[Pharmacological prevention disease with vitamin D--epidemiological evidence using the example of complications during pregnancy and birth]. / Medikamentöse Krankheitsprävention mit Vitamin D--Epidemiologische Evidenz am Beispiel von Komplika-tionen im Verlauf der Schwangerschaft und bei der Geburt.

National and international epidemiological studies have shown that relevant segments of populations are - especially in the winter period - vitamin D deficient and for the entire year vitamin D intake is far too low. This also applies to pregnant women. In January 2012 the German Nutrition Society has increased the intake recommendations for vitamin D by a factor of 4. It is suggested that a sufficient supply with vitamin D has high preventive potentials with respect to several chronic diseases and will potentially reduce the incidence of preterm birth. This paper considers the evidence of associations between vitamin D deficiency and adverse pregnancy outcomes. Based on the current epidemiological knowledge which is, however, sparse there is very low evidence that vitamin D deficiency is a relevant risk factor for adverse pregnancy outcomes. This makes it even more difficult to give rationale answers to emerging questions with respect to supplementation, dosage and vitamin D diagnostic measures. An observational study with 2 or 3 large obstetric clinics should be undertaken to clarify the central question without delay.

Treatment of Iron Deficiency in Women.

Iron deficiency with and without anaemia is a common cause of morbidity, particularly in women. Iron deficiency is generally the result of an imbalance between iron loss and iron absorption. In women with symptoms suspicious for iron deficiency, it is important to confirm or exclude the suspicion using proper tests. The use of serum ferritin levels is considered the gold standard for diagnosis. Although the ideal ferritin levels are not unknown the current consent is that levels < 40 ng/ml indicate iron deficiency, which needs to be treated in symptomatic patients. However, symptoms can already occur at ferritin levels of < 100 ng/ml and treatment must be adapted to the individual patient. Iron supplementation is only indicated in symptomatic patients diagnosed with iron deficiency whose quality of life is affected. It is important to treat iron deficiency together with its causes or risk factors. For example, blood loss from hypermenorrhea should be reduced. Women also need to receive information about the benefits of an iron-rich diet. If oral treatment with iron supplements is ineffective, parenteral iron administration is recommended.

Measurement of fetal head descent using the 'angle of progression' on transperineal ultrasound imaging is reliable regardless of fetal head station or ultrasound expertise.

OBJECTIVES: To assess whether ultrasound experience or fetal head station affects the reliability of measurement of fetal head descent using the angle of progression on intrapartum ultrasound images obtained by a single experienced operator, and to determine reliability of measurements when images were acquired by different operators with variable ultrasound experience. METHODS: One experienced obstetrician performed 44 transperineal ultrasound examinations of women at term and in prolonged second stage of labor with the fetus in the occipitoanterior position. Three midwives without ultrasound experience, three obstetricians with < 5 years' experience and three obstetricians with > 10 years' experience measured fetal head descent based on the angle of progression in the images obtained. The angle of progression was measured by two obstetricians in independent ultrasound examinations of 24 laboring women at term with the fetus in the cephalic position to allow assessment of the reliability of image acquisition. Intraclass correlation coefficients (ICCs) with 95% confidence interval (CI) were used to evaluate interobserver reliability and Bland-Altman analysis was used to assess interobserver agreement. RESULTS: In total, 444 measurements were performed and compared. Interobserver reliability with respect to offline image analysis was substantial (overall ICC, 0.72; 95% CI, 0.63-0.81). ICCs were 0.82 (95% CI, 0.70-0.89), 0.81 (95% CI, 0.71-0.88) and 0.61 (95% CI, 0.43-074) for observers with > 10 years', < 5 years' and no ultrasound experience, respectively. There were no significant differences between ICCs among observer groups according to ultrasound experience. Fetal head station did not affect reliability. Bland-Altman analysis indicated reasonable agreement between measurements obtained by two different operators with > 10 years' and < 5 years' ultrasound experience (bias, -1.09 degrees ; 95% limits of agreement, -8.76 to 6.58). The reliability of measurement of the angle of progression following separate image acquisition by two experienced operators was similar to the reliability of offline image analysis (ICC, 0.86; 95% CI, 0.70-0.93). CONCLUSIONS: Measurement of the angle of progression on transperineal ultrasound imaging is reliable regardless of fetal head station or the clinician's level of ultrasound experience.

[Supply of iodine during pregnancy--an inventory in Berlin, Germany]. / Jodversorgung in der Schwangerschaft--eine aktuelle Bestandsaufnahme in Berlin.

