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Thangarajah F, Soff J, Lenz C, Jeschke J, Kössendrup J, Papior D, Hagenbeck C, Kirn V, Scholten N. Care needs and self-induced measures of women with postpartum pelvic floor disorder- Results of a social media-based survey of 2930 women. Arch Gynecol Obstet 2024; 309:1467-1473. [PMID: 38353721 PMCID: PMC10894144 DOI: 10.1007/s00404-024-07369-6] [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: 10/01/2023] [Accepted: 01/02/2024] [Indexed: 02/25/2024]
Abstract
INTRODUCTION Pelvic floor disorders (PFD) occur in about 40% of women after delivery. Less is known about the intervention and care needs of women with postpartum PFD. The aim of this analysis was to analyze care needs and self-initiated measures to strengthen the pelvic floor in postpartum women in relation to incontinence and sexual dysfunction. Furthermore, influencing factors for self-initiated measures were evaluated. PATIENTS AND METHODS An anonymous online survey (via LimeSurvey) was conducted between September and October 2022 and distributed via social media (Instagram and Facebook). The survey explicitly addressed mothers with and without pelvic floor disorders up to 5 years postpartum (inclusion criteria). Validated instruments were employed to assess incontinence (ICIQ-SF) and sexual functioning (PISQ-IR: Condition Impact). The questions on the use of services and preventive measures, as well as on the interaction with a gynecologist, were based on self-developed items. RESULTS In total, 49.4% of the participants of the survey showed symptoms of urinary incontinence (UI). Furthermore, only 40.3% (n = 241) of women were actively asked by their gynecologists for the occurrence of UI or PFD among those who suffered from PFD. Overall, 79.3% of the participants of the survey with UI underwent measures to deal with the complaints. The ICIQ-SF Score was significantly associated with all self-induced measures. High School diplomas and academic degrees were associated with the use of love balls (p < 0.05). CONCLUSION The results of the study show the unmet needs of postpartum women. PFD should be addressed more frequently in the outpatient setting. Furthermore, more systematic information about the treatment of PFD could help to address unmet information needs and improve interventions.
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Affiliation(s)
- Fabinshy Thangarajah
- Department of Gynecology and Obstetrics, Medical Faculty, Hufelandstr. 55, 45147, Essen, Germany.
- Department of Gynecology and Obstetrics, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany.
| | - Johannes Soff
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany
| | - Caroline Lenz
- Department of Gynecology and Obstetrics, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany
| | - Janice Jeschke
- Department of Gynecology and Obstetrics, Medical Faculty, Kerpener Str. 34, 50931, Cologne, Germany
| | - Jan Kössendrup
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany
| | - David Papior
- Department of Gynecology and Obstetrics, Medical Faculty, Hufelandstr. 55, 45147, Essen, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Verena Kirn
- Breast Center at the Department of Obstetrics and Gynecology, Heilig Geist Krankenhaus/Teaching Hospital of the University of Cologne, Cologne, Germany
| | - Nadine Scholten
- Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research and Rehabilitation Science, Chair of Health Services Research, University of Cologne, Cologne, Germany
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Hoermann H, van Faassen M, Roeper M, Hagenbeck C, Herebian D, Muller Kobold AC, Dukart J, Kema IP, Mayatepek E, Meissner T, Kummer S. Association of Fetal Catecholamines With Neonatal Hypoglycemia. JAMA Pediatr 2024:2817130. [PMID: 38557708 PMCID: PMC10985628 DOI: 10.1001/jamapediatrics.2024.0304] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/26/2024] [Indexed: 04/04/2024]
Abstract
Importance Perinatal stress and fetal growth restriction increase the risk of neonatal hypoglycemia. The underlying pathomechanism is poorly understood. In a sheep model, elevated catecholamine concentrations were found to suppress intrauterine insulin secretion, followed by hyperresponsive insulin secretion once the adrenergic stimulus subsided. Objective To determine whether neonates with risk factors for hypoglycemia have higher catecholamine concentrations in umbilical cord blood (UCB) and/or amniotic fluid (AF) and whether catecholamines are correlated with postnatal glycemia. Design, Setting, and Participants In a prospective cohort study of 328 neonates at a tertiary perinatal center from September 2020 through May 2022 in which AF and UCB were collected immediately during and after delivery, catecholamines and metanephrines were analyzed using liquid chromatography with tandem mass spectrometry. Participants received postnatal blood glucose (BG) screenings. Exposure Risk factor for neonatal hypoglycemia. Main Outcomes and Measures Comparison of catecholamine and metanephrine concentrations between at-risk neonates and control participants, and correlation of concentrations of catecholamines and metanephrines with the number and severity of postnatal hypoglycemic episodes. Results In this study of 328 neonates (234 in the risk group: median [IQR] gestational age, 270 [261-277] days; and 94 in the control group: median [IQR] gestational age, 273 [270-278] days), growth-restricted neonates showed increased UCB median (IQR) concentrations of norepinephrine (21.10 [9.15-42.33] vs 10.88 [5.78-18.03] nmol/L; P < .001), metanephrine (0.37 [0.13-1.36] vs 0.12 [0.08-0.28] nmol/L; P < .001), and 3-methoxytyramine (0.149 [0.098-0.208] vs 0.091 [0.063-0.149] nmol/L; P = .001). Neonates with perinatal stress had increased UCB median (IQR) concentrations of norepinephrine (22.55 [8.99-131.66] vs 10.88 [5.78-18.03] nmol/L; P = .001), normetanephrine (1.75 [1.16-4.93] vs 1.25 [0.86-2.56] nmol/L; P = .004), and 3-methoxytyramine (0.120 [0.085-0.228] vs 0.091 [0.063-0.149] nmol/L; P = .008) (P < .0083 was considered statistically significant). Concentrations of UCB norepinephrine, metanephrine, and 3-methoxytyramine were negatively correlated with AF C-peptide concentration (rs = -0.212, P = .005; rs = -0.182, P = .016; and rs = -0.183, P = .016, respectively [P < .017 was considered statistically significant]). Concentrations of UCB norepinephrine, metanephrine, and 3-methoxytyramine were positively correlated with the number of hypoglycemic episodes (BG concentration of 30-45 mg/dL) (rs = 0.146, P = .01; rs = 0.151, P = .009; and rs = 0.180, P = .002, respectively). Concentrations of UCB metanephrine and 3-methoxytyramine were negatively correlated with the lowest measured BG concentration (rs = -0.149, P = .01; and rs = -0.153, P = .008, respectively). Conclusions and Relevance Neonates at risk for hypoglycemia displayed increased catecholamine and metanephrine concentrations that were correlated with postnatal hypoglycemic episodes and lower BG levels; these results are consistent with findings in a sheep model that fetal catecholamines are associated with neonatal β-cell physiology and that perinatal stress or growth restriction is associated with subsequent neonatal hyperinsulinemic hypoglycemia. Improving the pathomechanistic understanding of neonatal hypoglycemia may help to guide management of newborns at risk for hypoglycemia.
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Affiliation(s)
- Henrike Hoermann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Martijn van Faassen
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcia Roeper
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Diran Herebian
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Anneke C. Muller Kobold
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Juergen Dukart
- Institute of Neuroscience and Medicine, Brain and Behavior (INM-7), Research Centre Jülich, Jülich, Germany
- Institute of Systems Neuroscience, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Ido P. Kema
- Department of Laboratory Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Sebastian Kummer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
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Sourouni M, Germeyer A, Feißt M, Balzer A, Köster H, Minte A, Brüggmann D, Kohll C, Reinhardt K, Möginger M, Leonhardt A, Banz-Jansen C, Bohlmann M, Fröhlich C, Backes C, Hager D, Kaup L, Hollatz-Galuschki E, Engelbrecht C, Markfeld-Erol F, Hagenbeck C, Schäffler H, Winkler J, Stubert J, Rathberger K, Lüber L, Hertlein L, Machill A, Richter M, Berghäuser M, Weigel M, Morgen M, Horn N, Jakubowski P, Riebe B, Ramsauer B, Sczesny R, Schäfer-Graf UM, Schrey S, Kehl S, Lastinger J, Seeger S, Parchmann O, Iannaccone A, Rohne J, Gattung L, Morfeld CA, Abou-Dakn M, Schmidt M, Glöckner M, Jebens A, Sondern KM, Pecks U, Schmitz R, Möllers M. Correction: Multiple Gestation as a Risk Factor for SARS-CoV-2-Associated Adverse Maternal Outcome: Data From the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS). Geburtshilfe Frauenheilkd 2023; 83:e42. [PMID: 38292374 PMCID: PMC10827381 DOI: 10.1055/a-2232-5598] [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: 02/01/2024] Open
Abstract
[This corrects the article DOI: 10.1055/a-2196-6224.].
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Affiliation(s)
- Marina Sourouni
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Ariane Germeyer
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | - Alexandra Balzer
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | | | - Annemarie Minte
- Department of Obstetrics and Gynecology, Cristophorus Hospital, Coesfeld, Germany
| | - Dörthe Brüggmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Celine Kohll
- Gynäkologie und Geburtshilfe, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Kristin Reinhardt
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Halle, Halle, Germany
| | - Michaela Möginger
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - Anja Leonhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Constanze Banz-Jansen
- Gynäkologie und Geburtshilfe, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Germany
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | | | - Clara Backes
- Klinik für Gynäkologie und Geburtshilfe, Schön Hospital Munich Harlaching, München, Germany
| | - Dietrich Hager
- Klinik für Gynäkologie und Geburtshilfe, Thüringen-Kliniken Saalfeld-Rudolstadt, Thüringen, Germany
| | - Lisa Kaup
- Dr. Geisenhofer Clinic for Gynecology and Obstetrics, München, Germany
| | | | | | | | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Hening Schäffler
- Klinik für Gynäkologie und Geburtshilfe, Ulm University Hospital, Ulm, Germany
| | - Jennifer Winkler
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Stubert
- Dept. of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Katharina Rathberger
- Klinik für Frauenheilkunde und Geburtshilfe, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Laura Lüber
- Klinik für Gynäkologie und Geburtshilfe, Oberschwaben Hospital Group, Ravensburg, Germany
| | - Linda Hertlein
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU, München, Germany
| | - Antonia Machill
- Department of Obstetrics and Gynecology, Vinzenz Pallotti Hospital, Bensberg, Germany
| | - Manuela Richter
- Neonatologie, Kinderkrankenhaus auf der Bult, Hannover, Germany
| | - Martin Berghäuser
- Klinik für Kinderheilkunde, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Michael Weigel
- Frauenklinik, Leopoldina-Krankenhaus der Stadt Schweinfurt GmbH, Schweinfurt, Germany
| | - Mirjam Morgen
- Klinik für Gynäkologie und Geburtshilfe, St. Vincenz-Krankenhaus, Datteln, Germany
| | - Nora Horn
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Peter Jakubowski
- Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany
| | - Bastian Riebe
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Links der Weser gGmbH, Bremen, Germany
| | - Babett Ramsauer
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Robert Sczesny
- Klinik für Gynäkologie und Geburtshilfe, Marienhaus Hospital Saint Elisabeth Neuwied, Neuwied, Germany
| | | | - Susanne Schrey
- Abteilung für Geburtsmedizin, Uniklinik Leipzig, Leipzig, Germany
| | - Sven Kehl
- Gynecology & Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Lastinger
- Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria
| | - Sven Seeger
- Klinik für Geburtshilfe, Krankenhaus St. Elisabeth und St. Barbara Halle, Halle, Germany
| | - Olaf Parchmann
- Klinik für Gynäkologie und Geburtshilfe, HELIOS Hospital Sangerhausen, Sangerhausen, Germany
| | - Antonella Iannaccone
- Klinik für Gynäkologie und Geburtshilfe, University Hospital Essen, Essen, Germany
| | - Jens Rohne
- Klinik für Gynäkologie und Geburtshilfe, Maria Heimsuchung Caritas Klinik Pankow, Berlin, Germany
| | - Luise Gattung
- Klinik für Gynäkologie und Geburtshilfe, Bad Salzungen Hospital, Bad Salzungen, Germany
| | | | - Michael Abou-Dakn
- Klinik für Gynäkologie, St. Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
| | - Markus Schmidt
- Gynecology & Obstetrics, Sana Kliniken Duisburg GmbH, Duisburg, Germany
| | - Michaela Glöckner
- Abteilung für Gynäkologie und Geburtshilfe, Hospital Memmingen, Memmingen, Germany
| | - Anja Jebens
- Abteilung für Gynäkologie und Geburtshilfe, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
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Sourouni M, Germeyer A, Feißt M, Balzer A, Köster H, Minte A, Brüggmann D, Kohll C, Reinhardt K, Möginger M, Leonhardt A, Banz-Jansen C, Bohlmann M, Fröhlich C, Backes C, Hager D, Kaup L, Hollatz-Galuschki E, Engelbrecht C, Markfeld-Erol F, Hagenbeck C, Schäffler H, Winkler J, Stubert J, Rathberger K, Lüber L, Hertlein L, Machill A, Richter M, Berghäuser M, Weigel M, Morgen M, Horn N, Jakubowski P, Riebe B, Ramsauer B, Sczesny R, Schäfer-Graf UM, Schrey S, Kehl S, Lastinger J, Seeger S, Parchmann O, Iannaccone A, Rohne J, Gattung L, Morfeld CA, Abou-Dakn M, Schmidt M, Glöckner M, Jebens A, Sondern KM, Pecks U, Schmitz R, Möllers M. Multiple Gestation as a Risk Factor for SARS-CoV-2-Associated Adverse Maternal Outcome: Data From the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS). Geburtshilfe Frauenheilkd 2023; 83:1508-1518. [PMID: 38046525 PMCID: PMC10689107 DOI: 10.1055/a-2196-6224] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/22/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Studies have shown that pregnant women with COVID-19 have a higher risk of intensive care unit admission and invasive mechanical ventilation support than non-pregnant women. Pregnancy-associated physiological changes in respiratory function may contribute to the elevated risk. Alteration in lung volumes and capacities are attributed to the mechanical impediment caused by the growing fetus. Multiple pregnancies may therefore compromise functional lung capacity earlier than singleton pregnancies and contribute to severe respiratory symptoms of COVID-19. Materials and Methods A total of 5514 women with a symptomatic SARS-CoV-2 infection during pregnancy registered in the COVID-19 Related Obstetric and Neonatal Outcome Study were included. The COVID-19-related adverse maternal outcomes were compared in 165 multiple versus 5349 singleton pregnancies. Combined adverse maternal outcome was defined as presence of COVID-19-related hospitalization and/or pneumonia and/or oxygen administration and/or transfer to ICU and/or death. Multivariate logistic regression was used to estimate the odds ratios and 95% confidence intervals were calculated. Results The frequency of dyspnea, likelihood of developing dyspnea in a defined pregnancy week and duration of the symptomatic phase of the COVID-19 infection did not differ between the two groups. On average, COVID-19-related combined adverse outcome occurred earlier during pregnancy in women expecting more than one child than in singleton pregnancies. The overall incidence of singular and combined COVID-19-associated adverse maternal outcomes was not significantly different between groups. However, regression analysis revealed that multiple gestation, preconceptional BMI > 30 kg/m 2 and gestational age correlated significantly with an increased risk of combined adverse maternal outcome. Conversely, maternal age and medically assisted reproduction were not significant risk factors for combined adverse maternal outcome. Conclusion Our data show that multiple gestation alone is a risk factor for COVID-19-associated combined adverse maternal outcome. Moreover, severe courses of COVID-19 in women expecting more than one child are observed earlier in pregnancy than in singleton pregnancies.
