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Sourouni M, Germeyer A, Feißt M, Balzer A, Köster H, Minte A, Brüggmann D, Kohll C, Reinhardt K, Möginger M, Leonhardt A, Banz-Jansen C, Bohlmann M, Fröhlich C, Backes C, Hager D, Kaup L, Hollatz-Galuschki E, Engelbrecht C, Markfeld-Erol F, Hagenbeck C, Schäffler H, Winkler J, Stubert J, Rathberger K, Lüber L, Hertlein L, Machill A, Richter M, Berghäuser M, Weigel M, Morgen M, Horn N, Jakubowski P, Riebe B, Ramsauer B, Sczesny R, Schäfer-Graf UM, Schrey S, Kehl S, Lastinger J, Seeger S, Parchmann O, Iannaccone A, Rohne J, Gattung L, Morfeld CA, Abou-Dakn M, Schmidt M, Glöckner M, Jebens A, Sondern KM, Pecks U, Schmitz R, Möllers M. Correction: Multiple Gestation as a Risk Factor for SARS-CoV-2-Associated Adverse Maternal Outcome: Data From the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS). Geburtshilfe Frauenheilkd 2023; 83:e42. [PMID: 38292374 PMCID: PMC10827381 DOI: 10.1055/a-2232-5598] [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: 02/01/2024] Open
Abstract
[This corrects the article DOI: 10.1055/a-2196-6224.].
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Affiliation(s)
- Marina Sourouni
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Ariane Germeyer
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | - Alexandra Balzer
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | | | - Annemarie Minte
- Department of Obstetrics and Gynecology, Cristophorus Hospital, Coesfeld, Germany
| | - Dörthe Brüggmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Celine Kohll
- Gynäkologie und Geburtshilfe, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Kristin Reinhardt
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Halle, Halle, Germany
| | - Michaela Möginger
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - Anja Leonhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Constanze Banz-Jansen
- Gynäkologie und Geburtshilfe, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Germany
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | | | - Clara Backes
- Klinik für Gynäkologie und Geburtshilfe, Schön Hospital Munich Harlaching, München, Germany
| | - Dietrich Hager
- Klinik für Gynäkologie und Geburtshilfe, Thüringen-Kliniken Saalfeld-Rudolstadt, Thüringen, Germany
| | - Lisa Kaup
- Dr. Geisenhofer Clinic for Gynecology and Obstetrics, München, Germany
| | | | | | | | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Hening Schäffler
- Klinik für Gynäkologie und Geburtshilfe, Ulm University Hospital, Ulm, Germany
| | - Jennifer Winkler
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Stubert
- Dept. of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Katharina Rathberger
- Klinik für Frauenheilkunde und Geburtshilfe, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Laura Lüber
- Klinik für Gynäkologie und Geburtshilfe, Oberschwaben Hospital Group, Ravensburg, Germany
| | - Linda Hertlein
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU, München, Germany
| | - Antonia Machill
- Department of Obstetrics and Gynecology, Vinzenz Pallotti Hospital, Bensberg, Germany
| | - Manuela Richter
- Neonatologie, Kinderkrankenhaus auf der Bult, Hannover, Germany
| | - Martin Berghäuser
- Klinik für Kinderheilkunde, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Michael Weigel
- Frauenklinik, Leopoldina-Krankenhaus der Stadt Schweinfurt GmbH, Schweinfurt, Germany
| | - Mirjam Morgen
- Klinik für Gynäkologie und Geburtshilfe, St. Vincenz-Krankenhaus, Datteln, Germany
| | - Nora Horn
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Peter Jakubowski
- Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany
| | - Bastian Riebe
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Links der Weser gGmbH, Bremen, Germany
| | - Babett Ramsauer
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Robert Sczesny
- Klinik für Gynäkologie und Geburtshilfe, Marienhaus Hospital Saint Elisabeth Neuwied, Neuwied, Germany
| | | | - Susanne Schrey
- Abteilung für Geburtsmedizin, Uniklinik Leipzig, Leipzig, Germany
| | - Sven Kehl
- Gynecology & Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Lastinger
- Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria
| | - Sven Seeger
- Klinik für Geburtshilfe, Krankenhaus St. Elisabeth und St. Barbara Halle, Halle, Germany
| | - Olaf Parchmann
- Klinik für Gynäkologie und Geburtshilfe, HELIOS Hospital Sangerhausen, Sangerhausen, Germany
| | - Antonella Iannaccone
- Klinik für Gynäkologie und Geburtshilfe, University Hospital Essen, Essen, Germany
| | - Jens Rohne
- Klinik für Gynäkologie und Geburtshilfe, Maria Heimsuchung Caritas Klinik Pankow, Berlin, Germany
| | - Luise Gattung
- Klinik für Gynäkologie und Geburtshilfe, Bad Salzungen Hospital, Bad Salzungen, Germany
| | | | - Michael Abou-Dakn
- Klinik für Gynäkologie, St. Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
| | - Markus Schmidt
- Gynecology & Obstetrics, Sana Kliniken Duisburg GmbH, Duisburg, Germany
| | - Michaela Glöckner
- Abteilung für Gynäkologie und Geburtshilfe, Hospital Memmingen, Memmingen, Germany
| | - Anja Jebens
- Abteilung für Gynäkologie und Geburtshilfe, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
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Sourouni M, Germeyer A, Feißt M, Balzer A, Köster H, Minte A, Brüggmann D, Kohll C, Reinhardt K, Möginger M, Leonhardt A, Banz-Jansen C, Bohlmann M, Fröhlich C, Backes C, Hager D, Kaup L, Hollatz-Galuschki E, Engelbrecht C, Markfeld-Erol F, Hagenbeck C, Schäffler H, Winkler J, Stubert J, Rathberger K, Lüber L, Hertlein L, Machill A, Richter M, Berghäuser M, Weigel M, Morgen M, Horn N, Jakubowski P, Riebe B, Ramsauer B, Sczesny R, Schäfer-Graf UM, Schrey S, Kehl S, Lastinger J, Seeger S, Parchmann O, Iannaccone A, Rohne J, Gattung L, Morfeld CA, Abou-Dakn M, Schmidt M, Glöckner M, Jebens A, Sondern KM, Pecks U, Schmitz R, Möllers M. Multiple Gestation as a Risk Factor for SARS-CoV-2-Associated Adverse Maternal Outcome: Data From the COVID-19 Related Obstetric and Neonatal Outcome Study (CRONOS). Geburtshilfe Frauenheilkd 2023; 83:1508-1518. [PMID: 38046525 PMCID: PMC10689107 DOI: 10.1055/a-2196-6224] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/22/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction Studies have shown that pregnant women with COVID-19 have a higher risk of intensive care unit admission and invasive mechanical ventilation support than non-pregnant women. Pregnancy-associated physiological changes in respiratory function may contribute to the elevated risk. Alteration in lung volumes and capacities are attributed to the mechanical impediment caused by the growing fetus. Multiple pregnancies may therefore compromise functional lung capacity earlier than singleton pregnancies and contribute to severe respiratory symptoms of COVID-19. Materials and Methods A total of 5514 women with a symptomatic SARS-CoV-2 infection during pregnancy registered in the COVID-19 Related Obstetric and Neonatal Outcome Study were included. The COVID-19-related adverse maternal outcomes were compared in 165 multiple versus 5349 singleton pregnancies. Combined adverse maternal outcome was defined as presence of COVID-19-related hospitalization and/or pneumonia and/or oxygen administration and/or transfer to ICU and/or death. Multivariate logistic regression was used to estimate the odds ratios and 95% confidence intervals were calculated. Results The frequency of dyspnea, likelihood of developing dyspnea in a defined pregnancy week and duration of the symptomatic phase of the COVID-19 infection did not differ between the two groups. On average, COVID-19-related combined adverse outcome occurred earlier during pregnancy in women expecting more than one child than in singleton pregnancies. The overall incidence of singular and combined COVID-19-associated adverse maternal outcomes was not significantly different between groups. However, regression analysis revealed that multiple gestation, preconceptional BMI > 30 kg/m 2 and gestational age correlated significantly with an increased risk of combined adverse maternal outcome. Conversely, maternal age and medically assisted reproduction were not significant risk factors for combined adverse maternal outcome. Conclusion Our data show that multiple gestation alone is a risk factor for COVID-19-associated combined adverse maternal outcome. Moreover, severe courses of COVID-19 in women expecting more than one child are observed earlier in pregnancy than in singleton pregnancies.
