation, or pregnancy. Gene conversion is the predominating factor in generating RHD-CE-D and RHCE-D-CE hybrids like -D-. Methods We report here immunohematological and obstetrical data from 2 of the 5 pregnancies of a 24-year-old woman presenting with the -D- phenotype with anti-Rh17. Blood group typing, antibody screening, antibody differentiation, direct antiglobulin test (DAT), and antibody titers were performed by routine gel technology and tube testing. Additionally, molecular genetic analysis was performed. Fetal surveillance was done by sonographic evaluation of the fetal middle cerebral artery peak systolic velocity (MCA-PSV). Results Blood group typing showed O, C-c-D+E-e- and the DAT was negative. DNA sequencing revealed homozygosity for an RHCE-D(3-9)-CE null allele. Anti-Rh17 titers in the fourth pregnancy remained between 1:8 and 1:128, and no signs for a fetal anemia were observed. However, in the fifth pregnancy, the antibody titers increased up to 1:4,096. Signs of moderate fetal anemia were detected and cesarean section was performed at 34 + 6 weeks of gestation. The newborn presented with hemolytic anemia (cord blood hemoglobin [Hb] = 8.5 mg/dL). She received 2 compatible (small) packed RBC concentrates, phototherapy, and intravenous immunoglobulins. Conclusion Our case shows that the risk for hemolytic complications increases with the number of pregnancies of sensitized women. Only people who also lack CcEe antigens are compatible as donors. The role of such rare donors as lifesavers, their freedom, and voluntariness conflict with the urgent need for compatible blood.
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Affiliation(s)
- Patrick P Torreiter
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Susanne Macher
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Eva-Maria Matzhold
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Bernhard Resch
- Divison of Neonatology, Medical University of Graz, Graz, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Günther F Körmöczi
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Helene Polin
- Red Cross Transfusion Service of Upper Austria, Linz, Austria
| | - Leopold Neuhold
- Institute of Ethics and Sociology, University of Graz, Graz, Austria
| | - Marlies Schönbacher
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
| | - Peter Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Wagner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
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Tollenaar LSA, Slaghekke F, Lewi L, Ville Y, Lanna M, Weingertner A, Ryan G, Arévalo S, Khalil A, Brock CO, Klaritsch P, Hecher K, Gardener G, Bevilacqua E, Kostyukov KV, Bahtiyar M, Kilby M, Tiblad E, Oepkes D, Lopriore E. Treatment and outcome of 370 cases with spontaneous or post-laser twin anemia-polycythemia sequence managed in 17 fetal therapy centers. Ultrasound Obstet Gynecol 2020; 56:378-387. [PMID: 32291846 PMCID: PMC7497010 DOI: 10.1002/uog.22042] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 03/23/2020] [Accepted: 03/25/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To investigate the antenatal management and outcome in a large international cohort of monochorionic twin pregnancies with spontaneous or post-laser twin anemia-polycythemia sequence (TAPS). METHODS This study analyzed data of monochorionic twin pregnancies diagnosed antenatally with spontaneous or post-laser TAPS in 17 fetal therapy centers, recorded in the TAPS Registry between 2014 and 2019. Antenatal diagnosis of TAPS was based on fetal middle cerebral artery peak systolic velocity > 1.5 multiples of the median (MoM) in the TAPS donor and < 1.0 MoM in the TAPS recipient. The following antenatal management groups were defined: expectant management, delivery within 7 days after diagnosis, intrauterine transfusion (IUT) (with or without partial exchange transfusion (PET)), laser surgery and selective feticide. Cases were assigned to the management groups based on the first treatment that was received after diagnosis of TAPS. The primary outcomes were perinatal mortality and severe neonatal morbidity. The secondary outcome was diagnosis-to-birth interval. RESULTS In total, 370 monochorionic twin pregnancies were diagnosed antenatally with TAPS during the study period and included in the study. Of these, 31% (n = 113) were managed expectantly, 30% (n = 110) with laser surgery, 19% (n = 70) with IUT (± PET), 12% (n = 43) with delivery, 8% (n = 30) with selective feticide and 1% (n = 4) underwent termination of pregnancy. Perinatal mortality occurred in 17% (39/225) of pregnancies in the expectant-management group, 18% (38/215) in the laser group, 18% (25/140) in the IUT (± PET) group, 10% (9/86) in the delivery group and in 7% (2/30) of the cotwins in the selective-feticide group. The incidence of severe neonatal morbidity was 49% (41/84) in the delivery group, 46% (56/122) in the IUT (± PET) group, 31% (60/193) in the expectant-management group, 31% (57/182) in the laser-surgery group and 25% (7/28) in the selective-feticide group. Median diagnosis-to-birth interval was longest after selective feticide (10.5 (interquartile range (IQR), 4.2-14.9) weeks), followed by laser surgery (9.7 (IQR, 6.6-12.7) weeks), expectant management (7.8 (IQR, 3.8-14.4) weeks), IUT (± PET) (4.0 (IQR, 2.0-6.9) weeks) and delivery (0.3 (IQR, 0.0-0.5) weeks). Treatment choice for TAPS varied greatly within and between the 17 fetal therapy centers. CONCLUSIONS Antenatal treatment for TAPS differs considerably amongst fetal therapy centers. Perinatal mortality and morbidity were high in all management groups. Prolongation of pregnancy was best achieved by expectant management, treatment by laser surgery or selective feticide. © 2020 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)
- L. S. A. Tollenaar
- Department of Obstetrics, Division of Fetal therapyLeiden University Medical CenterLeidenThe Netherlands
| | - F. Slaghekke
- Department of Obstetrics, Division of Fetal therapyLeiden University Medical CenterLeidenThe Netherlands
| | - L. Lewi
- Department of Obstetrics and GynecologyUniversity Hospitals LeuvenLeuvenBelgium
| | - Y. Ville
- Department of Obstetrics and Maternal‐Fetal MedicineHôpital Necker‐Enfants Malades, AP‐HPParisFrance
| | - M. Lanna
- Fetal Therapy Unit ‘U. Nicolini’, Vittore Buzzi Children's HospitalUniversity of MilanMilanItaly
| | - A. Weingertner
- Department of Obstetrics and GynecologyStrasbourg University HospitalStrasbourg CedexFrance
| | - G. Ryan
- Fetal Medicine Unit, Ontario Fetal Centre, Mount Sinai HospitalUniversity of TorontoTorontoCanada
| | - S. Arévalo
- Maternal Fetal Medicine Unit, Department of ObstetricsVall d'Hebron University HospitalBarcelonaSpain
| | - A. Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation TrustUniversity of LondonLondonUK
- Vascular Biology Research CentreMolecular and Clinical Sciences Research Institute, St George's University of LondonLondonUK
| | - C. O. Brock
- The Fetal Center, Department of Obstetrics, Children's Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UT Health, McGovern Medical SchoolUniversity of TexasHoustonTXUSA
| | - P. Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and GynecologyMedical University of Graz, GrazAustria
| | - K. Hecher
- Department of Obstetrics and Fetal MedicineUniversity Medical Center Hamburg‐EppendorfHamburgGermany
| | - G. Gardener
- Department of Maternal Fetal MedicineMater Mothers' HospitalSouth BrisbaneQueenslandAustralia
| | - E. Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital BrugmannUniversité Libre de BruxellesBrusselsBelgium
| | - K. V. Kostyukov
- Acad. V. I. Kulakov Research Center of ObstetricsGynecology, and Perinatology, Ministry of Health of the Russian FederationMoscowRussia
| | - M. O. Bahtiyar
- Department of Obstetrics, Gynecology and Reproductive SciencesYale School of MedicineNew HavenCTUSA
| | - M. D. Kilby
- Fetal Medicine Centre, Birmingham Women's and Children's Foundation TrustUniversity of BirminghamBirminghamUK
| | - E. Tiblad
- Center for Fetal MedicineKarolinska University HospitalStockholmSweden
| | - D. Oepkes
- Department of Obstetrics, Division of Fetal therapyLeiden University Medical CenterLeidenThe Netherlands
| | - E. Lopriore
- Department of Pediatrics, Division of NeonatologyLeiden University Medical CenterLeidenThe Netherlands
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Klaritsch P, Ciresa-König A, Pristauz-Telsnigg G. COVID-19 During Pregnancy and Puerperium - A Review by the Austrian Society of Gynaecology and Obstetrics (OEGGG). Geburtshilfe Frauenheilkd 2020; 80:813-819. [PMID: 32817988 PMCID: PMC7428372 DOI: 10.1055/a-1207-0702] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023] Open
Abstract
After the first case of COVID-19 pneumonia was reported in Wuhan, Hubei Province, China, in December 2019, the infection quickly spread to the rest of China and then to the wider world. The available information on pregnant women infected with COVID-19 is now significantly greater. There are now several case series and systematic reviews of cohorts, some of which include more than 100 cases. This review evaluates the scientific literature available until May 1, 2020 and discusses common questions about COVID-19 in the context of pregnancy and the postpartum period.
