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1.
Z Geburtshilfe Neonatol ; 223(6): 373-394, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31801169

RESUMO

AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS: The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS: Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.


Assuntos
Ruptura Prematura de Membranas Fetais , Trabalho de Parto Prematuro/prevenção & controle , Guias de Prática Clínica como Assunto , Nascimento Prematuro , Sociedades Médicas , Prevenção Terciária , Incompetência do Colo do Útero , Áustria , Feminino , Ruptura Prematura de Membranas Fetais/prevenção & controle , Ruptura Prematura de Membranas Fetais/terapia , Humanos , Recém-Nascido , Obstetrícia , Gravidez , Nascimento Prematuro/prevenção & controle , Nascimento Prematuro/terapia , Sistema de Registros
2.
Geburtshilfe Frauenheilkd ; 79(11): 1171-1175, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31736505

RESUMO

This position paper describes clinically important, practical aspects of cervical pessary treatment. Transvaginal ultrasound is standard for the assessment of cervical length and selection of patients who may benefit from pessary treatment. Similar to other treatment modalities, the clinical use and placement of pessaries requires regular training. This training is essential for proper pessary placement in patients in emergency situations to prevent preterm delivery and optimize neonatal outcomes. Consequently, pessaries should only be applied by healthcare professionals who are not only familiar with the clinical implications of preterm birth as a syndrome but are also trained in the practical application of the devices. The following statements on the clinical use of pessary application and its removal serve as an addendum to the recently published German S2-consensus guideline on the prevention and treatment of preterm birth.

3.
Z Geburtshilfe Neonatol ; 223(5): 304-316, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31623006

RESUMO

AIMS: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. METHODS: Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). RECOMMENDATIONS: Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.


Assuntos
Guias de Prática Clínica como Assunto , Nascimento Prematuro , Áustria , Feminino , Humanos , Recém-Nascido , Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Nascimento Prematuro/prevenção & controle , Prevenção Primária , Sistema de Registros , Prevenção Secundária , Sociedades Médicas
4.
J Matern Fetal Neonatal Med ; : 1-7, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31522584

RESUMO

Objective: The presence of sonographic funneling is a co-predictor of spontaneous preterm birth (sPTB). The aim of this study was to assess the outcome in patients with a short cervix and funneling after a McDonald cerclage or an Arabin pessary. Methods: We retrospectively analyzed data of 238 singleton pregnancies with cervical shortening <25 mm subclassified by either isolated cervical shortening (n = 105) or cervical shortening and additional funneling (n = 133). In the group of isolated cervical shortening, a total of 93 patients had received a cervical pessary and 12 had McDonald cerclage. In the group of patients with additional funneling, 98 had received a cervical pessary and 35 had a cerclage. We evaluated PTB rates <28, <32, <34, and <37 weeks as well as prolongation of gestation, birth weight, and admission to NICU. Results: In the pessary groups (n = 191), funneling resulted in a significantly higher rate of PTB before 34 weeks as compared to patients with isolated cervical shortening (26.5 versus 8.6%, p=.0066). Similarly, in the cerclage groups (n = 47), funneling resulted in an absolute increase of PTB, albeit not significant (37.1 versus 0%, p=.1435) due to the smaller number. There were no significant differences in terms of prevention of PTB before 34 weeks in patients treated with pessary or cerclage, neither in the group of patients with isolated shortening nor in the group of patients with additional funneling (p=.9771 and p=.3916, respectively). However, in patients with funneling, we demonstrated a significantly lower neonatal admission rate in the pessary arm (n = 27, 27.6%) as compared to the cerclage arm (n = 31, 88.6%) (p = .0002). Similarly, the NICU admission time was shorter in both pessary groups -with and without funneling - as compared to patients treated with cerclage (p = .0000). Conclusion: Pessary placement and cerclage should optimally be considered before the presence of funneling. Furthermore, there were lower rates of neonatal admission during pregnancy and a shorter admission time of babies after birth when mothers received a cervical pessary as compared to the group with cervical cerclage.