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Affiliation(s)
- Marina Sourouni
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Ariane Germeyer
- Gynäkologische Endokrinologie und Fertilitätsstörungen, University Hospital Heidelberg, Heidelberg, Germany
| | - Manuel Feißt
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | - Alexandra Balzer
- Universitätsklinikum Heidelberg, Institut für Medizinische Biometrie, Heidelberg, Germany
| | | | - Annemarie Minte
- Department of Obstetrics and Gynecology, Cristophorus Hospital, Coesfeld, Germany
| | - Dörthe Brüggmann
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Celine Kohll
- Gynäkologie und Geburtshilfe, Klinikum rechts der Isar der Technischen Universität München, München, Germany
| | - Kristin Reinhardt
- Geburtshilfe und Pränatalmedizin, Universitätsklinikum Halle, Halle, Germany
| | - Michaela Möginger
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Giessen und Marburg, Standort Marburg, Marburg, Germany
| | - Anja Leonhardt
- Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Chemnitz gGmbH, Chemnitz, Germany
| | - Constanze Banz-Jansen
- Gynäkologie und Geburtshilfe, Evangelisches Klinikum Bethel gGmbH, Bielefeld, Germany
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | | | - Clara Backes
- Klinik für Gynäkologie und Geburtshilfe, Schön Hospital Munich Harlaching, München, Germany
| | - Dietrich Hager
- Klinik für Gynäkologie und Geburtshilfe, Thüringen-Kliniken Saalfeld-Rudolstadt, Thüringen, Germany
| | - Lisa Kaup
- Dr. Geisenhofer Clinic for Gynecology and Obstetrics, München, Germany
| | | | | | | | - Carsten Hagenbeck
- Department of Gynecology and Obstetrics, University Hospital Düsseldorf, Heinrich Heine Universität Düsseldorf, Düsseldorf, Germany
| | - Hening Schäffler
- Klinik für Gynäkologie und Geburtshilfe, Ulm University Hospital, Ulm, Germany
| | - Jennifer Winkler
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Johannes Stubert
- Dept. of Gynecology and Obstetrics, University of Rostock, Rostock, Germany
| | - Katharina Rathberger
- Klinik für Frauenheilkunde und Geburtshilfe, Hospital St. Hedwig of the Order of St. John, Regensburg, Germany
| | - Laura Lüber
- Klinik für Gynäkologie und Geburtshilfe, Oberschwaben Hospital Group, Ravensburg, Germany
| | - Linda Hertlein
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, LMU, München, Germany
| | - Antonia Machill
- Department of Obstetrics and Gynecology, Vinzenz Pallotti Hospital, Bensberg, Germany
| | - Manuela Richter
- Neonatologie, Kinderkrankenhaus auf der Bult, Hannover, Germany
| | - Martin Berghäuser
- Klinik für Kinderheilkunde, Florence-Nightingale-Krankenhaus, Düsseldorf, Germany
| | - Michael Weigel
- Frauenklinik, Leopoldina-Krankenhaus der Stadt Schweinfurt GmbH, Schweinfurt, Germany
| | - Mirjam Morgen
- Klinik für Gynäkologie und Geburtshilfe, St. Vincenz-Krankenhaus, Datteln, Germany
| | - Nora Horn
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Lichtenberg, Berlin, Germany
| | - Peter Jakubowski
- Department of Gynecology and Obstetrics, University of Tübingen, Tübingen, Germany
| | - Bastian Riebe
- Klinik für Gynäkologie und Geburtshilfe, Klinikum Links der Weser gGmbH, Bremen, Germany
| | - Babett Ramsauer
- Klinik für Geburtsmedizin, Vivantes Klinikum Neukölln, Berlin, Germany
| | - Robert Sczesny
- Klinik für Gynäkologie und Geburtshilfe, Marienhaus Hospital Saint Elisabeth Neuwied, Neuwied, Germany
| | | | - Susanne Schrey
- Abteilung für Geburtsmedizin, Uniklinik Leipzig, Leipzig, Germany
| | - Sven Kehl
- Gynecology & Obstetrics, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Julia Lastinger
- Gynecology, Obstetrics and Gynecological Endocrinology, Kepler University Hospital, Linz, Austria
| | - Sven Seeger
- Klinik für Geburtshilfe, Krankenhaus St. Elisabeth und St. Barbara Halle, Halle, Germany
| | - Olaf Parchmann
- Klinik für Gynäkologie und Geburtshilfe, HELIOS Hospital Sangerhausen, Sangerhausen, Germany
| | - Antonella Iannaccone
- Klinik für Gynäkologie und Geburtshilfe, University Hospital Essen, Essen, Germany
| | - Jens Rohne
- Klinik für Gynäkologie und Geburtshilfe, Maria Heimsuchung Caritas Klinik Pankow, Berlin, Germany
| | - Luise Gattung
- Klinik für Gynäkologie und Geburtshilfe, Bad Salzungen Hospital, Bad Salzungen, Germany
| | | | - Michael Abou-Dakn
- Klinik für Gynäkologie, St. Joseph Krankenhaus Berlin-Tempelhof, Berlin, Germany
| | - Markus Schmidt
- Gynecology & Obstetrics, Sana Kliniken Duisburg GmbH, Duisburg, Germany
| | - Michaela Glöckner
- Abteilung für Gynäkologie und Geburtshilfe, Hospital Memmingen, Memmingen, Germany
| | - Anja Jebens
- Abteilung für Gynäkologie und Geburtshilfe, Vivantes Klinikum im Friedrichshain, Berlin, Germany
| | | | | | - Ralf Schmitz
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
| | - Mareike Möllers
- Gynecology and Obstetrics, University Hospital Münster, Münster, Germany
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Toth B, Bohlmann M, Hancke K, Kuon R, Nawroth F, von Otte S, Rogenhofer N, Rudnik-Schöneborn S, Schleußner E, Tempfer C, Vomstein K, Wischmann T, von Wolff M, Würfel W, Zschocke J. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry No. 015/050, May 2022). Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/a-1895-9940] [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: 11/27/2022] Open
Abstract
Abstract
Purpose The aim of this guideline is to standardize the diagnosis and therapy of recurrent miscarriage (RM) using evidence from the recent literature. This is done by using
consistent definitions, objective evaluations and standardized treatment protocols.
Methods When this guideline was compiled, special consideration was given to previous recommendations in prior versions of this guideline and the recommendations of the European
Society of Human Reproduction and Embryology, the Royal College of Obstetricians and Gynecologists, the American College of Obstetricians and Gynecologists and the American Society for
Reproductive Medicine, and a detailed individual search of the literature about the different topics was carried out.
Recommendations Recommendations about the diagnostic and therapeutic procedures offered to couples with RM were developed based on the international literature. Special attention was
paid to known risk factors such as chromosomal, anatomical, endocrinological, physiological coagulation, psychological, infectious and immune disorders. Recommendations were also developed
for those cases where investigations are unable to find any abnormality (idiopathic RM).
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Affiliation(s)
- Bettina Toth
- Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Universität Innsbruck, Innsbruck, Austria
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabeth Krankenhaus Lörrach, Lörrach, Germany
| | - Katharina Hancke
- Klinik für Frauenheilkunde, Universitätsklinikum Ulm, Ulm, Germany
| | - Ruben Kuon
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
| | | | - Sören von Otte
- Kinderwunschzentrum, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Nina Rogenhofer
- Klinikum der Universität München – Frauenklinik Maistraße, München, Germany
| | | | | | - Clemens Tempfer
- Universitätsfrauenklinik, Ruhr-Universität Bochum, Bochum, Germany
| | - Kilian Vomstein
- Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Universität Innsbruck, Innsbruck, Austria
| | - Tewes Wischmann
- Institut für Medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael von Wolff
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | | | - Johannes Zschocke
- Zentrum für Medizinische Genetik, Universität Innsbruck, Innsbruck, Austria
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Zöllkau J, Bohlmann M, Mingers N, Pecks U, Weschenfelder F, Groten T. Hypertensive Schwangerschaftserkrankungen und
SARS-CoV-2/COVID-19: Auswertung des nationalen
CRONOS-Registers. Z Geburtshilfe Neonatol 2022; 227:120-126. [PMID: 36368683 DOI: 10.1055/a-1962-6964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ZusammenfassungSARS-CoV-2-Infektion und COVID-19-Erkrankung sind in internationalen
Registerstudien mit einem erhöhten Risiko für hypertensive
Schwangerschaftserkrankungen assoziiert. Hypertensive Erkrankungen stellen zudem
einen Risikofaktor eines schweren COVID-19-Verlaufes in der Schwangerschaft dar.