BACKGROUND: Iodised salt was introduced in Germany in the early 1980s. A nation-wide study in 1996 showed that iodine levels among the population had improved since the introduction of the supplementation. The study did not separately investigate the iodine status of pregnant women. In our prospective study, we used three parameters to assess the iodine levels among pregnant women. PATIENTS AND METHODS: Between October 1999 and February 2000, we asked 109 German-speaking patients seeking prenatal care in our clinic to participate. Following informed consent, we measured goiter volume by ultrasound and collected venous blood (serum) and urine samples. We asked patients about any history of thyroid gland illnesses and about iodine supplementation which is generally given to pregnant patients in Germany. The blood and urine samples were stored at -18 degrees C until measurement. We used the iodine-creatinine-ratio to measure ioduria. Iodine was measured using the Cer-Arsenite-method (Dade-Behring). The thyroglobulin concentration in serum was measured using RIA. RESULTS: The mean iodine-creatinine ratio was 181 +/- 109 microg/g, 20.4 % of the patients had a ratio between 50 and 100 microg/g which is defined as iodine deficiency I degrees (WHO). 8.7 % of the patients had thyreoglobulin levels above the cut-off value of 50 ng/ml. 12.6 % of the patients had a goiter (volume > 18 ml). 58 % of the patients were taking iodine supplements. These patients had significantly higher iodine-creatinine ratio levels (204 microg/g vs. 148 microg/g, P = 0.007) and lower serum thyroglobulin levels (38.4 vs. 34.1 pmol/l, P = 0.06) than non-supplemented patients. CONCLUSIONS: The prevalence of goiter reflects an extended period of iodine deficiency. Using laboratory methods, up to 20.4 % of pregnant women were identified as having an iodine deficiency which indicates the need for a general iodine supplementation during pregnancy.

[Obstetrical care in Berlin: possibilities for delivery from the gynaecologists' point of view]. / Geburtshilfe in Berlin: Die Entbindungsmöglichkeiten aus der Sicht der niedergelassenen Frauenärztinnen und Frauenärzte.

BACKGROUND: Berlin offers a variety of delivery facilities: maternity clinics, birth centres, obstetrical practices and ambulant working midwives for the various options and kinds of delivery. To select an individual service is a difficult task for most women. In this process of decision-making the gynaecologist plays an important part. This raised the question as to how established gynaecologists appraise the available services, which delivery sites they recommend, and what criteria are decisive for their recommendation. METHODS: A postal survey of all the 523 gynaecologists of Berlin was conducted anonymously, 273 (52.2 %) of whom completed the questionnaire. RESULTS: The results of the study demonstrated that the most important aspects for the recommendation of a delivery place are the technological equipment and qualification of the staff. However, characteristics of good care and support and an atmosphere of kindness and mutual trust are equally important. According to these goals, criticism has been expressed especially in the area of care and kindness, larger obstetrical divisions having more defaults in this regard. CONCLUSIONS: Future developments in delivery units of hospitals should take into consideration that both safety and optimal care are expected.

Prenatal sonographic findings of thalamic cavernous angioma.

A cavernous angioma of the thalamus is a rare congenital brain tumor. We report the perinatal management and follow-up to 2 years in a case diagnosed in utero at 37 weeks of gestation, and review the literature.

Computerized cardiotocography following vibroacoustic stimulation of premature fetuses.

OBJECTIVE: The purpose of this study was to examine the effect of vibroacoustic stimulation (VAS) on the fetal heart rates (FHRs) in a group of premature fetuses. STUDY DESIGN: The FHRs were analyzed using the Oxford Sonicaid Computer System 8000, 30 min preceding and then 3 times following VAS. RESULTS: The changes of the mean FHR after VAS in the premature group and the control group of term fetuses occurred in the first 10 min after VAS. The greatest increase in the number of accelerations occurred in both groups during the 11-20 min following VAS. The long-term variability increased significantly in all 3 study periods in premature fetuses and only in the periods of 0-10 and 11-20 min in the control group. The increase in short-term variability was similar in both groups and it was greatest in the period of 11-20 min. CONCLUSION: Most of the heart rate changes of premature fetuses occur between 11 and 20 min following VAS.

[Pictures by pregnant patients with premature labor. Initial experiences with art therapy]. / Bilder von Schwangeren mit vorzeitigen Wehen. Erste Erfahrungen eines maltherapeutischen Angebots.

Patients with preterm labor not only suffer from anxiety and uncertainty regarding the healthy development of their child but, especially as inpatients, in part severely from loss of autonomy and feelings of insufficiency. By the creative therapeutic means of art therapy it is aimed at influencing the disturbed emotional state and strengthening self-esteem. During the sessions patients experience challenge, success and relaxation with endurance some time after the sessions. Paintings produced by hospitalized patients in art therapeutic sessions are presented. Further psychophysiological investigations are in process for controlling the effects on preterm labor. Paintings of inpatients are discussed.