5.
Geburtshilfe Frauenheilkd ; 79(8): 800-812, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423016

RESUMO

Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods Based on the international literature, the members of the participating medical societies and organizations developed Recommendations and Statements. These were adopted following a formal process (structured consensus conference with neutral moderation, voting was done in writing using the Delphi method to achieve consensus). Recommendations Part I of this short version of the guideline lists Statements and Recommendations on the epidemiology, etiology, prediction and primary and secondary prevention of preterm birth.

6.
Geburtshilfe Frauenheilkd ; 79(8): 813-833, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31423017

RESUMO

Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recently published scientific literature, the experience of the members of the guideline commission and the views of self-help groups. Methods The members of the participating medical societies and organizations developed Recommendations and Statements based on the international literature. The Recommendations and Statements were adopted following a formal consensus process (structured consensus conference with neutral moderation, voting done in writing using the Delphi method to achieve consensus). Recommendations Part 2 of this short version of the guideline presents Statements and Recommendations on the tertiary prevention of preterm birth and the management of preterm premature rupture of membranes.

7.
Case Rep Womens Health ; 22: e00121, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31193133

RESUMO

Cranio-cervico-facial tumors are rare. While ultrasound is the gold-standard method for diagnosing these anomalies, three-dimensional ultrasound and prenatal magnetic resonance imaging are complementary tools for reaching a precise diagnosis. Hemangiomas, meningoceles, proboscis lateralis, skin appendages and other fetal tumors are the main differential diagnoses. The prenatally assumed diagnosis of these malformations can change postnatally, with the ready identifcation of additional clinical features. We present a case of prenatally suspected proboscis lateralis. This diagnosis was revised postnatally to a facial hemangioma. The tumor did not regress with ß-blocker therapy for 5 months, and so a biopsy was then performed, which showed it was a granular cell tumor (GCT). This was later successfully excised, with clear margins. This case is important because there has been only one reported case of neonatal GCT, and because it shows that even with technologically advanced prenatal diagnostic methods, reaching the correct diagnosis can still be challenging.

8.
J Matern Fetal Neonatal Med ; : 1-9, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30700183

RESUMO

BACKGROUND: Patients with cervical shortening obtained by transvaginal ultrasound and/or previous preterm delivery are at increased risk for preterm birth in the current pregnancy. The aim of the present cohort study was to compare the rate of preterm birth and early neonatal parameters in patients at risk and screening patients who received either a cerclage or a combined treatment of cerclage and cervical pessary. METHODS: A retrospective cohort study was conducted from March 2005 to March 2017 including all patients in our department which received a McDonald cerclage or a combined treatment of McDonald cerclage and an Arabin pessary. A total of 81 women with singleton pregnancies were considered the final sample of this cohort study, of whom 34 patients received a cerclage and 47 patients received a cerclage combined with a pessary. Patients "at risk" with a history of preterm birth at <37 weeks of gestation, late-term abortion, conization, or cervical cerclage in a previous pregnancy because of a cervical shortening <10th percentile and women with no inherent historic risk factors but a current cervical length <3rd percentile (screening group) were analyzed separately. We defined delivery <34 weeks of gestation as the primary outcome. Secondary outcomes were preterm birth (PTB) <28, <32, and <37 weeks of gestation, admission to the neonatal intensive care unit (NICU), neonatal admission time, birthweight, and prolongation of the gestation. RESULTS: There were no differences between the two study groups with regard to baseline characteristics. Delivery <34 weeks of gestation occurred in 32.4 and 27.7% of patients treated with cerclage versus combined treatment respectively (p = .48). Similarly, there was no difference in the rate of preterm birth at <28, <32, or <37 weeks of gestation. The mean neonatal admission time at the neonatal intensive care unit was shorter in the combined treatment group versus in the cerclage group (p = .02). There was a trend for higher birthweight (2368 g ± 962 vs. 2650 g ± 1063) in favor of the combined treatment arm (p = .077). CONCLUSION: The combined treatment of cerclage with an Arabin pessary seems to be a considerable alternative in the prevention of spontaneous PTB (sPTB), especially for patients with cervical length <3rd percentile, and in particular for patients with amnion prolapse in terms of birthweight and neonatal admission time.

