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1.
Placenta ; 62: 58-65, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29405968

RESUMO

INTRODUCTION: Preeclampsia is a hypertensive, gestational disease, which is still the leading cause of pregnancy related morbidity and mortality. The impairment of placental angiogenesis and vascularization is discussed to be of etiopathologic relevance. Deytrosination and tyrosination of α-tubulin is important for the stability and dynamics of microtubules. An increase of α-tubulin detyrosination leads to microtubule stabilization, which is an essential prerequisite for physiologic vascular tube morphogenesis during angiogenesis. So far, little is known about the specific localization of detyrosinated (detyr) and tyrosinated (tyr) tubulin in the placenta and its relevance for preeclampsia. METHODS: Placental expression of detyr- and tyr-tubulin was analyzed by immunohistochemistry, immunofluorescence and western blot. For western blot quantification we used biopsies from healthy placentas (n = 21) and placentas from pregnancies complicated with small for gestational age (n = 5), preeclampsia (n = 5) or both (n = 5). RESULTS: Specific placental localization of detyr-tubulin was detected in the fetal endothelial cells of the placenta. Villous and extravillous trophoblasts as well as villous stroma cells were tyr-tubulin positive. Detyr-tubulin protein expression was significantly decreased in placentas complicated by preeclampsia. CONCLUSIONS: In summary, we report an accumulation of detyr-tubulin in villous vessels of the placenta and a significantly reduced level of detyr-tubulin in placental biopsies of preeclampsia cases. The reduction of placental detyr-tubulin in preeclampsia could suggest a deficit in villous vascular plasticity and might be associated with the impaired arborization of the disease.


Assuntos
Placenta/metabolismo , Pré-Eclâmpsia/metabolismo , Processamento de Proteína Pós-Traducional/fisiologia , Tubulina (Proteína)/metabolismo , Tirosina/metabolismo , Vilosidades Coriônicas/metabolismo , Células Endoteliais/metabolismo , Feminino , Humanos , Recém-Nascido Pequeno para a Idade Gestacional , Microtúbulos/metabolismo , Gravidez , Células Estromais/metabolismo
2.
J Insect Physiol ; 106(Pt 3): 163-171, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29278714

RESUMO

In the face of global warming, both the absolute thermal tolerance of an ectotherm, and its ability to shift its tolerance level via acclimation, are thought to be fundamentally important. Understanding the links between tolerance and its plasticity is therefore critical to accurately predict vulnerability to warming. Previous studies in a number of ectotherm taxa suggest trade-offs in the evolution of thermal tolerance and its plasticity, something which does not, however, apply to Deronectes diving beetles, where these traits are instead positively correlated. Here we revisit the relationship between thermal tolerance and plasticity in these beetles, paying attention to a recently discovered morphological adaptation supporting under water respiration - setal tracheal gills. Hollow setae on the elytra interconnect with the beetle's tracheal system, providing a gas exchange surface that allows oxygen to be extracted directly from the water. This enables individuals to stay submerged for longer than their subelytral air stores would allow. We show that hypoxia reduced heat tolerance, especially when individuals were denied access to air, forcing them to rely solely on aquatic gas exchange. Species with higher densities of these gas-exchanging setae exhibited improved cold tolerance, but reduced heat tolerance and lower plasticity of heat tolerance. Differences in setal tracheal gill density across species were also related to habitat use: species with low gill density were found mainly in intermittent, warmer rivers, where underwater gas exchange is more problematic and risks of surfacing may be smaller. Moreover, when controlling for differences in gill density we no longer found a significant relationship between heat tolerance and its plasticity, suggesting that the previously reported positive relationship between these variables may be driven by differences in gill density. Differences in environmental conditions between the preferred habitats could simultaneously select for characteristic differences in both thermal tolerance and gill density. Such simultaneous selection may have resulted in a non-causal association between cold tolerance and gill density. For heat tolerance, the correlations with gill density could reflect a causal relationship. Species relying strongly on diffusive oxygen uptake via setal tracheal gills may have a reduced oxygen supply capacity and may be left with fewer options for matching oxygen uptake to oxygen demand during acclimation, which could explain their reduced heat tolerance and limited plasticity. Our study helps shed light on the mechanisms that underpin thermal tolerance and plasticity in diving air-breathing ectotherms, and explores how differences in thermal tolerance across species are linked to their selected habitat, morphological adaptations and evolutionary history.