Als pathophysiologische Gemeinsamkeit beider Erkrankungen wird die
Schädigung des Endothels angesehen.Daten des nationalen CRONOS-Registers (Datenstand 05/2021; 1104
schwangere Frauen mit SARS-CoV-2-Infektion) wurden hinsichtlich des
Zusammenhangs zu hypertensiven Schwangerschaftserkrankungen und dem Outcome von
Mutter, Schwangerschaft, Neugeborenen und COVID-19-Erkrankung analysiert. Bei
Vorliegen einer hypertensiven Schwangerschaftserkrankung war signifikant
häufiger ein schweres kombiniertes Outcome der Schwangerschaft (17,3 vs.
4,3%, p=0,001), der Mutter (25,0 vs. 9,4%,
p=0,001) und des Neugeborenen (28,8 vs. 9,1%, p<0,0005)
zu verzeichnen. Das Outcome der COVID-19-Erkrankung unterschied sich hingegen
nicht (3,8 vs. 7,5%, p=0,424). Hypertensive
Schwangerschaftserkrankungen sollten im Management einer SARS-CoV-2-Infektion in
der Schwangerschaft als Risikofaktor angesehen werden. Dies kann Implikationen
auf die Therapie haben, wie zum Beispiel mit monoklonalen Antikörpern
haben.
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Affiliation(s)
- Janine Zöllkau
- Klinik für Geburtsmedizin, Universitätsklinikum Jena,
Jena, Germany
| | - Michael Bohlmann
- Frauenheilkunde und Geburtshilfe, St Elisabethen-Krankenhaus
Lörrach gGmbH, Lörrach, Germany
| | - Nina Mingers
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Schleswig-Holstein Campus Kiel, Jena,
Germany
| | - Ulrich Pecks
- Klinik für Gynäkologie und Geburtshilfe,
Universitätsklinikum Schleswig-Holstein Campus Kiel, Jena,
Germany
| | | | - Tanja Groten
- Klinik für Geburtsmedizin, Universitätsklinikum Jena,
Jena, Germany
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Ziert Y, Abou-Dakn M, Backes C, Banz-Jansen C, Bock N, Bohlmann M, Engelbrecht C, Gruber TM, Iannaccone A, Jegen M, Keil C, Kyvernitakis I, Lang K, Lihs A, Manz J, Morfeld C, Richter M, Seliger G, Sourouni M, von Kaisenberg CS, Wegener S, Pecks U, von Versen-Höynck F. Maternal and neonatal outcomes of pregnancies with COVID-19 after medically assisted reproduction: results from the prospective COVID-19-Related Obstetrical and Neonatal Outcome Study. Am J Obstet Gynecol 2022; 227:495.e1-495.e11. [PMID: 35452651 PMCID: PMC9015950 DOI: 10.1016/j.ajog.2022.04.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 04/04/2022] [Accepted: 04/07/2022] [Indexed: 11/18/2022]
Abstract
Background Severe acute respiratory syndrome coronavirus type 2 infections in pregnancy have been associated with maternal morbidity, admission to intensive care, and adverse perinatal outcomes such as preterm birth, stillbirth, and hypertensive disorders of pregnancy. It is unclear whether medically assisted reproduction additionally affects maternal and neonatal outcomes in women with COVID-19. Objective To evaluate the effect of medically assisted reproduction on maternal and neonatal outcomes in women with COVID-19 in pregnancy. Study Design A total of 1485 women with COVID-19 registered in the COVID-19 Related Obstetric and Neonatal Outcome Study (a multicentric, prospective, observational cohort study) were included. The maternal and neonatal outcomes in 65 pregnancies achieved with medically assisted reproduction and in 1420 spontaneously conceived pregnancies were compared. We used univariate und multivariate (multinomial) logistic regressions to estimate the (un)adjusted odds ratios and 95% confidence intervals for adverse outcomes. Results The incidence of COVID-19-associated adverse outcomes (eg, pneumonia, admission to intensive care, and death) was not different in women after conceptions with COVID-19 than in women after medically assisted reproduction pregnancies. Yet, the risk of obstetrical and neonatal complications was higher in pregnancies achieved through medically assisted reproduction. However, medically assisted reproduction was not the primary risk factor for adverse maternal and neonatal outcomes including pregnancy-related hypertensive disorders, gestational diabetes mellitus, cervical insufficiency, peripartum hemorrhage, cesarean delivery, preterm birth, or admission to neonatal intensive care. Maternal age, multiple pregnancies, nulliparity, body mass index >30 (before pregnancy) and multiple gestation contributed differently to the increased risks of adverse pregnancy outcomes in women with COVID-19 independent of medically assisted reproduction. Conclusion Although women with COVID-19 who conceived through fertility treatment experienced a higher incidence of adverse obstetrical and neonatal complications than women with spontaneous conceptions, medically assisted reproduction was not the primary risk factor.
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Affiliation(s)
- Yvonne Ziert
- Institute of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Michael Abou-Dakn
- Department of Obstetrics and Gynecology, St. Joseph Hospital, Berlin, Germany
| | - Clara Backes
- Department of Obstetrics and Gynecology, München Klinik Harlaching, Munich, Germany
| | - Constanze Banz-Jansen
- Department of Gynecology and Obstetrics, Protestant Hospital of Bethel Foundation, University Medical School OWL, Bielefeld, Germany
| | - Nina Bock
- Department of Obstetrics and Gynecology, Klinikum Hanau, Hanau, Germany
| | - Michael Bohlmann
- Department of Obstetrics and Gynecology, St. Elisabeth Hospital Loerrach, Loerrach, Germany
| | | | - Teresa Mia Gruber
- Department of Obstetrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Antonella Iannaccone
- Department of Obstetrics and Gynecology, University of Duisburg-Essen, Essen, Germany
| | - Magdalena Jegen
- Department of Gynecology and Obstetrics, University Hospital, LMU Munich, Munich, Germany
| | - Corinna Keil
- Department of Gynecology and Obstetrics, University Hospital Marburg, Philipps University Marburg, Marburg, Germany
| | - Ioannis Kyvernitakis
- Department of Obstetrics and Prenatal Medicine, Asklepios Clinic Barmbek, Hamburg, Germany
| | - Katharina Lang
- Department of Obstetrics and Gynecology, Albertinen Krankenhaus, Hamburg, Germany
| | - Angela Lihs
- Department of Obstetrics and Gynecology, Klinikverbund Suedwest, Boeblingen, Germany
| | - Jula Manz
- Department of Obstetrics and Gynecology, City Hospital, Darmstadt, Deutschland
| | - Christine Morfeld
- Department of Obstetrics, Diakovere Henriettenstift, Hannover, Germany
| | - Manuela Richter
- Department of Neonatology, Kinderkrankenhaus auf der Bult, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Gregor Seliger
- Center for Reproductive Medicine & Andrology and Department of Obstetrics & Prenatal Medicine, University Hospital, Halle (Saale), Germany
| | - Marina Sourouni
- Department of Obstetrics and Gynecology, University Clinic, Muenster, Germany
| | | | - Silke Wegener
- Department of Obstetrics and Gynecology, Ernst von Bergmann Hospital, Potsdam, Germany
| | - Ulrich Pecks
- Department of Obstetrics and Gynecology, University Hospital of Schleswig-Holstein, Kiel, Germany
| | - Frauke von Versen-Höynck
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hannover Medical School, Hannover, Germany.
