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Erlenwein J, Emons MI, Petzke F, Quintel M, Staboulidou I, Przemeck M. The effectiveness of an oral opioid rescue medication algorithm for postoperative pain management compared to PCIA : A cohort analysis. Anaesthesist 2020; 69:639-648. [PMID: 32617631 PMCID: PMC7458942 DOI: 10.1007/s00101-020-00806-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Revised: 05/11/2020] [Accepted: 05/27/2020] [Indexed: 11/17/2022]
Abstract
Background Standard protocols or algorithms are considered essential to ensure adequate analgesia. Germany has widely adopted postoperative protocols for pain management including oral opioids for rescue medication, but the effectiveness of such protocols has only been evaluated longitudinally in a before and after setting. The aim of this cohort analysis was to compare the effectiveness of an oral opioid rescue medication algorithm for postoperative management of pain to the gold standard of patient-controlled intravenous analgesia (PCIA). Material and methods This study compared cohorts of patients of two prospective observational studies undergoing elective total hip replacement. After surgery patients received piritramide to achieve a pain score of ≤3 on the numeric rating scale (NRS 0–10). A protocol was started consisting of oral long-acting oxycodone and ibuprofen (basic analgesia). Cohort 1 (C1, 126 patients) additionally received an oral opioid rescue medication (hydromorphone) when reporting pain >3 on the NRS. Cohort 2 (C2, 88 patients) was provided with an opioid by PCIA (piritramide) for opioid rescue medication. Primary endpoints were pain intensity at rest, during movement, and maximum pain intensity within the first 24 h postoperative. Secondary endpoints were opioid consumption, functional outcome and patient satisfaction with pain management. Results Pain during movement and maximum pain intensity were higher in C1 compared to C2: pain on movement median 1st–3rd quartile: 6 (3.75–8) vs. 5 (3–7), p = 0.023; maximum pain intensity: 7 (5–9) vs. 5 (3–8), p = 0.008. There were no differences in pain intensity at rest or between women and men in either group. The mean opioid consumption in all patients (combined PACU, baseline, and rescue medication; mean ± SD mg ME) was 126.6 ± 51.8 mg oral ME (median 120 (87.47–154.25) mg ME). Total opioid consumption was lower in C1 than C2 (117 ± 46 mg vs 140 ± 56 mg, p = 0.002) due to differences in rescue opioids (C1: 57 ± 37 mg ME, C2: 73 ± 43 mg ME, p = 0.006, Z = −2.730). Basic analgesia opioid use was comparable (C1: 54 ± 31 mg ME, C2: 60 ± 36 mg ME, p = 0.288, Z = −1.063). There were no differences in respect to the addition of non-opioids and reported quality of mobilization, sleep, frequency of nausea and vomiting, or general satisfaction with pain management. Conclusion In this study PCIA provided a better reduction of pain intensity, when compared to a standardized protocol with oral opioid rescue medication. This effect was associated with increased opioid consumption. There were no differences in frequencies of opioid side effects. This study was a retrospective analysis of two cohorts of a major project. As with all retrospective studies, our analysis has several limitations to consider. Data can only represent the observation of clinical practice. It cannot reflect the quality of a statement of a randomized controlled trial. Observational studies do not permit conclusions on causal relationships.
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Affiliation(s)
- J Erlenwein
- Department of Anesthesiology, University Hospital, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany.
| | - M I Emons
- Department of Anesthesiology, University Hospital, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - F Petzke
- Department of Anesthesiology, University Hospital, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - M Quintel
- Department of Anesthesiology, University Hospital, Georg August University of Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany
| | - I Staboulidou
- Fetal Medicine Center Hannover, Podbielskistraße 122, 30177, Hannover, Germany
| | - M Przemeck
- Department of Anesthesiology and Intensive Care, Annastift, Hannover, Anna-von-Borries-Straße 1-7, 30625, Hannover, Germany
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Kühnle E, Jungk J, Klapdor R, Kohls F, Hillemanns P, Staboulidou I. Einfluss von 3D Ultraschall und Beschäftigungstherapie auf die Entwicklung depressiver Symptome von hospitalisierten Risikoschwangeren. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- E Kühnle
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
| | - J Jungk
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
| | - R Klapdor
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
| | - F Kohls
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
| | - P Hillemanns
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
| | - I Staboulidou
- Medizinische Hochschule Hannover, Klinik für Frauenheilkunde und Geburtshilfe, Hannover, Deutschland
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Polkowski M, Schippert C, Kundu S, Kuehnle E, Hillemanns P, Staboulidou I. Neonatales und maternales Kurzzeitoutcome nach vaginal operativen Entbindungen im Vergleich zu sekundären Sectiones. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kundu S, Ehr JV, Kühnle E, Schippert C, Soergel P, Hillemanns P, Staboulidou I. Inter-und Intraobserver Variabilität der subpartu CTG-Interpretation und Einschätzung des arteriellen Geburts-pHs. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kundu S, Karakas H, Staboulidou I, Schippert C, Hertel H, Hillemanns P, Soergel P. Peri- und postoperatives Management sowie Outcome bei gynäkologischen Patientinnen mit einer extremen Adipositas (Grad 3, BMI über 40). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Lanowski JS, Lanowski G, Schippert C, Drinkut K, Hillemanns P, Staboulidou I. Fetale Gewichtsschätzung am Termin-Ultraschall oder abdominale Palpation? Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Kundu S, Weiß C, Schippert C, Staboulidou I, Hertel H, Hillemanns P, Soergel P. Intensität postoperativer Schmerzen nach laparoskopisch assistierter Hysterektomie in Abhängigkeit vom intraoperativen CO2-Druck. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1592794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Klages K, Kundu S, Erlenwein J, Elsässer M, Hillemanns P, Staboulidou I. Korrelation der Angst- und Schmerzempfindung während Chorionzottenbiopsie und Amniozentese. Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Kohls F, Kühnle E, Philippeit A, Dieks D, Hillemanns P, Staboulidou I. Rhesus-Inkompatibilität und fetale Anämie – ist ein hoher Anti-D-Titer sicher assoziiert mit einer fetalen Anämie? Ein Fallbericht. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Herms S, Kohls F, Kühnle E, Kundu S, Hillemanns P, Staboulidou I. Korrelation des pH-Wertes aus der Mikroblutuntersuchung mit dem tatsächlichen Geburts-pH. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Salmoukas C, Kundu S, Soergel P, Hillemanns P, von Kaisenberg C, Staboulidou I. Background Knowledge and Attitude of Pregnant Women towards Ultrasound Screening at 20–23 Weeks Gestation. Z Geburtshilfe Neonatol 2015; 220:16-20. [DOI: 10.1055/s-0035-1545287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- C. Salmoukas
- Department of Cardiothoracic, Transplantation and Vascular Surgery, University School of Hanover, Hanover, Germany
| | - S. Kundu
- Department of Gynecology and Obstetrics, University Medical School of Hanover, Hanover, Germany