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Affiliation(s)
- Philipp Klaritsch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - Alexandra Ciresa-König
- Universitätsklinik für Gynäkologie und Geburtshilfe, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Gunda Pristauz-Telsnigg
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
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Stampalija T, Thornton J, Marlow N, Napolitano R, Bhide A, Pickles T, Bilardo CM, Gordijn SJ, Gyselaers W, Valensise H, Hecher K, Sande RK, Lindgren P, Bergman E, Arabin B, Breeze AC, Wee L, Ganzevoort W, Richter J, Berger A, Brodszki J, Derks J, Mecacci F, Maruotti GM, Myklestad K, Lobmaier SM, Prefumo F, Klaritsch P, Calda P, Ebbing C, Frusca T, Raio L, Visser GHA, Krofta L, Cetin I, Ferrazzi E, Cesari E, Wolf H, Lees CC. Fetal cerebral Doppler changes and outcome in late preterm fetal growth restriction: prospective cohort study. Ultrasound Obstet Gynecol 2020; 56:173-181. [PMID: 32557921 DOI: 10.1002/uog.22125] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/14/2020] [Accepted: 05/29/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To explore the association between fetal umbilical and middle cerebral artery (MCA) Doppler abnormalities and outcome in late preterm pregnancies at risk of fetal growth restriction. METHODS This was a prospective cohort study of singleton pregnancies at risk of fetal growth restriction at 32 + 0 to 36 + 6 weeks of gestation, enrolled in 33 European centers between 2017 and 2018, in which umbilical and fetal MCA Doppler velocimetry was performed. Pregnancies were considered at risk of fetal growth restriction if they had estimated fetal weight and/or abdominal circumference (AC) < 10th percentile, abnormal arterial Doppler and/or a fall in AC growth velocity of more than 40 percentile points from the 20-week scan. Composite adverse outcome comprised both immediate adverse birth outcome and major neonatal morbidity. Using a range of cut-off values, the association of MCA pulsatility index and umbilicocerebral ratio (UCR) with composite adverse outcome was explored. RESULTS The study population comprised 856 women. There were two (0.2%) intrauterine deaths. Median gestational age at delivery was 38 (interquartile range (IQR), 37-39) weeks and birth weight was 2478 (IQR, 2140-2790) g. Compared with infants with normal outcome, those with composite adverse outcome (n = 93; 11%) were delivered at an earlier gestational age (36 vs 38 weeks) and had a lower birth weight (1900 vs 2540 g). The first Doppler observation of MCA pulsatility index < 5th percentile and UCR Z-score above gestational-age-specific thresholds (1.5 at 32-33 weeks and 1.0 at 34-36 weeks) had the highest relative risks (RR) for composite adverse outcome (RR 2.2 (95% CI, 1.5-3.2) and RR 2.0 (95% CI, 1.4-3.0), respectively). After adjustment for confounders, the association between UCR Z-score and composite adverse outcome remained significant, although gestational age at delivery and birth-weight Z-score had a stronger association. CONCLUSION In this prospective multicenter study, signs of cerebral blood flow redistribution were found to be associated with adverse outcome in late preterm singleton pregnancies at risk of fetal growth restriction. Whether cerebral redistribution is a marker describing the severity of fetal growth restriction or an independent risk factor for adverse outcome remains unclear, and whether it is useful for clinical management can be answered only in a randomized trial. © 2020 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)
- T Stampalija
- Unit of Fetal Medicine and Prenatal Diagnosis, Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - J Thornton
- School of Clinical Sciences, University of Nottingham, Division of Obstetrics and Gynaecology, Maternity Department, City Hospital, Nottingham, UK
| | - N Marlow
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
| | - R Napolitano
- UCL Elizabeth Garrett Anderson Institute for Women's Health, University College London, London, UK
- Fetal Medicine Unit, University College London Hospitals NHS Foundation Trust, London, UK
| | - A Bhide
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust and Molecular & Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - T Pickles
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - C M Bilardo
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - S J Gordijn
- Department of Obstetrics and Gynaecology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - W Gyselaers
- Faculty of Medicine and Life Sciences, Hasselt University, Agoralaan, Diepenbeek, Belgium
- Department of Obstetrics & Gynaecology, Ziekenhuis Oost-Limburg, Genk and Department Physiology, Hasselt University, Diepenbeek, Belgium
| | - H Valensise
- Department of Surgery, Division of Obstetrics and Gynecology, Tor Vergata University, Policlinico Casilino Hospital, Rome, Italy
| | - K Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany
| | - R K Sande
- Department of Obstetrics and Gynecology, Stavanger University Hospital, Stavanger and Department of Clinical Science, University of Bergen, Bergen, Norway
| | - P Lindgren
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - E Bergman
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - B Arabin
- Department of Obstetrics Charite, Humboldt University Berlin and Clara Angela Foundation, Berlin, Germany
| | - A C Breeze
- Fetal Medicine Unit, Leeds General Infirmary, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - L Wee
- The Princess Alexandra Hospital NHS Trust, Harlow, UK
| | - W Ganzevoort
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - J Richter
- Department of Gynecology and Obstetrics, UZ Leuven and Department of Regeneration and Development, KU Leuven, Leuven, Belgium
| | - A Berger
- Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria
| | - J Brodszki
- Department of Pediatric Surgery and Neonatology, Lund University, Skane University Hospital, Lund, Sweden
| | - J Derks
- Department of Perinatal Medicine, University of Utrecht, Utrecht, The Netherlands
| | - F Mecacci
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - G M Maruotti
- Department of Neurosciences, Reproductive and Dentistry Sciences, University of Naples 'Federico II', Naples, Italy
| | | | - S M Lobmaier
- Department of Obstetrics and Gynecology, Klinikum Rechts Der Isar, Technical University of Munich, Munich, Germany
| | - F Prefumo
- Department of Obstetrics and Gynecology, ASST Spedali Civili di Brescia and University of Brescia, Brescia, Italy
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - P Calda
- Department of Obstetrics and Gynaecology, General University Hospital and First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - C Ebbing
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - T Frusca
- Department of Obstetrics and Gynecology, University of Parma, Parma, Italy
| | - L Raio
- Department of Obstetrics & Gynecology, University Hospital of Bern, Bern, Switzerland
| | - G H A Visser
- Department of Obstetrics, Division of Woman and Baby, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L Krofta
- Institute for the Care of Mother and Child, Prague, Czech Republic and Third Medical Faculty, Charles University, Prague, Czech Republic
| | - I Cetin
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - E Ferrazzi
- Department of Obstetrics and Gynecology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico and Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | - E Cesari
- Department of Obstetrics and Gynecology, Vittore Buzzi Children's Hospital, University of Milan, Milan, Italy
| | - H Wolf
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Reproduction and Development Research Institute, Amsterdam, The Netherlands
| | - C C Lees
- Imperial College School of Medicine, Imperial College London and Department of Fetal Medicine, Queen Charlotte's and Chelsea Hospital, Imperial College NHS trust, London, UK
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Tollenaar LS, Lopriore E, Faiola S, Lanna M, Stirnemann J, Ville Y, Lewi L, Devlieger R, Weingertner AS, Favre R, Hobson SR, Ryan G, Rodo C, Arévalo S, Klaritsch P, Greimel P, Hecher K, de Sousa MT, Khalil A, Thilaganathan B, Bergh EP, Papanna R, Gardener GJ, Carlin A, Bevilacqua E, Sakalo VA, Kostyukov KV, Bahtiyar MO, Wilpers A, Kilby MD, Tiblad E, Oepkes D, Middeldorp JM, Haak MC, Klumper FJ, Akkermans J, Slaghekke F. Post-Laser Twin Anemia Polycythemia Sequence: Diagnosis, Management, and Outcome in an International Cohort of 164 Cases. J Clin Med 2020; 9:E1759. [PMID: 32517071 PMCID: PMC7355738 DOI: 10.3390/jcm9061759] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 05/19/2020] [Accepted: 05/25/2020] [Indexed: 02/02/2023] Open
Abstract
The aim of this study was to investigate the management and outcome in the post-laser twin anemia polycythemia sequence (TAPS). Data of the international TAPS Registry, collected between 2014 and 2019, were used for this study. The primary outcomes were perinatal mortality and severe neonatal morbidity. Secondary outcomes included a risk factor analysis for perinatal mortality and severe neonatal morbidity. A total of 164 post-laser TAPS pregnancies were included, of which 92% (151/164) were diagnosed antenatally and 8% (13/164) postnatally. The median number of days between laser for TTTS and detection of TAPS was 14 (IQR: 7-28, range: 1-119). Antenatal management included expectant management in 43% (62/151), intrauterine transfusion with or without partial exchange transfusion in 29% (44/151), repeated laser surgery in 15% (24/151), selective feticide in 7% (11/151), delivery in 6% (9/151), and termination of pregnancy in 1% (1/151). The median gestational age (GA) at birth was 31.7 weeks (IQR: 28.6-33.7; range: 19.0-41.3). The perinatal mortality rate was 25% (83/327) for the total group, 37% (61/164) for donors, and 14% (22/163) for recipients (p < 0.001). Severe neonatal morbidity was detected in 40% (105/263) of the cohort and was similar for donors (43%; 51/118) and recipients (37%; 54/145), p = 0.568. Independent risk factors for spontaneous perinatal mortality were antenatal TAPS Stage 4 (OR = 3.4, 95%CI 1.4-26.0, p = 0.015), TAPS donor status (OR = 4.2, 95%CI 2.1-8.3, p < 0.001), and GA at birth (OR = 0.8, 95%CI 0.7-0.9, p = 0.001). Severe neonatal morbidity was significantly associated with GA at birth (OR = 1.5, 95%CI 1.3-1.7, p < 0.001). In conclusion, post-laser TAPS most often occurs within one month after laser for TTTS, but may develop up to 17 weeks after initial surgery. Management is mostly expectant, but varies greatly, highlighting the lack of consensus on the optimal treatment and heterogeneity of the condition. Perinatal outcome is poor, particularly due to the high rate of perinatal mortality in donor twins.