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6
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Vomstein K, Aulitzky A, Strobel L, Bohlmann M, Feil K, Rudnik-Schöneborn S, Zschocke J, Toth B. Recurrent Spontaneous Miscarriage: a Comparison of International Guidelines. Geburtshilfe Frauenheilkd 2021; 81:769-779. [PMID: 34276063 PMCID: PMC8277441 DOI: 10.1055/a-1380-3657] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 12/08/2020] [Accepted: 02/01/2021] [Indexed: 01/11/2023] Open
Abstract
While roughly 30% of all women experience a spontaneous miscarriage in their lifetime, the incidence of recurrent (habitual) spontaneous miscarriage is 1 – 3% depending on the employed definition. The established risk factors include endocrine, anatomical, infection-related, genetic, haemostasis-related and immunological factors. Diagnosis is made more difficult by the sometimes diverging recommendations of the respective international specialist societies. The present study is therefore intended to provide a comparison of existing international guidelines and recommendations. The guidelines of the ESHRE, ASRM, the DGGG/OEGGG/SGGG and the recommendations of the RCOG were analysed. It was shown that investigation is indicated after 2 clinical pregnancies and the diagnosis should be made using a standardised timetable that includes the most frequent causes of spontaneous miscarriage. The guidelines concur that anatomical malformations, antiphospholipid syndrome and thyroid
dysfunction should be excluded. Moreover, the guidelines recommend carrying out pre-conception chromosomal analysis of both partners (or of the aborted material). Other risk factors have not been included in the recommendations by all specialist societies, on the one hand because of a lack of diagnostic criteria (luteal phase insufficiency) and on the other hand because of the different age of the guidelines (chronic endometritis). In addition, various economic and consensus aspects in producing the guidelines influence the individual recommendations. An understanding of the underlying decision-making process should lead in practice to the best individual diagnosis and resulting treatment being offered to each couple.
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Affiliation(s)
- Kilian Vomstein
- Medical University Innsbruck, Department of Gynaecological Endocrinology and Reproductive Medicine, Innsbruck, Austria
| | - Anna Aulitzky
- Medical University Innsbruck, Department of Gynaecological Endocrinology and Reproductive Medicine, Innsbruck, Austria
| | - Laura Strobel
- Medical University Innsbruck, Department of Gynaecological Endocrinology and Reproductive Medicine, Innsbruck, Austria
| | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St Elisabethen-Krankenhaus Lörrach gGmbH, Lörrach, Germany
| | - Katharina Feil
- Medical University Innsbruck, Department of Gynaecological Endocrinology and Reproductive Medicine, Innsbruck, Austria
| | | | - Johannes Zschocke
- Zentrum für medizinische Genetik, Medizinische Universität Innsbruck, Innsbruck, Austria
| | - Bettina Toth
- Medical University Innsbruck, Department of Gynaecological Endocrinology and Reproductive Medicine, Innsbruck, Austria
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7
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Wöckel A, Basiora P, Bohlmann M, Decker T, Falbrede J, Fasching P, Forstbauer H, Hesse T, Hoffmann O, Jackisch C, Kaczerowsky A, Lorenz R, Lüdtke-Heckenkamp K, Lüftner D, Marmé F, Mueller T, Mundhenke C, Nusch A, Petersen V, Prange-Krex G, Reimer T, Resch T, Roos C, Tomé O, Weishap A. Abstract P1-19-33: Real-world efficacy of ribociclib + aromatase inhibitor, or endocrine monotherapy, or chemotherapy as first-line treatment in postmenopausal women with HR-positive, HER2-negative locally advanced or metastatic breast cancer: Second interim analysis from the RIBANNA study. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p1-19-33] [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: 11/16/2022]
Abstract
Abstract
Background: Ribociclib (RIB, a selective CDK4/6 inhibitor) plus an aromatase inhibitor (AI) or fulvestrant (FUL) is approved for the treatment of premenopausal and postmenopausal women with HR+/HER2- advanced breast cancer (aBC). Real-world evidence for the effectiveness, safety and tolerability of RIB + AI/FUL in routine clinical practice is needed to support the use of this combination. Methods: RIBANNA is a noninterventional study ongoing in Germany since October 2017. Premenopausal and postmenopausal patients (N=3020) treated with RIB + AI/FUL, or endocrine monotherapy (ET), or chemotherapy (CT) as first-line treatment for HR+/HER2- aBC in accordance with German guidelines were included. Data are being collected from clinical practice in all 3 cohorts. Further lines of treatment are noted to examine outcomes of sequential therapy. Results: For the first interim analysis, 461 patients were enrolled until October 9, 2018, while full analysis set comprised 282 patients (Table 1). The first-line mean daily dose of RIB was 382 mg including and 540 mg excluding dose interruptions, respectively. RIB was prescribed mainly in combination with letrozole (83%), anastrozole (8%), and exemestane (7%); ET included nonsteroidal AI (64%), selective estrogen receptor degrader (25%), selective estrogen receptor modulator (7%), and steroidal AI (5%); CT included taxane-based monotherapy (30%) or combination therapy (27%), other monotherapy (23%) or other combination therapy (13%), and anthracycline-based combination therapy (5%). Conclusion: RIBANNA study showed diverse population characteristics among patients who received RIB treatment in a real-world setting. Based on the baseline demographics data, RIB (CDK4/6 inhibitor) treatment was found to be very well adopted among premenopausal and postmenopausal patients with HR+/HER2- aBC. The second interim analysis is planned for October 2019. Updated baseline data of approximately 1200 to 1300 patients and information on safety and dose modification for first-line patients from all cohorts will be presented.
Table 1. Baseline demographic characteristicsTotal (N = 282)RIB + AI (n = 216)Endocrine therapy (n = 26)Chemotherapy (n = 40)Mean age, years (SD)67 (11)67 (10)71 (12)62 (10)Mean time since initial diagnosis, years5.45.56.53.9T stage at initial diagnosis, n (%)T0+T161 (100)48 (79)6 (10)7 (11)T2-T4198 (100)149 (75)17 (9)32 (16)N stage at initial diagnosis, n (%)N0+N1186 (100)144 (77)16 (9)26 (14)N2+N364 (100)48 (75)5 (8)11 (17)M stage at initial diagnosis, n (%)M0156 (100)121 (78)14 (9)21 (13)M1101 (100)75 (74)9 (9)17 (17)Locally advanced, n (%)101 (100)73 (72)9 (9)19 (19)Metastatic, n (%)101 (100)75 (74)9 (9)17 (17)Metastatic location, n (%)CNS, liver, lungs119 (100)96 (81)1 (1)22 (18)Bone only84 (100)62 (74)17 (20)5 (6)Skin, lymph nodes, other52 (100)37 (71)6 (11)9 (17)
Citation Format: Achim Wöckel, Pawel Basiora, Michael Bohlmann, Thomas Decker, Jörg Falbrede, Peter Fasching, Helmut Forstbauer, Tobias Hesse, Oliver Hoffmann, Christian Jackisch, Anna Kaczerowsky, Ralf Lorenz, Kerstin Lüdtke-Heckenkamp, Diana Lüftner, Frederik Marmé, Thomas Mueller, Christoph Mundhenke, Arnd Nusch, Volker Petersen, Gabriele Prange-Krex, Toralf Reimer, Thomas Resch, Christian Roos, Oliver Tomé, Anja Weishap. Real-world efficacy of ribociclib + aromatase inhibitor, or endocrine monotherapy, or chemotherapy as first-line treatment in postmenopausal women with HR-positive, HER2-negative locally advanced or metastatic breast cancer: Second interim analysis from the RIBANNA study [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-19-33.