| | - P. Soergel
- Department of Gynecology and Obstetrics, University Medical School of Hanover, Hanover, Germany
| | - P. Hillemanns
- Department of Gynecology and Obstetrics, University Medical School of Hanover, Hanover, Germany
| | - C. von Kaisenberg
- Department of Gynecology and Obstetrics, University Medical School of Hanover, Hanover, Germany
| | - I. Staboulidou
- Department of Gynecology and Obstetrics, University Medical School of Hanover, Hanover, Germany
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Staboulidou I, Bock N, Günter HH, Steinborn A, Gebauer G, Scharf A. Analyse des Nackentransparenz (NT-)Screeningkonzepts an der Frauenklinik der MHH: Eine prospektive Follow-up-Studie. Z Geburtshilfe Neonatol 2015; 219:147. [DOI: 10.1055/s-0035-1549868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
| | - N. Bock
- Universitäts-Frauenklinik Göttingen, Göttingen
| | - H.-H. Günter
- Frauenklinik der Med. Hochschule Hannover, Hannover
| | - A. Steinborn
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - G. Gebauer
- Universitäts-Frauenklinik Heidelberg, Heidelberg
| | - A. Scharf
- Frauenklinik der Med. Hochschule Hannover, Hannover
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Schippert C, Garcia-Rocha G, Schaff C, Soergel P, Staboulidou I, Schlösser H. Rekonstruktive, organerhaltende Mikrochirurgie bei Störungen der Tubenfunktion: nach wie vor eine Alternative zur In-vitro-Fertilisation (IVF). Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0034-1396191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- C. Schippert
- Frauenklinik der Medizinischen Hochschule Hannover, Bereich Gynäkologische Endokrinologie und Reproduktionsmedizin
| | - G. Garcia-Rocha
- Frauenklinik der Medizinischen Hochschule Hannover, Bereich Gynäkologische Endokrinologie und Reproduktionsmedizin
| | - C. Schaff
- Frauenklinik der Medizinischen Hochschule Hannover, Bereich Gynäkologische Endokrinologie und Reproduktionsmedizin
| | - P. Soergel
- Frauenklinik der Medizinischen Hochschule Hannover, Bereich Gynäkologische Endokrinologie und Reproduktionsmedizin
| | - I. Staboulidou
- Frauenklinik der Medizinischen Hochschule Hannover, Bereich Gynäkologische Endokrinologie und Reproduktionsmedizin
| | - H. Schlösser
- Frauenklinik der Medizinischen Hochschule Hannover, Bereich Gynäkologische Endokrinologie und Reproduktionsmedizin
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Erlenwein J, Kundu S, Schippert C, Soergel P, Hillemanns P, Staboulidou I. Attitude toward, acceptance of and knowledge about female sterilization as a method of contraception. Eur J Obstet Gynecol Reprod Biol 2014; 185:83-7. [PMID: 25541529 DOI: 10.1016/j.ejogrb.2014.11.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Revised: 11/18/2014] [Accepted: 11/21/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Surgical sterilization via tubal ligation or the disconnection of the tubes is a method of permanent contraception. The aim of this study was to evaluate the attitude, acceptance and knowledge of women about female sterilization as a method of contraception in terms of the social and cultural backgrounds of those women. STUDY DESIGN Prospective study based on an anonymous questionnaire that analyzed background knowledge, attitude, influence factors and motivation regarding sterilization, as well as the reasons for declining. The questionnaire also attempted to evaluate the effects on the self-esteem of the women, as well as the impact of religious dogma and the related beliefs. RESULTS One thousand, eight hundred questionnaires were distributed, and 1247 women completed the questionnaire—a response rate of 69.3%. There were mainly positive attitudes toward sterilization as a contraceptive method. Cultural background, including religion and faith; the mother's experiences and point of view; knowledge; family planning and the actual life situation have an influence on the attitudes toward and acceptance of sterilization as a contraceptive method and on the final choice of a contraceptive method. CONCLUSION Cultural background and present life situation have a great impact on the attitude toward and acceptance of sterilization as a method of contraception, thus influencing the final choice of a contraceptive method. Detailed counselling about this topic is essential and should be improved.
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Affiliation(s)
- J Erlenwein
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany; University of Göttingen, Department of Anesthesiology, Göttingen, Germany
| | - S Kundu
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany
| | - C Schippert
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany
| | - P Soergel
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany
| | - P Hillemanns
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany
| | - I Staboulidou
- University Medical School of Hannover, Department of Gynaecology and Obstetrics, Hannover, Germany.
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Kagan KO, Staboulidou I, Cruz J, Wright D, Nicolaides KH. Two-stage first-trimester screening for trisomy 21 by ultrasound assessment and biochemical testing. Ultrasound Obstet Gynecol 2010; 36:542-547. [PMID: 20503223 DOI: 10.1002/uog.7663] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES This study was carried out to examine the performance of a contingent policy in first-trimester screening for trisomy 21, in which the estimated risk was first derived by a combination of maternal age, fetal nuchal translucency (NT) thickness, presence/absence of the nasal bone, blood flow in the ductus venosus or flow across the tricuspid valve, and biochemical testing was carried out only in those who were found to have an intermediate risk. We also examined the performance of a policy in which the estimated risk was first derived by a combination of maternal age and biochemical testing, and ultrasound examination was carried out only in those with an intermediate risk. METHODS The data for this study were derived from prospective screening for trisomy 21 in singleton pregnancies, using, as markers, a combination of maternal age, fetal NT thickness and maternal-serum free β-human chorionic gonadotropin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A), in a one-stop clinic for first-trimester assessment of risk at 11 + 0 to 13 + 6 weeks of gestation. Assessment of the fetal nasal bone, ductus venosus flow and tricuspid flow were also routinely performed by appropriately trained sonographers. The performance of different screening policies was examined. RESULTS The study population consisted of 19 614 pregnancies with a normal karyotype or delivery of a phenotypically normal baby (euploid group) and 122 cases of trisomy 21. The best performance was achieved by a contingent policy in which first-stage screening was based on maternal age, fetal NT thickness and either tricuspid valve or ductus venosus blood flow, followed by biochemical testing only those with an intermediate risk, of 1 in 51 to 1 in 1000 (which constituted about 20% of the total). The performance of contingent screening in which first-stage testing relies on biochemistry was poorer than when first-stage screening was performed by ultrasound examination because, in order to achieve the same detection rate, the false-positive rate was twice as high. CONCLUSION Effective first-trimester screening for trisomy 21 can be achieved by a contingent policy in which first-stage testing is based on ultrasound examination and second-stage biochemical testing is carried out in only 20% of the patients.