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Affiliation(s)
- Lisanne S.A. Tollenaar
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.O.); (J.M.M.); (M.C.H.); (F.J.C.M.K.); (J.A.); (F.S.)
| | - Enrico Lopriore
- Department of Pediatrics, Division of Neonatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Stefano Faiola
- Fetal Therapy Unit “U. Nicolini”, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (S.F.); (M.L.)
| | - Mariano Lanna
- Fetal Therapy Unit “U. Nicolini”, Vittore Buzzi Children’s Hospital, University of Milan, 20154 Milan, Italy; (S.F.); (M.L.)
| | - Julien Stirnemann
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, 75015 Paris, France; (J.S.); (Y.V.)
| | - Yves Ville
- Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker Enfants Malades, AP-HP, 75015 Paris, France; (J.S.); (Y.V.)
| | - Liesbeth Lewi
- Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium; (L.L.); (R.D.)
| | - Roland Devlieger
- Department of Obstetrics and Gynecology, University Hospitals Leuven, 3000 Leuven, Belgium; (L.L.); (R.D.)
| | - Anne Sophie Weingertner
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, CEDEX, 67000 Strasbourg, France; (A.S.W.); (R.F.)
| | - Romain Favre
- Department of Obstetrics and Gynecology, Strasbourg University Hospital, CEDEX, 67000 Strasbourg, France; (A.S.W.); (R.F.)
| | - Sebastian R. Hobson
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada; (S.R.H.); (G.R.)
| | - Greg Ryan
- Fetal Medicine Unit, Department of Obstetrics & Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, ON M5G 1X5, Canada; (S.R.H.); (G.R.)
| | - Carlota Rodo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (C.R.); (S.A.)
| | - Silvia Arévalo
- Maternal Fetal Medicine Unit, Department of Obstetrics, Vall d’Hebron University Hospital, 08035 Barcelona, Spain; (C.R.); (S.A.)
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (P.K.); (P.G.)
| | - Patrick Greimel
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, 8036 Graz, Austria; (P.K.); (P.G.)
| | - Kurt Hecher
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (K.H.); (M.T.d.S.)
| | - Manuela Tavares de Sousa
- Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany; (K.H.); (M.T.d.S.)
| | - Asma Khalil
- Fetal Medicine Unit, St George University Hospital NHS Foundation Trust, London SW17 0RE, UK; (A.K.); (B.T.)
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George University Hospital NHS Foundation Trust, London SW17 0RE, UK; (A.K.); (B.T.)
| | - Eric P. Bergh
- The Fetal Center, Department of Obstetrics, Children’s Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UT Health, McGovern Medical School, University of Texas, Houston, TX 77030, USA; (E.P.B.); (R.P.)
| | - Ramesha Papanna
- The Fetal Center, Department of Obstetrics, Children’s Memorial Hermann Hospital, Gynecology and Reproductive Sciences, UT Health, McGovern Medical School, University of Texas, Houston, TX 77030, USA; (E.P.B.); (R.P.)
| | - Glenn J. Gardener
- Department of Maternal Fetal Medicine, Mater Mothers’ Hospital, South Brisbane, QLD 4101, Australia;
| | - Andrew Carlin
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, 1020 Brussels, Belgium; (A.C.); (E.B.)
| | - Elisa Bevilacqua
- Department of Obstetrics and Gynecology, University Hospital Brugmann, Université Libre de Bruxelles, 1020 Brussels, Belgium; (A.C.); (E.B.)
| | - Victorya A. Sakalo
- Acad. V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, 495 Moscow, Russia; (V.A.S.); (K.V.K.)
| | - Kirill V. Kostyukov
- Acad. V.I. Kulakov Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, 495 Moscow, Russia; (V.A.S.); (K.V.K.)
| | - Mert O. Bahtiyar
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA; (M.O.B.); (A.W.)
| | - Abigail Wilpers
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, CT 06510, USA; (M.O.B.); (A.W.)
| | - Mark D. Kilby
- Fetal Medicine Centre, Birmingham Women’s and Children’s Foundation Trust, University of Birmingham, Birmingham B4 6NH, UK;
| | - Eleonor Tiblad
- Center for Fetal Medicine, Karolinska University Hospital, 171 76 Stockholm, Sweden;
| | - Dick Oepkes
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.O.); (J.M.M.); (M.C.H.); (F.J.C.M.K.); (J.A.); (F.S.)
| | - Johanna M. Middeldorp
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.O.); (J.M.M.); (M.C.H.); (F.J.C.M.K.); (J.A.); (F.S.)
| | - Monique C. Haak
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.O.); (J.M.M.); (M.C.H.); (F.J.C.M.K.); (J.A.); (F.S.)
| | - Frans J.C.M. Klumper
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.O.); (J.M.M.); (M.C.H.); (F.J.C.M.K.); (J.A.); (F.S.)
| | - Joost Akkermans
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.O.); (J.M.M.); (M.C.H.); (F.J.C.M.K.); (J.A.); (F.S.)
| | - Femke Slaghekke
- Department of Obstetrics, Division of Fetal therapy, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (D.O.); (J.M.M.); (M.C.H.); (F.J.C.M.K.); (J.A.); (F.S.)
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Hochstätter R, Greimel P, Kampelmühler E, Gellen J, Csapo Bence D, Klaritsch P. Die Plazenta als diagnostisches Tool im zweiten Trimenon – Fall einer Partialmole in der 22. SSW mit lebendem Fetus. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713219] [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: 10/24/2022] Open
Affiliation(s)
- R Hochstätter
- Klinische Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - P Greimel
- Klinische Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - E Kampelmühler
- Diagnostik & Forschungsinstitut für Pathologie, Medizinische Universität Graz
| | - J Gellen
- Klinische Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - D Csapo Bence
- Klinische Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - P Klaritsch
- Klinische Abteilung für Geburtshilfe, Medizinische Universität Graz
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24
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Schütz A - M, Bruckner M, Mileder L, Hochstätter R, Taumberger N, Klaritsch P. Valaciclovir-Therapie bei einem symptomatischen CMV-infizierten Feten: ein Fallbericht. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1713226] [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: 10/24/2022] Open
Affiliation(s)
- M Schütz A -
- Klinische Abteilung für Geburtshilfe, Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Österreich
| | - M Bruckner
- Klinische Abteilung für Neonatologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Österreich
| | - L Mileder
- Klinische Abteilung für Neonatologie, Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Österreich
| | - R Hochstätter
- Klinische Abteilung für Geburtshilfe, Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Österreich
| | - N Taumberger
- Klinische Abteilung für Geburtshilfe, Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Österreich
| | - P Klaritsch
- Klinische Abteilung für Geburtshilfe, Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Österreich
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25
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Baik-Schneditz N, Pichler G, Schwaberger B, Binder-Heschl C, Mileder L, Reiss IKH, Avian A, Greimel P, Klaritsch P, Urlesberger B. Effect of Intrauterine Growth Restriction on Cerebral Regional Oxygen Saturation in Preterm and Term Neonates during Immediate Postnatal Transition. Neonatology 2020; 117:324-330. [PMID: 32516786 DOI: 10.1159/000507583] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 12/19/2019] [Accepted: 03/29/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Intrauterine growth restriction (IUGR) is associated with adverse perinatal outcome. Affected fetuses commonly display typical blood flow redistribution towards the brain ("brain sparing"). Accordingly, increased cerebral oxygen saturation has been observed in IUGR neonates within the first days of life. AIM The aim of our study was to assess cerebral oxygenation behavior during immediate neonatal transition in IUGR infants. METHODS This is a retrospective single-center observational cohort study. Cerebral regional oxygen saturation (crSO2) was measured with near-infrared spectroscopy in neonates during the first 15 min after birth. Neonates with IUGR (IUGR group) were matched for gestational age (±1 week) and gender with neonates that were appropriate for gestational age (AGA). The AGA:IUGR matching ratio was 3:1. Arterial oxygen saturation (SpO2), heart rate (HR), crSO2, and cerebral fractional tissue oxygen extraction (cFTOE) were compared between the groups. RESULTS Between August 2010 and October 2017, 45 neonates with IUGR were identified and matched to 135 AGA neonates. Mean gestational age was 33.1 ± 3.0 weeks in the IUGR group and 33.5 ± 2.7 weeks in the AGA group. Mean birth weight was 1,559 ± 582 g in the IUGR group and 2,051 ± 679 g in the AGA group. There was a significant group difference in crSO2 beginning at 5 min and continuing for the rest of the observation time with higher crSO2 values in the IUGR group (main effect group: p = 0.011; interaction time × group: p = 0.039). In cFTOE, a significant difference could be observed at 5-9 and 11-13 min with lower rates of oxygen extraction in the IUGR group (main effect group: p = 0.025; interaction time × group: p = 0.463). Concerning SpO2 and HR, there was no significant difference between the IUGR and the AGA neonates. CONCLUSION Neonates of the IUGR group did show significantly higher crSO2 values and significantly lower cFTOE values already during immediate neonatal transition compared to the AGA group.