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Affiliation(s)
- Marina Sourouni
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Ariane Germeyer
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | - Alexandra Balzer
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | | | - Annemarie Minte
- Department of Obstetrics and Gynecology, Cristophorus Hospital, Coesfeld, Germany
| | - Dörthe Brüggmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Celine Kohll
- Gynäkologie und Geburtshilfe, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Kristin Reinhardt
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Halle, Halle, Germany
| | - Michaela Möginger
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - Anja Leonhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Constanze Banz-Jansen
- Gynäkologie und Geburtshilfe, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Germany
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | | | - Clara Backes
- Klinik für Gynäkologie und Geburtshilfe, Schön Hospital Munich Harlaching, München, Germany
| | - Dietrich Hager
- Klinik für Gynäkologie und Geburtshilfe, Thüringen-Kliniken Saalfeld-Rudolstadt, Thüringen, Germany
| | - Lisa Kaup
- Dr. Geisenhofer Clinic for Gynecology and Obstetrics, München, Germany
| | | | | | | | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Hening Schäffler
- Klinik für Gynäkologie und Geburtshilfe, Ulm University Hospital, Ulm, Germany
| | - Jennifer Winkler
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Stubert
- Dept. of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Katharina Rathberger
- Klinik für Frauenheilkunde und Geburtshilfe, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Laura Lüber
- Klinik für Gynäkologie und Geburtshilfe, Oberschwaben Hospital Group, Ravensburg, Germany
| | - Linda Hertlein
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU, München, Germany
| | - Antonia Machill
- Department of Obstetrics and Gynecology, Vinzenz Pallotti Hospital, Bensberg, Germany
| | - Manuela Richter
- Neonatologie, Kinderkrankenhaus auf der Bult, Hannover, Germany
| | - Martin Berghäuser
- Klinik für Kinderheilkunde, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Michael Weigel
- Frauenklinik, Leopoldina-Krankenhaus der Stadt Schweinfurt GmbH, Schweinfurt, Germany
| | - Mirjam Morgen
- Klinik für Gynäkologie und Geburtshilfe, St. Vincenz-Krankenhaus, Datteln, Germany
| | - Nora Horn
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Peter Jakubowski
- Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany
| | - Bastian Riebe
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Links der Weser gGmbH, Bremen, Germany
| | - Babett Ramsauer
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Robert Sczesny
- Klinik für Gynäkologie und Geburtshilfe, Marienhaus Hospital Saint Elisabeth Neuwied, Neuwied, Germany
| | | | - Susanne Schrey
- Abteilung für Geburtsmedizin, Uniklinik Leipzig, Leipzig, Germany
| | - Sven Kehl
- Gynecology & Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Lastinger
- Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria
| | - Sven Seeger
- Klinik für Geburtshilfe, Krankenhaus St. Elisabeth und St. Barbara Halle, Halle, Germany
| | - Olaf Parchmann
- Klinik für Gynäkologie und Geburtshilfe, HELIOS Hospital Sangerhausen, Sangerhausen, Germany
| | - Antonella Iannaccone
- Klinik für Gynäkologie und Geburtshilfe, University Hospital Essen, Essen, Germany
| | - Jens Rohne
- Klinik für Gynäkologie und Geburtshilfe, Maria Heimsuchung Caritas Klinik Pankow, Berlin, Germany
| | - Luise Gattung
- Klinik für Gynäkologie und Geburtshilfe, Bad Salzungen Hospital, Bad Salzungen, Germany
| | | | - Michael Abou-Dakn
- Klinik für Gynäkologie, St. Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
| | - Markus Schmidt
- Gynecology & Obstetrics, Sana Kliniken Duisburg GmbH, Duisburg, Germany
| | - Michaela Glöckner
- Abteilung für Gynäkologie und Geburtshilfe, Hospital Memmingen, Memmingen, Germany
| | - Anja Jebens
- Abteilung für Gynäkologie und Geburtshilfe, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
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Zhou H, Khan D, Hussain SM, Gerdes N, Hagenbeck C, Rana M, Cornelius JF, Muhammad S. Colchicine prevents oxidative stress-induced endothelial cell senescence via blocking NF-κB and MAPKs: implications in vascular diseases. J Inflamm (Lond) 2023; 20:41. [PMID: 38001470 PMCID: PMC10675905 DOI: 10.1186/s12950-023-00366-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Smoking, alcohol abuse, and hypertension are - among others, potential risk factors for cardiovascular diseases. These risk factors generate oxidative stress and cause oxidative stress-induced DNA damage, resulting in cellular senescence and senescence-associated secretory phenotype (SASP). The SASP factors in feed-forward response exacerbate inflammation and cause tissue remodeling, resulting in atherosclerotic plaque formation and rupture. RESULTS Colchicine inhibited ROS generation and mitigated oxidative stress-induced DNA damage. It dampened oxidative stress-induced endothelial cell senescence and improved the expression of DNA repair protein KU80 and aging marker Lamin B1. The drug attenuated the expression of senescence marker P21 at mRNA and protein levels. The pathway analysis showed that colchicine inhibited NF-κB and MAPKs pathways and subdued mTOR activation. Colchicine also attenuated mRNA expression of interleukin (IL)-1β, IL-6, IL-8, MCP-1, ICAM-1, and E-selectin. Furthermore, colchicine reduced the mRNA and protein expression of matrix metalloproteinase (MMP-2). CONCLUSION In summary, colchicine blocked oxidative stress-induced senescence and SASP by inhibiting the activation of NF-κB and MAPKs pathways.
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Affiliation(s)
- Huakang Zhou
- Department of Neurosurgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine- Universität Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Dilaware Khan
- Department of Neurosurgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine- Universität Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany.
| | - Sajid Muhammad Hussain
- Cologne Center for Genomics (CCG), University of Cologne, Weyertal 115b, 50931, Cologne, Germany
| | - Norbert Gerdes
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty and University Hospital, Heinrich-Heine-University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
- Cardiovascular Reasearch Institute Düsseldorf (CARID), Medical Faculty, Heinrich-Heine- University Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Medical Faculty, Heinrich-Heine University Düsseldorf, 40225, Düsseldorf, Germany
| | - Majeed Rana
- Department of Oral-, Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Jan Frederick Cornelius
- Department of Neurosurgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine- Universität Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
| | - Sajjad Muhammad
- Department of Neurosurgery, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine- Universität Düsseldorf, Moorenstrasse 5, 40225, Düsseldorf, Germany
- Department of Neurosurgery, University Hospital Helsinki, Topeliuksenkatu 5, Helsinki, 00260, Finland
- Department of Neurosurgery, King Edward Medical University, Lahore, Pakistan
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Zöllkau J, Heimann Y, Hagenbeck C, Pecks U, Abou-Dakn M, Schlösser R, Schohe A, Dressler-Steinbach I, Manz M, Banz-Jansen C, Reuschel E, Iannaccone A, Bohlmann MK, Kraft K, Fill Malfertheiner S, Wimberger P, Kolben T, Bartmann C, Longardt AC. Breastfeeding Behavior Within the Covid-19 Related Obstetric and Neonatal Outcome Study (CRONOS). J Hum Lact 2023; 39:625-635. [PMID: 37712573 DOI: 10.1177/08903344231190623] [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] [Indexed: 09/16/2023]
Abstract
BACKGROUND The SARS-CoV-2 pandemic and its influence on peripartum processes worldwide led to issues in breastfeeding support. RESEARCH AIM The aim of this study was to describe breastfeeding behavior and peripartum in-hospital management during the pandemic in Germany and Austria. METHODS This study was a descriptive study using a combination of secondary longitudinal data and a cross-sectional online survey. Registry data from the prospective multicenter COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS) cohort study (longitudinal, medical records of 1,815 parent-neonate pairs with confirmed SARS-CoV-2 infection during pregnancy) and a cross-sectional online survey of CRONOS hospitals' physicians (N = 67) were used for a descriptive comparison of feeding outcomes and postpartum management. RESULTS In 93.7% (n = 1700) of the cases in which information on the neonate's diet was provided, feeding was with the mother's own milk. Among neonates not receiving their mother's own milk, 24.3% (n = 26) reported SARS-CoV-2 infection as the reason. Peripartum maternal SARS-CoV-2 infection, severe maternal COVID-19 including the need for intensive care unit (ICU) treatment or invasive ventilation, preterm birth, mandatory delivery due to COVID-19, and neonatal ICU admission were associated with lower rates of breastfeeding. Rooming-in positively influenced breastfeeding without affecting neonatal SARS-CoV-2 frequency (4.2% vs. 5.6%). CRONOS hospitals reported that feeding an infant their mother's own milk continued to be supported during the pandemic. In cases of severe COVID-19, four of five hospitals encouraged breastfeeding. CONCLUSION Maintaining rooming-in and breastfeeding support services in the CRONOS hospitals during the pandemic resulted in high breastfeeding rates.