Assuntos
Besouros/fisiologia , Oxigênio/fisiologia , Termotolerância , Animais , Besouros/anatomia & histologia , Ecossistema , Brânquias/anatomia & histologia
3.
J Exp Clin Cancer Res ; 36(1): 165, 2017 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-29169400

RESUMO

BACKGROUND: Human placental development resembles tumorigenesis, due to the invasive and fusogenic potential of trophoblasts. However, these features are tightly controlled in trophoblasts. Disturbance of this spatial and temporal regulation is thought to contribute to the rare formation of choriocarcinomas. Promoter hypermethylation and loss of the tumor suppressor Retinoic acid receptor responder 1 (RARRES1) were shown to contribute to cancer progression. Our study investigated the epigenetic and transcriptional regulation of RARRES1 in healthy human placenta in comparison to choriocarcinoma cell lines and cases. METHODS: Three choriocarcinoma cell lines (Jeg-3, JAR and BeWo) were treated with three different retinoic acid derivates (Am580, Tazarotene and all-trans retinoic acid) and 5-aza-2'-deoxycytidine. We analyzed RARRES1 promoter methylation by pyrosequencing and performed realtime-PCR quantification to determine RARRES1 expression in placental tissue and trophoblastic cell lines. Additionally, RARRES1 was stained in healthy placentas and in biopsies of choriocarcinoma cases (n = 10) as well as the first trimester trophoblast cell line Swan71 by immunofluorescence and immunohistochemistry. RESULTS: In the choriocarcinoma cell lines, RARRES1 expression could not be induced by sole retinoic acid treatment. Stimulation with 5-aza-2'-deoxycytidine significantly induced RARRES1 expression, which then could be further increased with Am580, Tazarotene and all-trans retinoic acid. In comparison to healthy placenta, choriocarcinoma cell lines showed a hypermethylation of the RARRES1 promoter, which correlated with a reduced RARRES1 expression. In concordance, RARRES1 protein expression was lost in choriocarcinoma tissue. Additionally, in the trophoblastic cell line Swan71, we found a significant induction of RARRES1 expression with increased cell density, during mitosis and in syncytial knots. CONCLUSIONS: Our findings showed that RARRES1 expression is absent in choriocarcinoma due to promoter methylation. Based on our analysis, we hypothesize that RARRES1 might exert tumor suppressive functions in multiple cellular processes (e.g. cell cycle regulation, adhesion, invasion and apoptosis).


Assuntos
Coriocarcinoma/genética , Metilação de DNA , Regulação para Baixo , Proteínas de Membrana/genética , Neoplasias Uterinas/genética , Linhagem Celular Tumoral , Coriocarcinoma/metabolismo , Progressão da Doença , Epigênese Genética , Feminino , Regulação Neoplásica da Expressão Gênica , Humanos , Proteínas de Membrana/metabolismo , Gravidez , Regiões Promotoras Genéticas , Análise de Sequência de DNA , Neoplasias Uterinas/metabolismo
4.
Arch Gynecol Obstet ; 294(3): 487-93, 2016 09.
Artigo em Inglês | MEDLINE | ID: mdl-26742730

RESUMO

INTRODUCTION: To evaluate the influence of the time interval between examination and delivery on the accuracy of sonographic fetal weight estimation (WE). MATERIALS AND METHODS: 8723 singleton pregnancies were included in this retrospective cohort study. Fetuses were divided into eight groups with regard to the time interval between estimation and delivery (group 1: 0 days; group 2: 1-3 days; group 3: 4-7 days; group 4: 8-14 days; group 5: 15-21 days; group 6: 22-28 days; group 7: 29-35 days; group 8: 36-42 days). The accuracy of WE was compared between the different time interval groups and five commonly used formulas using means of percentage errors (MPE), medians of absolute percentage errors, and proportions of estimates within 10 % of actual birth weight. RESULTS: In group one, the Hadlock I and Warsof formula showed a systematic underestimation of fetal weight (negative MPEs). No systematic error was found with the Hadlock II formula and the equations of Merz and Shepard showed a systematic overestimation (positive MPEs). MPE values of the Hadlock I, II and Warsof formulas were closest to zero in WEs of group two. From group three to six, MPE values decreased continuously. With the Merz and Shepard equations MPEs were closest to zero in group four. DISCUSSION: The best accuracy of sonographic WE with most of the commonly used equations is achieved within a scan-to-delivery interval of 1 week.


Assuntos
Peso ao Nascer , Peso Fetal , Ultrassonografia Pré-Natal , Adulto , Estudos Transversais , Feminino , Humanos , Gravidez , Estudos Retrospectivos
5.
Ultrasound Obstet Gynecol ; 47(6): 674-9, 2016 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-26094600