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Affiliation(s)
- K O Kagan
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Dagklis T, Defigueiredo D, Staboulidou I, Casagrandi D, Nicolaides KH. Isolated single umbilical artery and fetal karyotype. Ultrasound Obstet Gynecol 2010; 36:291-295. [PMID: 20549772 DOI: 10.1002/uog.7717] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine the need for fetal karyotyping in cases of an isolated single umbilical artery (SUA) identified during the second-trimester routine anomaly scan. METHODS All patients booked for antenatal care and delivery in our hospital are offered two ultrasound scans in pregnancy, one at 11-13 weeks' gestation as part of screening for chromosomal defects and another at 20-23 weeks for detailed fetal examination. In addition we examine patients referred from other hospitals because of suspected fetal abnormalities during their routine second-trimester scan. We performed a search of the database to retrieve all cases with an SUA and reviewed the ultrasound findings, fetal karyotype and pregnancy outcome. RESULTS There were 643 cases with SUA, including 424 (65.9%) where the condition was isolated, 133 (20.7%) with one major fetal defect and 86 (13.4%) with multiple defects. The incidence of chromosomal abnormalities was 0% in the isolated SUA group, 3.7% in those with one defect and 50.7% in those with multiple defects. The commonest chromosomal abnormalities were trisomy 18, trisomy 13 and triploidy, which together accounted for 82.9% of cases. CONCLUSION The finding of an SUA should prompt the sonographer to search for fetal defects and if these are found the risk for chromosomal abnormalities is increased. In cases of apparently isolated SUA there is no evidence of increased risk of chromosomal abnormalities.
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Affiliation(s)
- T Dagklis
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital Medical School, London, UK
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Kagan KO, Staboulidou I, Syngelaki A, Cruz J, Nicolaides KH. The 11-13-week scan: diagnosis and outcome of holoprosencephaly, exomphalos and megacystis. Ultrasound Obstet Gynecol 2010; 36:10-14. [PMID: 20564304 DOI: 10.1002/uog.7646] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To determine the prevalence and outcome of fetuses with holoprosencephaly, exomphalos and megacystis diagnosed at 11-13 weeks of gestation. METHODS As part of a prospective screening study for trisomy 21 in singleton pregnancies at 11 + 0 to 13 + 6 weeks' gestation, transabdominal ultrasound examination was performed to diagnose holoprosencephaly, exomphalos and megacystis. Fetal karyotype and pregnancy outcome in fetuses with these defects were examined. RESULTS Screening was carried out in 57 119 pregnancies. The prevalence of holoprosencephaly, exomphalos and megacystis was 1 : 1298, 1 : 381 and 1 : 1632, respectively. Chromosomal abnormalities, mainly trisomies 18 and 13, were found in 65.9% of fetuses with holoprosencephaly, in 55.3% with exomphalos and in 31.4% with megacystis. There was spontaneous resolution of the defect by 20 weeks in 92.5% of euploid fetuses with exomphalos containing only bowel and in 90% of the euploid fetuses with megacystis and bladder length of < or = 15 mm. CONCLUSIONS A high proportion of fetuses with holoprosencephaly, exomphalos and megacystis diagnosed at 11-13 weeks of gestation are aneuploid, but in the majority of cases exomphalos and megacystis represent temporary abnormalities that resolve spontaneously.
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Affiliation(s)
- K O Kagan
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Spencer K, Spencer CE, Stamatopoulou A, Staboulidou I, Nicolaides KH. Early vaginal bleeding has no impact on markers used in first trimester aneuploidy screening. Prenat Diagn 2010; 30:547-50. [PMID: 20509154 DOI: 10.1002/pd.2519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the impact of early vaginal bleeding on the levels of markers used in first trimester screening for aneuploidy. METHODS A retrospective analysis was carried out on the free beta human chorionic gonadotrophin (beta-hCG) and pregnancy associated plasma protein-A (PAPP-A) levels and nuchal translucency thickness in 49 653 women with a normal singleton fetus who had first trimester combined screening for Down Syndrome in three centres. Median MoMs and the distribution of log MoMs of the two markers were compared in two groups-7470 women who self-reported vaginal bleeding and 42 183 women who reported no vaginal bleeding at any stage prior to the screening test. RESULTS The overall median MoM free beta-hCG and that in the bleeding and non-bleeding group were 0.9854, 1.0012 and 0.9832, and for PAPP-A were 1.0407, 1.0413 and 1.037. There was no significant difference between the bleeding and non-bleeding group by median test (p = 0.080) or by t-test comparing log MoMs (p = 0.1305) for free beta-hCG and for PAPP-A with median test (p = 0.5071) or by t-test comparing log MoMs (p = 0.1740). For delta nuchal translucency (NT) there was also no significant difference between the bleeding and non-bleeding group (p = 0.055). CONCLUSION Vaginal bleeding has little or no impact on first trimester marker levels and no correction is necessary.
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Affiliation(s)
- K Spencer
- Prenatal Screening Unit, Clinical Biochemistry Department, King George Hospital, Goodmayes IG3 8YB, UK.
