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Salfelder A, Lueken RP, Bormann C, Gallinat A, Möller CP, Busche D, Nugent W, Krüger E, Nugent A, Maucher A, Auweiler U, Deckardt R, Saks M, Füger T, Haßkamp T, Krichbaum M, Brökelmann J, Bung P, Hennefründ J, Heeder M, Dohnke H, Hoffmeister U, Scotland V. Die laparoskopische suprazervikale Hysterektomie. Prospektive Multizenterstudie des VAAO. Geburtshilfe Frauenheilkd 2005. [DOI: 10.1055/s-2005-837595] [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: 10/25/2022] Open
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Deckardt R, Lueken RP, Gallinat A, Möller CP, Busche D, Nugent W, Salfelder A, Dohnke H, Hoffmeister U, Dewitt E, Hennefründ J, Hasskamp T, Krichbaum M, Maucher A, Auweiler U, Brökelmann J, Saks M, Füger T. Comparison of transvaginal ultrasound, hysteroscopy, and dilatation and curettage in the diagnosis of abnormal vaginal bleeding and intrauterine pathology in perimenopausal and postmenopausal women. J Am Assoc Gynecol Laparosc 2002; 9:277-82. [PMID: 12101322 DOI: 10.1016/s1074-3804(05)60404-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE To compare transvaginal ultrasound, hysteroscopy, and dilation and curettage (D&C) in the evaluation of women with perimenopausal and postmenopausal bleeding. DESIGN Descriptive study (Canadian Task Force classification II-1). SETTING Seven outpatient clinics. PATIENTS One thousand two hundred eighty-six women. INTERVENTION Transvaginal ultrasound, hysteroscopy, and D&C. MEASUREMENTS AND MAIN RESULTS Of our patient population, 29 (2.26%) had a histologic diagnosis of endometrial carcinoma; in 2 of them (7.14%) endometrial thickness was 5 mm or less. In 10 women (34.5%), endometrial carcinoma was missed by hysteroscopy (sensitivity 65.52%, specificity 99.92%). Complication rate of D&C was 1.4%. CONCLUSION In women with perimenopausal and postmenopausal bleeding neither transvaginal ultrasound nor hysteroscopy as a single diagnostic tool is suitable to rule out endometrial cancer.
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Affiliation(s)
- R Deckardt
- Gynaekologische Praxisklinik, Helene-Weber-Allee 19, Munich 80637, Germany
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Römer T, Deckardt R, Lobodasch K, Bernau M, Kemnitz J, Dewitt E, Koepcke E, Bethge HC, Kienle E, Hillger H, Wallwiener D. [Effectiveness and tolerance of depot leuprorelin acetate for preoperative endometrium flattening before endometrial ablation. German Leuprorelin Study Group]. Zentralbl Gynakol 2001; 122:519-24. [PMID: 11072686 DOI: 10.1055/s-2000-10080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE In order to assess the efficacy and tolerability of leuprorelin acetate depot in pre-operative flattening of the endometrium prior to hysteroscopic endometrial ablation, 94 patients from eight centres were included in the per protocol analysis. MATERIAL AND PATIENTS The patients included were pre- or peri-menopausal, had completed their family planning and had intractable uterine bleeding. The primary target criterion was the reduction in maximum endometrial thickness after two injections of leuprorelin acetate depot with an interval of four weeks between injections. Surgery took place two weeks after the second injection. RESULTS Sufficient pre-treatment was achieved in 91.5% of the patients with > 50% decrease and/or a type 1 endometrium according to sonographic and/or endometrial atrophy (Score 11) according to the central histological evaluation. The endometrium was flattened by a mean of 4.0 +/- 4.1 mm. In terms of clinical response, amenorrhoea, hypomenorrhoea or normal menstruation were achieved after endometrial ablation. Hence 91.5% of patients benefited from the overall treatment after six weeks and still 83% after six months. The trial medication was well tolerated overall. The most common side-effect described was hot flushes which could be attributed to the deliberate oestrogen withdrawal. CONCLUSION In view of the good study results, hormone-suppressive pretreatment of the endometrium can be recommended prior to elective ablation. Surgery should take place during the oestrogen-suppressed phase.
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Affiliation(s)
- T Römer
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universität Köln.