RESUMO

OBJECTIVE: To determine whether the amniotic fluid index (AFI) or the single deepest vertical pocket (SDP) technique for estimating amniotic fluid volume is superior for predicting adverse pregnancy outcome. METHODS: This was a multicenter randomized controlled trial including 1052 pregnant women with a term singleton pregnancy across four hospitals in Germany. Women were assigned randomly, according to a computer-generated allocation sequence, to AFI or SDP measurement for estimation of amniotic fluid volume. Oligohydramnios was defined as AFI ≤ 5 cm or the absence of a pocket measuring at least 2 × 1 cm. The diagnosis of oligohydramnios was followed by labor induction. The primary outcome measure was postpartum admission to a neonatal intensive care unit. Further outcome parameters were the rates of diagnosis of oligohydramnios and induction of labor (for oligohydramnios or without specific indication), and mode of delivery. RESULTS: Postpartum admission to a neonatal intensive care unit was similar between groups (4.2% (n = 21) vs 5.0% (n = 25); relative risk (RR), 0.85 (95% CI, 0.48-1.50); P = 0.57). In the AFI group, there were more cases of oligohydramnios (9.8% (n = 49) vs 2.2% (n = 11); RR, 4.51 (95% CI, 2.2-8.57); P < 0.01) and more cases of labor induction for oligohydramnios (12.7% (n = 33) vs 3.6% (n = 10); RR, 3.50 (95% CI, 1.76-6.96); P < 0.01) than in the SDP group. Moreover, an abnormal cardiotocography was seen more often in the AFI group than in the SDP group (32.3% (n = 161) vs 26.2% (n = 132); RR, 1.23 (95% CI, 1.02-1.50); P = 0.03). The other outcome measures were not significantly different between the two groups. CONCLUSIONS: Use of the AFI method increased the rate of diagnosis of oligohydramnios and labor induction for oligohydramnios without improving perinatal outcome. The SDP method is therefore the favorable method to estimate amniotic fluid volume, especially in a population with many low-risk pregnancies. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.


Assuntos
Líquido Amniótico/diagnóstico por imagem , Trabalho de Parto Induzido/estatística & dados numéricos , Oligo-Hidrâmnio/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Feminino , Humanos , Terapia Intensiva Neonatal , Oligo-Hidrâmnio/epidemiologia , Admissão do Paciente/estatística & dados numéricos , Valor Preditivo dos Testes , Gravidez , Resultado da Gravidez
6.
Geburtshilfe Frauenheilkd ; 75(3): 238-243, 2015 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-25914416

RESUMO

Aim: The combination of mechanical and drug procedures for the induction of labour seems to be beneficial. Accordingly, the normal procedure in clinical routine has been changed and induction of labour by means of a balloon catheter has been implemented. The aim of this study was to find out if this procedural change has resulted in a more effective induction of labour. Materials and Method: In this historical cohort study 230 inductions of labour at term in the year 2012 were compared with 291 inductions of labour in the year 2013, all at the University of Erlangen Perinatal Centre. Exclusion criteria were, among others, a multiple pregnancy, a premature rupture of membranes and a prior Caesarean section. In 2012 births were induced solely by use of the drugs dinoprostone and misoprostol, in 2013 not only with misoprostol but also mainly by use of a balloon catheter. The primary target parameter was the rate of failed labour inductions, defined as "no birth within 72 hours". Results: Altogether 521 inductions of labour were analysed. The rate of failed inductions of labour could be reduced by the changes in induction method (first-time mothers: 23 vs. 9 %, p = 0.0059; multiparous women: 10 vs. 1 %, p = 0.0204). Furthermore, the rate of primary Caesarean sections due to failed induction of labour (5.7 vs. 1.4 %, p = 0.0064), that of the observation of green amniotic fluid (first-time mothers: 23 vs. 9 %, p = 0.0059; multiparous women: 10 vs. 1 %, p = 0.0204) and of infantile infections (first-time mothers: 23 vs. 9 %, p = 0.0059; multiparous women: 10 vs. 1 %, p = 0.0204) were all reduced as well. Conclusion: The routine use of a balloon catheter for induction of labour has markedly improved the procedure. There were fewer failed labour inductions and fewer Caesarean sections due to failed induction of labour.

7.
Z Geburtshilfe Neonatol ; 219(2): 87-91, 2015 Apr.
Artigo em Alemão | MEDLINE | ID: mdl-25901869

RESUMO

PURPOSE: Many international guidelines recommend induction of labour beyond 41 weeks to reduce perinatal morbidity and mortality. In 2010, a new German guideline with this recommendation was published. The aim of this study was to investigate whether this recommendation influenced clinical outcome. MATERIAL AND METHODS: All cases with induction of labour beyond 40 weeks in 2008, 2009, 2011 and 2012 were examined. Multiple pregnancy and Caesarean section in the case history were exclusion criteria. The years before publication of the new German guideline (2008 and 2009) were compared with those afterwards (2011 and 2012) with regard to several outcome parameters like rate of labour induction, efficacy of induction of labour and foetal outcome. RESULTS: After publication of the guideline there were more inductions of labour undertaken (300 [11.2%] vs. 472 [15.4%], p<0.0001) with less pregnancies beyond 42 weeks (9 [3%] vs. 5 [1%], p=0.0489). However, there was no difference concerning the efficacy of induction of labour, e. g., the ratio of Caesarean sections was not increased. There was no impairment of foetal outcome, in contrast, the ratio of postpartal admission to NICU was decreased (42 [14.2%] vs. 31 [6.7%], p=0.0006). CONCLUSION: The new recommendation of the German guideline to induce labour beyond 41 weeks leads to more cases with induction of labour without any negative impact on its efficacy or foetal outcome.