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Spencer K, Staboulidou I, Nicolaides KH. First trimester aneuploidy screening in the presence of a vanishing twin: implications for maternal serum markers. Prenat Diagn 2010; 30:235-40. [DOI: 10.1002/pd.2445] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Poon LCY, Staboulidou I, Maiz N, Plasencia W, Nicolaides KH. Hypertensive disorders in pregnancy: screening by uterine artery Doppler at 11-13 weeks. Ultrasound Obstet Gynecol 2009; 34:142-148. [PMID: 19644947 DOI: 10.1002/uog.6452] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVES To examine the performance of screening for hypertensive disorders in pregnancy by a combination of the maternal factor-derived a-priori risk with the uterine artery (UtA) pulsatility index (PI) and to determine whether it is best in such screening to use the mean PI of the two arteries, the highest PI or the lowest PI. METHODS This was a prospective screening study for pre-eclampsia (PE) requiring delivery before 34 weeks (early PE), late PE and gestational hypertension (GH) in women attending their routine first hospital visit in pregnancy at 11 + 0 to 13 + 6 weeks of gestation. Maternal history was recorded and color flow Doppler imaging was used to measure the left and right UtA-PI. The performance of screening for PE and GH by a combination of the maternal factor-derived a-priori risks determined in a previous study and the UtA-PI was assessed. RESULTS There were 8061 (96.4%) cases unaffected by PE or GH, 37 (0.4%) that developed early PE, 128 (1.5%) with late PE and 140 (1.7%) with GH. The lowest, mean and highest UtA-PI were significantly higher in early PE and late PE than in the controls (P < 0.0001) and in early PE than late PE (P < 0.0001). The lowest UtA-PI was higher in GH than in controls (P = 0.014). The best performance in screening was provided by the lowest PI. The detection rate of early PE at a 10% false-positive rate increased from 47% in screening by maternal factors alone to 81% in screening by maternal factors and the lowest UtA-PI. The respective detection rates for late PE increased from 41% to 45% and those for GH increased from 31% to 35%. CONCLUSIONS The patient-specific risk for PE and GH can be derived by combining the disease-specific maternal factor-derived a-priori risk with the measurement of the lowest UtA-PI in a multivariate regression model.
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MESH Headings
- Arteries/diagnostic imaging
- Epidemiologic Methods
- Female
- Humans
- Hypertension, Pregnancy-Induced/diagnostic imaging
- Hypertension, Pregnancy-Induced/epidemiology
- Hypertension, Pregnancy-Induced/physiopathology
- Pregnancy
- Pregnancy Trimester, First
- Pregnancy-Associated Plasma Protein-A/analysis
- Ultrasonography, Doppler, Color/standards
- Ultrasonography, Doppler, Color/statistics & numerical data
- Ultrasonography, Prenatal/standards
- Ultrasonography, Prenatal/statistics & numerical data
- Uterus/blood supply
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Affiliation(s)
- L C Y Poon
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Soergel P, Staboulidou I, Claus V, Schippert C, Hillemanns P. Beeinflusst die Stellung des Mondes die Geburt? Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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22
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Soergel P, Staboulidou I, Zempel W, Grüssner S, Kaisenberg CV, Hillemanns P. Treffsicherheit der fetometrischen Gewichtsschätzung in der klinischen Routine. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Kagan KO, Cicero S, Staboulidou I, Wright D, Nicolaides KH. Fetal nasal bone in screening for trisomies 21, 18 and 13 and Turner syndrome at 11-13 weeks of gestation. Ultrasound Obstet Gynecol 2009; 33:259-264. [PMID: 19248005 DOI: 10.1002/uog.6318] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To investigate the performance of first-trimester screening for aneuploidies by including assessment of the fetal nasal bone in the combined test of maternal age, fetal nuchal translucency (NT) thickness, fetal heart rate (FHR) and serum free beta-human chorionic gonadotropin (beta-hCG) and pregnancy-associated plasma protein-A (PAPP-A). METHODS Screening by the combined test was performed in singleton pregnancies, including 19,614 with euploid fetuses, 122 with trisomy 21, 36 with trisomy 18, 20 with trisomy 13 and eight with Turner syndrome. In all cases the fetal nasal bone was assessed and classified as present or absent. We examined the performance of two screening strategies: firstly, assessment of the nasal bone in all patients and secondly, first-stage screening using the combined test in all patients followed by second-stage assessment of the nasal bone only in those with an intermediate risk of 1 in 51 to 1 in 1000 after the first stage. To validate the new risk algorithm we used a second independent dataset of 19 651 fetuses, including 139 with trisomy 21. RESULTS The nasal bone was absent in 2.6% of the euploid fetuses, 59.8% with trisomy 21, 52.8% with trisomy 18, 45.0% with trisomy 13 and in none of the fetuses with Turner syndrome. Respective figures for an absent nasal bone in the validation population, which contained fewer Black women, were 0.6%, 62.6%, 55.3%, 35.3% and 41.7%. In a screening policy based on maternal age, fetal NT, FHR, serum free beta-hCG and PAPP-A, for a fixed risk cut-off of 1 : 100, the false-positive rate was 3.0%. The standardized detection rates were 91% for trisomy 21 and 100% for trisomy 18, trisomy 13 and Turner syndrome, respectively. Assessment of the nasal bone in all pregnancies reduced the false-positive rate to 2.5% without changing the detection rate. A detection rate of 93% was achieved with the two-stage strategy at a false-positive rate of 2.4% in which it was necessary to assess the nasal bone in only 15% of the total population. In the validation dataset, screening by the combined test and using a risk cut-off of 1 : 100 detected 90% of the cases with trisomy 21 for a false-positive rate of 4%. Inclusion of the nasal bone increased the detection rate to 92% for a false-positive rate of 2.9%. Contingent screening detected 92% of cases for a false-positive rate of 2.9%. CONCLUSIONS Assessment of the fetal nasal bone improves the performance of first-trimester screening for trisomy 21.
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MESH Headings
- Adolescent
- Adult
- Algorithms
- Chorionic Gonadotropin, beta Subunit, Human/blood
- Chorionic Gonadotropin, beta Subunit, Human/genetics
- Chromosomes, Human, 13-15/genetics
- Chromosomes, Human, 16-18/genetics
- Down Syndrome/diagnosis
- Female
- Heart Rate, Fetal/genetics
- Humans
- Maternal Age
- Middle Aged
- Nasal Bone/abnormalities
- Nasal Bone/diagnostic imaging
- Nuchal Translucency Measurement
- Pregnancy
- Pregnancy Trimester, First/blood
- Pregnancy Trimester, First/genetics
- Pregnancy-Associated Plasma Protein-A/analysis
- Pregnancy-Associated Plasma Protein-A/genetics
- Prospective Studies
- Risk Assessment
- Trisomy/diagnosis
- Trisomy/genetics
- Turner Syndrome/genetics
- Ultrasonography, Prenatal
- Young Adult
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Affiliation(s)
- K O Kagan
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, London, UK
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Lautmann K, Staboulidou I, Wüstemann M, Günter H, Scharf A, Hillemanns P. Heterotopic pregnancy: simultaneous intrauterine and ectopic pregnancy following IVF treatment with the birth of a healthy child. Ultraschall Med 2009; 30:71-73. [PMID: 17926256 DOI: 10.1055/s-2007-963214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Although spontaneous simultaneous intrauterine and ectopic pregnancy was an extremely rare event in the past, it is increasingly being diagnosed since the rate of assisted reproduction technique (ART) gestations increased. Due to the serious consequences, delayed diagnosis should be prevented in order to salvage the viable intrauterine fetus and avoid maternal morbidity and mortality. This case report demonstrates that the pitfalls of the diagnosis of heterotopic pregnancy make early diagnosis difficult and the prevention of heterotopic pregnancies by single embryo transfer should be continuously discussed. The role of high resolution ultrasound scans and the importance of close monitoring of early pregnancies following ART are emphasized because early diagnosis of heterotopic pregnancy results in a similar perinatal outcome as singleton pregnancies.
