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Arch Gynecol Obstet ; 288(1): 41-8, 2013 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-23389246


OBJECTIVE: To identify patients at very high risk for adverse pregnancy outcome (APO) at the 20- to 23-week scan and to assess the effectiveness of Aspirin (ASS) and low molecular weight heparin (LMWH) starting after this examination. PATIENTS AND METHODS: By applying an algorithm based on multivariate logistic regression analysis using the parameters maternal age, parity, body mass index (BMI), mean pulsatility index of both uterine arteries (meanPI), presence of uni- or bilateral notch, and depth of notch (mean notch index (meanNI), we retrospectively calculated the individual risk for APO of 21,302 singleton pregnancies. We isolated a subgroup of 426 patients with the highest calculated probability for APO (cpAPO > 27.8 %). 147 had been treated with ASS; 73 with LMWH, 15 patients with a combination of ASS and LMWH, and 191 patients had not received anticoagulants. RESULTS: Administration of ASS starting after 20 gestational weeks in comparison to non-treated patients significantly reduced the frequency of intrauterine/neonatal death (IUD/NND), preeclampsia <33 weeks (PE < 33), and preterm delivery <33 weeks (PD < 33), while the frequency of IUGR showed a tendency to be elevated (P = 0.061). The subgroup of high-risk patients treated with LMWH was characterised by a higher a priori risk for APO and showed no significant reduction of any form of APO but an increased frequency of PE. CONCLUSION: Individual assessment of risk for APO by applying a simple algorithm based on biometrical/biographical as well as sonographic parameters may serve as basis for drug intervention studies. The administration of ASS in high-risk patients starting after 20 gestational weeks reduced the frequency of most of the severe forms of adverse pregnancy outcome in high-risk patients. A complication-reducing effect of LMWH starting after 20 weeks of gestation in patients could not be proven. From an ethical point of view, it may not be justified any more to preclude high-risk patients from administration of ASS or to perform studies of ASS against placebo.

Anticoagulantes/uso terapéutico , Aspirina/uso terapéutico , Heparina de Bajo-Peso-Molecular/uso terapéutico , Complicaciones del Embarazo/prevención & control , Algoritmos , Anticoagulantes/efectos adversos , Aspirina/efectos adversos , Índice de Masa Corporal , Femenino , Muerte Fetal/prevención & control , Retardo del Crecimiento Fetal/inducido químicamente , Heparina de Bajo-Peso-Molecular/efectos adversos , Humanos , Recién Nacido , Edad Materna , Paridad , Preeclampsia/prevención & control , Embarazo , Resultado del Embarazo , Nacimiento Prematuro/prevención & control , Flujo Pulsátil , Estudios Retrospectivos , Medición de Riesgo , Ultrasonografía , Arteria Uterina/diagnóstico por imagen
Prenat Diagn ; 32(6): 550-6, 2012 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-22517407


OBJECTIVE: To assess the prevalence and detection rate of major anomalies (MAs) by applying first trimester anomaly scan (FTAS) including first trimester fetal echocardiography (FTFE) to all fetuses and discuss ethical implications. METHODS: The study group included 6879 consecutive fetuses with known outcome of pregnancy (follow-up: 98%), 6565 with 'normal' nuchal translucency (NT) (≤ P95), 314 with 'increased' NT (> P95). All fetuses received FTAS/FTFE. As MAs with the potential of being detected at FTAS/FTFE, we defined anomalies present at conception or developed during first trimester. RESULTS: Prevalence of MAs in fetuses with 'normal' NT reached 1.7%. Although 29.8% of chromosomal abnormalities were found in the group of 'normal' NT, 77% of MAs accompanied by a normal karyotype were found in this group. In fetuses with 'normal' NT and MA, diagnosis was made prenatally in 87.4% (FTAS/FTFE: 58.6%). CONCLUSION: A relevant number of MA is present in fetuses with 'normal' NT. More than half will be detected by FTAS/FTFE. As consequence, one should discuss a concept in which also in fetuses with 'normal' NT, FTAS/FTFE should be offered. This concept can also be justified from an ethical point of view, which focuses on the principles of nonmaleficence, justice and respect for autonomy of the pregnant woman.

Anomalías Congénitas/diagnóstico por imagen , Medida de Translucencia Nucal/ética , Ultrasonografía Prenatal/ética , Aberraciones Cromosómicas/embriología , Reacciones Falso Negativas , Femenino , Corazón Fetal/diagnóstico por imagen , Edad Gestacional , Humanos , Embarazo , Resultado del Embarazo
Rejuvenation Res ; 13(6): 741-7, 2010 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-21208061


By creating fertility reserves, women are now able to become pregnant using their own eggs, even after menopause. Multiple arguments already exist against postmenopausal motherhood, most of which stress the potential risk of damage involved due to the mother's advanced age. Consequently, the question arises: Can successful antiaging medicine be applied to preserve or enhance cognitive and physical capacity at an advanced age and invalidate these objections? In this article, we shall explore this issue further and come to three main conclusions: (1) Until now, enabling postmenopausal women to become pregnant has not been a specific objective of antiaging medicine. (2) Postmenopausal motherhood can find legitimacy through the development and success of antiaging medicine. (3) The acceptance of postmenopausal motherhoods in our society first requires that antiaging medicine itself find some sort of ethical legitimacy. To evaluate the arguments for and against antiaging medicine and postmenopausal motherhood, it is important to take into consideration two points more in depth, which are constantly being impacted by both medical arguments alike: (1) The identity and role of medicine itself as well as (2) the normative role of our body`s natural boundaries.

Envejecimiento/fisiología , Ética Médica , Edad Materna , Madres , Preparaciones Farmacéuticas , Posmenopausia/fisiología , Rejuvenecimiento , Femenino , Fertilidad , Humanos , Infertilidad Femenina , Embarazo