Assuntos
Trabalho de Parto Induzido/estatística & dados numéricos , Trabalho de Parto Induzido/normas , Obstetrícia/normas , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/estatística & dados numéricos , Padrões de Prática Médica/normas , Adulto , Feminino , Alemanha/epidemiologia , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Gravidez , Resultado da Gravidez , Revisão da Utilização de Recursos de Saúde
8.
Arch Gynecol Obstet ; 292(4): 805-11, 2015 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-25870017

RESUMO

PURPOSE: To evaluate the accuracy of intrapartum sonographic weight estimation (WE). MATERIALS AND METHODS: This retrospective, cross-sectional study included 1958 singleton pregnancies. Inclusion criteria were singleton pregnancy with cephalic presentation, vaginal delivery and ultrasound examination with complete biometric parameters performed on the day of delivery during the latent or active phase of labor, and absence of chromosomal or structural anomalies. The accuracy of intrapartum WE was compared to a control group of fetuses delivered by primary cesarean section at our perinatal center and an ultrasound examination with complete biometric parameters performed within 3 days before delivery (n = 392). Otherwise, the same inclusion criteria as in the study group were applied. The accuracy of WE was compared between five commonly applied formulas using means of percentage errors (MPE), medians of absolute percentage errors (MAPE), and proportions of estimates within 10 % of actual birth weight. RESULTS: In the whole study group, all equations showed a systematic underestimation of fetal weight (negative MPEs). Overall, best MAPE and MPE values were found with the Hadlock II formula, using BPD, AC and FL as biometric parameters (Hadlock II, MPE: -1.28; MAPE: 6.52). MPEs differed significantly between WE in the study and control group for all evaluated formulas: in the control group, either no systematic error (Hadlock III, IV and V) or a significant overestimation (Hadlock I, II) was found. Regarding MAPEs, application of the Hadlock III (HC, AC, FL) and V (AC) formula resulted in significant lower values in the control group (Hadlock III, MAPE: 7.48 vs. 5.95, p = 0.0008 and Hadlock V, MAPE: 8.79 vs. 7.52, p = 0.0085). No significant differences were found for the other equations. CONCLUSIONS: A systematic underestimation of fetal weight has to be taken into account in sonographic WE performed intrapartum. Overall, the best results can be achieved with WE formulas using the BPD as the only head measurement.


Assuntos
Peso Fetal/fisiologia , Ultrassonografia Pré-Natal/métodos , Adulto , Biometria , Peso ao Nascer/fisiologia , Cefalometria/métodos , Cefalometria/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico , Feminino , Humanos , Trabalho de Parto , Valor Preditivo dos Testes , Gravidez , Análise de Regressão , Estudos Retrospectivos
9.
Eur J Vasc Endovasc Surg ; 50(2): 167-74, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25892322

RESUMO

OBJECTIVE: Little is known about the interactions between extracellular matrix (ECM) proteins and locally acting mechanical conditions and material macroscopic properties in abdominal aortic aneurysm (AAA). In this study, ECM components were investigated with correlation to corresponding biomechanical properties and loads in aneurysmal arterial wall tissue. METHODS: Fifty-four tissue samples from 31 AAA patients (30♂; max. diameter Dmax 5.98 ± 1.42 cm) were excised from the aneurysm sac. Samples were divided for corresponding immunohistological and mechanical analysis. Collagen I and III, total collagen, elastin, and proteoglycans were quantified by computational image analysis of histological staining. Pre-surgical CT data were used for 3D segmentation of the AAA and calculation of mechanical conditions by advanced finite element analysis. AAA wall stiffness and strength were assessed by repeated cyclical, sinusoidal and destructive tensile testing. RESULTS: Amounts of collagen I, III, and total collagen were increased with higher local wall stress (p = .002, .017, .030, respectively) and strain (p = .002, .012, .020, respectively). AAA wall failure tension exhibited a positive correlation with collagen I, total collagen, and proteoglycans (p = .037, .038, .022, respectively). α-Stiffness correlated with collagen I, III, and total collagen (p = .011, .038, and .008), while ß-stiffness correlated only with proteoglycans (p = .028). In contrast, increased thrombus thickness was associated with decreased collagen I, III, and total collagen (p = .003, .020, .015, respectively), and AAA diameter was negatively associated with elastin (p = .006). CONCLUSIONS: The present results indicate that in AAA, increased locally acting biomechanical conditions (stress and strain) involve increased synthesis of collagen and proteoglycans with increased failure tension. These findings confirm the presence of adaptive biological processes to maintain the mechanical stability of AAA wall.