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Affiliation(s)
- K Lautmann
- Frauenklinik, Medizinische Hochschule Hannover, Hannover.
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25
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Staboulidou I, Wüstemann M, Vaske B, Scharf A, Hillemanns P, Schmidt P. Interobserver variability of the measurement of fetal nasal bone length between 11+0 and 13+6 gestation weeks among experienced and inexperienced sonographers. Ultraschall Med 2009; 30:42-46. [PMID: 18773384 DOI: 10.1055/s-2008-1027402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
PURPOSE Examination of fetal nasal bone (NB) by ultrasound between 11 + 0 and 13 + 6 gestation weeks has been proposed as an additional tool in the detection of trisomy 21 and therefore its application and implementation are used in a broad range. The study aimed at evaluating the interobserver feasibility of the measurement of fetal nasal bone length in comparison with experienced and inexperienced sonographers. MATERIALS AND METHODS The study population was comprised of women who chose to have first trimester screening (FTS) at the Fetal Medicine Unit of the University Medical School of Hannover. Two experienced (> 400 FTS examinations, sonographer 1 and 2) and one inexperienced sonographer (95 FTS examinations, sonographer 3) were asked to measure the nasal bone length consecutively and independently of each other. Statistical analysis was performed for any differences and variations in the results. RESULTS The fetal profile was examined in 220 cases. The median nasal bone length by sonographer one was 2.4 cm, sonographer two 2.4 cm and sonographer three 2 cm. The differences between the results of sonographer 1 and 3 as well 2 and 3 were statistically significant. There were no significant variations between the results of sonographer 1 and 2. There was also no significant difference in the results concerning nuchal translucency and crown-rump length among the three examiners. CONCLUSION The uncertainty and the difficulties of an inexperienced examiner with the presenting of the nasal bone, as shown by published data sets as well as by the variability of the measurement results of this study, with all the consequences in the risk calculation and counseling show that this tool should only be implemented by experienced and quality-controlled sonographers with a minimum amount of examinations. Because of its major impact in risk calculation and the importance of the nasal bone as a sonographic marker, documentation of the sonographer's skills is mandatory for the use of the nasal bones as an additional sonographic marker in first trimester screening.
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Affiliation(s)
- I Staboulidou
- University Medical School of Hannover, Department of Obstetrics and Gynecology, Hannover.
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26
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Schippert C, Garcia-Rocha G, Schaff C, Soergel P, Staboulidou I, Schlösser H. Rekonstruktive, organerhaltende Mikrochirurgie bei Störungen der Tubenfunktion: nach wie vor eine Alternative zur In-vitro-Fertilisation (IVF). Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1038942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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27
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Elsässer M, Stoiber B, Maul H, Staboulidou I, Scharf A, Sohn C, Schmidt P. Aneurysma der Vena galeni in der 22. SSW – Verlauf und Prognose eines ausgeprägten Aneurysmas der Vena galeni in der 22. SSW. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1089264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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28
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Staboulidou I, Maiz N, Nicolaides K. Screening for adverse pregnancy outcome by Ductus venosus Doppler at 11–13+6 weeks – Ductus venosus at 11–13+6 weeks. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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29
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Staboulidou I, Wüstemann M, Schmidt P, Günter HH, Hillemanns P, Scharf A. [Influence of circadian rhythm on fetal and maternal Doppler parameters--is a diurnal variation detectable?]. Z Geburtshilfe Neonatol 2008; 212:47-52. [PMID: 18432556 DOI: 10.1055/s-2008-1004638] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Doppler sonography is an established method in fetal medicine. Up to now a possible circadian rhythm of fetal and maternal Doppler parameters has only been insufficiently characterized and documented. This survey aimed at evaluating the significance of Doppler parameters with regard to diurnal variations. We have analyzed whether or not a circadian rhythm of fetal and maternal Doppler parameters is detectable. MATERIAL AND METHODS A non-selected collective of 100 patients with a singleton pregnancy between the 20th and 39th week of gestation was examined with Doppler sonography at the Medical School of Hannover. Besides the Doppler sonography, which was performed at three fixed times a day, the maternal blood pressure was examined each time. Outcome parameters were resistance index (RI), pulsatility index (PI) and the maximum velocity (V (max)) of the A. umbilicalis, A. cerebri media and the Aa. uterinae as well as the maternal blood pressure. RESULTS There were no significant differences for the RI, PI and V (max) of the Aa. uterinae for the whole collective, nor for the subgroups of maternal hypertonia, preeclampsia, notching and fetal growth restriction (IUGR). There were also no significant diurnal variations of the Doppler parameters for the fetal vessels. In particular, there were no differences in the measured Doppler parameters in comparison to the collective with unremarkable gravidity. In some subgroups statistical significance could be achieved, but due to the minor variations, no clinical importance has to be considered. CONCLUSION A circadian rhythm of the Doppler parameters could not be confirmed in the examined collective. The time of the applied Doppler sonography on physiological conditions might represent a factor which does not affect the validity of the Doppler sonographic results. As a consequence a single Doppler examination at a freely chosen time seems to be sufficient to obtain a correct assessment of fetal and maternal blood perfusion. Further studies on larger collectives are necessary to evaluate the clinical importance of a possible circadian rhythm, especially in fetuses with pathological Doppler values.
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Affiliation(s)
- I Staboulidou
- Medizinische Hochschule Hannover, Abteilung für Gynäkologie und Geburtshilfe.