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Affiliation(s)
- Nariae Baik-Schneditz
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria, .,Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Medical University of Graz, Graz, Austria, .,Research Unit for Cerebral Development and Oximetry, Division of Neonatology, Medical University of Graz, Graz, Austria,
| | - Gerhard Pichler
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Cerebral Development and Oximetry, Division of Neonatology, Medical University of Graz, Graz, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Cerebral Development and Oximetry, Division of Neonatology, Medical University of Graz, Graz, Austria
| | - Corinna Binder-Heschl
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Cerebral Development and Oximetry, Division of Neonatology, Medical University of Graz, Graz, Austria
| | - Lukas Mileder
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Cerebral Development and Oximetry, Division of Neonatology, Medical University of Graz, Graz, Austria
| | - Irwin K H Reiss
- Division of Neonatology, Department of Pediatrics, Erasmus Medical Center (MC), University MC Rotterdam, Rotterdam, The Netherlands
| | - Alexander Avian
- Institute for Medical Informatics, Statistics, and Documentation, Medical University of Graz, Graz, Austria
| | - Patrick Greimel
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria.,Research Unit for Neonatal Micro- and Macrocirculation, Division of Neonatology, Medical University of Graz, Graz, Austria.,Research Unit for Cerebral Development and Oximetry, Division of Neonatology, Medical University of Graz, Graz, Austria
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26
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Vujic J, Marsoner K, Lipp-Pump AH, Klaritsch P, Mischinger HJ, Kornprat P. Non-obstetric surgery during pregnancy - an eleven-year retrospective analysis. BMC Pregnancy Childbirth 2019; 19:382. [PMID: 31653246 PMCID: PMC6815034 DOI: 10.1186/s12884-019-2554-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 10/02/2019] [Indexed: 12/21/2022] Open
Abstract
Background Diagnosis and management of non-obstetric abdominal pathologies during pregnancy are clinically challenging for both obstetricians and general surgeons. Our aim was to evaluate the outcome of pregnant patients who had undergone non-obstetric abdominal surgery. Methods We retrospectively reviewed 76 pregnant patients who had required surgery for non-obstetric abdominal pathologies during pregnancy at our department from January 2005 to December 2015. Data were collected retrospectively from medical records as well as from our institutional perinatal database. We evaluated data for clinical presentation, perioperative management, preterm labor, and maternal and fetal outcomes. Results The patients’ mean age was 29 (interquartile range IQR 25–33) years. Indications for surgery were acute appendicitis in 63%, adnexal pathology in 11%, cholecystolithiasis in 5% and other indications in 21%; surgery was performed in an elective setting in 18% and in an emergent/urgent setting in 82%. In five cases, complications, three of them oncological, called for further surgery. Ninety-seven percent of operations were conducted under general anesthesia. Median skin-to-skin time was 50 (37–80) minutes, median in-hospital stay was 4 (3.5–6) days, and 5 % required postoperative intensive care. Preterm labor occurred in 15%, miscarriage in 7% (none of them directly related to abdominal surgery). Conclusion Abdominal surgery for non-obstetric pathology during pregnancy can be performed safely, if mandatory, without increases in maternal and fetal pathology, miscarriage, and preterm birth rates.
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Affiliation(s)
- J Vujic
- Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria
| | - K Marsoner
- Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria
| | - A H Lipp-Pump
- Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - P Klaritsch
- Department of Gynecology and Obstetrics, Medical University of Graz, Graz, Austria
| | - H J Mischinger
- Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria
| | - P Kornprat
- Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, A-8036, Graz, Austria.
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Kozlowski P, Burkhardt T, Gembruch U, Gonser M, Kähler C, Kagan KO, von Kaisenberg C, Klaritsch P, Merz E, Steiner H, Tercanli S, Vetter K, Schramm T. DEGUM, ÖGUM, SGUM and FMF Germany Recommendations for the Implementation of First-Trimester Screening, Detailed Ultrasound, Cell-Free DNA Screening and Diagnostic Procedures. Ultraschall Med 2019; 40:176-193. [PMID: 30001568 DOI: 10.1055/a-0631-8898] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
First-trimester screening between 11 + 0 and 13 + 6 weeks with qualified prenatal counseling, detailed ultrasound, biochemical markers and maternal factors has become the basis for decisions about further examinations. It detects numerous structural and genetic anomalies. The inclusion of uterine artery Doppler and PlGF screens for preeclampsia and fetal growth restriction. Low-dose aspirin significantly reduces the prevalence of severe preterm eclampsia. Cut-off values define groups of high, intermediate and low probability. Prenatal counseling uses detection and false-positive rates to work out the individual need profile and the corresponding decision: no further diagnosis/screening - cell-free DNA screening - diagnostic procedure and genetic analysis. In pre-test counseling it must be recognized that the prevalence of trisomy 21, 18 or 13 is low in younger women, as in submicroscopic anomalies in every maternal age. Even with high specificities, the positive predictive values of screening tests for rare anomalies are low. In the general population trisomies and sex chromosome aneuploidies account for approximately 70 % of anomalies recognizable by conventional genetic analysis. Screen positive results of cfDNA tests have to be proven by diagnostic procedure and genetic diagnosis. In cases of inconclusive results a higher rate of genetic anomalies is detected. Procedure-related fetal loss rates after chorionic biopsy and amniocentesis performed by experts are lower than 1 to 2 in 1000. Counseling should include the possible detection of submicroscopic anomalies by comparative genomic hybridization (array-CGH). At present, existing studies about screening for microdeletions and duplications do not provide reliable data to calculate sensitivities, false-positive rates and positive predictive values.
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Affiliation(s)
- Peter Kozlowski
- praenatal.de, Prenatal Medicine and Genetics, Düsseldorf, Germany
| | - Tilo Burkhardt
- Clinic of Obstetrics, University Hospital Zurich, Switzerland
| | - Ulrich Gembruch
- Department of Obstetrics and Perinatal Medicine, Medical University Bonn, Germany
| | - Markus Gonser
- Department of Obstetrics and Prenatal Medicine HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany
| | | | - Karl-Oliver Kagan
- Department of Obstetrics and Prenatal Medicine, Medical University Tübingen, Germany
| | - Constantin von Kaisenberg
- Obstetrics and Fetal Medicine, Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University Graz, Austria
| | - Eberhard Merz
- Center for Ultrasound and Prenatal Medicine, Frankfurt, Germany
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Bjelic-Radisic V, Hartmann B, Reisinger J, Trapp E, Benedicic C, Klaritsch P, Dunst E, Brcic I, Tamussino K. Abstract P1-12-19: Quality of life of patients with pregnancy- associated breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-12-19] [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: 11/16/2022]
Abstract
Abstract
Background: Breast cancer (BC) is the most common cancer diagnosed during pregnancy and occurs between one in 3000 to one in 10 000 pregnancies. The first international guidelines for the diagnosis and therapy of pregnancy associated BC (PABC) has been developed in 2003. The 5 year survival rate is similar to the non-pregnant women with the same stage of disease. In contrast to the data about the oncological outcome of patients with PABC, the literature about quality of life (QoL) of those patients is lacking. The aim of the study was to investigate the QoL of patients with PABC.