Assuntos
Aorta Abdominal/química , Aorta Abdominal/fisiopatologia , Aneurisma da Aorta Abdominal/metabolismo , Aneurisma da Aorta Abdominal/fisiopatologia , Proteínas da Matriz Extracelular/análise , Hemodinâmica , Idoso , Idoso de 80 Anos ou mais , Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Ruptura Aórtica/etiologia , Ruptura Aórtica/metabolismo , Ruptura Aórtica/fisiopatologia , Aortografia/métodos , Fenômenos Biomecânicos , Progressão da Doença , Feminino , Análise de Elementos Finitos , Humanos , Masculino , Pessoa de Meia-Idade , Interpretação de Imagem Radiográfica Assistida por Computador , Fatores de Risco , Estresse Mecânico , Tomografia Computadorizada por Raios X , Rigidez Vascular
10.
Geburtshilfe Frauenheilkd ; 75(11): 1130-1139, 2015 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-26719596

RESUMO

Due to rising rates of labour induction in industrialised countries, safe and effective methods of induction have once again become a focus of interest and research. Prostaglandins are effective for cervical ripening and induction of uterine contractions. They do, however, cause overstimulation of the uterus in up to 20 % of cases, sometimes causing changes in fetal heart rate. Transcervical balloon catheters provide an alternative to prostaglandins for labour induction and have been used for this purpose for almost 50 years. This induction method has experienced a recent renaissance in clinical practice that is reflected in an annually rising number of publications on its use. Balloon catheters allow gentle ripening of the cervix without causing uterine overstimulation. The two catheters available are the Foley catheter (off-label use) and the double balloon catheter, which is licensed for use in induction of labour. Both are as effective as prostaglandins, and do not increase the risk of infection to mother or child. Catheter induction also requires less monitoring compared to prostaglandins resulting in improved patient satisfaction. Balloon catheters provide a useful and promising option to achieve vaginal delivery despite failed prostaglandin induction. Intravenous oxytocin is nevertheless required in up to 85 % of cases for adequate induction/augmentation of contractions. Balloon catheters, vaginal PGE2 and misoprostol are equally effective in the context of an unripe/unfavourable cervix, the rate of uterine hyperstimulation being significantly lower, and the need for oxytocin significantly higher for catheters. Balloon catheters are increasingly being used in combination or sequentially with oral/vaginal misoprostol, although there is currently inadequate published data on the subject. International guidelines recommend the use of balloon catheters for labour induction with an unripe cervix (also following previous caesarean section) as an alternative to prostaglandins, particularly when these are not available or are contraindicated.

11.
Arch Gynecol Obstet ; 292(1): 59-67, 2015 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25534163

RESUMO

PURPOSE: To evaluate the influence of the time interval between examination and delivery on the accuracy of sonographic weight estimation (WE) in fetal macrosomia. MATERIALS AND METHODS: 896 singleton pregnancies (birth weight > 4,000 g) with a total of 1,281 sonographic weight estimations were included in this retrospective cohort study. Fetuses were divided into six groups with regard to the time interval between estimation and delivery: group 1: scan-to-delivery interval: 0 days; group 2: scan-to-delivery interval: 1-3 days; group 3: scan-to-delivery interval: 4-7 days; group 4: scan-to-delivery interval: 8-14 days; group 5: scan-to-delivery interval: 15-21 days; group 6: scan-to-delivery interval: 22-42 days. The accuracy of WE was compared between five commonly used formulas using means of percentage errors (MPE), random error, medians of absolute percentage errors (MAPE), and proportions of estimates within 10 % of actual birth weight. RESULTS: Significant differences were found between the time interval groups with regard to MAPE and MPE values (p < 0.001). All formulas showed a systematic underestimation of fetal weight (negative MPEs) (p < 0.05). MPE values were closest to zero in time interval group 1 and 2. From group 3 to 6, a continuous decrease was observed. The lowest MAPE was found with the Merz formula in group 1 and 2. Values increased continuously from group 3 to 6. Differences between time interval group one and three did not reach statistical significance. CONCLUSIONS: WE in fetal macrosomia shows the best results when examinations are performed within 7 days before delivery, using the formula of Merz et al. Accuracy significantly decreases after this time period.


Assuntos
Parto Obstétrico , Macrossomia Fetal/diagnóstico por imagem , Peso Fetal/fisiologia , Ultrassonografia Pré-Natal/métodos , Adulto , Peso ao Nascer , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
12.
Ultraschall Med ; 36(3): 284-9, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-24927106