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30
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Lautmann K, Staboulidou I, Schippert C, Hillemanns P, Wüstemann M. [Feto-amniotic shunting for lower urinary tract obstruction (LUTO)--a case report]. Z Geburtshilfe Neonatol 2008; 211:250-3. [PMID: 18176906 DOI: 10.1055/s-2007-981408] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Posterior urethral valves are the main cause of fetal lower urinary tract obstruction (LUTO) with typical sonographic signs like urinary tract dilatation and reduction of amniotic fluid. LUTO is associated with a high rate of perinatal mortality and is the main cause of kidney failure in early childhood. In such cases vesico-amniotic shunting is a common but risky procedure of fetal surgery to prevent anhydramnion and lethal lung hypoplasia. This case report demonstrates that lung hypoplasia can be prevented by vesico-amniotic shunting of the fetal megacytis in the 23rd week of gestation in a fetus with lower urinary tract obstruction and anhydramnion. The prenatal measured concentration of cystatin C in the fetal urine correlated with the postnatal impaired kidney function. The indication and therapeutic benefit of vesico-amniotic shunting remain controversially discussed in the literature because until today there is no evidence for a reduction in perinatal or long-term morbidity due to early fetal kidney damage. The earlier ultrasound detection of LUTO during the first trimester of pregnancy proposes the possibility of earlier intervention and protection of nephrogenesis. First case studies about first trimester vesico-amniotic shunting have been published; the influence on the postnatal kidney function merits further well-structured investigation.
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Affiliation(s)
- K Lautmann
- Medizinische Hochschule Hannover, Frauenklinik, Hannover.
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Schmidt P, Hörmansdörfer C, Staboulidou I, Seydel J, Vaske B, Brocker K, Hillemanns P. Gesundheitsökonomische Aspekte des Downsyndrom-Screenings. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2007-989413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Schmidt P, Staboulidou I, Elsässer M, Vaske B, Hillemanns P, Scharf A. How Imprecise May the Measurement of Fetal Nuchal Translucency Be without Worsening First-Trimester Screening? Fetal Diagn Ther 2008; 24:291-5. [DOI: 10.1159/000158520] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 07/16/2007] [Indexed: 11/19/2022]
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Kessel S, Staboulidou I, Oehler K, Hillemanns P, Scharf A, Günter HH. [Gestational diabetes under clinical conditions in aspired normoglycemia: investigation for correlation of blood glucose daily profiles and fetometric ultrasound parameters]. Z Geburtshilfe Neonatol 2007; 211:185-90. [PMID: 17960516 DOI: 10.1055/s-2007-981328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND One of the therapeutic aims in gestational diabetes (GDM) is to prevent the development of fetal hypertrophy by adaptation of maternal glycemic control. Relating to this context, maternal blood glucose daily profiles and fetal biometry ultrasound parameters were analysed for a possible correlation. A special focus was given to the question as to whether a latency period exists for this possible connection. PATIENTS AND METHODS 152 pregnancies affected by GDM, without fetal malformations or aneuploidies, were enrolled. Altogether, 746 ultrasound examinations consisting of 7 fetometric parameters each and 1 288 blood glucose daily profiles originating from the 20 (th) to 40 (th) gestational week were systematically investigated for interrelation by correlation and multiple regression analysis. RESULTS No robust, constant correlation between the analysed parameters could be observed. However, marked differences between latency periods were noticed. Blood glucose parameters, which revealed significant regressions with fetal abdominal circumference, had an average time lag of 6.2 +/- 2.5 weeks, whereas the latency period for head circumference averaged 2.4 +/- 1.2 weeks. The overall small-for-gestational-age (SGA) rate was 20 %, pregnant women with a body mass index > 30 kg / m (2) revealed the highest rate of 28 %. CONCLUSIONS Therapeutic intervention depending on sonographically detected hypertrophy must be considered as being delayed. The currently valid therapeutic criteria including intended normoglycemia and regular fetometric ultrasound controls cannot prevent markedly high SGA rates, especially among obese women, in adequately treated GDM.
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Affiliation(s)
- S Kessel
- Abteilung I für Geburtshilfe, Pränatalmedizin und allg. Gynäkologie, Frauenklinik der Med. Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover
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Maul H, Mann J, Schmidt P, Staboulidou I, Koch L, Sohn C. Geburtshilfe. Magnesiumtherapie in der Schwangerschaft zur Vermeidung von kindlichen Hirnschäden. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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35
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Hertel H, Gösling A, Staboulidou I, Hillemanns P. Laparoskopische Zerviko-Utero-Sakropexie zur fertilitätserhaltenden Behandlung eines Genitalprolaps. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-988680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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36
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Soergel P, Wang X, Stepp H, Staboulidou I, Hertel H, Hillemanns P. Photodynamische Therapie cervikaler intraepithelialer Neoplasien mit Hexaminolevulinat (HAL) – Ergebnisse einer Pilotstudie. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-988694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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37
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Soergel P, Reiff J, Stepp H, Staboulidou I, Hillemanns P. Photodetektion infiltrierter Lymphknoten mittels Porphyrin-Fluoreszenz beim Ovarialkarzinom. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-988693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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38
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Kessel S, Staboulidou I, Oehler K, Hillemanns P, Scharf A, Günter HH. Der Gestationsdiabetes unter klinischen Bedingungen bei angestrebter Normoglykämie: Detaillierter Verlauf fetometrischer Parameter zwischen der 20. und 40. Schwangerschaftswoche. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-965285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Tzialidou I, Oehler K, Scharf A, Staboulidou I, Westhoff-Bleck M, Hillemanns P, Günter HH. [Marfan syndrome in pregnancy: presentation of four cases and discussion]. Z Geburtshilfe Neonatol 2007; 211:36-41. [PMID: 17327991 DOI: 10.1055/s-2007-960544] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The coincidence of Marfan syndrome and pregnancy means a high risk for mother and child, as it is associated with cardiovascular and obstetric complications. We report our experience of four pregnancies with the Marfan syndrome. The course of pregnancy, the peripartum management and both the maternal and neonatal outcomes of four pregnant women with the Marfan syndrome, who were treated in our department between 1995 and 2005, were retrospectively analysed. The pregnancies of two women were complicated by premature rupture of membranes (36 (th) gestational week) and premature uterine contractions with cervical incompetence (30 (th) gestational week), respectively. One patient developed class 3 (NYHA) heart failure in the 3 (rd) trimenon. Two out of four women had mild cardiovascular disease and could deliver vaginally. In the other two cases a primary Caesarean section was performed at the 36 (th) week of gestation because of severe cardiovascular morbidity. No patient had a progressive aortic dilatation, dissection or rupture. The neonatal outcome was uneventful in all cases. Three newborns underwent a genetic evaluation for the Marfan syndrome, in two of them mutations in the fibrillin 1 gene were detected. Women with the Marfan syndrome should be counselled pre-conception and observed by an interdisciplinary team during pregnancy. If the aortic root diameter is < 40 mm, without progression in pregnancy, and in the absence of severe valve insufficiency, then pregnancy is in most cases well tolerated and vaginal delivery can be performed.