Materials and methods: Patients with PABC diagnosed and treated at our department in the period between 2000 and 2016 were included in the study. Clinical and demographic data were collected from the data base. The QOL was assessed using the EORTC QLQ-C30, the EORTC QLQ-BR 45 and the EORTC SHQ-22. The QoL results were compared with reference data (EORTC Reference Values) of BC patients. Statistical analysis was performed using descriptive statistics and t-test to test the significance.
Results: In the analysed period, twenty-one patients with PABC were found. In 16 patients BC had been diagnosed during the pregnancy and in 5 patients during the first year after delivery. Mean age at the time of diagnosis was 34.24 (SD±3.3), mean pregnancy week 21.14 (SD±10.28), and 8 months (SD±5.0) for patients with the diagnosis in the first year after the delivery. All patients underwent surgery, as well as chemotherapy. In addition, 10 patients received hormonal therapy and 12 irradiation.
16 patients lived at the time of the QoL assessment and received the QoL questionnaire per mail. After the mean follow up of 5.2 years, there were no statistically significant differences in EORTC QLQ C30 scales between our population and reference data except for constipation which a better score in our population. Clinical relevant differences were found in scales: physical functioning, role functioning and symptom dyspnea with the better score in our population. Our patients reported clinical relevant more financial difficulties. In the disease specific questionnaire EORTC BC 45, patients with PABC showed statistically significantly worse score in the following scales: body image, upset by hair loss, side effects of the systemic therapy and future perspective. 40% of the patients had a decreased libido and 37% of patients reported that therapy negatively impaired sexual activity. 25% of patients reported that they fill less feminine because of the disease.
Conclusion: The results revealed that QoL in patients with PABC is more impaired compared to the overall QoL reference data of BC patients. Despite the small number of patients, the results indicate that PABC patients are a vulnerable group, especially regarding outer appearance (body image, upset by hair loss, fill les feminine). The QLQ BR 45 showed more sensitivity to assess the impact on QoL of these patients than EORTC QLQ C30 and underlines the necessity to use disease-specific questionnaires in specific patient populations.
Citation Format: Bjelic-Radisic V, Hartmann B, Reisinger J, Trapp E, Benedicic C, Klaritsch P, Dunst E, Brcic I, Tamussino K. Quality of life of patients with pregnancy- associated breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-12-19.
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Affiliation(s)
- V Bjelic-Radisic
- Medical University Graz, Graz, Austria; Helios Universitätsklinik, Wuppertal, Germany; Medical University Graz, Institut for Pathology, Graz, Austria
| | - B Hartmann
- Medical University Graz, Graz, Austria; Helios Universitätsklinik, Wuppertal, Germany; Medical University Graz, Institut for Pathology, Graz, Austria
| | - J Reisinger
- Medical University Graz, Graz, Austria; Helios Universitätsklinik, Wuppertal, Germany; Medical University Graz, Institut for Pathology, Graz, Austria
| | - E Trapp
- Medical University Graz, Graz, Austria; Helios Universitätsklinik, Wuppertal, Germany; Medical University Graz, Institut for Pathology, Graz, Austria
| | - C Benedicic
- Medical University Graz, Graz, Austria; Helios Universitätsklinik, Wuppertal, Germany; Medical University Graz, Institut for Pathology, Graz, Austria
| | - P Klaritsch
- Medical University Graz, Graz, Austria; Helios Universitätsklinik, Wuppertal, Germany; Medical University Graz, Institut for Pathology, Graz, Austria
| | - E Dunst
- Medical University Graz, Graz, Austria; Helios Universitätsklinik, Wuppertal, Germany; Medical University Graz, Institut for Pathology, Graz, Austria
| | - I Brcic
- Medical University Graz, Graz, Austria; Helios Universitätsklinik, Wuppertal, Germany; Medical University Graz, Institut for Pathology, Graz, Austria
| | - K Tamussino
- Medical University Graz, Graz, Austria; Helios Universitätsklinik, Wuppertal, Germany; Medical University Graz, Institut for Pathology, Graz, Austria
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Nazifovic E, Husslein H, Lakovschek I, Heinzl F, Wenzel-Schwarz E, Klaritsch P, Kilic E, Hoesel S, Bind R, Pabinger M, Zeisler H, Kuessel L. Differences between evidence-based recommendations and actual clinical practice regarding tocolysis: a prospective multicenter registry study. BMC Pregnancy Childbirth 2018; 18:446. [PMID: 30445929 PMCID: PMC6240217 DOI: 10.1186/s12884-018-2078-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 04/19/2018] [Accepted: 10/30/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND International guidelines recommend that tocolytic therapy be restricted to a single 48-h application. However, multiple cycles of tocolytic therapy and maintenance therapy that exceeds 48 h appear to play a role in daily clinical practice. We aimed to evaluate current trends in clinical practice with respect to treatment with tocolytic agents and to identify differences between evidence-based recommendations and daily clinical practice in Austria. METHODS A prospective multicenter registry study was conducted from October 2013 through April 2015 in ten obstetrical departments in Austria. Women ≥18 years of age who received tocolytic therapy following a diagnosis of threatened preterm birth were included, and details were obtained regarding clinical characteristics, tocolytic therapy, and pregnancy outcome. RESULTS A total of 309 women were included. We observed a median of 2 cycles of tocolytic therapy per patient (IQR 1-3) with a median duration of 2 days per cycle (IQR 2-5). Repeat tocolysis was administered in 41.7% of women, resulting in up to six tocolysis cycles; moreover, 40.8% of the first tocolysis cycles were maintenance tocolysis (i.e., longer than 48 h). Only 25.6% of women received one single 48-h tocolysis cycle in which they received antenatal corticosteroids for fetal lung maturation in accordance evidence-based recommendations. CONCLUSIONS Here, we report a clear disparity between evidence-based recommendations and daily practice with respect to tocolysis. We believe that the general practice of prescribing tocolytic therapy must be revisited. Furthermore, our findings highlight the need for contemporary studies designed to investigate the effectiveness of performing maintenance and/or repetitive tocolysis treatment.
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Affiliation(s)
- Emina Nazifovic
- Department of Gynecology and Obstetrics, Semmelweis Frauenklinik, Bastiengasse 36-38, A-, 1180, Vienna, Austria
| | - Heinrich Husslein
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel 18-20, A-, 1090, Vienna, Austria
| | - Ioana Lakovschek
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A - 8036 Graz, Graz, Austria
| | - Florian Heinzl
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel 18-20, A-, 1090, Vienna, Austria
| | - Elisabeth Wenzel-Schwarz
- Department of Gynecology and Obstetrics, St. Josef Krankenhaus, Auhofstrasse 189, A-, 1130, Vienna, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, A - 8036 Graz, Graz, Austria
| | - Ekrem Kilic
- Department of Gynecology and Obstetrics, Medical University of Krems, University Hospital of Tulln, Alter Ziegelweg 10, A-3430, Tulln, Austria
| | - Sarah Hoesel
- Department of Gynecology and Obstetrics, Klinikum Klagenfurt am Wörthersee, Feschnigstraße 11, A-, 9020, Klagenfurt am Wörthersee, Austria
| | - Rudolf Bind
- Department of Gynecology and Obstetrics, Landesklinikum Zwettl, Probstei 5, A-, 3910, Zwettl, Austria
| | - Magdalena Pabinger
- Department of Gynecology and Obstetrics, Krankenanstalt Rudolfstiftung, Juchgasse 25, A-, 1030, Vienna, Austria
| | - Harald Zeisler
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel 18-20, A-, 1090, Vienna, Austria
| | - Lorenz Kuessel
- Department of Gynecology and Obstetrics, Medical University of Vienna, Waehringer Guertel 18-20, A-, 1090, Vienna, Austria.
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30
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Mautner E, Kalchmair H, Avian A, Deutsch M, Greimel E, Klaritsch P. Health-Related Quality of Life and Depression in Women following Intrauterine Interventions in Complicated Monochorionic Twin Pregnancies. Fetal Diagn Ther 2018; 46:125-132. [PMID: 30408785 DOI: 10.1159/000492325] [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: 03/01/2018] [Accepted: 07/20/2018] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The aim of this study was to explore maternal health-related quality of life (HRQoL) and depression following intrauterine interventions in complicated monochorionic twin pregnancies at the Medical University Graz. MATERIAL AND METHODS In a cross-sectional questionnaire survey, women with at least one liveborn infant following intrauterine intervention during 2011 and 2015 were matched with uncomplicated monochorionic and dichorionic pregnancies. All completed the 12-Item Short Form Health Survey to measure HRQoL and the Patient Health Questionnaire-9 to measure depression. Results were compared with local normative values. RESULTS There were no differences in physical and mental HRQoL as compared to those with uncomplicated pregnancy. However, the whole study population had significantly lower HRQoL scores (p < 0.001) than the normative sample. Additionally, 11% of the whole study population experienced moderate (6.2%) or moderately severe (4.6%) depression. Women following uncomplicated dichorionic pregnancy revealed more depressive symptoms compared to women with intervention. DISCUSSION Women with at least one surviving infant following intervention in complicated monochorionic twin pregnancy do not seem to have an impaired HRQoL as compared to women following uncomplicated monochorionic or dichorionic pregnancies. However, twin pregnancy itself appears to impair HRQoL, at least in the first 4 postnatal years.