RESUMO

PURPOSE: The accuracy of the sonographic weight estimation (WE) of fetuses with congenital diaphragmatic hernia (CDH) is significantly lower than that of fetuses without any malformations. The objective of this study was to develop and evaluate the first specific sonographic weight formula for fetuses with CDH. MATERIALS AND METHODS: In a retrospective, multicenter, cohort study, a statistical estimation technique known as "multivariable fractional polynomial regression" was applied to a group of 146 fetuses with CDH. Each fetus underwent an ultrasound examination with complete biometric parameters within 7 days of delivery. A new formula was derived using the obtained data and was then compared with other commonly used equations. The accuracy of the different formulas was compared using means of signed percentage errors (SPE), medians of absolute percentage errors (MAPE), and fractions of estimates within prespecified error bounds. RESULTS: The new derived formula is: EFW = 10^(4.6729 107 371 + 0.2365 011 768 * HC + 0.2228 897 682 * FL^2 - 0.0129 895 773 * FL^3 - 1.0470 039 072 * (FL * HC)^0.5 + 0.0004 314 661 * (AC * HC) - [in case of liver herniation] 0.0062 112 122), where EFW is the estimated fetal weight, HC is the head circumference, AC is the abdominal circumference, and FL is the femur length. The new formula proved to be superior to other established equations, showing both the lowest median absolute percentage error (MAE: 6.97) and mean signed percentage error (SPE: 0.40), and the best distribution of absolute percentage errors within prespecified error bounds. CONCLUSION: This new formula significantly improves weight estimation in fetuses with CDH.


Assuntos
Peso Fetal , Hérnias Diafragmáticas Congênitas/diagnóstico por imagem , Ultrassonografia Pré-Natal/métodos , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Masculino , Modelos Estatísticos , Gravidez , Análise de Regressão , Estudos Retrospectivos
13.
Ultraschall Med ; 36(6): 630-6, 2015 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-25014478

RESUMO

PURPOSE: To determine the accuracy of sonographic weight estimation (WE) for small-for-gestational-age (SGA) fetuses, and to further differentiate the evaluation between symmetric and asymmetric SGA fetuses. MATERIALS AND METHODS: The accuracy of WE in SGA fetuses (n = 898) was evaluated using 14 sonographic models and was further differentiated between symmetric (n = 750) and asymmetric (n = 148) SGA fetuses. SGA fetuses were considered to be asymmetric with a head circumference to abdominal circumference ratio above the 95th percentile. The accuracy of the different formulas was compared using means of percentage errors (MPE), medians of absolute percentage errors (MAPE), and proportions of estimates within 10 % of actual birth weight. RESULTS: RESULTS for the subgroup of asymmetric SGA fetuses differed significantly from the subgroup of symmetric SGA fetuses. MPE values were closer to zero with most of the formulas in the asymmetric SGA group. Apart from the Siemer, Shepard, Merz and Warsof equations, all formulas showed an underestimation of fetal weight in asymmetric SGA fetuses. In contrast, in the symmetric SGA group, all of the formulas commonly used for fetuses in a normal weight range showed a systematic overestimation of fetal weight. Overall the best accuracy was achieved by using the Sabbagha equation (MPE 1.7 %; SD 9.0 %; MAPE: 6.0). CONCLUSION: An accurate WE in SGA fetuses is feasible using the Sabbagha formula. However, one has to be aware of the significant differences in WE between symmetric and asymmetric SGA fetuses.


Assuntos
Peso Fetal/fisiologia , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Cefalometria , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Gravidez , Estudos Retrospectivos , Sensibilidade e Especificidade , Estatística como Assunto , Circunferência da Cintura
14.
BJOG ; 122(1): 129-36, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25327872

RESUMO

OBJECTIVE: To evaluate the efficacy of inducing labour using a double-balloon catheter and oral misoprostol sequentially, in comparison with oral misoprostol alone. DESIGN: A multicentre randomised controlled trial. SETTING: Five hospitals in Germany. POPULATION: A total of 326 pregnant women with an unfavourable cervix undergoing labour induction at term. METHODS: Women were randomly assigned according to a computer-generated allocation sequence to sequential use of double-balloon catheter and oral misoprostol (study group) or oral misoprostol alone (control group). In the study group, the double-balloon catheter was used the first day before starting oral misoprostol the second day. MAIN OUTCOME MEASURES: The primary outcome measure was the induction-to-delivery interval, and a further outcome parameter was delivery within 48 hours. RESULTS: The median times for induction of labour until delivery were 32.4 hours in the study group and 22.5 hours in the control group (P = 0.004). This difference was not seen when evaluating according to parity (nulliparous, P = 0.19; parous, P = 0.06). The rate of vaginal delivery within 48 hours did not differ between both groups. The number of applications of misoprostol (two versus three, P < 0.001) and the dose of misoprostol used was lower in the study group (100 versus 200 µg, P < 0.001). In the study group, there were more Apgar scores of <7 at 5 minutes (8 versus 1, P = 0.04). CONCLUSIONS: The use of a double-balloon catheter on the first day, before starting oral misoprostol on the second day, did not improve the induction to delivery interval and the rate of delivery within 48 hours, in comparison with oral misoprostol alone.