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Deckardt R, Schreiber Y, Kretschmer M, Brill AI. Is local anesthesia beneficial in preventing shoulder pain after laparoscopy? J Am Assoc Gynecol Laparosc 1999; 6:521-3. [PMID: 10610209 DOI: 10.1016/s1074-3804(99)80024-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Deckardt R, Saks M, McMullen T. Ambulatory Gynecologic Surgery. The Journal of the American Association of Gynecologic Laparoscopists 1996; 3:S8. [PMID: 9074098 DOI: 10.1016/s1074-3804(96)80154-x] [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] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A retrospective study evaluated the feasibility and safety of operative gynecologic procedures performed in an ambulatory surgical center. Between July 1993 and December 1995, 5766 women (mean age 36.9 yrs, range 13-95 yrs) who were referred to our center underwent surgery. The most common preoperative diagnoses were dysfunctional bleeding, missed abortion, postmenopausal bleeding, cervical dysplasia, mullerian duct malformation, infertility, endometriosis, adhesions, desire for sterilization, adnexal mass, lower abdominal pain, ectopic pregnancy, and fibroids. A total of 2351 laparoscopies, 2 laparotomies, and 3415 vaginal procedures were performed. The most common procedures were dilatation and curettage, 1455; hysteroscopy, 1051; adnexal surgery, 810; tubal ligation, 679; abdominal myomectomy, 186; operative hysteroscopy, 145; and cone biopsy, 118. The duration of surgery was 10 to 210 minutes. Most patients (99.51%) were discharged between 2 and 8 hours after surgery. Only 28 (0.49%) had to be admitted to the hospital; 18 women had preoperatively planned admissions and 10 were unexpectedly admitted postoperatively. The intraoperative and postoperative complication rate was 0.50% (29). We believe that ambulatory surgery is safe and efficient with proper patient selection and when the surgeon and the anesthetist have significant expertise.
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Affiliation(s)
- R Deckardt
- Zentrum Fuer Ambulante Gyn. Operationen, Helene-Weber-Allee 19, 80637 Munich, Germany
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Beutel M, Willner H, Deckardt R, Von Rad M, Weiner H. Similarities and differences in couples' grief reactions following a miscarriage: results from a longitudinal study. J Psychosom Res 1996; 40:245-53. [PMID: 8861120 DOI: 10.1016/0022-3999(95)00520-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Recent studies have documented grief and depressive reactions in women after a miscarriage. However, the men's reactions to their partner's experience have been neglected. In a controlled follow-up study, 56 couples were studied shortly after the miscarriage, and 6 (N = 47) and 12 months later (N = 45). The participants completed standardized questionnaires for depression, physical complaints, anxiety, and grief. Contrary to commonly held beliefs, men do grieve, but less intensely and enduringly than their partners. The manner in which they experience their grief is similar to that of the women, except that the men cry less and feel less need to talk about it. Unlike the women they do not react with an increased depressive reaction (compared to age- and sex-matched community control groups). Giving up their personal expectations, hopes for, and fantasies about the unborn child is a major source of grieving for both. Some men feel burdened by their wives' grief or depressive reactions. Conflicting reactions may affect the couples' interactions and promote depressive reactions in the women.
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Affiliation(s)
- M Beutel
- Psychosomatische Poliklinik, Technische Universität Munchen, Germany
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Abstract
Bereavement is a major risk factor for physical illness, grief, depression, and anxiety. In contrast to recent tendencies in the psychiatric literature to equate grief and depression, we propose that a careful discrimination between the two must be made for diagnostic, therapeutic, and investigative purposes. We report the results of a longitudinal study of a frequent but neglected event, miscarriage early in pregnancy, to make this point. Clinical criteria for differentiating grief and depressive reactions were developed based on phenomenological criteria and theoretical considerations. We hypothesized that the detrimental psychological and physical consequences occur only when the miscarriage was not mourned and resulted in a depressive reaction, but not in a grief reaction. In a controlled, representative study, 125 consecutive women were assessed shortly after their miscarriage (before the 20th week of gestation) and 6 months (N = 94) and 12 months (N = 90) later. Assessments included standardized questionnaires for life events, depression, physical complaints, anxiety, and a specific, multidimensional grief scale (Munich Grief Scale) that we had developed previously. Immediately after the miscarriage, the average anxiety and depression scores were elevated when compared with 80 pregnant and 125 age-matched community controls. Twenty percent of the patients who had miscarried showed a grief reaction, 12% showed a depressive reaction, and 20% responded with a combined depressive and grief reaction. The remaining women (48%) reported no changes in their emotional reactions. As predicted, longer-lasting psychological, social, and health status changes followed the initial depressive, but not the grief reactions. Depressive reactions were predicted by a history of previous depression, a lack of social resources, and an ambivalent attitude to the lost fetus. The grief measures were reliable and made it possible to discriminate between grief and depression.