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Affiliation(s)
- Eva Mautner
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Hannah Kalchmair
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Alexander Avian
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Maria Deutsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Elfriede Greimel
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria,
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31
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Greimel P, Csapo B, Haeusler M, Lang U, Klaritsch P. A Modified Technique for Cord Transection in Monochorionic Monoamniotic Twin Pregnancies. Fetal Diagn Ther 2018; 44:236-240. [PMID: 30089297 DOI: 10.1159/000489882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 05/08/2018] [Indexed: 11/19/2022]
Abstract
Monochorionic monoamniotic (MA) twins are at increased risk for intrauterine demise (IUD) and discordant anomalies. Selective feticide by cord occlusion may be an option in case of unfavorable discordant problems. In MA pregnancies, however, the surviving co-twin still remains at serious risk for IUD due to progressive cord entanglement. Cord transection has therefore been recommended to protect the survivor. This procedure may turn out to be difficult. We herein describe a modified fetoscopic technique for laser transection using a grasping forceps. We present technical details and clinical outcome in 2 cases of cord transection: one following cord occlusion and the other following spontaneous IUD. Cord transection was performed at 19 and 26 weeks gestation, respectively. A 3 Fr grasping forceps with a working length of 35 cm was used for controlled manipulation of the umbilical cord during transection. There were no procedure-related complications and both surviving co-twins had favorable neonatal outcome. Cord transection using a grasping forceps facilitates easy and precise fetoscopic release of the umbilical cord. To the best of our knowledge, this is the first report on post mortem cord transection after spontaneous single IUD with favorable outcome for the survivor.
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Klaritsch P. Re: Influence of chorionicity and gestational age at single fetal loss on risk of preterm birth in twin pregnancy: analysis of STORK multiple pregnancy cohort. F. D'Antonio, B. Thilaganathan, T. Dias and A. Khalil, on behalf of the Southwest Thames Obstetric Research Collaborative (STORK). Ultrasound Obstet Gynecol 2017; 50: 723-727. Ultrasound Obstet Gynecol 2017; 50:681-682. [PMID: 29205585 DOI: 10.1002/uog.18939] [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)
- P Klaritsch
- Department of Obstetrics and Gynecology, Medical University Graz, Auenbruggerplatz 14, A-8036, Graz, Austria
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33
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Boucek J, de Haan J, Halaska MJ, Plzak J, Van Calsteren K, de Groot CJM, Dahl Steffensen K, Fruscio R, Massolt ET, Klaritsch P, Zola P, Amant F. Maternal and obstetrical outcome in 35 cases of well-differentiated thyroid carcinoma during pregnancy. Laryngoscope 2017; 128:1493-1500. [PMID: 28988434 DOI: 10.1002/lary.26936] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 04/30/2017] [Revised: 07/13/2017] [Accepted: 08/29/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVES/HYPOTHESIS Thyroid cancer, with 6% to 10% of cancer diagnoses, is one of the most common malignancies during pregnancy. Its treatment poses a risk for the pregnancy, as the thyroid gland plays a crucial role in the evolution of pregnancy. The aim of this study is to evaluate treatment of primary well-differentiated thyroid carcinoma during pregnancy and fetal and maternal outcomes. STUDY DESIGN This is an international cohort study. METHODS Primary thyroid cancer patients were identified from the database of the International Network on Cancer, Infertility, and Pregnancy registration study. Data on histopathological characteristics, diagnostic and therapeutic interventions, outcome (obstetrical, neonatal, and maternal) and maternal follow-up were analyzed. RESULTS Thirty-five patients with well-differentiated thyroid carcinoma were eligible. All 35 patients underwent surgery, 29 (83%) of which during pregnancy. Procedures during pregnancy were mainly total thyroidectomies (n = 24). The median number of days between diagnosis and surgical treatment was different between the groups with surgery during and after pregnancy (27 vs. 139 days, P < .001). Both maternal and neonatal outcomes were uncomplicated, regardless of gestational age during surgery. CONCLUSIONS Well-differentiated thyroid carcinoma diagnosed during pregnancy has a favorable outcome for both mother and child. Surgical management during pregnancy has no negative impact on the pregnancy regardless of the trimester at the time of surgery. However, the potential negative effects of thyroid surgery early in pregnancy demand management of these patients in an experienced multidisciplinary team to provide the best possible care for these patients and their unborn babies. LEVEL OF EVIDENCE 4. Laryngoscope, 128:1493-1500, 2018.
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Affiliation(s)
- Jan Boucek
- Department of Otorhinolaryngology, Head and Neck Surgery, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
| | - Jorine de Haan
- Department of Oncology, University of Leuven, Leuven, Belgium.,Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Michael J Halaska
- Department of Obstetrics and Gynecology, 3rd Medical Faculty, Charles University and Faculty Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - Jan Plzak
- Department of Otorhinolaryngology, Head and Neck Surgery, Charles University in Prague, University Hospital Motol, Prague, Czech Republic
| | - Kristel Van Calsteren
- Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium.,Department of Reproduction and Regeneration, University of Leuven, Leuven, Belgium
| | - Christianne J M de Groot
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, the Netherlands
| | - Karina Dahl Steffensen
- Department of Clinical Oncology, Vejle Hospital, Vejle, Denmark.,Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Robert Fruscio
- Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Monza, Italy
| | - Elske T Massolt
- Department of Endocrinology, Rotterdam Thyroid Center, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Paolo Zola
- Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Frédéric Amant
- Department of Oncology, University of Leuven, Leuven, Belgium.,Division of Gynecologic Oncology, University Hospitals Leuven, Leuven, Belgium.,Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam, the Netherlands
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34
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Gottschalk I, Strizek B, Mallmann MR, Müller A, Geipel A, Gembruch U, Klaritsch P, Csapo B, Berg C. Outcome of Bronchopulmonary Sequestration with Massive Pleural Effusion after Intrafetal Vascular Laser Ablation. Fetal Diagn Ther 2017; 44:149-155. [DOI: 10.1159/000479793] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/25/2017] [Indexed: 11/19/2022]
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35
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Kroisel PM, Häusler M, Klaritsch P, Karpf E, Zebedin D, Tiran B, Pertl B, Wagner K. Targeted enrichment sequencing in two midterm pregnancies with severe abnormalities on ultrasound. Lancet 2017; 389:1857-1858. [PMID: 28495170 DOI: 10.1016/s0140-6736(17)31049-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 11/30/2016] [Accepted: 01/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
| | - Martin Häusler
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynaecology, Medical University of Graz, Graz, Austria
| | - Eva Karpf
- Institute of Pathology, Medical University of Graz, Graz, Austria
| | - Doris Zebedin
- Department of Paediatric Radiology, Medical University of Graz, Graz, Austria
| | - Beate Tiran
- Department of Laboratory Medicine, Medical University of Graz, Graz, Austria
| | | | - Klaus Wagner
- Institute of Human Genetics, Medical University of Graz, Graz, Austria.