[Evaluating pulse oximetry in the fetus. Case control study for detection of undesirable complications]. / Evaluierung der Pulsoximetrie am Feten. Fallkontrollstudie zur Erfassung unerwünschter Komplikationen.

OBJECTIVES: Fetal pulse oximetry (PO) requires basically continuous contact of a transcervically positioned oxisensor with fetal skin. To improve signal quality adjustments of the oxisensor may be necessary. Against this background it was our intention to find out if this intrauterine device causes an increase in fetal or maternal infectious morbidity. STUDY DESIGN: We enrolled into this prospective trial 63 deliveries monitored by a blinded fetal pulse oximeter (N 400, Nellcor Inc. Pleasanton, CA) and a fetal oxisensor (FS 10; lambda = 660 + 890 nm). The control group of similar gestational age was formed by 63 chronologically following deliveries under responsibility of the same physician to reduce personal bias of obstetrical management. RESULTS: While the obstetrical risk factors (non-reassuring FHR i.e.) were significantly higher in the group with PO, gestational age, number of operative deliveries, pH of umbilical cord and Apgar score ratings did not show any significant difference. The number of post partum anaemias and local or systemic infections were identical (3 in each group). Seven neonates of the PO group had to be transferred to NICU versus 12 in the control group. The duration of antibiotic treatment, mechanical ventilation or phototherapy did not differ significantly; neither did the number of neonatal infections. CONCLUSION: In the group of fetuses monitored by fetal pulse oximetry there was no increase in fetal or maternal infectious morbidity. There was no evidence of adverse side effects which might limit the advantage of continuous oxygen saturation monitoring.

Antepartum vibroacoustic stimulation in patients with low fetal heart rate variability.

OBJECTIVE: The purpose of this study was to examine the effect of vibroacoustic stimulation during low fetal heart rate (FHR) variability. METHODS: FHR was analyzed 30 min before and 30 min after computerized vibroacoustic stimulation using the Oxford Sonicaid system 8000. The study comprised 32 healthy pregnant women with low antepartum FHR variability. The significance of difference of the median values was examined using Wilcoxon's matched-pairs signed-ranks test. RESULTS: Vibroacoustic stimulation of the fetus during low FHR variability evoked a significant increase in the number of accelerations (> 10 bpm) and an increase in long- and short-term variation. CONCLUSION: Our findings indicate that vibroacoustic stimulation during low FHR variability produces an abrupt change from a quiet to an active fetal state.

In-vivo NMR spectroscopy of the fetal lung in guinea-pigs.

We have been successful in achieving phosphorus NMR in-vivo spectra of the fetal lung in an animal model. We used pregnant guinea-pigs with a gestational age of 45 to 65 days. The spectra were recorded on a Bruker tomograph (BMT 24/30) with a field strength of 2.35 T. The spectra showed a typical pattern. After recording the animals were sacrificed and the lungs were prepared for electron microscopic examinations. In the spectra peaks were found which appeared to be phosphorylcholine and phosphatidylcholine. For one peak it could be observed that the relative signal intensity increased with increasing gestational age as well as with increasing lung maturity. This could not be observed for other peaks. So the lecithin of the surfactant in the tissue of the fetal lung appears to be directly accessible through phosphorus in-vivo NMR spectroscopy. The peaks found appear already before the lamellar bodies are present in the pneumocytes type II.

[Prospective study of administering a single-dose prophylactic antibiotic in primarily indicated abdominal cesarean section]. / Prospektive Studie zur einzeitigen Antibiotikaprophylaxe bei primär indizierter abdominaler Schnittentbindung.

A prospective study was carried out with the participation of 60 pregnant women to elucidate the question if a unilateral antibiotic-prophylaxis is also indicated for a primary caesarean section. With the help of a random-list two collectives were formed with 30 pregnant women each. After delivery of the child one collective was given 4 g Mezlocillin (Baypen) i.v., the other collective did not receive an antibiotic. We analyzed the postoperative period of storage, postoperative fever, postoperative quality of healing, endometritis, urinary tract infection and the necessity of a postoperative antibiotic therapy. In addition we investigated swabs of the ear of the newborn, swabs from the cervix of the mother and blood culture of umbilical vein. Significantly less postoperative disorder of healing could be observed in the prophylaxis collective. All other investigated parameters did not show any significant differences in both collectives. Also there were no significant differences of infections in both collectives, therefore there is no indication for an antibiotic prophylaxis at a primary caesarean section.