9.
Eur J Obstet Gynecol Reprod Biol ; 229: 70-75, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30107363

RESUMO

INTRODUCTION: To evaluate the effects of synthetic osmotic dilators (Dilapan-S/ Dilasoft) in women who required induction of labour in a large prospective multicentre international observational study. MATERIALS AND METHODS: Primary outcomes were duration of Dilapan-S/Dilasoft insertion (hours), total induction - delivery interval (hours) and the rate of vaginal deliveries within 24 h (%). Secondary outcomes were the number of dilators inserted, Bishop score increase after extraction of Dilapan-S/Dilasoft, complications during induction (uterine contractions, uterine tachysystole and hyperstimulation, effect on the fetus) and post induction (infections and neonatal outcomes), agents / procedures used for subsequent induction of labour, immediate rate of spontaneous labours following cervical ripening period, rate of spontaneous vaginal deliveries, rate of instrumental vaginal deliveries and caesarean sections. RESULTS: Total of 543 women were recruited across 11 study sites, of which, 444 women were eligible for analysis. With Dilapan-S/Dilasoft use of <12 h (n = 188) the overall vaginal delivery rate was 76.6% with 45.7% of these births occurring within 24 h, 66% within 36 h and 75.5% within 48 h from insertion of Dilapan-S/Dilasoft. The mean insertion-delivery interval for this group was 24.3(±10.4) hours. With Dilapan-S/Dilasoft use of >12 h (n = 256), the overall vaginal delivery rate was 64.8%, with 16% of these births occurring within 24 h, 48.4% within 36 h and 54.7% within 48 h from insertion of Dilapan-S/Dilasoft. The mean insertion-delivery interval for this group was 39.1(±29.2) hours. The mean gain in the Bishops score was +3.6(±2.3). The mean number of Dilapan-S/Dilasoft dilators used was 3.8 (±1.1). The overall rate of caesarean section was 30.1%. The overall complication rate was low including infection risk. No adverse neonatal outcome was attributable to the use of Dilapan-S/Dilasoft. CONCLUSION: Dilapan-S/Dilasoft are safe and effective methods for cervical ripening. Their use is associated with low maternal and neonatal complication rates. Future research should aim at level I clinical trials comparing Dilapan-S to other mechanical or pharmacological cervical ripening agents. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT02318173.


Assuntos
Trabalho de Parto Induzido/métodos , Polímeros/administração & dosagem , Adulto , Feminino , Humanos , Gravidez , Estudos Prospectivos , Adulto Jovem
10.
Geburtshilfe Frauenheilkd ; 78(6): 585-595, 2018 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-29962517

RESUMO

Preterm birth is one of the major global health problems and part of the Millennium Development goals because of the associated high number of perinatal or neonatal mortality and long-term risks of neurodevelopmental and metabolic diseases. Transvaginal sonography has meanwhile been established as a screening tool for spontaneous preterm birth despite its relatively low sensitivity when considering only the cervical length. Vaginal progesterone has been shown to reduce prematurity rates below 34 weeks in a screening population of singleton pregnancies. Up to now, no positive long-term effect could be demonstrated after 2 years. It seems to have no benefit to prolong pregnancies after a period of preterm contractions and in risk patients without cervical shortening. Meta-analyses still demonstrate conflicting results dependent on quality criteria used for selection. A cerclage is only indicated in singleton pregnancies with previous spontaneous preterm birth and a combined cervical shortening in the current pregnancy. Nevertheless, the short- and long-term outcome has never been evaluated, whereas maternal complications may be increased. There is no evidence for a prophylactic cervical cerclage in twin pregnancies even in cases with cervical shortening. Emergency cerclage remains an indication after individual counseling. The effect of a cervical pessary in singleton pregnancy seems to be more pronounced in studies where a few investigators with increasing experience have treated and followed the patients at risk for preterm birth. Mainly in twin pregnancies, pessary treatment seems to be promising compared to other treatment options of secondary prevention when the therapy is started at early stages of precocious cervical ripening. At present, several international trials with the goal to reduce global rates of prematurity are in progress which will hopefully allow to specify the indications and methods of intervention for certain subgroups. When trials are summarized, prospective meta-analyses carry a lower risk of bias than the meanwhile uncontrolled magnitude of retrospective meta-analyses with conflicting results.