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Affiliation(s)
- Janine Zöllkau
- Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Yvonne Heimann
- Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel University, Kiel, Germany
| | - Michael Abou-Dakn
- Department of Obstetrics and Gynecology, St. Joseph-Hospital, Berlin, Germany
| | - Rolf Schlösser
- Hospital for Children and Adolescents, University Hospital of Frankfurt, Frankfurt, Germany
| | - Anna Schohe
- Department of Obstetrics and Gynecology, St. Joseph-Hospital, Berlin, Germany
| | | | - Maike Manz
- Department of Obstetrics and Gynecology, Darmstadt City Hospital, Darmstadt, Germany
| | - Constanze Banz-Jansen
- Department of Gynecology and Obstetrics, Protestant Hospital of Bethel Foundation, Bielefeld, Germany
| | - Edith Reuschel
- University Department of Obstetrics and Gynecology, The Hospital St. Hedwig of The Order of St. John, University of Regensburg, Regensburg, Germany
| | | | - Michael K Bohlmann
- Department of Obstetrics and Gynecology, St. Elisabeth' Hospital, Loerrach, Germany
| | - Katrina Kraft
- Department of Obstetrics and Gynecology, Munich Municipal Hospital, Harlaching, Munich, Germany
| | - Sara Fill Malfertheiner
- University Department of Obstetrics and Gynecology, The Hospital St. Hedwig of The Order of St. John, University of Regensburg, Regensburg, Germany
| | - Pauline Wimberger
- Department of Gynecology and Obstetrics, TU Dresden, Dresden, Germany
| | - Thomas Kolben
- Department for Obstetrics and Gynecology, University Hospital, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Catharina Bartmann
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
| | - Ann - Carolin Longardt
- Clinic for Pediatrics and Adolescent Medicine I / Neonatology, University Hospital Schleswig-Holstein, Kiel University, Kiel, Germany
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Hagenbeck C, Soff J, Mause L, Hoffmann J, Ohnhäuser T, Stöcker A, Zöllkau J, Scholten N. Gynaecologists' perceptions of outpatient gynaecologic and obstetric care in Germany during the COVID-19 pandemic. BMC Health Serv Res 2023; 23:1079. [PMID: 37817213 PMCID: PMC10566176 DOI: 10.1186/s12913-023-10045-1] [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: 02/21/2023] [Accepted: 09/18/2023] [Indexed: 10/12/2023] Open
Abstract
The measures taken to contain the COVID-19 pandemic had a major impact on society, affecting medical care as well as the utilization of medical services. We aimed to identify pandemic-related changes in gynaecologic/obstetric care through the personal experience of practitioners in the outpatient sector in Germany. Three consecutive anonymous online surveys of practising gynaecologists were conducted during the pandemic (07-09/2020, 11-12/2020 and 09-11/2021). Appointment management, medical supply and patients' demand as well as concomitant circumstances were queried. Data from 860 (393, 262 and 205 from the first, second and third surveys, respectively) respondents were analysed. At the peak of the first COVID-19 wave, more than 50% of the gynaecologists surveyed had cancelled cancer screening appointments. There was a significant association between fear of self-infection and cancellation of cancer screening appointments (p = 0.006). An increase in domestic violence was reported by 13%, an increase in obesity by 67% and more advanced tumours due to delayed screening by 24% of respondents. Primary gynaecological oncological prevention was reduced in supply and demand during the COVID-19 pandemic, and this shortfall should be addressed in future similar situations. Prenatal care has been offered continuously since the start of the pandemic in Germany.
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Affiliation(s)
- Carsten Hagenbeck
- Department of Gynaecology and Obstetrics, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
| | - Johannes Soff
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Laura Mause
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Jan Hoffmann
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Tim Ohnhäuser
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Arno Stöcker
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
| | - Janine Zöllkau
- Department of Obstetrics, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Nadine Scholten
- Faculty of Human Sciences, Faculty of Medicine and University Hospital Cologne, Institute of Medical Sociology, Health Services Research, and Rehabilitation Science, University of Cologne, Eupener Str. 129, 50933, Köln, Germany
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Zhou H, Khan D, Gerdes N, Hagenbeck C, Rana M, Cornelius JF, Muhammad S. Colchicine Protects against Ethanol-Induced Senescence and Senescence-Associated Secretory Phenotype in Endothelial Cells. Antioxidants (Basel) 2023; 12:antiox12040960. [PMID: 37107335 PMCID: PMC10135532 DOI: 10.3390/antiox12040960] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 03/13/2023] [Revised: 04/11/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Inflammaging is a potential risk factor for cardiovascular diseases. It results in the development of thrombosis and atherosclerosis. The accumulation of senescent cells in vessels causes vascular inflammaging and contributes to plaque formation and rupture. In addition to being an acquired risk factor for cardiovascular diseases, ethanol can induce inflammation and senescence, both of which have been implicated in cardiovascular diseases. In the current study, we used colchicine to abate the cellular damaging effects of ethanol on endothelial cells. Colchicine prevented senescence and averted oxidative stress in endothelial cells exposed to ethanol. It lowered the relative protein expression of aging and senescence marker P21 and restored expression of the DNA repair proteins KU70/KU80. Colchicine inhibited the activation of nuclear factor kappa B (NFκ-B) and mitogen activated protein kinases (MAPKs) in ethanol-treated endothelial cells. It reduced ethanol-induced senescence-associated secretory phenotype. In summary, we show that colchicine ameliorated the ethanol-caused molecular events, resulting in attenuated senescence and senescence-associated secretory phenotype in endothelial cells.
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Affiliation(s)
- Huakang Zhou
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Dilaware Khan
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Norbert Gerdes
- Division of Cardiology, Pulmonology and Vascular Medicine, University Hospital and Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, University Clinic, 40225 Düsseldorf, Germany
| | - Majeed Rana
- Department of Oral, Maxillofacial and Facial Plastic Surgery, University Hospital Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany
| | - Jan Frederick Cornelius
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
| | - Sajjad Muhammad
- Department of Neurosurgery, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, 40225 Düsseldorf, Germany
- Department of Neurosurgery, University Hospital Helsinki, Topeliuksenkatu 5, 00260 Helsinki, Finland
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Hoffmann J, Dresbach T, Hagenbeck C, Scholten N. Factors associated with the closure of obstetric units in German hospitals and its effects on accessibility. BMC Health Serv Res 2023; 23:342. [PMID: 37020222 PMCID: PMC10077609 DOI: 10.1186/s12913-023-09204-1] [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: 09/30/2022] [Accepted: 02/20/2023] [Indexed: 04/07/2023] Open
Abstract
BACKGROUND An increase in regionalization of obstetric services is being observed worldwide. This study investigated factors associated with the closure of obstetric units in hospitals in Germany and aimed to examine the effect of obstetric unit closure on accessibility of obstetric care. METHODS Secondary data of all German hospital sites with an obstetrics department were analyzed for 2014 and 2019. Backward stepwise regression was performed to identify factors associated with obstetrics department closure. Subsequently, the driving times to a hospital site with an obstetrics department were mapped, and different scenarios resulting from further regionalization were modelled. RESULTS Of 747 hospital sites with an obstetrics department in 2014, 85 obstetrics departments closed down by 2019. The annual number of live births in a hospital site (OR = 0.995; 95% CI = 0.993-0.996), the minimal travel time between two hospital sites with an obstetrics department (OR = 0.95; 95% CI = 0.915-0.985), the availability of a pediatrics department (OR = 0.357; 95% CI = 0.126-0.863), and population density (low vs. medium OR = 0.24; 95% CI = 0.09-0.648, low vs. high OR = 0.251; 95% CI = 0.077-0.822) were observed to be factors significantly associated with the closure of obstetrics departments. Areas in which driving times to the next hospital site with an obstetrics department exceeded the 30 and 40 min threshold slightly increased from 2014 to 2019. Scenarios in which only hospital sites with a pediatrics department or hospital sites with an annual birth volume of ≥ 600 were considered resulted in large areas in which the driving times would exceed the 30 and 40 min threshold. CONCLUSION Close distances between hospital sites and the absence of a pediatrics department at the hospital site associate with the closure of obstetrics departments. Despite the closures, good accessibility is maintained for most areas in Germany. Although regionalization may ensure high-quality care and efficiency, further regionalization in obstetrics will have an impact on accessibility.
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Affiliation(s)
- Jan Hoffmann
- Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Eupener Str. 129, 50933, Cologne, Germany.
| | - Till Dresbach
- University Hospital Bonn, Department of Neonatology and Pediatric Intensive Care Medicine, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Carsten Hagenbeck
- Department of Obstetrics and Gynecology, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Nadine Scholten
- Faculty of Medicine and University Hospital Cologne, Faculty of Human Sciences, Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Eupener Str. 129, 50933, Cologne, Germany
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10
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Pecks U, Agel L, Doubek KJ, Hagenbeck C, Jennewein L, von Kaisenberg C, Kranke P, Leitner S, Mand N, Rüdiger M, Zöllkau J, Mingers N, Sitter M, Louwen F. SARS-CoV-2 in Pregnancy, Birth and Puerperium. Guideline of the DGGG und DGPM (S2k-Level, AWMF Registry Number 015/092, March 2022). Geburtshilfe Frauenheilkd 2023. [DOI: 10.1055/a-2003-5983] [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: 03/11/2023] Open
Abstract
Abstract
Objective This S2k guideline of the German Society for Gynecology and Obstetrics (DGGG) and the German Society of Perinatal Medicine (DGPM) contains consensus-based recommendations for the care and treatment of pregnant women, parturient women, women who have recently given birth, and breastfeeding women with SARS-CoV-2 infection and their newborn infants. The aim of the guideline is to provide recommendations for action in the time of the COVID-19 pandemic for professionals caring for the above-listed groups of people.
Methods The PICO format was used to develop specific questions. A systematic targeted search of the literature was carried out using PubMed, and previously formulated statements and recommendations issued by the DGGG and the DGPM were used to summarize the evidence. This guideline also drew on research data from the CRONOS registry. As the data basis was insufficient for a purely evidence-based guideline, the guideline was compiled using an S2k-level consensus-based process. After summarizing and presenting the available data, the guideline authors drafted recommendations in response to the formulated PICO questions, which were then discussed and voted on.
Recommendations Recommendations on hygiene measures, prevention measures and care during pregnancy, delivery, the puerperium and while breastfeeding were prepared. They also included aspects relating to the monitoring of mother and child during and after infection with COVID-19, indications for thrombosis prophylaxis, caring for women with COVID-19 while they are giving birth, the presence of birth companions, postnatal care, and testing and monitoring the neonate during rooming-in or on the pediatric ward.
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Affiliation(s)
- Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Lena Agel
- Technische Hochschule Aschaffenburg, Hebammenkunde, Aschaffenburg, Germany
| | | | - Carsten Hagenbeck
- Geburtshilfe und Perinatalmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Lukas Jennewein
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Frankfurt Goethe-Universität, Frankfurt am Main, Germany
| | - Constantin von Kaisenberg
- Pränatalmedizin und Geburtshilfe im Perinatalzentrum, Universitätsklinik der Medizinischen Hochschule Hannover, Hannover, Germany
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Sabine Leitner
- Bundesverband „Das frühgeborene Kind“ e. V., Frankfurt, Germany
| | - Nadine Mand
- Philipps-Universität Marburg, Zentrum für Kinder- und Jugendmedizin, Marburg, Germany
| | - Mario Rüdiger
- Klinik für Kinder- und Jugendmedizin, Fachbereich Neonatologie und pädiatrische Intensivmedizin, Medizinische Fakultät der TU Dresden, Dresden, Germany
| | - Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Jena, Germany
| | - Nina Mingers
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Magdalena Sitter
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | - Frank Louwen
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Frankfurt Goethe-Universität, Frankfurt am Main, Germany
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11
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Schaal NK, Hagenbeck C, Helbig M, Wulff V, Märthesheimer S, Fehm T, Hepp P. The influence of being pregnant during the COVID-19 pandemic on birth expectations and antenatal bonding. J Reprod Infant Psychol 2023; 41:15-25. [PMID: 34407711 DOI: 10.1080/02646838.2021.1962825] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE The aim of the present study was to compare birth expectations and antenatal bonding of women pregnant prior to and during the COVID-19 pandemic. MATERIALS AND METHODS In total, 74 pregnant women (mean age: 33.9 ± 4.1 years, gestational age: 36 ± 2 weeks) participated in the study, who were pregnant either during the the COVID-19 pandemic (corona group, N = 35, April-July 2020) or before the pandemic (control group, N = 39, October 2017-January 2019). Birth expectations were measured using the Wijma Delivery Expectancy Questionnaire (WDEQ) and Salmon's Item List (SIL) and antenatal bonding with the Maternal Antenatal Attachment Scale (MAAS). Additionally, the corona group indicated their level of worry regarding different pandemic-related aspects using visual analogue scales. RESULTS The corona group displayed significantly elevated fear of childbirth measured by the WDEQ and lower antenatal bonding quality compared to the control group. The additional items regarding COVID-19 burdens highlighted that the aspects that the partner may not be present during labour and that no visitors will be allowed in hospital were associated with the highest worries. CONCLUSIONS Midwives and gynaecologists should be aware of the negative impact of the COVID-19 pandemic on fear of childbirth and antenatal bonding .