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Affiliation(s)
- M Beutel
- Psychosomatische Poliklinik, Technische Universität München, Germany
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Beutel M, Deckardt R. [Medical management after spontaneous abortion]. Geburtshilfe Frauenheilkd 1995; 55:M93-5. [PMID: 7498712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Affiliation(s)
- M Beutel
- Abteilung für Psychosomatische Medizin und Psychotherapie, Städtisches Krankenhaus München-Harlaching
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Abstract
STUDY OBJECTIVE To compare the outcome of laparoscopic treatment of adnexal masses with treatment by laparotomy. The procedures, their duration, and associated complications also were evaluated. DESIGN Women were randomized to undergo either procedure based on the ward to which they were admitted. SETTING A university teaching hospital. PATIENTS The 192 patients were admitted with a preoperative diagnosis of adnexal mass. INTERVENTIONS Surgical procedures were cystectomy, salpingectomy, oophorectomy, and unilateral or bilateral salpingo-oophorectomy. Organ-preserving techniques were used wherever possible. All tissue specimens were examined histologically. MEASUREMENTS AND MAIN RESULTS The mean duration of surgery was statistically not significantly different between the groups, 96.8 minutes for minimally invasive surgery, and 116 minutes for laparotomy. Organ preservation did reach statistical significance at 65.7% and 17.2% respectively (p <0.001). Postoperative morbidity was statistically lower in patients undergoing minimally invasive procedures. Preoperative tumor marker levels did not correlate well with postoperative histology. One woman in the laparotomy group had histologically proved ovarian cancer. Minimally invasive surgery was converted to laparotomy in three patients in whom malignancy was suspected at the start of operation. CONCLUSIONS Laparoscopic management of adnexal masses has definite advantages over laparotomy, for example, lower postoperative morbidity. In addition, intraoperative endoscopic diagnosis is highly accurate, and the frequency of unnecessary procedures is lower.
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Affiliation(s)
- R Deckardt
- Zentrum für ambulante gynaekologische, Operationen und Laserchirurgie, Helene-Weber-Allee 19, 80637 Muenchen, Germany
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Fischbach F, Deckardt R, Graeff H. [Ciprofloxacin/metronidazole vs. cefoxitin/doxycycline: comparison of two therapy schedules for treatment of acute pelvic infection]. Geburtshilfe Frauenheilkd 1994; 54:337-40. [PMID: 8088489 DOI: 10.1055/s-2007-1022851] [Citation(s) in RCA: 5] [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: 01/28/2023] Open
Abstract
The efficacy and safety of two antibiotic regimens for the treatment of acute pelvic inflammatory disease (PID) was compared in a prospective and randomised study. 57 patients received either 0.2 gms ciprofloxacin intravenously b.i.d. in combination with 0.5 g metronidazole intravenously t.i.d. (n = 26), or alternatively 2 g cefoxitin intravenously t.i.d. in combination with doxycycline 0.1 g b.i.d. (n = 31). After commencing therapy intravenously, medication with ciprofloxacin, metronidazole and doxycycline was continued orally after two or three days. In the ciprofloxacin/metronidazole group, PID was found to be severe in 7, moderate in 12 and mild in 7 patients. The numbers in the cefoxitin/doxycycline group were 8, 20 and 3 respectively. The clinical result after treatment with ciprofloxacin/metronidazole was resolution of all symptoms in 24 patients and improvement in 2 others. In the cefoxitin/doxycycline treated group, resolution was found in 27 patients, improvement in 2 others. Failure occurred in 2 patients. 53 different microorganisms as the suspected cause of PID were isolated in the ciprofloxacin/metronidazole group and 56 in the cefoxitin/doxycycline group. According to our clinical and bacteriological criteria, treatment for PID was successful in 97% of the ciprofloxacin/metronidazole group and in 87% of the cefoxitin/doxycycline group. Adverse reactions were found in 4 patients in the ciprofloxacin/metronidazole treated group. Therapy had to be terminated in 3 of these patients. In the cefoxitin/doxycycline group 2 patients had adverse reactions, and therapy had to be terminated in one of these patients. According to our results, both antibiotic regimens can be recommended for the treatment of PID.