11.
Ultraschall Med ; 39(1): 56-68, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-26844710

RESUMO

PURPOSE: To assess the time intervals of the cardiac cycle in healthy fetuses in the second and third trimester using color tissue Doppler imaging (cTDI) and to evaluate the influence of different sizes of sample gates on time interval values. MATERIALS AND METHODS: Time intervals were measured from the cTDI-derived Doppler waveform using a small and large region of interest (ROI) in healthy fetuses. RESULTS: 40 fetuses were included. The median gestational age at examination was 26 + 1 (range: 20 + 5 - 34 + 5) weeks. The median frame rate was 116/s (100 - 161/s) and the median heart rate 143 (range: 125 - 158) beats per minute (bpm). Using small and large ROIs, the second trimester right ventricular (RV) mean isovolumetric contraction times (ICTs) were 39.8 and 41.4 ms (p = 0.17), the mean ejection times (ETs) were 170.2 and 164.6 ms (p < 0.001), the mean isovolumetric relaxation times (IRTs) were 52.8 and 55.3 ms (p = 0.08), respectively. The left ventricular (LV) mean ICTs were 36.2 and 39.4 ms (p = 0.05), the mean ETs were 167.4 and 164.5 ms (p = 0.013), the mean IRTs were 53.9 and 57.1 ms (p = 0.05), respectively. The third trimester RV mean ICTs were 50.7 and 50.4 ms (p = 0.75), the mean ETs were 172.3 and 181.4 ms (p = 0.49), the mean IRTs were 50.2 and 54.6 ms (p = 0.03); the LV mean ICTs were 45.1 and 46.2 ms (p = 0.35), the mean ETs were 175.2 vs. 172.9 ms (p = 0.29), the mean IRTs were 47.1 and 50.0 ms (p = 0.01), respectively. CONCLUSION: Isovolumetric time intervals can be analyzed precisely and relatively independent of ROI size. In the near future, automatic time interval measurement using ultrasound systems will be feasible and the analysis of fetal myocardial function can become part of the clinical routine.


Assuntos
Coração Fetal , Frequência Cardíaca Fetal , Ultrassonografia Pré-Natal , Ecocardiografia Doppler , Feminino , Coração Fetal/diagnóstico por imagem , Idade Gestacional , Humanos , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Valores de Referência
12.
J Perinat Med ; 45(3): 367-373, 2017 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-27505083

RESUMO

BACKGROUND: Erythropoietin seems to play an important role in the regulation of fetal hypoxemia. The present prospective study was designed to determine if changes in erythropoietin levels can be found in fetuses with severe early-onset growth restriction and hemodynamic compromise. METHODS AND RESULTS: Erythropoietin, hemoglobin, hematocrit, platelet counts, normoblasts, lacate, arterial and venous blood gasses in the umbilical cord were determined in 42 fetuses with fetal growth restriction (IUGR) with absent (zero-flow) and 26 IUGR fetuses with retrograde end-diastolic flow (reverse-flow) in the umbilical artery. Color Doppler measurements were performed on the middle cerebral artery (PI) and ductus venosus [(S-a)/D and (S-a)/Vmean]. Erythropoietin concentrations were significantly lower in the zero-flow group (median: 128.0 mU/mL; range: 60.3-213 mU/mL) compared with the reverse-flow group (median: 202.5 mU/mL; range: 166-1182 mU/mL). Significant differences in median lactate concentrations were observed between the zero-flow group: 3.28 mmol/L (range; 2.3-4.7 mmol/L), and reverse-flow group: 5.6 mmol/L (range: 3.8-7.5 mmol/L). Fetuses with reverse-flow had significantly lower median platelet counts than fetuses with zero-flow (74 vs. 155/µL) and significantly lower normoblast counts (63 vs. 342/100 WBC). CONCLUSIONS: Fetuses with severe IUGR due to chronic placental insufficiency and absent or reversed flow in the umbilical artery show increased erythropoietin levels.