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Affiliation(s)
- Nora K Schaal
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Martina Helbig
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Verena Wulff
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Sarah Märthesheimer
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - Tanja Fehm
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Philip Hepp
- Clinic for Gynecology and Obstetrics, University Clinic, Augsburg, Germany.,Clinic for Gynecology and Obstetrics, HELIOS University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany
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12
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Heinen N, Marheinecke CS, Bessen C, Blazquez-Navarro A, Roch T, Stervbo U, Anft M, Plaza-Sirvent C, Busse S, Klöhn M, Schrader J, Vidal Blanco E, Urlaub D, Watzl C, Hoffmann M, Pöhlmann S, Tenbusch M, Steinmann E, Todt D, Hagenbeck C, Zimmer G, Schmidt WE, Quast DR, Babel N, Schmitz I, Pfänder S. In-depth analysis of T cell immunity and antibody responses in heterologous prime-boost-boost vaccine regimens against SARS-CoV-2 and Omicron variant. Front Immunol 2022; 13:1062210. [PMID: 36618413 PMCID: PMC9811676 DOI: 10.3389/fimmu.2022.1062210] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022] Open
Abstract
With the emergence of novel Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) Variants of Concern (VOCs), vaccination studies that elucidate the efficiency and effectiveness of a vaccination campaign are critical to assess the durability and the protective immunity provided by vaccines. SARS-CoV-2 vaccines have been found to induce robust humoral and cell-mediated immunity in individuals vaccinated with homologous vaccination regimens. Recent studies also suggest improved immune response against SARS-CoV-2 when heterologous vaccination strategies are employed. Yet, few data exist on the extent to which heterologous prime-boost-boost vaccinations with two different vaccine platforms have an impact on the T cell-mediated immune responses with a special emphasis on the currently dominantly circulating Omicron strain. In this study, we collected serum and peripheral blood mononuclear cells (PBMCs) from 57 study participants of median 35-year old's working in the health care field, who have received different vaccination regimens. Neutralization assays revealed robust but decreased neutralization of Omicron VOC, including BA.1 and BA.4/5, compared to WT SARS-CoV-2 in all vaccine groups and increased WT SARS-CoV-2 binding and neutralizing antibodies titers in homologous mRNA prime-boost-boost study participants. By investigating cytokine production, we found that homologous and heterologous prime-boost-boost-vaccination induces a robust cytokine response of CD4+ and CD8+ T cells. Collectively, our results indicate robust humoral and T cell mediated immunity against Omicron in homologous and heterologous prime-boost-boost vaccinated study participants, which might serve as a guide for policy decisions.
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Affiliation(s)
- Natalie Heinen
- Department of Molecular & Medical Virology, Ruhr University Bochum, Bochum, Germany
| | | | - Clara Bessen
- Department of Molecular Immunology, Ruhr University Bochum, Bochum, Germany
| | - Arturo Blazquez-Navarro
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital, University Hospital of the Ruhr University Bochum, Herne, Germany,BIH Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Toralf Roch
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital, University Hospital of the Ruhr University Bochum, Herne, Germany,BIH Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ulrik Stervbo
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital, University Hospital of the Ruhr University Bochum, Herne, Germany
| | - Moritz Anft
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital, University Hospital of the Ruhr University Bochum, Herne, Germany
| | | | - Sandra Busse
- Department of Molecular Immunology, Ruhr University Bochum, Bochum, Germany
| | - Mara Klöhn
- Department of Molecular & Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Jil Schrader
- Department of Molecular & Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Elena Vidal Blanco
- Department of Molecular & Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Doris Urlaub
- Department for Immunology, Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany
| | - Carsten Watzl
- Department for Immunology, Leibniz Research Centre for Working Environment and Human Factors (IfADo) at TU Dortmund, Dortmund, Germany
| | - Markus Hoffmann
- Infection Biology Unit, German Primate Center, Göttingen, Germany
| | - Stefan Pöhlmann
- Infection Biology Unit, German Primate Center, Göttingen, Germany
| | - Matthias Tenbusch
- Institut für klinische und molekulare Virologie, Universitätsklinikum Erlangen und Friedrich-Alexander-Universität (FAU) Erlangen-Nürnberg, Erlangen, Germany
| | - Eike Steinmann
- Department of Molecular & Medical Virology, Ruhr University Bochum, Bochum, Germany
| | - Daniel Todt
- Department of Molecular & Medical Virology, Ruhr University Bochum, Bochum, Germany,European Virus Bioinformatics Center, Jena, Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Gert Zimmer
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany,Department of Infectious Diseases and Pathobiology, Vetsuisse Faculty, University of Bern, Bern, Switzerland
| | | | - Daniel Robert Quast
- Department of Medicine I, St. Josef-Hospital Bochum, Ruhr University Bochum, Bochum, Germany
| | - Nina Babel
- Center for Translational Medicine and Immune Diagnostics Laboratory, Medical Department I, Marien Hospital, University Hospital of the Ruhr University Bochum, Herne, Germany,BIH Center for Regenerative Therapies, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Ingo Schmitz
- Department of Molecular Immunology, Ruhr University Bochum, Bochum, Germany,*Correspondence: Ingo Schmitz, ; Stephanie Pfänder,
| | - Stephanie Pfänder
- Department of Molecular & Medical Virology, Ruhr University Bochum, Bochum, Germany,*Correspondence: Ingo Schmitz, ; Stephanie Pfänder,
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Pecks U, Agel L, Doubek K, Hagenbeck C, von Kaisenberg C, Kranke P, Jennewein L, Louwen F, Leitner S, Mand N, Mingers N, Sitter M, Rüdiger M. COVID-19 in Schwangerschaft, Geburt und Wochenbett. Gynäkologie 2022. [PMCID: PMC9424838 DOI: 10.1007/s00129-022-04983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/29/2022]
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14
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Hoermann H, Mokwa A, Roeper M, Salimi Dafsari R, Koestner F, Hagenbeck C, Mayatepek E, Kummer S, Meissner T. Reliability and Observer Dependence of Signs of Neonatal Hypoglycemia. J Pediatr 2022; 245:22-29.e2. [PMID: 35240137 DOI: 10.1016/j.jpeds.2022.02.045] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: 12/07/2021] [Revised: 01/24/2022] [Accepted: 02/08/2022] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate, using video documentation, the sensitivity, specificity, and interobserver reliability of visualizable signs of neonatal hypoglycemia at different glucose concentrations in neonates. STUDY DESIGN In a prospective cohort study of 145 neonates with and without risk factors for hypoglycemia, 430 videos were recorded before blood glucose measurements and analyzed by 10 blinded investigators of different professions. The primary outcome measures were sensitivity and specificity for clinical detection of hypoglycemia. RESULTS The overall sensitivity to detect low blood glucose (<55 mg/dL [<3.1 mmol/L]) based on signs was 30%, and the specificity was 82%. Significantly more investigators suspected hypoglycemia while viewing videos of infants with blood glucose levels of 46-54 mg/dL (2.6-3.0 mmol/L) and 30-45 mg/dL (1.7-2.5 mmol/L) compared with ≥55 mg/dL (≥3.1 mmol/L) (29 ± 3% and 31 ± 4% vs 18 ± 1%; P = .001; P = .007). After 48 hours of life, significantly more investigators suspected hypoglycemia in videos of infants with blood glucose levels of ≤45 mg/dL (≤2.5 mmol/L) compared with blood glucose levels of >45 mg/dL (>2.5 mmol/L) (28.9 ± 8.1% vs 10.9 ± 1.8%; P = .007). For blood glucose levels 30-45 mg/dL (1.7-2.5 mmol/L), sensitivity varied widely between investigators, ranging from 5% to 62%. Three hypoglycemic episodes <30 mg/dL (<1.7 mmol/L) were only partially recognized. CONCLUSIONS Clinical observation of signs is neither sensitive nor specific to detect neonatal hypoglycemia, and there are large interobserver differences. Thus, guidelines on neonatal hypoglycemia should reconsider whether distinguishing between asymptomatic and symptomatic hypoglycemia provides useful information for the management of neonatal hypoglycemia, because it may pose a risk for systematic under-recognition and undertreatment, leading to an increased risk for neurodevelopmental impairment. TRIAL REGISTRATION German Clinical Trials Register: DRKS00021500 www.drks.de/drks_web/setLocale_EN.do.
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Affiliation(s)
- Henrike Hoermann
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf Germany
| | - Anna Mokwa
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf Germany
| | - Marcia Roeper
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf Germany
| | - Roschan Salimi Dafsari
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf Germany
| | - Felix Koestner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf Germany
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - Ertan Mayatepek
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf Germany
| | - Sebastian Kummer
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf Germany
| | - Thomas Meissner
- Department of General Pediatrics, Neonatology and Pediatric Cardiology, Medical Faculty, University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf Germany.
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15
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Zöllkau J, Hagenbeck C, Schleußner E. Impfen in der Schwangerschaft. gynäkologie + geburtshilfe 2022. [PMCID: PMC8983084 DOI: 10.1007/s15013-022-4327-y] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Carsten Hagenbeck
- Klinik für Frauenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Ekkehard Schleußner
- Klink für Geburtsmedizin, Frauenklinik am Universitätsklinikum Jena, Bachstr. 18, 07740 Jena, Germany
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16
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Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Short Version)]. Z Geburtshilfe Neonatol 2022; 226:16-24. [PMID: 35180805 DOI: 10.1055/a-1687-2233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the short version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).
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Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Deutschland
| | - Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Deutschland
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Deutschland
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Rolf Schlösser
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Deutschland
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17
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Hagenbeck C, Schleußner E, Fehm T, Baston-Büst DM, Pecks U, Zöllkau J. Evidente Informationen teilen - beratend aufklären - Familien schützen. gynäkologie + geburtshilfe 2022. [PMCID: PMC8858659 DOI: 10.1007/s15013-022-4294-3] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Carsten Hagenbeck
- Klinik für Frauenheilkunde, Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Ekkehard Schleußner
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Tanja Fehm
- Universitätsklinikum Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Germany
| | - Dunja Maria Baston-Büst
- Universitätsklinikum Düsseldorf, Univ. interdisziplinäres Kinderwunschzentrum DDF, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe,Universitätsklinikum Schleswig-Holstein, Arnold-Heller-Straße 3, 24105 Kiel, Germany
| | - Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
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18
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Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Recommendations for SARS-CoV-2/COVID-19 during Pregnancy, Birth and Childbed - Update November 2021 (Long Version)]. Z Geburtshilfe Neonatol 2021; 226:e1-e35. [PMID: 34918334 DOI: 10.1055/a-1688-9398] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Since the onset of the SARS-CoV-2 pandemic, the German Society of Gynecology and Obstetrics and the Society for Peri-/Neonatal Medicine have published and repeatedly updated recommendations for the management of SARS-CoV-2 positive pregnancies and neonates. As a continuation of existing recommendations, the current update addresses key issues related to the prenatal, perinatal, and postnatal care of pregnant women, women who have given birth, women who have recently given birth, women who are breastfeeding with SARS-CoV-2 and COVID-19, and their unborn or newborn infants, based on publications through September 2021. Recommendations and opinions were carefully derived from currently available scientific data and subsequently adopted by expert consensus. This guideline - here available in the long version - is intended to be an aid to clinical decision making. Interpretation and therapeutic responsibility remain with the supervising local medical team, whose decisions should be supported by these recommendations. Adjustments may be necessary due to the rapid dynamics of new evidence. The recommendations are supported by the endorsement of the professional societies: German Society for Perinatal Medicine (DGPM), German Society of Gynecology and Obstetrics (DGGG), German Society for Prenatal and Obstetric Medicine (DGPGM), German Society for Pediatric Infectiology (DGPI), Society for Neonatology and Pediatric Intensive Care Medicine (GNPI).
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Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena, Deutschland
| | - Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Deutschland
| | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin, Universitätsklinikum Hamburg-Eppendorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Campus Kiel, Universitätsklinikum Schleswig-Holstein, Deutschland
| | - Dietmar Schlembach
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Deutschland
| | - Arne Simon
- Klinik für Pädiatrische Onkologie und Hämatologie, Universitätsklinikum des Saarlandes, Homburg/Saar, Deutschland
| | - Rolf Schlösser
- Schwerpunkt Neonatologie, Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Deutschland
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19
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Hagenbeck C, Hamza A, Kehl S, Maul H, Lammert F, Keitel V, Hütten MC, Pecks U. Management of Intrahepatic Cholestasis of Pregnancy: Recommendations of the Working Group on Obstetrics and Prenatal Medicine - Section on Maternal Disorders. Geburtshilfe Frauenheilkd 2021; 81:922-939. [PMID: 34393256 PMCID: PMC8354365 DOI: 10.1055/a-1386-3912] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 02/05/2021] [Indexed: 02/07/2023] Open
Abstract
Intrahepatic cholestasis of pregnancy (ICP) is the most common liver disease specific to pregnancy. The cardinal symptom of pruritus and a concomitant elevated level of bile acids in the serum and/or alanine aminotransferase (ALT) are suggestive for the diagnosis. Overall, the maternal prognosis is good. The fetal outcome depends on the bile acid level. ICP is associated with increased risks for adverse perinatal outcomes, including preterm delivery, meconium-stained amniotic fluid, and stillbirth. Acute fetal asphyxia and not chronic uteroplacental dysfunction leads to stillbirth. Therefore, predictive fetal monitoring is not possible. While medication with ursodeoxycholic acid (UDCA) improves pruritus, it has not been shown to affect fetal outcome. The indication for induction of labour depends on bile acid levels and gestational age. There is a high risk of recurrence in subsequent pregnancies.