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MESH Headings
- Adult
- Aortic Dissection/diagnosis
- Aortic Dissection/genetics
- Aortic Aneurysm, Abdominal/diagnosis
- Aortic Aneurysm, Abdominal/genetics
- Cesarean Section
- DNA Mutational Analysis
- Female
- Fetal Membranes, Premature Rupture/diagnosis
- Fibrillin-1
- Fibrillins
- Genetic Counseling
- Genetic Testing
- Heart Failure/diagnosis
- Heart Failure/genetics
- Humans
- Infant, Newborn
- Marfan Syndrome/diagnosis
- Marfan Syndrome/genetics
- Microfilament Proteins/genetics
- Obstetric Labor Complications/diagnosis
- Obstetric Labor Complications/genetics
- Obstetric Labor, Premature/diagnosis
- Obstetric Labor, Premature/genetics
- Pregnancy
- Pregnancy Complications/diagnosis
- Pregnancy Complications/genetics
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/genetics
- Pregnancy Trimester, Third
- Pregnancy, High-Risk
- Retrospective Studies
- Uterine Cervical Incompetence/diagnosis
- Uterine Cervical Incompetence/genetics
- Vacuum Extraction, Obstetrical
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Affiliation(s)
- I Tzialidou
- Medizinische Hochschule Hannover, Zentrum Frauenheilkunde, Abteilung I: Frauenheilkunde und Geburtshilfe.
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Schmidt P, Staboulidou I, Soergel P, Hillemanns P, Scharf A. Individualized growth charts for ultrasound measurements can significantly improve fetal monitoring. Arch Gynecol Obstet 2007; 276:315-21. [PMID: 17375314 DOI: 10.1007/s00404-007-0355-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Accepted: 03/01/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE For monitoring pregnancies it is useful to reduce unnecessary examinations due to wrongfully assumed growth retardation in cases with a small fetal growth potential. It also makes sense to improve the detection of objectively retardated children in order to a disproportionately high growth potential. It was the aim of this study to modify the standard growth charts for ultrasound parameters according to parental influences to better display the individual growth potential. MATERIAL AND METHODS In a prospective trial 1,390 ultrasound measurements of 174 completed pregnancies were observed. For all patients a standard questionnaire was conducted in which possible predictors for fetal growth were collected. Customizing the growth charts had been achieved by (1) calculating the general impact of parental factors on the ultrasound measurement values, (2) plotting the individual growth charts for each pregnancy and (3) analyzing the difference of every observed measurement from either unchanged normal values or customized growth charts. RESULTS The obtained biparietal diameter measurements all in all are 291 mm closer to the individualized charts than to the unmodified charts. The total improvement of all thoracal diameter measurements was found to be 294 mm, the summarized advancement of all abdomen circumference values was 1,005 mm and the femur length measurements are 296 mm nearer to customized charts. All results were statistically significant. DISCUSSION This is the first time the impact of several predictors on ultrasound growth charts had been analyzed. While other working groups have demonstrated the benefit of customizing the fetal weight and length, this concept had never been carried forward onto the growth charts for ultrasound values. The method to adjust the common mean values by so called 'modifiers' is derived from the mathematical concept of the sequential first-trimester screening for Down's syndrome. For customizing growth charts this approach seems to be useful as well. The feasability and the statistical benefit of customizing ultrasound growth charts has been demonstrated in this work. A larger study seems to be promising and should be performed. Further improvements could be obtained by using normal growth charts which were derived from the examined cohort.
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Affiliation(s)
- P Schmidt
- Department of Obstetrics and Gynecology, Medical University Hannover, Hannover, Germany.
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Schmidt P, Garcea R, Parussis E, Staboulidou I, Scharf A. A rare case of massive ovarian edema in an uncomplicated singleton pregnancy. Ultraschall Med 2007; 28:71-4. [PMID: 16703489 DOI: 10.1055/s-2006-926648] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
Massive Ovarian Edema (MOE) is a rare cause of ovarian enlargement. Only 77 cases have been reported in the world literature so far, merely three of which were observed during pregnancy. Two of these showed additional pathological changes of the affected ovary (torsion) or were found in twin pregnancy. The patient presented on hand is therefore only the second report of MOE in an uncomplicated singleton pregnancy. In this case, a therapeutical resection of the affected ovary was performed at 16 + 4 weeks of gestation. The further course of the pregnancy was uncomplicated.
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Affiliation(s)
- P Schmidt
- Frauenarztpraxis Dr. Schmidt, Wolfenbüttel.
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Hörmansdörfer C, Scharf A, Staboulidou I, Hillemanns P, Schmidt P. Improved fetal monitoring through individualized growth charts for ultrasound measurements. Z Geburtshilfe Neonatol 2007. [DOI: 10.1055/s-2007-1003016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Staboulidou I, Steinborn A, Schmidt P, Günter HH, Hillemanns P, Scharf A. [References values for the fetal nasal bone in the first trimenon of pregnancy in a normal collective. A prospective study]. Z Geburtshilfe Neonatol 2006; 210:173-8. [PMID: 17099839 DOI: 10.1055/s-2006-951741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Examination of the fetal nasal bone by ultrasound between 11 and 14 weeks gestation has been proposed as an additional tool in the detection of trisomy 21. However, the variability in the identification and the normal length of the fetal nasal bone have not been investigated sufficiently as yet. The aim of this study was to evaluate this parameter and to establish normal ranges for nasal bone length. METHOD Ultrasound examinations were carried out in 122 fetuses at 9, 10, 11, 12 and 20 weeks gestation. On the scans, the fetal profile was examined for the possibility of identification of the nasal bone. Normal nasal bone length reference ranges were generated using prenatal measurements. RESULTS The fetal profile was successfully examined in all cases. The nasal bone could first be visualised at 9 weeks gestation. The identification of the fetal nasal bone in all cases was achieved at 12 weeks gestation. The median nasal bone length was 0.29 mm at 9 weeks gestation, 0.96 mm at 10 weeks gestation, 1.73 mm at 11 weeks gestation, 2.25 at 12 weeks gestation, and 6.18 mm at 20 weeks gestation. CONCLUSION The reference ranges for the measurement of the fetal nasal bone length are similar to the findings in the published literature. Only with a knowledge of reference ranges for nasal bone length in normal fetuses can conclusions be drawn about the presence/absence of the bone or the presence of a hypoplastic nasal bone. Further studies are necessary to confirm these results and to obtain larger datasets to assess nasal bone as a quantitative marker.