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Affiliation(s)
- F Fischbach
- Frauenklinik, Technischen Universität München, Klinikum rechts der Isar
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Deckardt R, Beutel M, Schaudig K. [Long-term psychological sequelae of spontaneous abortion: do medical management, recent pregnancy and delivery really help in coping with grief?]. Geburtshilfe Frauenheilkd 1994; 54:347-54. [PMID: 8088491 DOI: 10.1055/s-2007-1022853] [Citation(s) in RCA: 7] [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: 01/28/2023] Open
Abstract
86 patients with spontaneous abortion were interviewed and followed up in a longitudinal study with an interview and standardised questionnaires shortly after the D&C at 7, 13 and 24 months later. Our results indicate profound and long-term adverse psychological sequelae. For most of the patients, a spontaneous abortion was considered to be of major importance. Without regard to the gestational age or ultrasonographic image, the embryo is represented early in fantasies and dreams as a child. The severity of grief reactions following abortion did not correlate well with gestational age or a new pregnancy. Mourning is still present 24 months after the abortion. While grief decreases continuously during the first 7 months following abortion, despair remains constant and self-reproachful coping shows even a statistically significant increase between months 13 and 24. The reason is, because 20% of patients develop a pathological grief reaction with an increase in depression, self-reproachful coping and physical complaints. This risk group of patients, who needs closer and more detailed observation and guidance, may be recognised as early as at the time of abortion.
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Affiliation(s)
- R Deckardt
- Frauenklinik und Poliklinik, Technischen Universität, Klinikum rechts der Isar, München
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Beutel M, Deckardt R, Schaudig K, Rolvering M. [Chronic grief after spontaneous abortion: results of a longitudinal study after 13 months]. Psychother Psychosom Med Psychol 1993; 43:411-9. [PMID: 8146259] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Presented are follow-up results on coping with spontaneous abortion. Although the majority of women feel that this is a significant negative life event, their grief gradually decreases within 7 to 13 months. Compared to population standards they are neither depressed nor do they suffer from increased physical complaints. A subgroup of women is identified with chronic ("pathological") grief based on increased or rising levels of grief (PGS), depression (SCL-90) and physical complaints (BL). Independently from a following pregnancy these women (about 20%) report a high importance of their abortion, painful feelings in seeing pregnant women and babies and fears of another abortion even after 13 months. Scores immediately after the abortion permit a good discrimination of patients with chronic grief and uncomplicated course: Patients who later develop chronic grief report a high level of negative feelings during the pregnancy leading to the loss, extensive preparations for the expected baby, an unsettled vocational and family situation and intensive strains and despair immediately thereafter. Conditions and ways of grieving with this specific loss are discussed.
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Affiliation(s)
- M Beutel
- Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Medizinische Psychologie, Technischen Universität München
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Deckardt R. Laparoskopische Therapie der Eileiterschwangerschaft mit Prostaglandinen. Arch Gynecol Obstet 1993. [DOI: 10.1007/bf02266408] [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: 10/24/2022]
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Deckardt R, Saks M, Gräff H. Laparoscopic therapy for tubal pregnancy using prostaglandins. J Reprod Med 1993; 38:587-91. [PMID: 8410861] [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: 01/30/2023]
Abstract
Nineteen patients with confirmed tubal pregnancy and constant or rising plasma beta-human chorionic gonadotropin (beta-hCG) levels were treated with laparoscopically guided injection of prostaglandin F2 alpha into the oviduct. Fifteen patients received additional prostaglandin E2 during three consecutive postoperative days. One patient was excluded from the study. The treatment was defined as successful when plasma beta-hCG levels declined below the lower detection limit and no further intervention other than prostaglandin application was required. The treatment was successful in 12 patients (66.7%). Given a beta-hCG level greater than 2,500 mU/mL as an exclusion criterion for treatment with prostaglandin, the success rate was 84.6%. Six patients underwent salpingotomy because of rising beta-hCG levels following treatment. The outcome was not related to the postoperative treatment with prostaglandin E2. None of the treated patients displayed any adverse reactions following prostaglandin F2 alpha application. Postoperative hysterosalpingography was performed on six successfully treated patients, demonstrating bilaterally patent fallopian tubes in all of them. Prostaglandin therapy in tubal pregnancy has been proven effective in selected cases.