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Affiliation(s)
| | - Amr Hamza
- Universitätsklinikum des Saarlandes, Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Homburg, Germany
- Kantonsspital Baden AG, Baden, Switzerland
| | - Sven Kehl
- Frauenklinik, Friedrich Alexander University Erlangen Nuremberg, Faculty of Medicine, Erlangen, Germany
| | - Holger Maul
- Section of Prenatal Disgnostics and Therapy, Asklepios Klinik Barmbek, Hamburg, Germany
| | - Frank Lammert
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Homburg, Germany
| | - Verena Keitel
- Universitätsklinikum Düsseldorf, Klinik für Gastroenterologie, Hepatologie und Infektiologie, Düsseldorf, Germany
| | - Matthias C. Hütten
- Clinique E2 Neonatology, Maastricht Universitair Medisch Centrum+, Maastricht, Netherlands
| | - Ulrich Pecks
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
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20
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Hagenbeck C, Pecks U, Lammert F, Hütten MC, Borgmeier F, Fehm T, Schleußner E, Maul H, Kehl S, Hamza A, Keitel V. [Intrahepatic cholestasis of pregnancy]. Gynakologe 2021; 54:341-356. [PMID: 33896963 PMCID: PMC8056200 DOI: 10.1007/s00129-021-04787-4] [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] [Subscribe] [Scholar Register] [Accepted: 03/08/2021] [Indexed: 12/19/2022]
Abstract
Die Schwangerschaftscholestase („intrahepatic cholestasis of pregnancy“, ICP) ist die häufigste schwangerschaftsspezifische Lebererkrankung. Das Leitsymptom Juckreiz sowie eine begleitende Serumkonzentrationserhöhung von Gallensäuren und/oder der Alaninaminotransferase (ALT) sind wegweisend in der Diagnosestellung. Die mütterliche Prognose ist gut. Das fetale Outcome ist abhängig von der Gallensäurenkonzentration. Die ICP ist dabei sowohl mit Frühgeburt als auch mit intrauterinem Fruchttod (IUFT) assoziiert. Dieser ist Folge einer akuten fetalen Asphyxie, nicht einer chronischen uteroplazentaren Dysfunktion. Ein prädiktives Monitoring, z. B. durch Kardiotokographie (CTG) oder Ultraschall gibt es nicht. Eine medikamentöse Therapie mit Ursodeoxycholsäure (UDCA) bessert den Juckreiz, aber beeinflusst das fetale Outcome nicht nachweislich. Eine Entbindungsindikation ist in Abhängigkeit von Gallensäurenkonzentration und Gestationsalter gegeben. In Folgeschwangerschaften besteht ein hohes Wiederholungsrisiko.
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Affiliation(s)
- Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Deutschland
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland
| | - Frank Lammert
- Klinik für Innere Medizin II, Universitätsklinikum des Saarlandes, Universität des Saarlandes, Homburg, Deutschland
| | - Matthias C. Hütten
- Neonatologie, Maastricht Universitair Medisch Centrum+, Maastricht, Niederlande
| | - Felix Borgmeier
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Deutschland
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Deutschland
| | | | - Holger Maul
- Frauenklinik, Asklepios Kliniken Barmbek, Wandsbek und Nord-Heidberg, Hamburg, Deutschland
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland
| | - Amr Hamza
- Kantonsspital Baden, Baden, Schweiz
- Klinikum für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universität des Saarlandes, Homburg, Deutschland
| | - Verena Keitel
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universität Düsseldorf, Düsseldorf, Deutschland
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21
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Hagenbeck C, Pecks U, Fehm T, Borgmeier F, Schleußner E, Zöllkau J. Im Zeichen der Pandemie. Heb Wiss 2020. [PMCID: PMC7649567 DOI: 10.1007/s43877-020-0008-z] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Affiliation(s)
- Carsten Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Tanja Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
| | - Felix Borgmeier
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Düsseldorf, Germany
| | | | - Janine Zöllkau
- Klinik für Geburtsmedizin, Universität Jena, Jena, Germany
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22
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Bizjak G, Borgmeier F, Hagenbeck C. Analyse von Effektivität und Outcome von Kind und Mutter bei Geburtseinleitung mit Misoprostol-Tablette im Vergleich zu Minprostin Vaginalgel. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- G Bizjak
- Universitätsklinik Düsseldorf, Frauenklinik
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Borgmeier F, Horst de Cuestas S, Bizjak G, Fehm T, Hagenbeck C. Geburtshilfliches Outcome der äußeren Wendung. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- F Borgmeier
- Universitätsklinikum Düsseldorf, Frauenklinik
| | | | - G Bizjak
- Universitätsklinikum Düsseldorf, Frauenklinik
| | - T Fehm
- Universitätsklinikum Düsseldorf, Frauenklinik
| | - C Hagenbeck
- Universitätsklinikum Düsseldorf, Frauenklinik
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Zöllkau J, Hagenbeck C, Hecher K, Pecks U, Schlembach D, Simon A, Schlösser R, Schleußner E. [Update on Recommendations for SARS-CoV-2/COVID-19 During Pregnancy, Birth and Childbed]. Z Geburtshilfe Neonatol 2020; 224:217-222. [PMID: 32838449 PMCID: PMC7516367 DOI: 10.1055/a-1199-6404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/26/2020] [Indexed: 02/07/2023]
Abstract
With begin of the SARS-CoV-2 pandemic the german obstetric, peri-/neonatological and pediatric professional societies published recommendations for care of pregnant and newborn, as well as for necessary staff protection in March 2020 [1-3]. Because of the rapid emerging increase of knowledge an update is required. This work therefore perceives as prosecution of the existing recommendations [1-3].Worldwide national recommendations were recently compared and published in a consensual review [4]. In methodological dependence this update of recommendations comments on key questions of pre-, peri- and postnatal care at SARS-CoV-2 and COVID-19, based on publications up to 30.05.2020. Statements represent a carefully concerned expert consensus and can change contemporary as new knowledge appears.The responsibility for concrete management remains at the local medical team, decisions should be supported by these recommendations.
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Affiliation(s)
| | | | - Kurt Hecher
- Klinik für Geburtshilfe und Pränatalmedizin,
Universitätsklinikum Hamburg-Eppendorf
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | | | - Arne Simon
- Klinik für Pädiatrische Onkologie und
Hämatologie, Universitätsklinikum des Saarlandes,
Homburg/Saar
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Schwerpunkt Neonatologie,
Universitätsklinikum Frankfurt
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Hagenbeck C, Hecher K, Pecks U, Schlembach D, Schleußner E, Schlösser R, Zöllkau J. DGGG und weitere Fachgesellschaften – Aktualisierte Empfehlungen zu SARS-CoV-2/COVID-19 in Schwangerschaft, Geburt und Wochenbett. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/a-1214-4878] [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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26
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Affiliation(s)
- C. Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - U. Pecks
- Campus Kiel, Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Schleswig-Holstein, Kiel, Deutschland
| | - T. Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - F. Borgmeier
- Klinik für Frauenheilkunde und Geburtshilfe, Universität Düsseldorf, Moorenstr. 5, 40225 Düsseldorf, Deutschland
| | - E. Schleußner
- Klinik für Geburtsmedizin, Universität Jena, Jena, Deutschland
| | - J. Zöllkau
- Klinik für Geburtsmedizin, Universität Jena, Jena, Deutschland
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Schaal NK, Hepp P, Heil M, Wolf OT, Hagenbeck C, Fleisch M, Fehm T. Perioperative anxiety and length of hospital stay after caesarean section - A cohort study. Eur J Obstet Gynecol Reprod Biol 2020; 248:252-256. [PMID: 32283431 DOI: 10.1016/j.ejogrb.2020.03.045] [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] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/19/2020] [Accepted: 03/25/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The caesarean section is one of the most frequently performed surgeries. Due to growing economic challenges, hospitals are encouraged to improve their cost-efficiency. One factor that influences hospital costs of caesarean sections is a prolonged hospital stay. STUDY DESIGN The aim of the current prospective study was to investigate psychosocial factors, with an emphasis on anxiety, and sociodemographic factors that are associated with longer hospital stay after caesarean sections with no medical complications. Data of 195 women who gave birth by caesarean section was analyzed. As possible predictors anxiety levels measured pre-, peri- and postoperative as well as age, parity (primiparous/multiparous), repeated caesarean (yes/no), BMI (<30/ ≥30), STAI-Trait scores, duration of surgery, PH arterial and Apgar 5 min. were entered into a backward linear regression with duration of hospital stay as the dependent factor. RESULTS The analysis revealed that higher age, primiparity as well as higher anxiety scores during the postoperative phase are significant factors associated with prolonged hospital stay. The significant model explains 22.1 % of the variance. CONCLUSION The results should sensitize the medical team to these risk factors in order to improve patients' recovery and shorten hospital stays.
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Affiliation(s)
- N K Schaal
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany.
| | - P Hepp
- Clinic for Gynecology and Obstetrics, HELIOS University Clinic, Wuppertal, University Witten/Herdecke, Germany; Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany; Clinic for Gynecology and Obstetrics, University Clinic, Augsburg, Germany
| | - M Heil
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - O T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Germany
| | - C Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - M Fleisch
- Clinic for Gynecology and Obstetrics, HELIOS University Clinic, Wuppertal, University Witten/Herdecke, Germany
| | - T Fehm
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
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Schaal NK, Fehm T, Wolf OT, Gielen P, Hagenbeck C, Heil M, Fleisch M, Hepp P. Comparing the course of anxiety in women receiving their first or repeated caesarean section: A prospective cohort study. Women Birth 2019; 33:280-285. [PMID: 31176587 DOI: 10.1016/j.wombi.2019.05.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/05/2018] [Revised: 02/15/2019] [Accepted: 05/22/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Around 30% of births are through caesarean section and repetition rates for receiving a caesarean section are high. AIM The aim of the prospective study was to compare the course of anxiety in women undergoing their first caesarean section and women experiencing a repeated caesarean section. PARTICIPANTS 304 women with an indication for an elective caesarean section took part. 155 received their first caesarean section and 149 received a repeated caesarean section. METHODS In order to measure the course of anxiety on the day of the caesarean section subjective anxiety levels were measured and saliva samples for cortisol determination were taken at admission, during skin closure and two hours after the surgery. Blood pressure and heart rate were documented at skin incision and skin closure. RESULTS Women experiencing their first caesarean section displayed significantly higher anxiety levels compared to women with a repeated caesarean section. Scores of the STAI-State and visual analogue scale for anxiety differed significantly at admission (p=.006 and p<.001) and heart rate and alpha amylase levels were significantly higher at skin closure (p=.027 and p=.029). CONCLUSION The results show that previous experience with a caesarean section has a soothing effect. The study aims to sensitize surgeons, anesthetists, nurses and midwives when treating women receiving a caesarean section and encourage them to incorporate soothing interventions, especially for women receiving their first caesarean section to reduce anxiety levels and consequently improve postoperative recovery and patients' satisfaction.
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Affiliation(s)
- N K Schaal
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany.
| | - T Fehm
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - O T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Germany
| | - P Gielen
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - C Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - M Heil
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
| | - M Fleisch
- Clinic for Gynecology and Obstetrics, HELIOS University Clinic, Wuppertal, University Witten/Herdecke, Germany
| | - P Hepp
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany; Clinic for Gynecology and Obstetrics, HELIOS University Clinic, Wuppertal, University Witten/Herdecke, Germany
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Schipper-Kochems S, Fehm T, Bizjak G, Fleitmann AK, Balan P, Hagenbeck C, Schäfer R, Franz M. Postpartum Depressive Disorder - Psychosomatic Aspects. Geburtshilfe Frauenheilkd 2019; 79:375-381. [PMID: 31000882 PMCID: PMC6461464 DOI: 10.1055/a-0759-1981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 07/11/2018] [Revised: 09/19/2018] [Accepted: 10/16/2018] [Indexed: 01/20/2023] Open
Abstract
Postpartum depression (PPD) is the most common mental illness in mothers following the birth of a child. Since the symptoms of PPD are similar to the normal stress of healthy women following childbirth, it is often difficult for the attending gynaecologist or midwife to diagnose this illness in a timely manner and thus initiate adequate treatment and comprehensive support for the patient. Even if there are options for a screening using evaluated questionnaires and subsequent psychotherapy and/or drug therapy in the treatment of PPD which has proven effective, it is seen that, in most treatment approaches, little consideration is given to the affect-controlled interaction and the bonding behaviour between mother and child. This article presents diagnostic measures and current therapeutic approaches as well as their integration in practice in order to achieve awareness of this topic in everyday clinical practice and show the pathways of appropriate treatment. Specific multiprofessional treatment approaches which centre on the mother-child relationship demonstrate successes with regard to depression in the mothers and also on the development of a secure mother-child bond and are thus a protective factor in the development of the affected children. The now well-known effects of PPD on the fathers as well as the negative impacts of paternal depression on child development make it clear that the treatment should not focus solely on maternal depression, but also always on the family bond between the mother, child and father in the treatment.