Assuntos
Eritropoetina/sangue , Retardo do Crescimento Fetal/sangue , Retardo do Crescimento Fetal/fisiopatologia , Artérias Umbilicais/fisiopatologia , Velocidade do Fluxo Sanguíneo , Feminino , Retardo do Crescimento Fetal/diagnóstico por imagem , Humanos , Hipercapnia/sangue , Hipercapnia/fisiopatologia , Hipóxia/sangue , Hipóxia/fisiopatologia , Contagem de Plaquetas , Gravidez , Estudos Prospectivos , Trombocitopenia/sangue , Trombocitopenia/fisiopatologia , Ultrassonografia Doppler em Cores , Ultrassonografia Pré-Natal , Artérias Umbilicais/diagnóstico por imagem
13.
Ultraschall Med ; 38(4): 403-410, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26331331

RESUMO

Purpose To evaluate pre- and post-procedure myocardial function in monochorionic twins with TTTS who underwent laser ablation of placental anastomoses using pulsed wave tissue Doppler imaging (pw TDI). Materials and Methods 20 monochorionic twin gestations with TTTS were included and underwent laser ablation at our center between 2011 and 2014. Prior to and after the intervention, cardiac function was assessed by measuring the mitral annular plane systolic excursion (MAPSE), the tricuspid annular plane systolic excursion (TAPSE), Tei index, isovolumetric contraction time (ICT), ejection time (ET), isovolumetric relaxation time (IRT) for the left ventricle in pulsed wave Doppler (pw D) ultrasound as well as ICT, ET, IRT and Tei index in pw TDI for the left and right ventricle. E-, A-, E´- and A´-wave peak velocity and the systolic downward motion (S´) were measured for both ventricles and the E/A, E/E´ and E´/A´ ratios were calculated. In a mean of 1.3 (SD 0.6) days after laser ablation, this measurement protocol was repeated. Results Pre-intervention recipients had longer ICT, ET and IRT in pw D and pw TDI compared to donors not reaching statistical significance for most parameters. Statistically significant were prolonged ICT in pw D (p 0.01) and ET (p 0.01) in pw TDI in recipients. In donor fetuses preoperative myocardial function did not differ significantly from postoperative myocardial function except in increased left ventricular ejection time of the left ventricle in pw TDI (p 0.04) and an increased E´/A´ratio (p 0.01). After laser coagulation, myocardial function was slightly altered in recipients as ICT and IRT shortened and Tei indices decreased but only reaching statistical significance in shortened IRTs in pw TDI for both ventricles. Conclusion Laser ablation of placental anastomoses in TTTS might influence myocardial function in the postoperative period. Shortened IRT intervals may reflect an improvement of diastolic function in recipients.


Assuntos
Transfusão Feto-Fetal , Terapia a Laser , Feminino , Transfusão Feto-Fetal/terapia , Feto , Ventrículos do Coração , Humanos , Placenta/cirurgia , Gravidez , Sístole
14.
Prenat Diagn ; 36(11): 1033-1040, 2016 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-27643757

RESUMO

OBJECTIVE: The aim of this study is to establish new Doppler reference values in a population with normal pulmonary veins during different phases of the fetal cardiac cycle for maximum blood flow velocities during ventricular systole (S), early ventricular diastole (D), atrial contraction (a), intensity-weighted mean velocity (Vmean) and the indices derived from these parameters [(S - a)/D] and [(S - a)/Vmean]. METHODS: The pulsed-wave color advanced dynamic flow Doppler technique was used in a prospective cross-sectional study of 365 low-risk pregnancies between 18 and 41 completed gestational weeks. Reference ranges were calculated for the individual measuring parameters based on a growth function from a four-parameter class of monotonic continuous functions according to the smallest square principle. RESULTS: During the observation period of 18 to 41 gestational weeks, a continuous increase was evident in maximum flow velocities for ventricular systole (S), early ventricular diastole (D), atrial contraction (a) and intensity-weighted mean velocity (Vmean) of 14.7 to 431.1, 12.5 to 426.2, 5.4 to 411.9 and 8.7 to 421.6 cm/s, respectively. Venous indices, however, showed a decrease with increasing gestational age: (S - a)/D from 0.9 to 0.7 and (S - a)/Vmean from 1 to 0.9. CONCLUSION: The newly established normal values for the fetal pulmonary vein can be used in standardized Doppler sonography measurement to assess the left atrial pressure in the fetal heart. © 2016 John Wiley & Sons, Ltd.