Assuntos
Cateterismo/métodos , Cateteres , Maturidade Cervical , Parto Obstétrico/estatística & dados numéricos , Trabalho de Parto Induzido/métodos , Misoprostol , Ocitócicos , Administração Oral , Adolescente , Adulto , Anestesia Epidural/estatística & dados numéricos , Anestesia Obstétrica/estatística & dados numéricos , Cesárea/estatística & dados numéricos , Terapia Combinada , Feminino , Humanos , Ocitocina , Gravidez , Resultado do Tratamento , Adulto Jovem
15.
Geburtshilfe Frauenheilkd ; 74(7): 656-660, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-25100880

RESUMO

Aim: Effective pain management during labour is important because pain affects the birth experience. Epidural analgesia is effective but often it may not be possible; however, inhaled analgesia offers another option. Use of inhaled nitrous oxide and oxygen for pain management in labour is well established in obstetrics but is still not used much in Germany. This study aimed to investigate the acceptance of the inhaled analgesia of inhaled nitrous oxide and oxygen by midwives and pregnant women during labour. Material and Methods: In this observational study carried out between April and September 2013, a total of 66 pregnant women received inhaled nitrous oxide and oxygen during labour on request and after prior assessment of suitability. After the birth, all of the women and the responsible midwives were interviewed about their experience and satisfaction with the inhaled analgesia. Results: A statistically significant reduction of pain was achieved with nitrous oxide and oxygen. The inhaled analgesia was mostly used by women who refused epidural analgesia. The likelihood of using inhaled nitrous oxide and oxygen again was reported as higher for patients who tolerated it well (p = 0.0129) and used it in the second stage of labour (p = 0.0003) and when bearing down (p = 0.0008). Conclusion: Inhaled nitrous oxide and oxygen is an effective method for pain management during labour and is accepted well by women in labour and by midwives.

16.
Geburtshilfe Frauenheilkd ; 74(2): 146-151, 2014 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-24741125

RESUMO

Purpose: The aim of the present study was to compare the safety and efficacy of the Kiwi OmniCup system with conventional vacuum delivery. Methods: A retrospective study of operative vaginal deliveries was done for 4682 births. The procedures included 217 operative vaginal deliveries (4.6 %), 79 of which were done using conventional vacuum extraction (37 %) and 138 using the Kiwi system (63 %). Results: Use of the Kiwi system was associated with a significant reduction in episiotomies (61 vs. 76 % in the control group; p < 0.05). The rates of successful completion of birth were comparable for the two systems (94 % with the Kiwi system and 99 % with conventional vacuum delivery). Cup detachment occurred significantly more often in the Kiwi group (p < 0.005), requiring a change to a different method of birth significantly more often. It was necessary to change the procedure significantly more often from the mid-pelvis (p < 0.05). The incidence of maternal and foetal injuries was similar for the two systems. Conclusions: With regard to obstetric efficacy and safety and foetal and maternal injuries, the Kiwi system is an acceptable alternative to the conventional vacuum cup. The advantages of the Kiwi system are its significantly lower episiotomy rate and its ease and rapidity of use.

17.
J Mech Behav Biomed Mater ; 29: 360-74, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24184860

RESUMO

This paper presents an improved identification method of the constitutive properties of lung parenchyma. We aim to determine the non-linear viscoelastic behavior of lung parenchyma with a particular focus on the compressible properties - i.e. the ability to change volume. Uniaxial tensile tests are performed on living precision-cut rat lung slices. Image registration is used to compute the displacement field at the surface of the sample. The constitutive model consists of a hyperelastic potential split into volumetric and isochoric contributions and a viscous contribution. This allows for the description of the experimentally observed hysteresis loop. The identification is performed numerically: each test is simulated using the realistic geometry of the sample; the difference between the measured and computed displacements is minimized with an optimization algorithm. We compare several hyperelastic potentials and we can determine the most suitable law for rat lung parenchyma. An exponential potential or a polynomial potential with a first order term and a third or higher order term give similarly satisfactory results. The identified parameters are: for the volumetric contribution: κ=7.25e4Pa, for the exponential form: k1=4.34e3Pa, k2=5.92, for the polynomial form: C1=2.87e3Pa, C3=3.83e4Pa. The identification of the time parameter for the viscous contribution shows that it depends on the loading frequency (0.2Hz: τ=0.257s, 0.4Hz: τ=0.123s, 0.8Hz: τ=0.050s). Adding a viscous contribution significantly increases the accuracy of the identification.


Assuntos
Elasticidade , Análise de Elementos Finitos , Processamento de Imagem Assistida por Computador , Pulmão , Teste de Materiais , Dinâmica não Linear , Resistência à Tração , Animais , Ratos , Viscosidade
18.
Geburtshilfe Frauenheilkd ; 73(8): 783-791, 2013 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-24771932