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Affiliation(s)
- I Staboulidou
- Frauenklinik der Medizinischen Hochschule Hannover, Hannover.
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Staboulidou I, Schauer J, Rau GA, Hass R, Hollwitz B, Scharf A. Antenatal Ultrasonographic Appearance of Isolated Fetal Ascites. Fetal Diagn Ther 2006; 21:501-5. [PMID: 16969003 DOI: 10.1159/000095661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2005] [Accepted: 12/06/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND Isolated fetal ascites can be caused by many heterogeneous disorders and is associated with a variety of conditions. Cloacal anomalies are rare abnormalities with a highly variable array of sonographic symptoms, which make them difficult to diagnose antenatally. We present a case with isolated fetal ascites without hydronephrosis caused by a cloacal malformation. CASE A 28-year-old woman, gravida 2, para 1, was referred to our unit at 18 weeks gestation with a hyperdense structure in the fetal liver. Cordocentesis revealed a normal karyotype and negative viral titers. Isolated fetal ascites occurred for the first time at 23 weeks gestation. Serial ultrasounds showed progressive fetal ascites with no hydronephrosis at any time and no other malformations apart from the previously diagnosed hyperechogenic liver structure. After the insertion of an abdomino-amniotic shunt, a temporary reduction of the sonographically detectable ascites could be achieved. Cesarean delivery was necessary due to a pathological CTG at 33 weeks of gestation. The baby was born with a markedly distended abdomen. Postnatal radiologic examination showed two fistulae between the cloaca and the notedly dilated vagina and the rectum respectively. At the age of 3 months a vaginoplasty was performed, which involved creating a correctly positioned vaginal opening, reconstruction of the urethra and rectum as well as occlusion of the two fistulae. CONCLUSION In view of the examinations, performed before and after delivery, it has to be assumed that fetal urine drained via the cloaca through the fallopian tubes into the abdomen. In contrast to usual appearance of cloacal malformations no hydronephrosis was detected and the kidney function was normal at all times. To our knowledge, this is the first published case of isolated fetal ascites without hydronephrosis caused by a cloacal malformation.
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Affiliation(s)
- I Staboulidou
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine and General Gynecology, Medical School of Hannover, Hannover, Germany.
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Staboulidou I, Freitag U, Marquardt R, Wüstemann M, Hillemanns P, Scharf A. [Quality assured ultrasound simulation training for the detection of fetal malformations--can a training benefit be evidenced?]. Z Geburtshilfe Neonatol 2006; 210:135-40. [PMID: 16941306 DOI: 10.1055/s-2006-947217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The factual sonographic training in obstetrics differs in Germany in a broad range. In this context, a tendency towards minimalistic dealings with this issue prevails. In contrast to this, the provisions of the German maternity guidelines relating to ultrasound clearly define quality oriented requirements serving altogether as a basic sonographic standard which mandatorily has to be met by all German Obstetricians. In order to close this gap between professional education and social demand, a training concept regarding obstetric ultrasound was devised by the German Association of Gynecologists utilizing the ultrasound simulator system. The aim of this study was to evaluate the usefulness and the effectiveness of this method and its potential role and benefit in structured sonographic training. MATERIAL AND METHODS Between October 2004 and August 2005, 74 obstetric ultrasound training courses according to the ultrasound simulator concept of the Medical School of Hanover were realized in nine federal states of Germany by the German Academy of Gynecology. The aim of these courses was it to procure ultrasound knowledge regarding the structured sonographic exclusion of fetal malformations in a compact manner. As a measure of quality assurance, a standardized questionnaire was issued before and after the courses in order to analyze the benefit of these simulator-based ultrasound courses. RESULTS The concept found prevailing approval (90 %) at the level of principle, practical implementation and clinical usefulness. 88,2 % of the participants estimated their subjective training effect as being good. The analysis of the questionnaire showed a statistically significant improvement of sonographic knowledge. On average, 74.1 % of the questions were answered correctly by the end of the course as opposed to a mere 46.3 % at the beginning. CONCLUSION Structured ultrasound training courses based on the ultrasound simulator system seem to be able to define a basic quality of training and significantly improves examiners' skills in prenatal medicine possible independent of local or structural factors. Hence they seem to be a suitable instrument to close the gap between the sonographic education worthy of improvement and the existing social demand for efficiacy of obstetric sonography.
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Affiliation(s)
- I Staboulidou
- Frauenklinik der Med. Hochschule Hannover, Hannover.
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Schmidt P, Pruggmayer M, Staboulidou I, Maul H, Wüstemann M, Beier P, Sohn C, Hillemanns P, Scharf A. Sind die Nackentransparenz, Papp-A oder ß-HCG vom mütterlichen Alter abhängig? Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Schippert C, Garcia-Rocha G, Otremba M, Wüstemann M, Staboulidou I, Schlößer HW. Therapiekonzept der schweren Endometriose (rAFS Grad IV): Rezidivhäufigkeit und postoperative Schwangerschaftsrate nach mikrochirurgischen Sterilitätslaparotomie und prä- bzw. postoperativer (anti)hormoneller Therapie. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Staboulidou I, Wüstemann M, Maul H, Schippert C, Hillemanns P, Scharf A. Der Stellenwert eines Notches in der Frühgravidität als Prädiktor eines pathologischen Schwangerschaftsverlaufes. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Schippert C, Garcia-Rocha G, Staboulidou I, Wüstemann M, Schlößer HW. Mikrochirurgie oder In-vitro-Fertilisation (IVF) bei Störungen der Tubenfunktion? Ergebnisse von 536 mikrochirurgischen Operationen aufgrund tubarer Sterilität an der Medizinischen Hochschule Hannover von 1990–2001. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Staboulidou I, Wüstemann M, Oehler K, Hollwitz B, Hillemanns P, Scharf A. Qualitätsgesichertes Ultraschall-Simulator-Training zur Erkennung fetaler Fehlbildungen. Analyse des Sonotrainerkonzeptes aus 11 Bundesländern. Geburtshilfe Frauenheilkd 2006. [DOI: 10.1055/s-2006-952603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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