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Affiliation(s)
- Achim Wöckel
- 1Department of Obstetrics and Gynecology, University Hospital Würzburg, Würzburg, Germany
| | - Pawel Basiora
- 2Department of General Medicine and Hematology and Oncology, Onkologische Schwerpunktpraxis Lohne, Lohne, Germany
| | - Michael Bohlmann
- 3Department of Gynecology and Obstetrics, Mannheim University Hospital, Mannheim, Germany
| | | | - Jörg Falbrede
- 5Department of Obstetrics and Gynecology, Lukaskrankenhaus Neuss, Neuss, Germany
| | - Peter Fasching
- 6Department of Obstetrics and Gynecology, University Hospital Erlangen, Erlangen, Germany
| | - Helmut Forstbauer
- 7Department of Internal Medicine, Practice Network Hematology and Internal Oncology, Troisdorf, Germany
| | - Tobias Hesse
- 8Department of Gynecology and Obstetrics, Agaplesion Diakonieklinikum Rotenburg, Rotenburg Wümme, Germany
| | - Oliver Hoffmann
- 9Department of Gynecology, Essen University Hospital, Essen, Germany
| | - Christian Jackisch
- 10Department of Obstetrics and Gynecology, Sana Klinikum Offenbach, Offenbach, Germany
| | - Anna Kaczerowsky
- 11Department of Gynecology, Katholisches Marienkrankenhaus, Hamburg, Germany
| | - Ralf Lorenz
- 12Gynecologic Oncology, Frauenärztliche Gemeinschaftspraxis Braunschweig, Braunschweig, Germany
| | | | - Diana Lüftner
- 14Department of Hematology, Oncology and Tumor Immunology, Charité University Hospital, Berlin, Germany
| | - Frederik Marmé
- 15Department of Gynecologic Oncology, University Hospital Heidelberg, Heidelberg, Germany
| | | | - Christoph Mundhenke
- 17Department of Obstetrics and Gynecology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Arnd Nusch
- 18Practice for Hematology and Medical Oncology Velbert, Velbert, Germany
| | | | | | | | - Thomas Resch
- 22Frauenarztpraxis Resch & Kollegen, Brandenburg A. D. Havel, Havel, Germany
| | | | - Oliver Tomé
- 24Department of Obstetrics and Gynecology, Vincentius-Diakonissen-Kliniken, Karlsruhe, Germany
| | - Anja Weishap
- 25Department of Obstetrics and Gynecology, Kreiskrankenhaus Gummersbach, Gummersbach, Germany
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8
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Toth B, Baston-Büst DM, Behre HM, Bielfeld A, Bohlmann M, Bühling K, Dittrich R, Goeckenjan M, Hancke K, Kliesch S, Köhn FM, Krüssel J, Kuon R, Liebenthron J, Nawroth F, Nordhoff V, Pinggera GM, Rogenhofer N, Rudnik-Schöneborn S, Schuppe HC, Schüring A, Seifert-Klauss V, Strowitzki T, Tüttelmann F, Vomstein K, Wildt L, Wischmann T, Wunder D, Zschocke J. Diagnosis and Therapy Before Assisted Reproductive Treatments. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Register Number 015-085, February 2019) - Part 1, Basic Assessment of the Woman. Geburtshilfe Frauenheilkd 2019; 79:1278-1292. [PMID: 31875858 DOI: 10.1055/a-1017-3389] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 12/24/2022] Open
Abstract
Introduction Supporting and counselling couples with fertility issues prior to starting ART is a multidisciplinary diagnostic and therapeutic challenge. The first German/Austrian/Swiss interdisciplinary S2k guideline on "Diagnosis and Therapy Before Assisted Reproductive Treatments (ART)" was published in February 2019. This guideline was developed in the context of the guidelines program of the German Society of Gynecology and Obstetrics (DGGG) in cooperation with the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Aims One third of the causes of involuntary childlessness are still unclear, even if the woman or man have numerous possible risk factors. Because the topic is still very much taboo, couples may be socially isolated and often only present quite late to a fertility center. At present, there is no standard treatment concept, as currently no standard multidisciplinary procedures exist for the diagnostic workup and treatment of infertility. The aim of this guideline is to provide physicians with evidence-based recommendations for counselling, diagnostic workup and treatment. Methods This S2k guideline was developed on behalf of the Guidelines Commission of the DGGG by representative members from different professional medical organizations and societies using a structured consensus process. Recommendations The first part of this guideline focuses on the basic assessment of affected women, including standard anatomical and endocrinological diagnostic procedures and examinations into any potential infections. Other areas addressed in this guideline are the immunological workup with an evaluation of the patient's vaccination status, an evaluation of psychological factors, and the collection of data relating to other relevant factors affecting infertility. The second part will focus on explanations of diagnostic procedures compiled in collaboration with specialists from other medical specialties such as andrologists, human geneticists and oncologists.
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Affiliation(s)
- Bettina Toth
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | | | - Hermann M Behre
- Zentrum für Reproduktionsmedizin und Andrologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | | | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabethen-Krankenhaus Lörrach, Lörrach, Germany
| | - Kai Bühling
- Abteilung für gynäkologische Endokrinologie, Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Katharina Hancke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Ulm, Ulm, Germany
| | - Sabine Kliesch
- Centrum für Reproduktionsmedizin und Andrologie, Abteilung für Klinische und Operative Andrologie, Universitätsklinik Münster, Münster, Germany
| | | | - Jan Krüssel
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ruben Kuon
- Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jana Liebenthron
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Verena Nordhoff
- Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinik Münster, Münster, Germany
| | | | - Nina Rogenhofer
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ludwig-Maximilians-Universität München, München, Germany
| | | | - Hans-Christian Schuppe
- Klinik und Poliklinik für Urologie, pädiatrische Urologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH - Standort Gießen, Gießen, Germany
| | - Andreas Schüring
- UKM Kinderwunschzentrum, Universitätsklinikum Münster, Münster, Germany
| | - Vanadin Seifert-Klauss
- Klinik und Poliklinik für Frauenheilkunde, Technische Universität München, München, Germany
| | - Thomas Strowitzki
- Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Frank Tüttelmann
- Institut für Humangenetik, Universitätsklinikum Münster, Münster, Germany
| | - Kilian Vomstein
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | - Ludwig Wildt
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | - Tewes Wischmann
- Institut für medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Dorothea Wunder
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinik Lausanne, Lausanne, Switzerland
| | - Johannes Zschocke
- Sektion für Humangenetik, Medizinische Universität Innsbruck, Innsbruck, Austria
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9
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Toth B, Baston-Büst DM, Behre HM, Bielfeld A, Bohlmann M, Bühling K, Dittrich R, Goeckenjan M, Hancke K, Kliesch S, Köhn FM, Krüssel J, Kuon R, Liebenthron J, Nawroth F, Nordhoff V, Pinggera GM, Rogenhofer N, Rudnik-Schöneborn S, Schuppe HC, Schüring A, Seifert-Klauss V, Strowitzki T, Tüttelmann F, Vomstein K, Wildt L, Wischmann T, Wunder D, Zschocke J. Diagnosis and Treatment Before Assisted Reproductive Treatments. Guideline of the DGGG, OEGGG and SGGG (S2k Level, AWMF Register Number 015-085, February 2019) - Part 2, Hemostaseology, Andrology, Genetics and History of Malignant Disease. Geburtshilfe Frauenheilkd 2019; 79:1293-1308. [PMID: 31875859 DOI: 10.1055/a-1017-3478] [Citation(s) in RCA: 2] [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: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 12/13/2022] Open
Abstract
Introduction Supporting and counselling couples with fertility issues prior to starting ART is a multidisciplinary diagnostic and therapeutic challenge. The first German-language interdisciplinary S2k guideline on "Diagnosis and Therapy Before Assisted Reproductive Treatments (ART)" was published in February 2019. The guideline was developed in the context of the guidelines program of the German Society of Gynecology and Obstetrics (DGGG) in cooperation with the Swiss Society of Gynecology and Obstetrics (SGGG) and the Austrian Society of Gynecology and Obstetrics (OEGGG). Aim In one third of cases, the cause of involuntary childlessness remains unclear, even if the woman or man have numerous possible risk factors. Because the topic is still very much taboo, couples may be socially isolated and often only present quite late to a fertility center. There is no standard treatment concept for these patients at present, as there are currently no standard multidisciplinary procedures for the diagnostic workup and treatment of infertility. The aim of this guideline is to provide physicians with evidence-based recommendations for counselling, diagnosis and treatment. Methods This S2k guideline was developed on behalf of the Guidelines Commission of the DGGG by representative members from different professional medical organizations and societies using a structured consensus process. Recommendations This second part of the guideline describes the hematological workup for women as well as additional diagnostic procedures which can be used to investigate couples and which are carried out in cooperation with physicians working in other medical fields such as andrologists, geneticists and oncologists.