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Affiliation(s)
- R Deckardt
- Frauenklinik der Technischen Universität Klinikum rechts der Isar, Munich, Germany
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15
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Affiliation(s)
- R Deckardt
- Frauenklinik der TU rechts der Isar, München
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Deckardt R, Saks M, Graeff H. [Hysteroscopic therapy of non-malignant uterine hemorrhage]. Gynakol Geburtshilfliche Rundsch 1993; 33 Suppl 1:32-3. [PMID: 8118332 DOI: 10.1159/000272149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Deckardt R, Saks M, Graeff H. [Surgical therapy of adnexa tumors. A comparison of minimally invasive surgery and laparotomy in 192 patients]. Gynakol Geburtshilfliche Rundsch 1993; 33 Suppl 1:40. [PMID: 8118351 DOI: 10.1159/000272152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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Beutel M, Deckardt R, Schaudig K, Franke S, Zauner R. [Grief, depression and anxiety after spontaneous abortion--a study of systematic evaluation and factors of influence]. Psychother Psychosom Med Psychol 1992; 42:158-66. [PMID: 1488507] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Recent studies demonstrate profound and long-lasting adverse psychological and family sequelae of a spontaneous abortion. However, decisive issues of quality, course and determinants cannot be answered sufficiently due to shortcomings of research (e.g. lack of representative samples and adequate measures, reliance on cross-sectional study designs). Grief reactions and their determinants are differentiated in relation to depressiveness and anxiety in 86 patients from a longitudinal study, employing the Perinatal Grief Scale (Thoedter et al. 1988) and standardized symptom checklists. For the majority of the women, around the 10th week of gestation, the embryo is psychologically represented in fantasies, dreams and concrete arrangements in reality. Immediately after the abortion, these women react with painful feelings of "active grief" and "despair". Additional stresses in the pregnancy and lack of social support predict "self-reproachful coping". Women with recurrent abortions who have no children show depressive reactions. Retrospectively, these also present more anxiety and depressive moods during pregnancy. Results support reliability and validity of the grief scale. Implications for counselling and psychotherapy of women after a spontaneous abortion are discussed with respect to these risk constellations.
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Affiliation(s)
- M Beutel
- Institut und Poliklinik für Psychosomatische Medizin, Technischen Universität München
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Schneider KT, Deckardt R, Rust M, Dumler EA, Graeff H. [Doppler flow changes in maternal and fetal blood vessels before and during peridural anesthesia]. Geburtshilfe Frauenheilkd 1991; 51:544-8. [PMID: 1936863 DOI: 10.1055/s-2007-1026196] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [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: 12/29/2022] Open
Abstract
26 women with an uneventful singleton pregnancy near term underwent scheduled Caesarean section with lumbar epidural anaesthesia (PDA). Doppler-flow measurements of the foetal umbilical artery and the maternal hypogastric artery were taken before and after sympathicolysis was established. The mean arterial blood pressure was maintained unchanged between the measurements. Both measurements were performed by the same examiner. Three patients received additional general anaesthesia during the operation because of inadequate analgesia. The resistance index (RI) with PDA decreased significantly in 23 patients by a mean of 7.6% (p less than 0.05). The RI in those patients (n = 3) with inadequate analgesia increased by a mean of 27%. The physiologically reversed diastolic flow in the maternal hypogastric artery was mathematically taken into consideration by applying the quotient of the systolic flow and the diastolic reversed flow (V/R-quotient). The V/R-quotient increased with established sympathicolysis by more than 180% in all but one patient. The neonates' mean umbilical artery pH was 7.32 (7.27 to 7.41), the mean five minute Apgar score was 10 (8 to 10).