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Affiliation(s)
- Stephanie Schipper-Kochems
- Clinical Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Gabriele Bizjak
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Ann Kristin Fleitmann
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Percy Balan
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich-Heine University, Düsseldorf, Germany
| | - Ralf Schäfer
- Clinical Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Matthias Franz
- Clinical Institute for Psychosomatic Medicine and Psychotherapy, University Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
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Hepp P, Hagenbeck C, Gilles J, Wolf OT, Goertz W, Janni W, Balan P, Fleisch M, Fehm T, Schaal NK. Effects of music intervention during caesarean delivery on anxiety and stress of the mother a controlled, randomised study. BMC Pregnancy Childbirth 2018; 18:435. [PMID: 30390639 PMCID: PMC6215648 DOI: 10.1186/s12884-018-2069-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [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: 08/01/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022] Open
Abstract
Background Stress and anxiety during pregnancy and childbirth have negative consequences for both mother and child. There are indications that music has a positive effect in this situation. The present study investigates the influence of music during the caesarean on anxiety and stress of the expectant mother. Methods The SAMBA study is a single-centre, controlled, randomized study including 304 patients. Women in the intervention group heard music via loudspeakers from one of four self-selected genres. The control group had standard treatment without music. The caesarean was performed in regional Anesthesia. At admission, at skin incision, during skin suture and two hours after completion of surgery, different subjective (State-Trait Anxiety Inventory, visual analogue scale for anxiety) and objective parameters (salivary cortisol/amylase, heart rate, blood pressure) were collected. Mixed-factorial Analysis of variances as well as independent sample t-tests were applied for data analysis. Results At skin suture, significantly lower anxiety levels were reported in the intervention group regarding State anxiety (31.56 vs. 34.41; p = .004) and visual analogue scale for anxiety (1.27 vs. 1.76; p = .018). Two hours after surgery, the measured visual analogue scale for anxiety score in the intervention group was still significantly lower (0.69 vs. 1.04; p = .018). The objective parameters showed significant differences between the groups in salivary cortisol increase from admission to skin suture (12.29 vs. 16.61 nmol/L; p = .043), as well as systolic blood pressure (130.11 vs. 136.19 mmHg; p = .002) and heart rate (88.40 vs. 92.57/min; p = .049) at skin incision. Conclusions Music during caesarean is an easy implementable and effective way of reducing stress and anxiety of the expectant mother. Trial registration German registry for clinical trials (DRKS00007840). Registered 16/06/2015. Retrospectively registered.
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Affiliation(s)
- Philip Hepp
- Clinic for Gynecology and Obstetrics, Helios University Hospital Wuppertal, University Witten/Herdecke, Heusnerstr 40, 42283, Wuppertal, Germany. .,Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany.
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Julius Gilles
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Wolfram Goertz
- Musikerambulanz, Heinrich-Heine-University, Düsseldorf, Germany
| | - Wolfgang Janni
- Clinic for Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Percy Balan
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Markus Fleisch
- Clinic for Gynecology and Obstetrics, Helios University Hospital Wuppertal, University Witten/Herdecke, Heusnerstr 40, 42283, Wuppertal, Germany
| | - Tanja Fehm
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Nora K Schaal
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
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31
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Schaal NK, Fehm T, Wolf OT, Gielen P, Hagenbeck C, Heil M, Fleisch M, Hepp P. Comparing the course of anxiety in women receiving their first compared to repeated caesarean section: a prospective study. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- NK Schaal
- Heinrich-Heine-University Düsseldorf, Department of Experimental Psychology, Düsseldorf, Deutschland
| | - T Fehm
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Deutschland
| | - OT Wolf
- Faculty of Psychology, Ruhr-University Bochum, Bochum, Deutschland
| | - P Gielen
- Heinrich-Heine-University Düsseldorf, Department of Experimental Psychology, Düsseldorf, Deutschland
| | - C Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Deutschland
| | - M Heil
- Heinrich-Heine-University Düsseldorf, Department of Experimental Psychology, Düsseldorf, Deutschland
| | - M Fleisch
- Clinic for Gynecology and Obstetrics, HELIOS University Clinic, Wuppertal, Deutschland
| | - P Hepp
- Clinic for Gynecology and Obstetrics, HELIOS University Clinic, Wuppertal, Deutschland
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32
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Hepp P, Hagenbeck C, Gilles J, Wolf OT, Goertz W, Janni W, Balan P, Fleisch M, Fehm T, Schaal NK. Effects of music intervention during caesarean section on anxiety and stress of the expectant mother – A prospective, controlled, randomized study. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- P Hepp
- Helios Universitätsklinikum Wuppertal, Landesfrauenklinik, Wuppertal, Deutschland
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Deutschland
| | - C Hagenbeck
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Deutschland
| | - J Gilles
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Deutschland
| | - OT Wolf
- Ruhr-Universität Bochum, Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Bochum, Deutschland
| | - W Goertz
- Universitätsklinikum Düsseldorf, Musikerambulanz, Düsseldorf, Deutschland
| | - W Janni
- Universitätsklinikum Ulm, Frauenklinik, Ulm, Deutschland
| | - P Balan
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Deutschland
| | - M Fleisch
- Helios Universitätsklinikum Wuppertal, Landesfrauenklinik, Wuppertal, Deutschland
| | - T Fehm
- Universitätsklinikum Düsseldorf, Frauenklinik, Düsseldorf, Deutschland
| | - NK Schaal
- Heinrich-Heine- Universität Düsseldorf, Experimentelle Psychologie, Düsseldorf, Deutschland
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Helbig M, Borgmeier F, Volkmer A, Hagenbeck C, Fehm T. 29-jährige GI in der 21+1 SSW mit intrauterinem Fruchttod (IUFT) und Erstdiagnose einer thrombotisch-thrombozytopenischen Purpura (TTP). Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- M Helbig
- Universitäts-Frauenklinik Düsseldorf, Düsseldorf, Deutschland
| | - F Borgmeier
- Universitäts-Frauenklinik Düsseldorf, Düsseldorf, Deutschland
| | - A Volkmer
- Universitäts-Frauenklinik Düsseldorf, Düsseldorf, Deutschland
| | - C Hagenbeck
- Universitäts-Frauenklinik Düsseldorf, Düsseldorf, Deutschland
| | - T Fehm
- Universitäts-Frauenklinik Düsseldorf, Düsseldorf, Deutschland
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Mehrnami S, Hagenbeck C, Fehm T, Ruckhäberle E, Bizjak G. Wehencocktail vs. herkömmliche Geburtseinleitung: Analyse des geburtshilflichen Outcomes. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- S Mehrnami
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Düsseldorf, Düsseldorf, Deutschland
| | - C Hagenbeck
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Düsseldorf, Düsseldorf, Deutschland
| | - T Fehm
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Düsseldorf, Düsseldorf, Deutschland
| | - E Ruckhäberle
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Düsseldorf, Düsseldorf, Deutschland
| | - G Bizjak
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Düsseldorf, Düsseldorf, Deutschland
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Hepp P, Fasching PA, Beckmann MW, Fehm T, Salmen J, Hagenbeck C, Jäger B, Widschwendter P, de Gregorio N, Schochter F, Mahner S, Harbeck N, Weissenbacher T, Kurt AG, Friedl TWP, Janni W, Rack B. Use of Granulocyte-colony Stimulating Factor During Chemotherapy and Its Association With CA27.29 and Circulating Tumor Cells-Results From the SUCCESS A Trial. Clin Breast Cancer 2018; 18:e1103-e1110. [PMID: 30017795 DOI: 10.1016/j.clbc.2018.06.006] [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: 10/12/2017] [Revised: 04/30/2018] [Accepted: 06/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Little is known about the effect of granulocyte colony-stimulating factor (G-CSF) treatment during adjuvant chemotherapy on prognostic markers. The present study explored the association between G-CSF and changes in cancer antigen (CA)27.29 and circulating tumor cell (CTC) levels during therapy. PATIENTS AND METHODS A total of 3754 node-positive or high-risk node-negative early-stage breast cancer patients were treated within the SUCCESS-A trial (simultaneous study of gemcitabine-docetaxel combination adjuvant treatment, as well as extended bisphosphonate and surveillance-trial). CA27.29 and CTCs were determined before the start and within 6 weeks after the end of chemotherapy. RESULTS Overall, 1324 of the 2646 patients (50.0%) available for analysis had ≥ 1 G-CSF applications during chemotherapy. G-CSF application was significantly associated with CA27.29 status before and after chemotherapy (χ2 = 30.6, df = 3; P < .001), because 238 patients (18.0%) with G-CSF treatment but only 146 (11.0%) without G-CSF treatment switched from a negative CA27.29 status before to a positive CA27.29 status after chemotherapy. In addition, patients with G-CSF application showed a significantly greater increase in CA27.29 levels after chemotherapy compared with patients without any G-CSF application during chemotherapy (Mann-Whitney U test; Z = -7.81, P < .001). No significant association was found between G-CSF application and CTC status before or after chemotherapy (χ2 = 1.2, df = 3; P = .75). CONCLUSION Cautious interpretation is needed regarding elevated levels of MUC-1-derived tumor markers such as CA27.29 shortly after adjuvant chemotherapy when G-CSF has been given, because G-CSF treatment was associated with increased CA27.29 levels after chemotherapy.
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Affiliation(s)
- Philip Hepp
- Department of Gynecology and Obstetrics, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany.
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen and Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen and Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - Tanja Fehm
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Jessica Salmen
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Bernadette Jäger
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Peter Widschwendter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | | | - Fabienne Schochter
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Sven Mahner
- Department of Gynecology and Obstetrics, University Hospital Ludwig Maximilian University of Munich, Munich, Germany
| | - Nadia Harbeck
- Department of Gynecology and Obstetrics, University Hospital Ludwig Maximilian University of Munich, Munich, Germany
| | - Tobias Weissenbacher
- Department of Gynecology and Obstetrics, University Hospital Ludwig Maximilian University of Munich, Munich, Germany
| | - Ayse-Gül Kurt
- Department of Gynecology and Obstetrics, University Hospital Ludwig Maximilian University of Munich, Munich, Germany
| | - Thomas W P Friedl
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
| | - Brigitte Rack
- Department of Gynecology and Obstetrics, University Hospital Ulm, Ulm, Germany
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Rahman MS, Spitzhorn LS, Wruck W, Hagenbeck C, Balan P, Graffmann N, Bohndorf M, Ncube A, Guillot PV, Fehm T, Adjaye J. The presence of human mesenchymal stem cells of renal origin in amniotic fluid increases with gestational time. Stem Cell Res Ther 2018; 9:113. [PMID: 29695308 PMCID: PMC5918774 DOI: 10.1186/s13287-018-0864-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 01/24/2018] [Revised: 03/19/2018] [Accepted: 04/10/2018] [Indexed: 12/17/2022] Open
Abstract
Background Established therapies for managing kidney dysfunction such as kidney dialysis and transplantation are limited due to the shortage of compatible donated organs and high costs. Stem cell-based therapies are currently under investigation as an alternative treatment option. As amniotic fluid is composed of fetal urine harboring mesenchymal stem cells (AF-MSCs), we hypothesized that third-trimester amniotic fluid could be a novel source of renal progenitor and differentiated cells. Methods Human third-trimester amniotic fluid cells (AFCs) were isolated and cultured in distinct media. These cells were characterized as renal progenitor cells with respect to cell morphology, cell surface marker expression, transcriptome and differentiation into chondrocytes, osteoblasts and adipocytes. To test for renal function, a comparative albumin endocytosis assay was performed using AF-MSCs and commercially available renal cells derived from kidney biopsies. Comparative transcriptome analyses of first, second and third trimester-derived AF-MSCs were conducted to monitor expression of renal-related genes. Results Regardless of the media used, AFCs showed expression of pluripotency-associated markers such as SSEA4, TRA-1-60, TRA-1-81 and C-Kit. They also express the mesenchymal marker Vimentin. Immunophenotyping confirmed that third-trimester AFCs are bona fide MSCs. AF-MSCs expressed the master renal progenitor markers SIX2 and CITED1, in addition to typical renal proteins such as PODXL, LHX1, BRN1 and PAX8. Albumin endocytosis assays demonstrated the functionality of AF-MSCs as renal cells. Additionally, upregulated expression of BMP7 and downregulation of WT1, CD133, SIX2 and C-Kit were observed upon activation of WNT signaling by treatment with the GSK-3 inhibitor CHIR99201. Transcriptome analysis and semiquantitative PCR revealed increasing expression levels of renal-specific genes (e.g., SALL1, HNF4B, SIX2) with gestational time. Moreover, AF-MSCs shared more genes with human kidney cells than with native MSCs and gene ontology terms revealed involvement of biological processes associated with kidney morphogenesis. Conclusions Third-trimester amniotic fluid contains AF-MSCs of renal origin and this novel source of kidney progenitors may have enormous future potentials for disease modeling, renal repair and drug screening. Electronic supplementary material The online version of this article (10.1186/s13287-018-0864-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Md Shaifur Rahman
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Lucas-Sebastian Spitzhorn
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Wasco Wruck
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Carsten Hagenbeck
- Department of Obstetrics and Gynaecology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Percy Balan
- Department of Obstetrics and Gynaecology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Nina Graffmann
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Martina Bohndorf
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Audrey Ncube
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Pascale V Guillot
- Institute for Women's Health, Maternal and Fetal Medicine Department, University College London, London, WC1E 6HX, UK
| | - Tanja Fehm
- Department of Obstetrics and Gynaecology, Medical Faculty, Heinrich Heine University Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - James Adjaye
- Institute for Stem Cell Research and Regenerative Medicine, Medical Faculty, Heinrich Heine University, Moorenstraße 5, 40225, Düsseldorf, Germany.