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36
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Zenz A, Greimel P, Klaritsch P. Hämodynamische Effekte und mütterliche Komplikationen nach intrauterinen Eingriffen bei monochorialen Mehrlingsschwangerschaften. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602347] [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: 10/19/2022] Open
Affiliation(s)
- A Zenz
- Universitätsfrauenklinik Graz, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - P Greimel
- Universitätsfrauenklinik Graz, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - P Klaritsch
- Universitätsfrauenklinik Graz, Abteilung für Geburtshilfe, Medizinische Universität Graz
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37
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Lipp-Pump A, Marsoner K, Kornprat P, Klaritsch P. Abdominalchirurgische Eingriffe während der Schwangerschaft – eine retrospektive Analyse über 11 Jahre. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602330] [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: 10/19/2022] Open
Affiliation(s)
- A Lipp-Pump
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - K Marsoner
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - P Kornprat
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
| | - P Klaritsch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz
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38
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Pfniß I, Csapo B, Häusler M, Greimel P, Lang U, Klaritsch P. Outcome von Drillingsschwangerschaften in Abhängigkeit ihrer Chorionizität – Datenanalyse eines Tertiärzentrums. Geburtshilfe Frauenheilkd 2017. [DOI: 10.1055/s-0037-1602335] [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: 10/19/2022] Open
Affiliation(s)
- I Pfniß
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - B Csapo
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - M Häusler
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - P Greimel
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - U Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
| | - P Klaritsch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Abteilung für Geburtshilfe, Medizinische Universität Graz
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39
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Kollmann M, Aldrian L, Scheuchenegger A, Mautner E, Herzog SA, Urlesberger B, Raggam RB, Lang U, Obermayer-Pietsch B, Klaritsch P. Early skin-to-skin contact after cesarean section: A randomized clinical pilot study. PLoS One 2017; 12:e0168783. [PMID: 28231274 PMCID: PMC5322896 DOI: 10.1371/journal.pone.0168783] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 12/05/2016] [Indexed: 11/18/2022] Open
Abstract
Objective Early bonding by skin-to-skin contact (SSC) has been demonstrated to be beneficial for mothers and newborns following vaginal delivery. The aim of this study was to investigate the impact of intraoperative bonding (early SSC) after cesarean section on neonatal adaptation, maternal pain and stress response. Study design This prospective, randomized-controlled pilot study was performed at a single academic tertiary hospital (Department of Obstetrics and Gynecology, Medical University of Graz, Austria) between September 2013 and January 2014. Women were randomly assigned to intraoperative (“early”) SCC (n = 17) versus postoperative (“late”) SCC (n = 18). Main variables investigated were neonatal transition (Apgar score, arterial oxygen saturation, heart rate and temperature), maternal pain perception and both maternal and neonatal stress response by measuring the stress biomarkers salivary free cortisol and salivary alpha amylase. Results There was no evidence for differences in parameters reflecting neonatal transition or stress response between the ‘Early SSC Group’ and the ‘Late SSC Group’. Maternal salivary cortisol and alpha-amylase levels as well as maternal wellbeing and pain did not differ between the groups. However, the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’ (p = 0.004). Conclusions This study did not reveal significant risks for the newborn in terms of neonatal transition when early SSC is applied in the operating room. Maternal condition and stress marker levels did not differ either, although the rise of maternal salivary alpha-amylase directly after delivery was higher in the ‘Early SSC Group’ compared to the ‘Late SSC Group’, which may indicate a stressor sign due to intensive activation of the sympathetic-adreno-medullary-system. This needs to be further evaluated in a larger prospective randomized trial. Trial registration ClinicalTrials.gov NCT01894880
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Affiliation(s)
- Martina Kollmann
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Lisa Aldrian
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Anna Scheuchenegger
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Eva Mautner
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Sereina A. Herzog
- Institute for Medical Informatics, Statistics and Documentation (IMI), Medical University of Graz, Graz, Austria
| | - Berndt Urlesberger
- Division of Neonatology, Department of Pediatrics and Adolescence Medicine, Medical University of Graz, Graz, Austria
| | - Reinhard B. Raggam
- Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Graz, Austria
- Division of Angiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Uwe Lang
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Barbara Obermayer-Pietsch
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
- * E-mail:
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40
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Reif P, Brezinka C, Fischer T, Husslein P, Lang U, Ramoni A, Zeisler H, Klaritsch P. Labour and Childbirth After Previous Caesarean Section: Recommendations of the Austrian Society of Obstetrics and Gynaecology (OEGGG). Geburtshilfe Frauenheilkd 2016; 76:1279-1286. [PMID: 28017971 DOI: 10.1055/s-0042-118335] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The new expert recommendation from the Austrian Society of Obstetrics and Gynaecology (OEGGG) comprises an interpretation and summary of guidelines from the leading specialist organisations worldwide (RCOG, ACOG, SOGC, CNGOF, WHO, NIH, NICE, UpToDate). In essence it outlines alternatives to the direct pathway to elective repeat caesarean section (ERCS). In so doing it aligns with international trends, according to which a differentiated, individualised clinical approach is recommended that considers benefits and risks to both mother and child, provides detailed counselling and takes the patient's wishes into account. In view of good success rates (60-85 %) for vaginal birth after caesarean section (VBAC) the consideration of predictive factors during antenatal birth planning has become increasingly important. This publication provides a compact management recommendation for the majority of standard clinical situations. However it cannot and does not claim to cover all possible scenarios. The consideration of all relevant factors in each individual case, and thus the ultimate decision on mode of delivery, remains the discretion and responsibility of the treating obstetrician.
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Affiliation(s)
- P Reif
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - C Brezinka
- Universitätsklinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - T Fischer
- Universitätsklinik für Frauenheilkunde und Geburtshilfe der Paracelsus Universität Salzburg, Salzburg, Austria
| | - P Husslein
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Wien, Vienna, Austria
| | - U Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
| | - A Ramoni
- Universitätsklinik für Gynäkologie und Geburtshilfe, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - H Zeisler
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Wien, Vienna, Austria
| | - P Klaritsch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz, Graz, Austria
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41
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Kollmann M, Scheuchenegger A, Aldrian L, Herzog S, Mautner E, Lang U, Urlesberger B, Obermayer-Pietsch B, Raggam RB, Klaritsch P. Früher Haut zu Haut Kontakt nach Kaiserschnitt – eine randomisierte klinische Pilotstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1582188] [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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42
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Kollmann M, Klaritsch P, Martins WP, Craciunas L, Raine-Fenning N. Reply: Maternal and neonatal outcomes in women diagnosed with PCOS by different definitions. Hum Reprod 2015; 31:225. [PMID: 26561544 DOI: 10.1093/humrep/dev285] [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: 11/12/2022] Open
Affiliation(s)
- M Kollmann
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, Graz 8036, Austria
| | - P Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, Graz 8036, Austria
| | - W P Martins
- Department of Obstetrics and Gynecology, Medical School of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto 14048-900, Brazil
| | - L Craciunas
- Clinical Academic Office, Medical School, Newcastle University, Newcastle upon Tyne NE2 4HH, UK
| | - N Raine-Fenning
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
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43
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Macher S, Wagner T, Rosskopf K, Reiterer F, Csapo B, Schlenke P, Klaritsch P. Severe case of fetal hemolytic disease caused by anti-C(w) requiring serial intrauterine transfusions complicated by pancytopenia and cholestasis. Transfusion 2015; 56:80-3. [PMID: 26496681 DOI: 10.1111/trf.13367] [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] [Received: 01/28/2015] [Revised: 08/07/2015] [Accepted: 08/08/2015] [Indexed: 12/01/2022]
Abstract
BACKGROUND Anti-C(w) are rarely found as a source for severe fetal and neonatal hemolytic diseases. We report a case with serial intrauterine transfusions complicated by pancytopenia and cholestasis in the neonatal period. CASE REPORT A 37-year-old woman revealed anti-C(w) with a titer of 512 in her fourth pregnancy. The fetus developed fetal anemia and a severe hydrops requiring three intrauterine red blood cell (RBC) transfusions. After birth at 33 + 0 weeks the newborn presented only transfused RBCs and suffered from anemia, thrombocytopenia, leukopenia, and a cholestatic liver disease. Blood counts improved after transfusion of 2 RBC units and one platelet concentrate and administration of hematopoietic growth factors. The symptoms of cholestasis improved slowly after therapy with ursodeoxycholic acid, vitamins, and medium-chain triglyceride-enriched formula feeding. CONCLUSION Anti-C(w) may lead to severe fetal anemia and consecutive complications. Surveillance of affected pregnancies with high antibody titers using sonographic evaluation of the middle cerebral artery peak systolic velocity should be warranted, especially in multiparous women.