Assuntos
Circulação Pulmonar , Veias Pulmonares/fisiologia , Ultrassonografia Doppler , Ultrassonografia Pré-Natal , Adulto , Velocidade do Fluxo Sanguíneo , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Valores de Referência , Adulto Jovem
15.
J Psychosom Obstet Gynaecol ; 37(4): 119-129, 2016 12.
Artigo em Inglês | MEDLINE | ID: mdl-27376660

RESUMO

INTRODUCTION: Antepartum risk and protective factors for postpartum depression (PPD; the most common mental disorder after childbirth besides postpartum anxiety), have been frequently investigated in cross-sectional studies, but less often longitudinally. This study examined linear and moderator effects of risk and protective factors for peripartum depression. First, we investigated the predictive power of risk factors (physical problems during pregnancy, pregnancy-related anxiety, stressful life events, dysfunctional self-consciousness (DSC)) and protective factors (resilience, social support) for antepartum depression (APD) and PPD. Second, as DSC plays an important role in major depression, we examined whether the protective factors moderate the association between the risk factors DSC and APD as well as PPD. METHODS: We conducted a prospective study with three measurement time points: six weeks antepartum (N = 297), as well as six weeks (N = 278) and twelve weeks (N = 266) postpartum. Direct and moderator effects on APD were analyzed using hierarchical regression analysis. Moderated mediation effects were investigated to explore whether the indirect, long-term effect of DSC on PPD six weeks after birth (PPD-6) and PPD twelve weeks after birth (PPD-12) is moderated by resilience. RESULTS: Predictors for APD were high DSC, high concerns about one's appearance, low resilience and low social support. Resilience buffered (weakened) the impact of DSC on APD and affected PPD-6 and PPD-12 indirectly through APD. DISCUSSION: The results suggest that PPD-12 is influenced directly and indirectly through PPD-6 by APD, but that this effect depends upon risk and protective factors, especially on the combined effects of resilience and DSC. The key finding of our study is the moderating (i.e. weakening) effect of resilience on the relationship between DSC and depression. Resilience and DSC may be an important issue for depression prevention and treatment programs in the peripartum period.


Assuntos
Depressão Pós-Parto/epidemiologia , Transtorno Depressivo Maior/epidemiologia , Complicações na Gravidez/epidemiologia , Adulto , Feminino , Alemanha/epidemiologia , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Fatores de Proteção , Fatores de Risco , Adulto Jovem
16.
PLoS One ; 11(5): e0156013, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27243815

RESUMO

OBJECTIVE: To evaluate the influence of the soluble fms-like tyrosine kinase 1/placental growth factor ratio in physicians' decision making in pregnant women with signs and symptoms of preeclampsia in routine clinical practice. METHODS: A multicenter, prospective, open, non-interventional study enrolled pregnant women presenting with preeclampsia signs and symptoms in several European perinatal care centers. Before the soluble fms-like tyrosine kinase 1/placental growth factor ratio result was known, physicians documented intended clinical procedures using an iPad® application (data locked/time stamped). After the result was available, clinical decisions were confirmed or revised and documented. An independent adjudication committee evaluated the appropriateness of decisions based on maternal/fetal outcomes. Clinician decision making with regard to hospitalization was the primary outcome. RESULTS: In 16.9% of mothers (20/118) the hospitalization decision was changed after knowledge of the ratio. In 13 women (11.0%), the initial decision to hospitalize was changed to no hospitalization. In seven women (5.9%) the revised decision was hospitalization. All revised decisions were considered appropriate by the panel of adjudicators (McNemar test; p < 0.0001). CONCLUSIONS: The use of the soluble fms-like tyrosine kinase 1/placental growth factor test influenced clinical decision making towards appropriate hospitalization in a considerable proportion of women with suspected preeclampsia. This is the first study to demonstrate the impact of angiogenic biomarkers on decision making in a routine clinical practice.