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Affiliation(s)
- Bettina Toth
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | | | - Hermann M Behre
- Zentrum für Reproduktionsmedizin und Andrologie, Universitätsklinikum Halle (Saale), Halle (Saale), Germany
| | | | - Michael Bohlmann
- Zentrum für Gynäkologie und Geburtshilfe, St. Elisabethen-Krankenhaus Lörrach, Lörrach, Germany
| | - Kai Bühling
- Abteilung für gynäkologische Endokrinologie, Klinik und Poliklinik für Gynäkologie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Ralf Dittrich
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Katharina Hancke
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinik Ulm, Ulm, Germany
| | - Sabine Kliesch
- Centrum für Reproduktionsmedizin und Andrologie, Abteilung für Klinische und Operative Andrologie, Universitätsklinik Münster, Münster, Germany
| | | | - Jan Krüssel
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ruben Kuon
- Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Jana Liebenthron
- Frauenklinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Verena Nordhoff
- Centrum für Reproduktionsmedizin und Andrologie, Universitätsklinik Münster, Münster, Germany
| | | | - Nina Rogenhofer
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Ludwig-Maximilians-Universität München, München, Germany
| | | | - Hans-Christian Schuppe
- Klinik und Poliklinik für Urologie, pädiatrische Urologie und Andrologie, Universitätsklinikum Gießen und Marburg GmbH - Standort Gießen, Gießen, Germany
| | - Andreas Schüring
- UKM Kinderwunschzentrum, Universitätsklinikum Münster, Münster, Germany
| | - Vanadin Seifert-Klauss
- Klinik und Poliklinik für Frauenheilkunde, Technische Universität München, München, Germany
| | - Thomas Strowitzki
- Gynäkologische Endokrinologie und Fertilitätsstörungen, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Frank Tüttelmann
- Institut für Humangenetik, Universitätsklinikum Münster, Münster, Germany
| | - Kilian Vomstein
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | - Ludwig Wildt
- Gynäkologische Endokrinologie und Reproduktionsmedizin, Universitätsklinikum Innsbruck, Innsbruck, Austria
| | - Tewes Wischmann
- Institut für medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Dorothea Wunder
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinik Lausanne, Lausanne, Switzerland
| | - Johannes Zschocke
- Sektion für Humangenetik, Medizinische Universität Innsbruck, Innsbruck, Austria
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10
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Stefanovic S, Wirtz R, Deutsch T, Sinn P, Hartkopf A, Schütz F, Bohlmann M, Sütterlin M, Schneeweiß A, Wallwiener M. Korrelation der CTC-Dynamik und der mRNA-quantifizierten Biomarkerkonvertierung zwischen primärem und metastasiertem Mammakarzinom. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1671627] [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)
- S Stefanovic
- Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - R Wirtz
- Stratifyer Molecular Pathology GmbH, Köln, Deutschland
| | - T Deutsch
- Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - P Sinn
- Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - A Hartkopf
- Unifrauenklinik Tübingen, Tübingen, Deutschland
| | - F Schütz
- Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Bohlmann
- Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - M Sütterlin
- Universitätsklinikum Mannheim, Universität Heidelberg, Mannheim, Deutschland
| | - A Schneeweiß
- Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - M Wallwiener
- Universitätsklinikum Heidelberg, Heidelberg, Deutschland
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11
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Feil K, Bohlmann M, Zschocke J, Rudnik-Schöneborn S, Nawroth F, Schleußner E, Rogenhofer N, Wischmann T, Würfel W, von Wolff M, Hancke K, von Otte S, Kuon R, Tempfer C, Toth B. New guidelines on recurrent miscarriage of the German, Austrian and Suisse society of obstetrics and gynecology (DGGG, OEGGG, SGGG). J Reprod Immunol 2018. [DOI: 10.1016/j.jri.2018.06.027] [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: 10/28/2022]
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12
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Toth B, Würfel W, Bohlmann M, Zschocke J, Rudnik-Schöneborn S, Nawroth F, Schleußner E, Rogenhofer N, Wischmann T, von Wolff M, Hancke K, von Otte S, Kuon R, Feil K, Tempfer C. Recurrent Miscarriage: Diagnostic and Therapeutic Procedures. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF Registry Number 015/050). Geburtshilfe Frauenheilkd 2018; 78:364-381. [PMID: 29720743 PMCID: PMC5925690 DOI: 10.1055/a-0586-4568] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 03/05/2018] [Accepted: 03/06/2018] [Indexed: 12/13/2022] Open
Abstract
Purpose Official guideline of the German Society of Gynecology and Obstetrics (DGGG), the Austrian Society of Gynecology and Obstetrics (ÖGGG) and the Swiss Society of Gynecology and Obstetrics (SGGG). The aim of this guideline was to standardize the diagnosis and treatment of couples with recurrent miscarriage (RM). Recommendations were based on the current literature and the views of the involved committee members. Methods Based on the current literature, the committee members developed the statements and recommendations of this guideline in a formalized process which included DELPHI rounds and a formal consensus meeting. Recommendations Recommendations for the diagnosis and treatment of patients with RM were compiled based on the international literature. Specific established risk factors such as chromosomal, anatomical, endocrine, hemostatic, psychological, infectious and immunological disorders were taken into consideration.
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Affiliation(s)
- Bettina Toth
- Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Universität Innsbruck, Innsbruck, Austria
| | | | | | - Johannes Zschocke
- Zentrum für Medizinische Genetik, Universität Innsbruck, Innsbruck, Austria
| | | | | | | | - Nina Rogenhofer
- Klinikum der Universität München - Frauenklinik Maistraße, München, Germany
| | - Tewes Wischmann
- Institut für Medizinische Psychologie, Universitätsklinikum Heidelberg, Heidelberg, Germany
| | - Michael von Wolff
- Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Switzerland
| | - Katharina Hancke
- Klinik für Frauenheilkunde, Universitätsklinikum Ulm, Ulm, Germany
| | - Sören von Otte
- Kinderwunschzentrum, Universitätsklinikum Schleswig-Holstein, Kiel, Germany
| | - Ruben Kuon
- Universitäts-Frauenklinik Heidelberg, Heidelberg, Germany
| | - Katharina Feil
- Klinik für Gynäkologische Endokrinologie und Reproduktionsmedizin, Universität Innsbruck, Innsbruck, Austria
| | - Clemens Tempfer
- Universitätsfrauenklinik, Ruhr-Universität Bochum, Bochum, Germany
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Kunz P, Fellenberg J, Moskovszky L, Sápi Z, Krenacs T, Machado I, Poeschl J, Lehner B, Szendrõi M, Ruef P, Bohlmann M, Bosch AL, Ewerbeck V, Kinscherf R, Fritzsching B. Improved survival in osteosarcoma patients with atypical low vascularization. Ann Surg Oncol 2014; 22:489-96. [PMID: 25155396 DOI: 10.1245/s10434-014-4001-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Indexed: 01/08/2023]
Abstract
BACKGROUND Osteosarcoma is considered a highly vascularized bone tumor with early metastatic dissemination through intratumoral blood vessels mostly into the lung. Novel targets for therapy such as tumor vascularization are highly warranted since little progress has been achieved in the last 30 years. However, proof of relevance for vascularization as a major prognostic parameter has been hampered by tumor heterogeneity, difficulty in detecting microvessels by immunohistochemistry, and small study cohorts. Most recently, we demonstrated that highly standardized whole-slide imaging could overcome these limitations (Kunz et al., PloS One 9(3):e90727, 2014). In this study, we applied this method to a multicenter cohort of 131 osteosarcoma patients to test osteosarcoma vascularization as a prognostic determinant. METHODS Computer-assisted whole-slide analysis, together with enzymatic epitope retrieval, was used for CD31-based microvessel quantification in 131 pretreatment formalin-fixed and paraffin-embedded biopsies from three bone tumor centers. Kaplan-Meier-estimated survival and chemoresponse were determined and multivariate analysis was performed. Conventional hot-spot-based microvessel density (MVD) determination was compared with whole-slide imaging. RESULTS We detected high estimated overall (p ≤ 0.008) and relapse-free (p ≤ 0.004) survival in 25 % of osteosarcoma patients with low osteosarcoma vascularization in contrast to other patient groups. Furthermore, all patients with low osteosarcoma vascularization showed a good response to neoadjuvant chemotherapy. Comparison of conventional MVD determination with whole-slide imaging suggests false high quantification or even exclusion of samples with low osteosarcoma vascularization due to difficult CD31 detection in previous studies. CONCLUSION Low intratumoral vascularization at the time of diagnosis is a strong predictor for prolonged survival and good response to neoadjuvant chemotherapy in osteosarcoma.