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van Rensburg R, Naskou J, Hagenbeck C, Neubauer H, Niederacher D, Fehm T, Beyer I. Characterization of third-trimester amniotic fluid stem cells. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Jäger B, Andergassen U, Neugebauer J, Alunni-Fabbroni M, Melcher C, Hagenbeck C, Albrecht S, Lorenz R, Decker T, Heinrich G, Fehm T, Schneeweiss A, Beckmann MW, Pantel K, Friese K, Fasching PA, Friedl TWP, Janni W, Rack BK. Persistenz zirkulierender Tumorzellen direkt nach und zwei Jahre nach adjuvanter Chemotherapie bei Patientinnen mit früher Brustkrebserkrankung – Ergebnisse der SUCCESS Studien. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hagenbeck C, Märthesheimer S, Schaal N, Burghardt B, Stevens F, Kreuzer V, Gilles J, Balan P, Goertz W, Wolf OT, Fehm T, Hepp P. Musikbegleittherapie bei Sectio caesarea und ihre Auswirkungen auf Angst: eine Pilotstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Hepp P, Hagenbeck C, Burghardt B, Jaeger B, Wolf OT, Fehm T, Schaal NK. Measuring the course of anxiety in women giving birth by caesarean section: a prospective study. BMC Pregnancy Childbirth 2016; 16:113. [PMID: 27188222 PMCID: PMC4870728 DOI: 10.1186/s12884-016-0906-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [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: 01/07/2016] [Accepted: 05/13/2016] [Indexed: 11/11/2022] Open
Abstract
Background Women undergoing elective caesarean section experience anxiety. However, course, extent and duration of anxiety have not been investigated yet. This study aimed to explore anxiety levels during the course of the day of surgery by employing and comparing subjective as well as objective measures. By examining their correlation it is intended to give methodological support for interventional studies. Methods This is a monocentric, prospectively planned study in which 47 women with an indication for primary caesarean section took part. Anxiety levels were evaluated using the State-Trait Anxiety Inventory (STAI-trait and STAI-state), the visual analogue scale for anxiety (VASA) as well as saliva cortisol at three time points on the day of the caesarean section (at admission, at skin closure and 2 h post surgery). Results Peak anxiety levels for the STAI-state and VASA were highest at admission and showed significant decreases to skin closure (p < .001). The subjective measures correlated significantly at all time points (p-values < .001). For cortisol levels the peak level of anxiety was shown at skin closure with a significant increase from admission to skin closure and a significant decrease from skin closure to 2 h post operation (p-values < .001). Additionally women with STAI-trait scores above the median showed significantly higher levels at the peaks of anxiety. Conclusion The study reveals the course of anxiety on the day of the caesarean section. A strong correlation of STAI-state and VASA was demonstrated. Cortisol showed a different course, which fits into its known biological kinetics. Taking into account all measures, anxiety seems to be most bothersome before surgery until skin closure. In a differentiated approach using STAI-trait scores as a discriminator we showed that the group with STAI-trait levels above the median is particularly prone to develop anxiety in the setting of the caesarean section and might therefore mostly be in need of an intervention against anxiety.
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Affiliation(s)
- Philip Hepp
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany. .,Clinic for Gynecology and Obstetrics, HELIOS Universitätsklinikum Wuppertal, University Witten/Herdecke, Vogelsangstr. 109, 42109, Wuppertal, Germany.
| | - Carsten Hagenbeck
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Bettina Burghardt
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Bernadette Jaeger
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Oliver T Wolf
- Department of Cognitive Psychology, Institute of Cognitive Neuroscience, Faculty of Psychology, Ruhr-University Bochum, Bochum, Germany
| | - Tanja Fehm
- Clinic for Gynecology and Obstetrics, Heinrich-Heine-University, Düsseldorf, Germany
| | - Nora K Schaal
- Department of Experimental Psychology, Heinrich-Heine-University, Düsseldorf, Germany
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Märthesheimer S, Hagenbeck C, Gilles J, Goertz W, Wolf OT, Fehm T, Schaal N, Hepp P. Musikbegleittherapie bei Sectio caesarea und ihre Auswirkungen auf Angst: eine Pilotstudie. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1571382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Jaeger BAS, Albrecht S, Schochter F, Melcher CA, Hagenbeck C, Friedl TWP, Rack B, Müller V, Fasching PA, Janni W, Fehm T. Abstract OT1-2-03: The DETECT-study concept: Treatment based on the phenotype of circulating tumor cells in HER2-negative metastatic breast cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-ot1-2-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The prognostic impact of circulating tumor cells (CTC) in metastatic breast cancer (MBC) is well demonstrated. The role of CTCs in predicting specific treatment response and the importance of CTC phenotypes for therapeutic decisions will be investigated within the DETECT-study concept.
Trial Design and eligibility criteria: The DETECT studies are prospective, multicenter, open-label clinical trials designed for patients with HER2-negative MBC and evidence of CTCs in the peripheral blood. DETECT III is a two-arm study for patients with HER2-positve CTCs, randomized to physician’s choice therapy (chemotherapy or endocrine treatment) with or without additional HER2-targeted treatment with lapatinib. DETECT IV combines tow single-arm studies aimed at patients with HER2-negative CTCs. Postmenopausal patients with hormone-receptor-positive MBC will be treated with the mTOR-inhibitor everolimus in combination with an endocrine therapy of physician’s choice (everolimus cohort), whereas patients with triple-negative or hormone-receptor-positive MBC and indication to chemotherapy will receive eribulin (eribulin cohort).
Specific aims: The primary objective of the trials is to estimate the clinical efficacy of treatments, assessed by the CTC clearance rate for DETECT III and by progression-free survival (PFS) for DETECT IV.
Methods: Prevalence of CTCs at various time points as well as the HER2 status of CTCs are assessed using the FDA-approved CellSearch System (Veridex, USA). After immunomagnetic enrichment with an anti-EpCam-antibody, cells were labelled with anti-CK8/18/19 and anti-CD45 antibodies to distinguish epithelial cells from leucocytes. A fluorescein conjugate antibody with anti-CK-Fluorescein Isothiocyanate (FITC) was used for HER2 phenotyping. The cut-off for CTC-positivity was 1 CTC and for HER2 1 CTC with strong HER2-staining (+++). Survival endpoints will be estimated using the Kaplan-Meier method.
Present and target accrual: Overall, about 2000 patients with HER2-negative MBC will have to be screened for CTCs to be able to recruit 228 patients with HER2-positive CTCs for DETECT III (which started in February 2012), 400 patients with HER2-negative CTCs for DETECT IV- everolimus cohort (which started in December 2013) and 120 patients for DETECT IV- eribulin cohort (which will start in the second half of 2014). 907 patients have been recruited for CTC screening until June 2014.
Perspectives: One screening for CTCs offers different treatment options for patients with HER2-negative MBC and evidence of CTCs within the DETECT-study concept. DETEC III is the first study to investigate a personalized targeted treatment based on the phenotype of CTCs. The addition of a HER2-targeted therapy in case of HER2-positive CTCs is innovative and in case of success will lead to new treatment strategies in MBC. DETECT IV complements DETECT III with regard to additional therapy indications.
Citation Format: Bernadette AS Jaeger, Susanne Albrecht, Fabienne Schochter, Carola A Melcher, Carsten Hagenbeck, Thomas WP Friedl, Brigitte Rack, Volkmar Müller, Peter A Fasching, Wolfgang Janni, Tanja Fehm. The DETECT-study concept: Treatment based on the phenotype of circulating tumor cells in HER2-negative metastatic breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr OT1-2-03.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Peter A Fasching
- 5University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN
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Jaeger BAS, Andergassen U, Neugebauer JK, Alunni-Fabbroni M, Melcher CA, Hagenbeck C, Albrecht S, Lorenz R, Decker T, Heinrich G, Fehm T, Schneeweiss A, Beckmann MW, Pantel K, Friese K, Fasching PA, Friedl TWP, Janni W, Rack BK. Abstract P4-01-08: Persistence of circulating tumor cells immediately after and two years after systemic adjuvant chemotherapy in patients with early breast cancer – Results of the German SUCCESS trials. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p4-01-08] [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
There is growing evidence that circulating tumor cells (CTCs) have prognostic impact in patients (pts) with early breast cancer (EBC). In this study the persistence of CTCs immediately after and two years after chemotherapy (Ctx) was prospectively evaluated according to molecular subtypes within the German multicentre SUCCESS trials.
Methods
SUCCESS A and C were randomized Phase III studies including pts with node positive or high-risk node negative EBC. In each trial two different adjuvant Ctx regimen were compared: FEC-DOC (3 cycles of FEC followed by 3 cycles of Docetaxel) to FEC-DG (3 cycles of FEC followed by 3 cycles of Docetaxel/Gemcitabine) in SUCCESS A and in the SUCCESS C study FEC-DOC to an anthracycline-free Ctx regimen (6 cycles of Docetaxel/Cyclophosphamide). Both studies involved a second randomization after Ctx: 2 vs. 5 years of zoledronic acid treatment (SUCCESS A) or 2-years of an individualized lifestyle-intervention program vs. general lifestyle recommendations (SUCCESS C). Adequate endocrine treatment and treatment with trastuzumab as indicated were included in both trials.
As part of the translational research program, 23ml of peripheral blood were drawn to isolate CTCs using the CellSearch System (Veridex, USA). After immunomagnetic enrichment with an anti-EpCam-antibody, cells were labelled with anti-CK8/18/19 and anti-CD45 antibodies to distinguish epithelial cells from leucocytes. The cut-off for CTC-positivity was ≥ 1 CTC.
Molecular subtypes were defined as luminal-A-like (hormone-receptor positive, G1 or 2), luminal-B-like (hormone-receptor positive, G3), HER2-positive and triple-negative.
Results
CTC analyses were performed for 3344 blood samples collected immediately after Ctx and for 1352 blood samples two years after Ctx. After Ctx 17.5% (584/3344) of the pts were CTC-positive (range 1 – 124 CTCs), and two years after Ctx the positivity rate for CTCs was 17.2% (233/1352, range 1-99).
CTC positivity as assessed immediately after Ctx differed significantly among molecular subtypes (chi-square test, p < 0.001): Pts with HER2-positive tumors were more likely to have CTCs in the blood (26.3%, 105/400) as compared to pts with luminal-A-like tumors (15.4%, 283/1842), luminal-B-like tumors (17.7%, 142/802), or triple-negative tumors (18.0%, 54/300).
Two years after Ctx CTC-positivity did not differ significantly among molecular subtypes (chi-square test, p = 0.463). CTC-positivity rates were 15.7% (96/613) for luminal-A-like tumors, 19.1% (49/256) for luminal-B-like tumors, 17.2% (51/296) for HER2-positive tumors, and 19.8% (37/187) for triple-negative tumors.
Conclusions
The data of this study confirm previous findings that CTCs may persist after standard adjuvant therapy. Immediately after Ctx CTCs seem to be more frequent in pts with HER2-positive tumors as compared to other molecular subtypes, while two years after Ctx no differences in CTC positivity among molecular subtypes were detected. These results might indicate good efficacy of HER2-targeted therapies on CTCs.
Citation Format: Bernadette AS Jaeger, Ulrich Andergassen, Julia K Neugebauer, Marianna Alunni-Fabbroni, Carola A Melcher, Carsten Hagenbeck, Susanne Albrecht, Ralf Lorenz, Thomas Decker, Georg Heinrich, Tanja Fehm, Andreas Schneeweiss, Matthias W Beckmann, Klaus Pantel, Klaus Friese, Peter A Fasching, Thomas WP Friedl, Wolfgang Janni, Brigitte K Rack. Persistence of circulating tumor cells immediately after and two years after systemic adjuvant chemotherapy in patients with early breast cancer – Results of the German SUCCESS trials [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-01-08.