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Affiliation(s)
- Susanne Macher
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Thomas Wagner
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Konrad Rosskopf
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | | | - Bence Csapo
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Peter Schlenke
- Department of Blood Group Serology and Transfusion Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
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44
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Schmid M, Klaritsch P, Arzt W, Burkhardt T, Duba HC, Häusler M, Hafner E, Lang U, Pertl B, Speicher M, Steiner H, Tercanli S, Merz E, Heling KS, Eiben B. Cell-Free DNA Testing for Fetal Chromosomal Anomalies in clinical practice: Austrian-German-Swiss Recommendations for non-invasive prenatal tests (NIPT). Ultraschall Med 2015; 36:507-510. [PMID: 26468773 DOI: 10.1055/s-0035-1553804] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- M Schmid
- Abteilung für Geburtshilfe und feto-maternale Medizin, Universitätsklinik für Frauenheilkunde Wien (Österreich)
| | - P Klaritsch
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz (Österreich)
| | - W Arzt
- Abteilung für Pränatalmedizin, Landesfrauen- und Kinderklinik Linz (Österreich)
| | - T Burkhardt
- Klinik für Geburtshilfe, Universitäts-Spital Zürich (Schweiz)
| | - H C Duba
- Zentrum Medizinische Genetik, Landes-Frauen- und Kinderklinik Linz (Österreich)
| | - M Häusler
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz (Österreich)
| | - E Hafner
- Geburtshilflich-Gynäkologische Abteilung, Sozialmedizinisches Zentrum Ost - Donauspital, Wien (Österreich)
| | - U Lang
- Universitätsklinik für Frauenheilkunde und Geburtshilfe, Medizinische Universität Graz (Österreich)
| | - B Pertl
- Pränatalzentrum, Privatklinik Graz-Ragnitz (Österreich)
| | - M Speicher
- Institut für Humangenetik, Universität Graz (Österreich)
| | - H Steiner
- Praxis für Pränatalmedizin, Praxis für Pränatalmedizin, Salzburg (Österreich)
| | - S Tercanli
- Ultraschall Freie-Strasse, Basel (Schweiz)
| | - E Merz
- Zentrum für Ultraschall und Pränatalmedizin; Frankfurt (Deutschland)
| | - K S Heling
- Praxis Friedrichstrasse für Pränataldiagnostik, Berlin (Deutschland)
| | - B Eiben
- Institut für Labormedizin und Klinische Genetik Rhein/ Ruhr, amedes Gruppe, Essen (Deutschland)
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45
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Kollmann M, Klaritsch P, Martins WP, Guenther F, Schneider V, Herzog SA, Craciunas L, Lang U, Obermayer-Pietsch B, Lerchbaum E, Raine-Fenning N. Maternal and neonatal outcomes in pregnant women with PCOS: comparison of different diagnostic definitions. Hum Reprod 2015. [PMID: 26223675 DOI: 10.1093/humrep/dev187] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION Does the prevalence of adverse maternal and neonatal outcomes vary in women diagnosed with polycystic ovary syndrome (PCOS) according to different definitions? SUMMARY ANSWER A comparison of different criteria revealed that there is a substantial risk for perinatal complications in PCOS women, regardless of the used definition. WHAT IS KNOWN ALREADY Pregnant women with PCOS are susceptible to perinatal complications. At present, there are three main definitions for PCOS. So far, we are aware of only one study, which found that the elevated risk for complications varied widely depending on the different phenotypes and features but only considered a relatively small sample size for some of the phenotypes. STUDY DESIGN, SIZE, DURATION Retrospective matched cohort study. PARTICIPANTS/MATERIALS, SETTING, METHODS Data of primiparous women with PCOS according to ESHRE/ASRM 2003 criteria and healthy controls giving birth to neonates ≥500 g were included. A total of 885 women were analysed: out of 177 women with PCOS, 85 (48.0%) met the National Institutes of Health (NIH) 1990 criteria, another 14 (7.9%) featured the additional phenotypes defined by The Androgen Excess and PCOS Society (AE-PCOS) 2006 criteria, 78 (44.1%) were classified as PCOS exclusively by the ESHRE/ASRM 2003 definition, and 708 represented the control group. MAIN RESULTS AND THE ROLE OF CHANCE The prevalence of adverse maternal (49.4 versus 64.3 versus 60.3%, P = 0.313) and neonatal (27.1 versus 35.7 versus 23.1%, P = 0.615) outcomes did not differ within the three PCOS groups (ESHRE/ASRM, NIH, AE-PCOS, respectively). Compared with healthy controls, the risk for maternal complications was increased in PCOS patients [odds ratio (OR) 2.57; 95% confidence interval (CI) 1.82-3.64; P < 0.001] while there was no difference in neonatal complications (OR 0.83; 95% CI 0.56-1.21; P = 0.343). LIMITATIONS, REASONS FOR CAUTION A limitation of our study is its retrospective design and the relatively small sample size, particularly in the AE-PCOS subgroup. WIDER IMPLICATIONS OF THE FINDINGS Since women with PCOS have, regardless of the used definition, a high risk of maternal and neonatal complications they should be informed and advised to follow regular checks in units where problems can be detected early to allow specialized care. STUDY FUNDING/COMPETING INTERESTS Marietta Blau Grant (Austrian Agency for International Cooperation in Education and Research; OeAD-GmbH) and mobility scholarship (Medical University of Graz).
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Affiliation(s)
- M Kollmann
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - P Klaritsch
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - W P Martins
- Department of Obstetrics and Gynaecology, Medical School of Ribeirao Preto, University of Sao Paulo, 14048-900 Ribeirao Preto, Brazil
| | - F Guenther
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - V Schneider
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - S A Herzog
- Institute for Medical Informatics, Statistics and Documentation (IMI), Medical University of Graz, 8036 Graz, Austria
| | - L Craciunas
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, NG7 2UH Nottingham, UK
| | - U Lang
- Division of Obstetrics and Maternal Fetal Medicine, Department of Obstetrics and Gynaecology, Medical University of Graz, Auenbruggerplatz 14, 8036 Graz, Austria
| | - B Obermayer-Pietsch
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - E Lerchbaum
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria
| | - N Raine-Fenning
- Division of Child Health, Obstetrics & Gynaecology, School of Medicine, University of Nottingham, NG7 2UH Nottingham, UK
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Kollmann M, Scheuchenegger A, Aldrian L, Herzog S, Mautner E, Lang U, Urlesberger B, Obermayer-Pietsch B, Klaritsch P. Pilotstudie: „Sectio Bonding/Early Skin-To-Skin Contact (SSC) after Caesarean Section”. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555044] [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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47
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Kollmann M, Günther F, Schneider V, Herzog S, Martins W, Raine-Fenning N, Obermayer-Pietsch B, Lang U, Klaritsch P. Polyzystisches Ovar Syndrom und perinatales Outcome: Vergleich der unterschiedlichen diagnostischen Kriterien. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555037] [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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Abstract
OBJECTIVE Aim of this study was to evaluate the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia. METHODS Data were prospectively collected from women diagnosed with placenta praevia in 10 Austrian hospitals in in the province of Styria between 1993 and 2012. We analyzed the incidence, potential risk factors and the respective outcomes of pregnancies with placenta praevia. Differences between women with major placenta praevia (complete or partial placenta praevia) and minor placenta praevia (marginal placenta praevia or low-lying placenta) were evaluated. RESULTS 328 patients with placenta praevia were identified. The province wide incidence of placenta praevia was 0.15%. Maternal morbidity was high (ante-partum bleeding [42.3%], post-partum hemorrhage [7.1%], maternal anemia [30%], comorbid adherent placentation [4%], and hysterectomy [5.2%]) and neonatal complications were frequent (preterm birth [54.9%], low birth weight <2500 g [35.6%], Apgar-score after five minutes <7 [5.8%], and fetal mortality [1.5%]. Women with major placenta praevia had a significant higher incidence of preterm delivery, birthweight <2500 g and Apgar-score after five minutes <7. CONCLUSIONS Placenta praevia was associated with adverse maternal (34.15%) and neonatal (60.06%) outcome. The extent of placenta praevia was not related with differences regarding risk factors and maternal outcome.
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Affiliation(s)
- Martina Kollmann
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
| | - Jakob Gaulhofer
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
| | - Uwe Lang
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
| | - Philipp Klaritsch
- a Department of Obstetrics and Gynecology , Medical University of Graz , Graz , Austria
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Abstract
PURPOSE To determine causes of polyhydramnios and the respective perinatal outcome. MATERIALS AND METHODS We retrospectively analyzed cases with polyhydramnios at the Medical University Graz, Austria from 2003 - 2011. Inclusion criteria were single deepest pocket ≥ 8 cm, amniotic fluid index ≥ 25 cm, each of the latter parameters > 95th percentile or subjective impression. Etiologies, including TORCH infection, diabetes and congenital malformations, as well as perinatal outcome were evaluated. RESULTS Out of 860 singleton pregnancies with polyhydramnios, 2.9 % had positive TORCH serology, 8.5 % had congenital anomalies, 19.8 % had maternal diabetes, and 68.8 % were idiopathic. The most common fetal anomalies were cardiac defects (32.9 %). Elective caesarean sections were more common in the groups with malformations and maternal diabetes. Low birth weight combined with severe polyhydramnios or maternal diabetes was associated with malformations. CONCLUSION Diagnosis of polyhydramnios should prompt glucose-tolerance testing, detailed sonography including fetal echocardiography, and TORCH serology. Especially pregnancies with polyhydramnios and small fetuses as well as those with maternal diabetes should be carefully evaluated for malformations.
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Affiliation(s)
- M Kollmann
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - J Voetsch
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - C Koidl
- Institute of Hygiene, Microbiology and Environmental Medicine, Medical University of Graz
| | - E Schest
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - M Haeusler
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - U Lang
- Department of Obstetrics and Gynecology, Medical University of Graz
| | - P Klaritsch
- Department of Obstetrics and Gynecology, Medical University of Graz
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Schmölzer T, Klaritsch P, Lang U, Reif P. Ursachen von IUFTs in der Steiermark in den Jahren 2003 – 2011. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1374785] [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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