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Affiliation(s)
- Pierre Kunz
- Department of Orthopedics and Traumatology, University Hospital Heidelberg, Heidelberg, Germany,
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Manz M, Bohlmann M, Bossung V, Fischer D, Gembicki M, Hartge DR, Nause S, Schorcht A, Schröer A, Weichert J, Rody A. Deziduose – Ursache bedrohlicher peripartaler Blutungszwischenfälle. Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361310] [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: 10/26/2022]
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Rogenhofer N, Bohlmann M, Beuter-Winkler P, Würfel W, Thaler C, Toth B. Management und Schwangerschaftsoutcome des Antithrombin-Mangels. Geburtshilfe Frauenheilkd 2013. [DOI: 10.1055/s-0033-1347784] [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: 10/26/2022] Open
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Hunold P, Eckey T, Ruhnke H, Beldoch MP, Bunke J, Neumann A, Bohlmann M, Barkhausen J. MR-gesteuerte HIFU- (high-intensity focused ultrasound) Ablation von symptomatischen Uterusmyomen mit einem neuen tischintegrierten System: Effektivität, Sicherheit und klinische Resultate. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311190] [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: 10/28/2022]
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Eckey T, Ruhnke H, Bohlmann M, Bunke J, Barkhausen J, Hunold P. Nichtinvasive Thermoablation von Uterusmyomen mittels MR-gesteuertem high-intensity focussed ultrasound (MRgFUS): Erste Ergebnisse aus Schleswig-Holstein. ROFO-FORTSCHR RONTG 2010. [DOI: 10.1055/s-0030-1268302] [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]
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Hoellen F, Noack F, Ribbat J, Stefanova I, Schröer A, Bohlmann M. Zum intrauterinen Fruchttod führendes fetales Rhabdomyosarkom mit ausgeprägter cardialer und placentarer Infiltration. Z Geburtshilfe Neonatol 2010; 214:167-9. [DOI: 10.1055/s-0030-1261894] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Kavallaris A, Banz C, Chalvatzas N, Hornemann A, Luedders D, Diedrich K, Bohlmann M. Laparoscopic nerve-sparing surgery of deep infiltrating endometriosis: description of the technique and patients' outcome. Arch Gynecol Obstet 2010; 284:131-5. [PMID: 20680309 DOI: 10.1007/s00404-010-1624-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2010] [Accepted: 07/12/2010] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The radical surgery of the deep infiltrating endometriosis of the rectovaginal septum and the uterosacral ligaments with or without bowel resection can cause a serious damage of the pelvic autonomic nerves with urinary retention and the need of self-catheterization. PATIENTS AND METHODS We introduce a case series report of 16 patients with laparoscopic nerve-sparing surgery of deep infiltrating endometriosis. We describe the technique step by step and compare the patients' outcome with patients who had undergone a non-nerve-sparing surgical technique. In 12 patients, a double-sided and in four patients, a single-sided identification of the inferior hypogastric nerve and plexus were performed. RESULTS In all patients at least single-sided resection of the uterosacral ligaments were performed. Postoperatively dysmenorrhoea, pelvic pain, and dyspareunia disappeared in all patients. The average operating time was 82 min (range 45-185). Postoperatively, the overall time to resume voiding function was 2 days. The residual urine volume was in all patients <50 ml at two ultrasound measurements. DISCUSSION Identification of the inferior hypogastric nerve and plexus was feasible. In comparison with non-nerve-sparing surgical technique, no cases of bladder self-catheterization for a long or even life time was observed, confirming the importance of the nerve-sparing surgical procedure.
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Affiliation(s)
- A Kavallaris
- Department of Obstetrics and Gynecology, University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
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Rogenhofer N, Bohlmann M, Thaler C, Friese K, Toth B. Habituelle Abortneigung: Evidenzbasierte Diagnostik und Therapie. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1250064] [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: 10/19/2022] Open
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Fritzsching B, Fritzsching E, Bohlmann M, Lüdders D, Pöschl J. Regulatorische T-Zellen: Aktivierung und Apoptosesensitivität bei humanen Neugeborenen. Klin Padiatr 2010. [DOI: 10.1055/s-0030-1261393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Nnoaham KE, Sivananthan S, Hummelshoj L, Jenkinson C, Webster P, Kennedy SH, Zondervan KT, Vodolazkaia A, Fassbender A, Kyama CM, Bokor A, Clerinx P, Gevaert O, Schols D, Huskens D, Meuleman C, Peeraer K, Tomassetti C, De Moor B, D'Hooghe TM, Opoien HK, Fedorcsak P, Abyholm T, Tanbo TG, Tanbo TG, Kavallaris A, Hornemann A, Bohlmann M, Griesinger G, Chalvatzas N, Diedrich K, Benaglia L, Pasin R, Somigliana E, Vercellini P, Ragni G, Fedele L, Bergqvist A, Lundholm C, Malki N, Swahn ML, Sparen P, Melin A. Session 05: Endometriosis: Impact, Diagnosis and Surgery. Hum Reprod 2010. [DOI: 10.1093/humrep/de.25.s1.5] [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: 11/13/2022] Open
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Hartge D, Dawson A, Bohlmann M, Diedrich K, Weichert J. Die Schwangere über 25 (BMI) – Herausforderung in der antenatalen und peripartalen Überwachung. Geburtshilfe Frauenheilkd 2010. [DOI: 10.1055/s-0030-1249948] [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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Bohlmann M. Reproduktionsmedizin. Eine Rolle für Oxytocin-Antagonisten in der Kinderwunschbehandlung? Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1240566] [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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Nitzschke M, Dembinski B, Bohlmann M, Strowitzki T, Von Wolff M. O681 Recurrent abortions - Systematic diagnostics and evidence based therapies can reduce the risk of further abortions. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)61054-7] [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: 11/30/2022]
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Bohlmann M, Luedders D, Baumann K, Thill M, Hornemann A. Geburtshilfe. Indikationen zur Antikoagulation in der Schwangerschaft. Geburtshilfe Frauenheilkd 2009. [DOI: 10.1055/s-0029-1186118] [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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Bohlmann M, Luedders D, Thill M, Hartge D, Diedrich K, Hornemann A. Allgemeine Gynäkologie. Thromboseprophylaxe auch bei ambulanten und minimal-invasiven gynäkologischen Eingriffen? Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1039288] [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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Hornemann A, Bohlmann M, Altgassen C, Wille C, Thill M, Diedrich K, Finas D. Primäre Sectiones subventionieren Spontangeburten. Spielen finanzielle Interessen bei der steigenden Sectiorate eine Rolle? Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1039049] [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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Kelling K, Banz C, Bohlmann M, Bohlmann MK, Dittmer C, Diedrich K, Thill M. Malignes Melanom der Klitoris – Kasuistik und Literaturübersicht. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-0028-1088860] [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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Bohlmann M, Luedders D, Speer R, Hornemann A, Bohlmann I, Diedrich K. Chronisch entzündliche Darmerkrankungen und Reproduktion - Aktuelles zu Datenlage und Behandlungskonzepten. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2007-989410] [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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Bohlmann M, Hornemann A, Baumann K, Weichert J, Fischer R, Luedders D. Aktuelle Therapiekonzepte. Maternale Thrombozytopenie als Schwangerschaftskomplikation. Geburtshilfe Frauenheilkd 2008. [DOI: 10.1055/s-2008-1038340] [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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Bohlmann M, Luedders D, Speer R. Aktuelle Therapiekonzepte. Thrombophilie und Schwangerschaftskomplikationen. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-989255] [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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Fischer R, Fischer R, Zimmermann A, Bohlmann M, Kemkes-Matthes B. THROMBOPHILIA AND SPONTANEOUS ABORTION - THERAPY WITH LMW-HEPARI. J Thromb Haemost 2007. [DOI: 10.1111/j.1538-7836.2007.tb01520.x] [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: 11/25/2022]
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Bohlmann M, Schauf B, Luedders D, Wallwiener D, Strowitzki T, von Wolff M. Aktuelles zur rationellen Diagnostik und Therapie habitueller Frühaborte. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2006-955970] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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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Bohlmann M, Brueggmann D, Schief W, May D, Tinneberg HR. Deziduose und Endometriose der Appendix als Ursache einer akuten abakteriellen Appendizitis. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2006-955969] [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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Bohlmann M, Tekesin I. Pränatalmedizin. Kompetenznetz in der Betreuung angeborener Herzfehler. Geburtshilfe Frauenheilkd 2007. [DOI: 10.1055/s-2007-964958] [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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Theodoropoulos I, Manolopoulos K, Von Georgi R, Bohlmann M, Münstedt K. Physicians and Complementary and Alternative Medicine Cancer Therapies in Greece: A Survey. J Altern Complement Med 2005; 11:703-8. [PMID: 16131295 DOI: 10.1089/acm.2005.11.703] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To assess the prevalence of complementary and alternative medicine (CAM) cancer therapies and attitudes toward them in a nonrandom sample of physicians in Greece. SUBJECTS Four hundred and ninety-four (494) physicians from private practices and hospitals in the Athens area were approached to complete a questionnaire on perceived cancer etiology, self-reported knowledge, and attitudes about CAM therapies used by cancer patients. Two hundred and thirty-six (236) (47.8%) questionnaires were returned. RESULTS Greek physicians are most familiar with homoeopathy (58.5%), diets (58.1%), antioxidants (vitamin C) (55.9%), and acupuncture (47.9%). Perceived rates of patients using CAM are low. Predominantly, physicians shared concepts of carcinogenesis accepted by conventional biomedicine. Only physicians who considered disorders of cellular metabolism or in the flow of body energy to be relevant believed that homoeopathy could be an adequate CAM therapy. CONCLUSIONS Greek physicians in our sample displayed little interest in CAM. However, media and Internet coverage may generate a greater demand for these methods in the future in Greece and physicians will thus need to be better informed.