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20
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Abstract
Pregnant women spend more than half of the day in an upright position. The physiological effects of this posture on the mother and the fetus are evaluated. Changes in vascular autoregulation and anatomy lead to maternal fainting in about 8% of women during early pregnancy. The immediate effects of such episodes on the fetus are unknown. There is a positive correlation of orthostatic dysregulations and abortions. In late pregnancy we found a significant increase in functional residual capacity in the upright posture. Minute volume and oxygen consumption were also significantly increase (p less than 0.001). Regarding the cardiovascular changes we detected a rhythmic change of the maternal heart rate with the change to upright position, which had not been published before. Change from the left lateral position to unsupported standing increased maternal heart rate by a mean of 27 beats per minute and a mean duration of 105 seconds in two thirds of the women. This was accompanied by a decreased cardiac output, systolic blood pressure and an increased oxygen consumption. The gravid uterus is responsible for these changes. During the upright position, the venous flow to the right ventricle is inhibited by the relaxed uterus. Contractions, leaning forward and the muscle pump improve the venous return. The phenomenon reached its maximum during the 38th week, where 71% of pregnant women displayed a cyclic change in heart rate. The fetal heart rate baseline is significantly increased in the upright position with a significantly reduced acceleration frequency (p less than 0.001). Combined with the data from epidemiologic studies, prolonged standing during late pregnancy may signal potential risks for the fetus such as low birth weight, prematurity and stillbirths because of an 'uterovascular syndrome'. Maternal standing possibly may be used as a physiological fetal stress test.
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Affiliation(s)
- K T Schneider
- Gynecological Clinic, Frauenklinik rechts der Isar, Technical University Munich, Fed. Rep. of Germany
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Abstract
Fifteen patients with laparoscopically diagnosed tubal pregnancy and constant or rising plasma beta-hCG levels were treated with prostaglandin F2 alpha and prostaglandin E2. Prostaglandin F2 alpha (5 mgms diluted in 10 cc of isotonic sodium solution) was injected transabdominally with a 22 gauge spinal needle during laparoscopy into the Fallopian tube. Prostaglandin E2 (500 micrograms ms) was given intramuscularly during three consecutive postoperative days. The treatment was defined as successful if plasma beta-hCG levels declined below the lower limit of detection and no further intervention other than prostaglandin application was required. The treatment was successful in eight patients. Six patients underwent laparotomy and salpingotomy because of rising beta-hCG levels. None of the treated patients displayed any adverse reactions following prostaglandin F2 alpha application. One patient underwent explorative laparotomy during the second postoperative day because of lower abdominal pain. During operation, no pathological change could be found. This patient was excluded from the study. In the group treated successfully (n = 8) seven out of eight patients had beta-hCG levels below 2500 mlU/ml preoperatively. In the unsuccessfully treated group (n = 6), four out of six patients had beta-hCG levels above 2500 mlU/ml preoperatively. Mean duration of beta-hCG decline to 10 percent of the maximum preoperative value was 15.8 +/- 8.64 days (mean +/- S.D.). Postoperatively, hysterosalpingography was performed in six out of eight successfully treated patients after three menstrual cycles (one patient had an intrauterine pregnancy, one patient refused written consent). The Fallopian tubes were patent bilaterally in all six patients.
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Affiliation(s)
- R Deckardt
- Frauenklinik und Poliklinik der Technischen Universität München, Klinikum rechts der Isar
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Abstract
Hemorrhage and sepsis may lead to multiple organ system failure caused by a redistribution of cardiac output and a reduction of tissue perfusion. The pathophysiologic changes caused by hemorrhage are frequently prevented by rapid diagnosis of the cause of the bleeding (e.g., vessel injury or coagulation disorder) and its therapy. The pathophysiologic changes in sepsis are mediated by toxins which affect almost every organ system. Knowledge of the predisposing factors, rapid recognition of signs and symptoms, and understanding of the underlying pathobiochemical and pathophysiologic changes are mandatory in the successful therapy of septic shock. The main therapeutic principle remains removal of the focus.
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Affiliation(s)
- H Graeff
- Frauenklinik und Poliklinik der Technischen Universität rechts der Isar, München
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Deckardt R, Fembacher PM, Schneider KT, Graeff H. Maternal arterial oxygen saturation during labor and delivery: pain-dependent alterations and effects on the newborn. Obstet Gynecol 1987; 70:21-5. [PMID: 3601266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
This study evaluated the effects of labor pain on maternal arterial hemoglobin oxygen saturation and neonatal acid-base status. Arterial oxygen saturation was monitored noninvasively by pulse oximetry during labor and delivery. The patients studied (N = 46) were divided into four groups according to obstetric history (primiparas and multiparas) and pain management during labor (lumbar peridural anesthesia versus meperidine and nitrous oxide). Nine patients at term but not in labor served as controls. Decreases of arterial oxygen saturation were related to both subjective pain, reported by visual pain analog scales, and to neonatal acid-base status at delivery. All values are reported as mean +/- standard deviation (SD). Primiparas with peridural anesthesia showed significantly less decrease in arterial oxygen saturation (1.7 +/- 1.4%; P less than .001; N = 15), superior scores on the visual pain analog scale (3.5 +/- 2.0), and a significantly better neonatal acid-base status (pH 7.29 +/- 0.06; P = .01; base excess -6.4 +/- 2.2; P less than .05) as compared with primiparas treated with meperidine and nitrous oxide (SaO2 7.2 +/- 3.9%; visual pain analog scale 7.1 +/- 1.2; pH 7.21 +/- 0.1; base excess -9.5 +/- 4.5; N = 16). In multiparas there was no statistically significant difference in decrease of arterial oxygen saturation, visual pain analog scale, and neonatal acid-base status.