Assuntos
Tomada de Decisão Clínica/métodos , Fator de Crescimento Placentário/metabolismo , Pré-Eclâmpsia/diagnóstico , Pré-Eclâmpsia/terapia , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/terapia , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/metabolismo , Adulto , Biomarcadores/metabolismo , Feminino , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Prospectivos , Adulto Jovem
17.
Arch Gynecol Obstet ; 294(6): 1133-1139, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27256338

RESUMO

PURPOSE: The aim of this study is to assess the value of the angiogenic factors for diagnosing preeclampsia and predicting the severity of manifestation. A secondary aim is assessing the combination of the uterine artery Doppler with the angiogenic factors for improving the diagnostic power. METHODS: This is a prospective single center study in a tertiary referral hospital. This study includes 728 individual patients. Inclusion criteria were singleton pregnancies, a referral to the hospital with suspicion of preeclampsia and any one or combination of the following symptoms: headache, upper abdominal pain, edema, and hypertension. Patients with complications that would affect the course of the pregnancy, such as placenta praevia, premature preterm rupture of membranes, breech presentation, and fetal chromosomal or structural anomalies, were excluded from the study. Blood samples collection and uterine artery Doppler ultrasound were performed at time of recruitment. The differences in sFlt-1, PlGF, and their quotient among normal collective and patients with preeclampsia were analyzed. Doppler ultrasound was performed by one of four highly qualified sonographers. Wilcoxon-Mann-Whitney U test, Spearman's rank correlation, receiver operating characteristic curves, Chi-square test, and logistic regression were used in the analysis. RESULTS: A total of 1003 individual samples for the angiogenic factors were included in the analysis. 584 out of the recruited 728 patients had follow-up data with delivery information at the study hospital. Patients with preeclampsia show a significant increase in sFlt-1, which directly correlate with the increased severity of manifestation (Spearman's ρ 0.49). The sFlt-1 cut-off value of 5424 pg/ml confirms preeclampsia with 83.7 % sensitivity, 68.1 % specificity, and 24 % misclassification rate. Preeclampsia patients also show a significant decrease in PlGF, which negatively correlates with the increased severity of manifestation (Spearman's ρ -0.39). A PlGF cut-off value of 118 pg/ml confirms preeclampsia with 47.6 % sensitivity, 71.4 % specificity, and 27 % misclassification rate. Logistic regression shows that a combination of the quotient from sFlt-1/PlGF with notching and uterine artery PI provides a valid model for diagnosing preeclampsia with a diagnostic power of 74.4 %. CONCLUSIONS: The study confirms the use of the sFlt-1 and PlGF for diagnosing preeclampsia. It also shows their significance in differentiating between different categories of preeclampsia according to severity. This study shows that the use of angiogenic factors in combination with ultrasound findings provides valid models for confirming preeclampsia.


Assuntos
Fator de Crescimento Placentário/sangue , Pré-Eclâmpsia/diagnóstico , Artéria Uterina/diagnóstico por imagem , Receptor 1 de Fatores de Crescimento do Endotélio Vascular/sangue , Feminino , Humanos , Pré-Eclâmpsia/sangue , Pré-Eclâmpsia/diagnóstico por imagem , Pré-Eclâmpsia/patologia , Gravidez , Estudos Prospectivos , Ultrassonografia Doppler/métodos , Artéria Uterina/patologia , Adulto Jovem
18.
Arch Gynecol Obstet ; 294(5): 917-924, 2016 11.
Artigo em Inglês | MEDLINE | ID: mdl-27016345

RESUMO

PURPOSE: To construct biventricular reference ranges for isovolumic time intervals (isovolumic contraction time, ICT; isovolumic relaxation time, IRT) and ejection time (ET) for colour tissue Doppler imaging (cTDI) between 15 and 37 weeks' in healthy fetuses. METHODS: This was a prospective multicentre cross-sectional study involving 160 singleton pregnancies between 15 and 37 weeks of gestation, using cTDI. ICT, ET, IRT and myocardial performance index (MPI) were analysed offline using a small region of interest (ROI) within the basal part of the right and left ventricular wall immediately distal to the annulus. Regression analysis was used to determine gestational age-adjusted reference ranges and to construct nomograms for cTDI parameters. RESULTS: Right and left ventricular ICT (p = 0.004 and p < 0.001) and ET (p = 0.011 and p = 0.050) increased, whereas IRT (p = 0.862 and p = 0.067) and MPI (p = 0.476 and p = 0.777) remained constant with gestational age. CONCLUSIONS: This is the first study to evaluate fetal isovolumic time intervals in the second and third trimesters of gestation using cTDI. Normal data for fetal isovolumic time intervals and biventricular MPI by colour tissue Doppler imaging are provided. The reference ranges may be useful in research or clinical studies and can be used in fetuses with compromised cardiac function.