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Affiliation(s)
- Ioannis Theodoropoulos
- Department of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Giessen, Germany
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Abstract
OBJECTIVE The objective of this study was to determine whether there is a link between integrins and components of the plasminogen system, regarding tumor cell invasion to the artificial extracellular matrix. METHODS Immunocytochemistry was performed with antibodies directed against integrins alpha2beta1, alpha4beta1, alpha5beta1, alpha6beta1, and alpha(nu)beta3 Cell adhesion was studied by cell attachment to matrix proteins. Integrin-mediated migration of cells into the artificial matrix was studied in an invasion assay. Last, immunoreactivity of the components of the plasminogen system was estimated by ELISA. RESULTS HEC-1A, Ishikawa, and AN3CA cell lines express the alpha 4 beta 1, alpha 5 beta 1, and alpha 6 beta 1 integrins. Adhesion of cells to fibronectin and laminin was inhibited by monoclonal antibodies directed against appropriate integrin subunits. Migration into the matrigel was partially blocked with mAbs to alpha4beta1 as well as alpha5beta1, alpha6beta1 integrins and their combination. No differences in either uPA or PAI-1 immunoreactivity were found after addition of the mAbs. CONCLUSION Alpha4beta1, alpha5beta1, and alpha6beta1 heterodimers mediate adhesion as well as migration into the artificial matrix matrigel of endometrial tumor cell lines. A cooperative signaling between these integrins and uPA or its inhibitor in modulation of in vitro cell invasion is rather unprobable.
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Affiliation(s)
- Sophia Prifti
- Department of Obstetrics and Gynaecology, Division of Gynecological Endocrinology and Reproductive Medicine, Ruprechts-Karls-Universität, Voss-Strasse 9, Heidelberg, 69115, Germany.
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Abstract
BACKGROUND Carvedilol and at least in some studies, amiodarone have been shown to improve symptoms and prognosis of patients with heart failure. There are no reports on the outcome of combined treatment with both drugs on top of angiotensin-converting enzyme inhibitors (ACEI), diuretics and digitalis. METHODS AND RESULTS In 109 patients with severe heart failure submitted for heart transplantation at one single center between the years 1996 and 1998 [left ventricular ejection fraction (LVEF) 24.6+/-11%, 85% males, 52% idiopathic dilated cardiomyopathy (DCM), mean observation time 1. 9+/-0.4 years] a therapy with low-dose amiodarone (1000 mg/week) plus titrated doses of carvedilol (target 50 mg/day) was instituted. In addition, patients received a prophylactic dual chamber pacemaker (PM) in order to protect from bradycardia and for continuous holter monitoring. The devices were programmed in back-up mode with a basal rate of 40 i.p.m. with a hysteresis of 25%. Significantly, more patients were in sinus rhythm after 1 year than at study entry (85% vs. 63%, P<0.01). In 47 patients, under therapy over at least 1 year, the resting heart rate fell from 90+/-19 to 59+/-5 b.p.m. (P<0.001). Ventricular premature contractions in 24-h holter ECGs were suppressed from 1.0+/-3 to 0.1+/-0.3%/24 h (P167 b.p.m. detected by the pacemaker (1.2+/-2.8 episodes/patient/3 months vs. 0.3+/-0.8 episodes/patient/3 months after 1 year (P<0.01). The LVEF increased from 26+/-10 to 39+/-13% (P<0.001). NYHA class improved from 3. 17+/-0.3 to 1.8+/-0.6 (P<0.001) as well as right heart catheterization data. From the total cohort, seven patients (6%) developed symptomatic documented bradycardic rhythm disturbances requiring reprogramming of their pacemakers to DDD(R)/VVI(R) mode with higher basic rates. Two of these patients developed AV block, four sinu-atrial blocks or sinus bradycardia and one patient had bradycardic atrial fibrillation. During the observation period five patients died (3 sudden, 1 due to heart failure and 1 due to mesenteric infarction). Two patients had undergone heart transplants. The 1-year survival rate (Kaplan-Meier) without transplantation was 89%. Compared to historic control patients with amiodarone only (n=154) or without either agent (n=283) this rate was 64 and 57% (P<0.01). CONCLUSIONS Heart failure patients benefit from a combined therapy with carvedilol and amiodarone resulting in a markedly improved NYHA stage, an increase in LV ejection fraction, a stabilization of sinus rhythm, a significant reduction in heart rate, a delay of electrical signal conduction and a suppression of ventricular ectopies. Approximately 6% of patients under such a regime became pacemaker-dependent in the first year. Compared to historic controls prognosis was better and the need for heart transplantation was lower. The exact role of either agent in combination or alone should be clarified in larger randomized studies.
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Affiliation(s)
- H Nägele
- Abt. Thorax- Herz- und Gefässchirurgie, Universitäts Krankenhaus Hamburg Eppendorf, Martinistr. 52, D-20246, Hamburg, Germany.
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Naegele H, Bohlmann M, Döring V, Kalmar P, Rödiger W. Results of aortic valve replacement with pulmonary and aortic homografts. J Heart Valve Dis 2000; 9:215-20; discussion 220-1. [PMID: 10772039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Aortic valve replacement with cryopreserved human pulmonary or aortic valves (homografts) is an attractive alternative to the implantation of mechanical valves or bioprostheses, as anticoagulation can be avoided and a near-normal anatomy restored. However, few reports exist on the long-term follow up of patients with this type of valve. METHODS Between 1990 and 1997, a total of 64 homografts were implanted in 62 adults (mean age 42 +/- 12 years) with non-endocarditic valve lesions (insufficiency, n = 16; stenosis, n = 20; combined lesions, n = 12; redo, n = 16). In total, 23 pulmonary grafts (PG) and 41 aortic grafts (AG) were used. Valves were obtained from the European Homograft Bank in Brussels. Two patients with aortic homografts were lost to follow up; the others were examined clinically and echocardiographically at yearly intervals (mean 3.6 +/- 2.0 years). Children aged less than 16 years (n = 21), and patients receiving a homograft due to endocarditis (n = 28) or during a Ross procedure (n = 16) were excluded from the study. RESULTS Three patients (5%) died due to early postoperative complications (two with AG, one with PG). Three PG had to be explanted due to primary malfunction, and five (total 35%) during further follow up due to severe aortic insufficiency (at a mean of 3.3 +/- 1.8 years). In contrast, all AG were functioning at the end of the observation period (log rank test, p = 0.0001, chi-square test 13.9). The mean echocardiographic degree of regurgitation for PG was significantly higher than for AG (2.2 +/- 1 vs. 0.75 +/- 0.7, p <0.0001). The peak transvalvular gradient did not differ between groups (PG 12.3 +/- 9 mmHg vs. AG 16.7 +/- 10 mmHg, p = NS). In respect of perioperative parameters, patients with PG showed a significantly higher body temperature during the first seven postoperative days (37.3 +/- 0.6 degrees C vs. 36.8 +/- 0.3 degrees C, p = 0.003). All three patients with acute graft malfunction in long-term follow up had a perioperative febrile response without overt bacterial infection. CONCLUSION In contrast to grafts of aortic origin, pulmonary homograft valves should not be used for aortic valve replacement because of their high rate of malfunction, both acutely and chronically. Higher postoperative body temperatures should lead to further investigations of possible enhanced immunoreactions against pulmonary homografts.
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Affiliation(s)
- H Naegele
- Department of Cardiothoracic and Vascular Surgery, University Clinic, Hamburg-Eppendorf, Hamburg, Germany
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Affiliation(s)
- B Petersen
- Abt. für Herz-, Thorax- und Gefässchirurgie am Universitätskrankenhaus Eppendorf, Martinistr. 52, 20246, Hamburg
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