RESUMO

Introduction: In Germany, cost and revenue structures of hospitals with defined treatment priorities are currently being discussed to identify uneconomic services. This discussion has also affected perinatal centres (PNCs) and represents a new economic challenge for PNCs. In addition to optimising the time spent in hospital, the hospital management needs to define the "best" patient mix based on costs and revenues. Method: Different theoretical models were proposed based on the cost and revenue structures of the University Perinatal Centre for Franconia (UPF). Multi-step marginal costing was then used to show the impact on operating profits of changes in services and bed occupancy rates. The current contribution margin accounting used by the UPF served as the basis for the calculations. The models demonstrated the impact of changes in services on costs and revenues of a level 1 PNC. Results: Contribution margin analysis was used to calculate profitable and unprofitable DRGs based on average inpatient cost per day. Nineteen theoretical models were created. The current direct costing used by the UPF and a theoretical model with a 100 % bed occupancy rate were used as reference models. Significantly higher operating profits could be achieved by doubling the number of profitable DRGs and halving the number of less profitable DRGs. Operating profits could be increased even more by changing the rates of profitable DRGs per bed occupancy. The exclusive specialisation on pathological and high-risk pregnancies resulted in operating losses. All models which increased the numbers of caesarean sections or focused exclusively on c-sections resulted in operating losses. Conclusion: These theoretical models offer a basis for economic planning. They illustrate the enormous impact potential changes can have on the operating profits of PNCs. Level 1 PNCs require high bed occupancy rates and a profitable patient mix to cover the extremely high costs incurred due to the services they are legally required to offer. Based on our theoretical models it must be stated that spontaneous vaginal births (not caesarean sections) were the most profitable procedures in the current DRG system. Overall, it currently makes economic sense for level I PNCs to treat as many low-risk pregnancies and neonates as possible to cover costs.

19.
Ultraschall Med ; 34(6): 573-9, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23143882

RESUMO

PURPOSE: To determine the accuracy of sonographic weight estimation (WE) for fetuses with congenital diaphragmatic hernia (CDH), and to assess whether certain sonographic models perform better than others in cases of CDH. MATERIAL AND METHODS: In a retrospective, multicenter cohort study, the accuracy of WE in fetuses with CDH (n = 172) was evaluated using eight sonographic models and was compared with a control group of fetuses without malformations (n = 172). Each fetus underwent ultrasound examination with complete biometric parameters within 7 days of delivery. The accuracy of the different formulas was compared using means of percentage errors (MPE), medians of absolute percentage errors (MAPE), and proportions of estimates within 10 % of actual birth weight. RESULTS: Fetuses with CDH had a significantly lower abdominal circumference (AC) in comparison with the control group (293.6 vs. 312.0 mm, p < 0.001). All of the formulas tested in fetuses with CDH, except for the Siemer equation (the only model that does not incorporate any abdominal measurements), showed significantly lower (more negative) MPEs, larger MAPEs, and smaller proportions of estimates within 10 % of actual birth weight in comparison with the control group.  CONCLUSION: The accuracy of sonographic WE in fetuses with CDH is significantly poorer than in fetuses without malformations, principally because of a larger systematic error due to artificially small AC measurements. The development of new, specific models derived from fetuses with CDH could improve the accuracy of WE for infants with this condition.


Assuntos
Peso Fetal/fisiologia , Hérnia Diafragmática/diagnóstico por imagem , Hérnias Diafragmáticas Congênitas , Ultrassonografia Pré-Natal/métodos , Peso ao Nascer/fisiologia , Cefalometria/métodos , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Fígado/anormalidades , Fígado/diagnóstico por imagem , Masculino , Valor Preditivo dos Testes , Gravidez , Valores de Referência , Análise de Regressão , Sensibilidade e Especificidade
20.
Z Geburtshilfe Neonatol ; 216(6): 246-52, 2012 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-23264179

RESUMO

PURPOSE: The aim of this study was to evaluate expectations of pregnant women on an ideal maternity hospital. MATERIAL AND METHODS: We prospectively performed a survey among 566 pregnant women with regard to their expectations on a perfect hospital for obstetrics. Data collection was accomplished in 3 obstetrical departments in Mannheim, Germany. The questionnaire contained 23 general questions about sociodemographic characteristics and 34 specific questions about the anticipated childbirth. Women who were less than 20 weeks pregnant and women who did not speak German fluently were excluded from this study. RESULTS: In our survey the possibility to get to know midwifes and doctors at information evenings and a guided delivery room tour were defined as very important factors by the interviewed women. Of particular importance was a continuous care by a single midwife and the physical attendance of a family member during childbirth. Furthermore, friendliness of the staff and medical care by paediatricians after childbirth were identified to be important. To some extent, a modern appearance of the ward was also a matter of importance. CONCLUSIONS: The medical treatment of mother and the newborn child and the friendliness of the staff have been identified as the most important factors with regard to the expectations of women on an ideal maternity hospital. In addition, a pleasant ambiance of the ward and regular visits by a lactation specialist were named as important.


Assuntos
Maternidades , Satisfação do Paciente , Gestantes/psicologia , Adulto , Feminino , Alemanha , Ambiente de Instituições de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Recém-Nascido , Tocologia , Relações Enfermeiro-Paciente , Relações Médico-Paciente , Gravidez , Estudos Prospectivos , Inquéritos e Questionários , Adulto Jovem
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