Assuntos
Ecocardiografia Doppler/métodos , Eletrocardiografia/métodos , Coração Fetal/diagnóstico por imagem , Estudos Transversais , Feminino , Desenvolvimento Fetal , Coração Fetal/embriologia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/embriologia , Humanos , Gravidez , Segundo Trimestre da Gravidez , Terceiro Trimestre da Gravidez , Estudos Prospectivos , Valores de Referência , Adulto Jovem
19.
J Perinat Med ; 43(2): 177-84, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25395596

RESUMO

AIMS: Regional and interinstitutional variations have been recognized in the increasing incidence of caesarean section. Modes of birth after previous caesarean section vary widely, ranging from elective repeat caesarean section (ERCS) and unplanned repeat caesarean section (URCS) after trial of labour to vaginal birth after caesarean section (VBAC). This study describes interinstitutional variations in mode of birth after previous caesarean section in relation to regional indicators in Germany. MATERIAL AND METHODS: A cross-sectional study using the birth registers of six maternity units (n=12,060) in five different German states (n=370,209). Indicators were tested by χ2 and relative deviations from regional values were expressed as relative risks and 95% confidence intervals. RESULTS: The percentages of women in the six units with previous caesarean section ranged from 11.9% to 15.9% (P=0.002). VBAC was planned for 36.0% to 49.8% (P=0.003) of these women, but actually completed in only 26.2% to 32.8% (P=0.66). Depending on the indicator, the units studied deviated from the regional data by up to 32% [relative risk 0.68 (0.47-0.97)] in respect of completed VBAC among all initiated VBAC. CONCLUSIONS: There is substantial interinstitutional variation in mode of birth following previous caesarean section. This variation is in addition to regional patterns.


Assuntos
Recesariana/estatística & dados numéricos , Nascimento Vaginal Após Cesárea/estatística & dados numéricos , Estudos Transversais , Feminino , Alemanha , Humanos , Gravidez
20.
Eur J Obstet Gynecol Reprod Biol ; 179: 246-50, 2014 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24853819

RESUMO

OBJECTIVES: We want to evaluate tissue Doppler imaging (TDI) for measuring cervical strain. We compare three different methods for measuring strain depending on the region of interest (ROI) placement and evaluate patient discomfort. We correlate the strain measured through TDI with cervical consistency index (CCI), cervical length and width of both cervical lips. STUDY DESIGN: This is a prospective study in 30 singleton primigravida pregnancies without obstetrical risks between 40+0 and 41+3 weeks of gestation. The CCI was calculated according to Parra-Saavedra et al. We tested three methods of measuring cervical elasticity depending on shape and location of ROIs. RESULTS: The CCI ranged between 36.4% and 71.9% with an average of 50.78%. The CCI shows negative correlation with strain and no correlation with cervical length or with the width of either cervical lip. The strain measurements regardless of tested method were reproducible and independent on cervical length. The average strain was higher in outer cervical regions. The ROIs placed on the anterior lip had higher reproducibility than those placed on the posterior lip. The average score for patient discomfort during examination was 3.7/10. CONCLUSION: The strain depends on the size and location of ROIs. The circular ROIs with diameter equal to the width of the cervical lip are recommended. There is a correlation between CCI and TDI. The cervix shows heterogeneous consistency with increased stiffness from the outer to the inner sections. The TDI seems to be an easy to learn, quickly to perform, acceptable and reproducible method for measuring cervical elasticity. There is room for optimization and refinement of measuring methods before being tested for clinical significance.


Assuntos
Colo do Útero/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Elasticidade , Feminino , Número de Gestações , Humanos , Gravidez , Estudos Prospectivos , Reprodutibilidade dos Testes
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