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Affiliation(s)
| | | | | | | | | | | | | | - Ralf Lorenz
- 4Gemeinschaftspraxis Dr. Lorenz / Hecker /Wesche
| | | | | | | | | | - Matthias W Beckmann
- 8University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN
| | - Klaus Pantel
- 9Institute for Tumor Biology, Center of Experimental Medicine, University Medical Center
| | | | - Peter A Fasching
- 8University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN
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Schochter F, Albrecht S, Friedl TWP, Melchers C, Hagenbeck C, Jäger B, Rack B, Müller V, Fasching PA, Janni W, Fehm T. DETECT IV – Multizentrische Studie bei Patientinnen mit HER2-negativem metastasierten Brustkrebs und persistierenden ausschließlich HER2-negativen zirkulierenden Tumorzellen (CTCs). Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Albrecht S, Schochter F, Melcher CA, Hagenbeck C, Friedl TWP, Jaeger B, Rack BK, Mueller V, Fasching PA, Janni W, Fehm TN. DETECT III/IV: Two combined clinical trials based on the phenotype of circulating tumor cells (CTCs). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.tps11132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Fabienne Schochter
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Carola Anna Melcher
- Department of Gynecology and Obstetrics, Heinrich Heine University, Duesseldorf, Germany
| | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, Heinrich Heine University, Duesseldorf, Germany
| | - Thomas W. P. Friedl
- Department of Gynecology and Obstetrics, Universitätsklinikum Ulm, Ulm, Germany
| | - Bernadette Jaeger
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Brigitte Kathrin Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich, Germany
| | - Volkmar Mueller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peter A. Fasching
- Department of Obstetrics and Gynecology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University of Duesseldorf, Germany, Düesseldorf, Germany
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Schochter F, Melcher C, Hagenbeck C, Friedl TWP, Jäger B, Rack BK, Müller V, Fasching PA, Janni W, Fehm T. Abstract OT2-6-10: DETECT IV – A multicenter, single arm, phase II study evaluating the efficacy of everolimus in combination with endocrine therapy in patients with HER2-negative, hormone-receptor positive metastatic breast cancer and HER2-negative circulating tumor cells (CTCs). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot2-6-10] [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: The monitoring of therapy efficacy in metastatic breast cancer (MBC) is a very important component of treatment. Several studies have indicated that the determination of prevalence and number of circulating tumor cells (CTCs) at various times during treatment may be an effective tool for assessing treatment efficacy. Even if the prognostic value of CTCs in MBC is well understood, the role of CTC prevalence and - in particular - CTC phenotype in predicting treatment response requires further investigation. While the recently started DETECT III-trial is designed to evaluate the effect of HER2-targeted therapy in patients with HER2-negative MBC and HER2-postive CTCs, DETECT IV aims to assess the effect of an endocrine treatment in combination with the mTOR-inhibitor everolimus for patients with HER2-negative CTCs.
SPECIFIC AIMS/TRIAL DESIGN: DETECT IV is a prospective, multicenter, open-label, single arm phase II study aimed at postmenopausal patients with hormone-receptor positive, HER2-negative metastatic breast cancer. Patients with HER2-negative CTCs will be treated with Everolimus in combination with an endocrine therapy according to the physician's choice (letrozole, anastrozole, exemestan or tamoxifen). The primary objective of the trial is to estimate the clinical efficacy of everolimus in combination with endocrine therapy as assessed by progression-free survival (PFS) in the targeted patient population. Additional research will be done on CTC dynamics and characteristics (e.g. PI3K-mutation-analysis). This will provide a better understanding of prognostic and predictive value of the CTCs. This clinical trial is one more step into a more personalized therapy for metastatic breast cancer and will provide further information on CTCs and their informative value during the therapy.
ELIGIBILITY CRITERIA: In this trial postmenopausal female patients suffering from hormone-receptor positive, HER2-negative metastasizing breast cancer with HER2-negative circulating tumor cells (CTC) and indication for standard anticancer therapy will be included.
STATISTICAL METHODS/TARGET ACCRUAL: DETECT IV will start in September 2013. The estimated number of patients is 400. Therefore, 2000 patients need to be screened for HER2-negative CTCs. This screening is combined with the DETECT III - trail, which started February 2012. The primary endpoint progression-free survival will be estimated using the Kaplan-Meier method. Prevalence and number of CTCs at various time points will be determined using the FDA-approved CellSearch System (Veridex, USA). In addition, different measures of CTC dynamics and their value for evaluating therapy efficacy or as a prognostic tool will be examined in detail by explorative data analyses.
Contact information: fabienne.schochter@uniklinik-ulm.de.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT2-6-10.
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Affiliation(s)
- F Schochter
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - C Melcher
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - C Hagenbeck
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - TWP Friedl
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - B Jäger
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - BK Rack
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - V Müller
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - PA Fasching
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - W Janni
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - T Fehm
- University of Ulm, Ulm, Germany; Düsseldorf University Hospital, Düsseldorf, Germany; University Hospital Ludwig-Maximilians-University, Munich, Germany; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
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de Gregorio N, Schochter F, Melcher C, Hagenbeck C, Friedl TWP, Jäger B, Rack BK, Müller V, Fasching PA, Janni W, Fehm T. Abstract OT1-1-11: DETECT III - A multicenter, randomized, phase III trial to compare standard therapy alone versus standard therapy plus lapatinib in patients with initially HER2-negative metastatic breast cancer and HER2-positive circulating tumor cells. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot1-1-11] [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: In metastatic breast cancer (MBC) patients, HER2 status may be subject to change and it has been shown that 20-30% of initially HER2-negative patients have HER2-positive metastases. The discordance of the HER2 status between primary tumor and circulating tumor cells (CTCs) may be an important factor affecting the response to HER2-targeted treatments; however, it is unclear if therapy based on the HER2 status of CTC offers a clinical benefit for patients.
Trial Design: DETECT III is a recruiting prospective, multicenter, open-label, two-arm, phase-III study for patients with HER2-negative MBC. Patients with HER2-positve CTCs are randomized to receive either a standard therapy of the physician's choice alone or a standard therapy plus additional HER2-targeted treatment with Lapatinib.
Main Eligibility criteria:
- Metastatic breast cancer;
- HER2-negative primary tumor tissue and/or biopsies from metastatic sites;
- Evidence of at least 1 HER2-positive CTC out of 7.5 ml blood;
- Indication for systemic treatment
- ≥1 lesion evaluable according to RECIST
Specific aims: The objective of the DETECT III trial is to estimate the clinical efficacy of standard therapy plus lapatinib as assessed by progression free survival (PFS) in patients with initially HER2-negative MBC and HER2-positive CTCs. Additional research will be performed on CTC dynamic and characteristics.
Present accrual and target accrual: The DETECT III – trial started February 2012 and has analyzed so far (2013-06-06) 506 patients. We found CTCs in 336 (66.4%) patients (median 7 CTCs, range 1-35078). 67 of these patients (19.9%) had at least one HER2 positive CTC. Estimated patient enrollment is 228.
Methods: The primary endpoint progression-free survival will be estimated using the Kaplan-Meier method. Prevalence and number of CTCs at various time points as well as the HER2 status of CTCs will be determined using the FDA-approved CellSearch System (Veridex, USA). In addition, different measures of CTC dynamics and their value for evaluating therapy efficacy or as a prognostic tool will be examined in detail by explorative data analyses.
Perspectives: The DETECT III-Trail is the first study where treatment is based on phenotypic characteristics of CTCs. If this trial succeeds in proving efficacy of lapatinib in patients with initially HER2-negative primary tumor but HER2-positive CTCs, it may lead to a new strategy for the treatment of metastatic breast cancer.
Contact information: nikolaus.de-gregorio@uniklinik-ulm.de.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT1-1-11.
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Affiliation(s)
- N de Gregorio
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - F Schochter
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - C Melcher
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - C Hagenbeck
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - TWP Friedl
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - B Jäger
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - BK Rack
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - V Müller
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - PA Fasching
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - W Janni
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
| | - T Fehm
- University of Ulm, Ulm, Germany; Heinrich Heine University, Ulm, Germany; Ludwig-Maximillians University, Munich, Germany; University Medical Center, Hamburg, Germany; Erlangen University Hospital, Erlangen, Germany
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Abstract
Evaluation of isolated tumour cells in bone marrow (BM) and peripheral blood has become a major focus of translational cancer research. The presence of disseminated tumour cells in BM is a common phenomenon observed in 30–40% of primary breast cancer patients and independently predicts reduced clinical outcome. The detection of circulating tumour cells (CTCs) in blood might become a desired alternative to the invasive and painful BM biopsy. Recent clinical trials confirmed the feasibility of CTC detection as a robust and reproducible parameter for prognostication in both adjuvant and metastatic setting. The characterisation of CTCs might become an important biomarker for therapy monitoring and help to identify specific targets for novel therapeutic strategies.
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Affiliation(s)
- Natalia Krawczyk
- Department of Obstetrics and Gynecology, University of Duesseldorf, Moorenstr. 5, 40225 Duesseldorf, Germany
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Banys M, Müller V, Melcher C, Aktas B, Kasimir-Bauer S, Hagenbeck C, Hartkopf A, Fehm T. Circulating tumor cells in breast cancer. Clin Chim Acta 2013; 423:39-45. [DOI: 10.1016/j.cca.2013.03.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 03/27/2013] [Accepted: 03/29/2013] [Indexed: 01/02/2023]
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Katzorke N, Rack BK, Haeberle L, Neugebauer JK, Melcher CA, Hagenbeck C, Forstbauer H, Ulmer HU, Soeling U, Kreienberg R, Fehm TN, Schneeweiss A, Beckmann MW, Fasching PA, Janni W. Prognostic value of HER2 on breast cancer survival. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.15_suppl.640] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
640 Background: HER2 overexpression and overamplification have originally been described as a prognostic factor indicating a poor prognosis. However the highly effective anti-HER2 treatment was approved in 2006 after several large randomized trials showing that the prognosis in HER2 positive women could be improved. Few data has been generated comparing HER2 positive patients treated with trastuzumab with comparable HER2 negative patients. Aim of this analysis was to investigate the prognostic relevance of HER2 status in a post trastuzumab approval study. Methods: The SUCCESS trial is an open-label, multicenter, randomized controlled, phase III study comparing FEC-docetaxel (Doc) vs. FEC-Doc-gemcitabine (Doc-G) regime and 2 vs. 5 year treatment with zoledronat in 3754 patients with primary breast cancer (N+ or high risk). All patients were treated per protocol with trastuzumab, if HER2 status was shown to be positive by local pathology. Furthermore HER2 status was a stratification factor. The prognostic value of HER2 status with respect to overall survival (OS) and progression-free survival (PFS), disregarding the above stated treatment arms, was studied with Cox proportional hazards regression models in univariate as well as multivariate analyses adjusted for age, BMI, tumor size, nodal status, grading, estrogen receptor status and progesterone receptor status. Results: 2628 patients were included into this analysis. Median Follow up time was 4.8 years, 221 deaths and 412 recurrences were recorded until data base closure. HER2 was not a prognostic factor in the univariate analysis (OS: HR= 0.86, 95% CI: 0.63 to 1.19; PFS: HR = 0.95, 95% CI: 0.76 to 1.19). In the multivariate analysis all of the above stated prognostic factors were of prognostic relevance. HER2 was of prognostic relevance with a HR of 0.67 (OS, 95% CI: 0.48 to 0.92) and 0.79 (PFS, 95% CI: 0.62 to 0.99) indicating that patients with a positive HER2 status had a better prognosis. Conclusions: Patients treated with trastuzumab showed a more favourable prognosis compared to HER2 negative patients in this prospectively randomized trial, possibly due to the therapeutic effect of HER2-targeted treatment.
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Affiliation(s)
- Nora Katzorke
- Department of Gynecology and Obstetrics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Brigitte Kathrin Rack
- Department of Gynecology and Obstetrics, Ludwig-Maximilians-University, Munich, Germany
| | - Lothar Haeberle
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | | | - Carola Anna Melcher
- Department of Gynecology and Obstetric, Heinrich Heine University, Duesseldorf, Germany
| | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, Heinrich Heine University, Duesseldorf, Germany
| | | | | | | | - Rolf Kreienberg
- Department of Gynecology and Obstetrics University Ulm, Ulm, Germany
| | - Tanja N. Fehm
- Department of Gynecology and Obstetrics, University of Tuebingen, Tuebingen, Germany
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - Matthias W. Beckmann
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - Peter A. Fasching
- Department of Obstetrics and Gynecology, University Erlangen, Erlangen, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
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