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Schneider KTM, Deckardt R, Graeff H, Huch A, Huch R. Ist mütterliches Stehen ein physiologischer fetaler Streßtest? Arch Gynecol Obstet 1987. [DOI: 10.1007/bf01783324] [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: 10/25/2022]
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Deckardt R. [Advantages of early artificial respiration of the newborn infant using a modified T-piece]. Geburtshilfe Frauenheilkd 1987; 47:121-3. [PMID: 3471623 DOI: 10.1055/s-2008-1035790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Onset of sufficient respiration in the newborn may be delayed and require respiratory assistance. Its early institution is mandatory and its mode guided by the respiratory requirements of the newborn at risk. In our Department we use a simple respiratory equipment consisting of a modified mask elbow and a pigtail bag. We have applied this system in over thousand newborns without any complications. Sufficient respiratory care is easily accomplished. The system offers advantages because of its simplicity. It is lightweight, transparent, without valves and enables the user to applicate assisted or controlled ventilation with or without CPAP or PEEP. Tidal volume and frequency of spontaneous respiration can be gauged by watching the inflated bag's movements. If sufficient fresh gas flow is provided, there is no hazardous rebreathing. An elevated orifice maintains a safe system pressure, while still permitting high inspiratory pressures for resuscitation. Pressures applied are checked by an attached manometer.
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Abstract
Term neonates (N = 35) with an one minute Apgar score of greater than or equal to 8 and mean umbilical artery pH values within normal were monitored by pulse oximetry. SaO2 monitoring started one minute after delivery. The initial SaO2 ranged from 40 to 75%. Neonates with a SaO2 above 80% five minutes after delivery remained untreated, neonates with a SaO2 below 80% received mask CPAP (figure 1). The initial difference in SaO2 between the groups was statistically significant (p less than 0.05). Mean umbilical artery pH and one, five and ten minutes Apgar score values were statistically not significant between the groups (p greater than 0.05). CPAP had been terminated as soon as SaO2 had reached 90%. This had been the lowest value monitored in spontaneously breathing neonates one day after delivery. Our findings indicate that neonates may sustain prolonged periods of decreased SaO2 which had not been detected by umbilical artery pH nor by the Apgar score. SaO2 monitoring by pulse oximetry served as a valuable method in the immediate newborn evaluation.
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Affiliation(s)
- R Deckardt
- Department of Obstetrics and Gynecology, Klinikum rechts der Isar der Technischen Universitaet, Munich, West Germany
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Deckardt R, Steward DJ. Noninvasive arterial hemoglobin oxygen saturation versus transcutaneous oxygen tension monitoring in the preterm infant. Crit Care Med 1984; 12:935-9. [PMID: 6499476 DOI: 10.1097/00003246-198411000-00002] [Citation(s) in RCA: 67] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We found that results from a transcutaneous arterial hemoglobin oxygen-saturation monitor correlated well with those from a co-oximeter. The monitor was not disturbed by differing hematocrit levels, the presence of fetal hemoglobin, or hypotension. We also found that the results of simultaneous transcutaneous arterial hemoglobin oxygen saturation (StcaO2) and transcutaneous oxygen tension (PtcO2) monitoring were predictably correlated over a wide range of hemoglobin saturations in preterm infants. When StcaO2 was between 80% and 95%, PtcO2 was at a safe level of 40 to 80 torr in 94% of the patients studied. StcaO2 monitoring as an index of arterial oxygenation has several advantages for the preterm infant.
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von Hugo R, Rust M, Deckardt R, Graeff H. [Amniotic fluid embolism]. Gynakologe 1984; 17:124-30. [PMID: 6088371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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