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Gottschalk I, Strizek B, Jehle C, Stressig R, Herberg U, Breuer J, Brockmeier K, Hellmund A, Geipel A, Gembruch U, Berg C. Pränatale Diagnose und postnatales Outcome von Feten mit Pulmonalatresia und Ventrikelseptumdefekt. Geburtshilfe Frauenheilkd 2018. [DOI: 10.1055/s-0038-1660603] [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)
- I Gottschalk
- Bereich für Pränatale Medizin und Gynäkologische Sonografie, Universitätsfrauenklinik Köln, Deutschland
| | - B Strizek
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
| | - C Jehle
- Bereich für Pränatale Medizin und Gynäkologische Sonografie, Universitätsfrauenklinik Köln, Deutschland
| | - R Stressig
- praenatal.de, Pränatale Medizin und Genetik, Köln, Deutschland
| | - U Herberg
- Abteilung für Kinderkardiologie, Universitätsklinik Bonn, Deutschland
| | - J Breuer
- Abteilung für Kinderkardiologie, Universitätsklinik Bonn, Deutschland
| | - K Brockmeier
- Klinik und Poliklinik für Kinderkardiologie, Universitätsklinik Köln, Deutschland
| | - A Hellmund
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
| | - A Geipel
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
| | - U Gembruch
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
| | - C Berg
- Bereich für Pränatale Medizin und Gynäkologische Sonografie, Universitätsfrauenklinik Köln, Deutschland
- Abteilung für Geburtshilfe und Pränatale Medizin, Universitätsklinik Bonn, Deutschland
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Wolter A, Gebert M, Degenhardt J, Kawecki A, Enzensberger C, Graupner O, Khalil M, Yerebakan C, Ritgen J, Stressig R, Axt-Fliedner R. Vergleich perintaler Daten und Outcome von pränatal versus postnatal diganostizierten Kindern mit Fallot-Tetralogie (TOF). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1593303] [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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Wolter A, Gebert M, Degenhardt J, Kawecki A, Enzensberger C, Graupner O, Khalil M, Yerebakan C, Ritgen J, Stressig R, Axt-Fliedner R. Vergleich perintaler Daten und Outcome von pränatal versus postnatal diganostizierten Kindern mit Fallot-Tetralogie (TOF). Geburtshilfe Frauenheilkd 2016. [DOI: 10.1055/s-0036-1583839] [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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Gottschalk I, Stressig R, Ritgen J, Herberg U, Breuer J, Vorndamme A, Strizek B, Willruth A, Geipel A, Gembruch U, Berg C. Extracardiac anomalies in prenatally diagnosed heterotaxy syndrome. Ultrasound Obstet Gynecol 2016; 47:443-449. [PMID: 25847110 DOI: 10.1002/uog.14871] [Citation(s) in RCA: 20] [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] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 03/29/2015] [Accepted: 03/31/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To assess the incidence and impact of extracardiac anomalies on the prognosis of fetuses with heterotaxy syndrome. METHODS All fetuses diagnosed with heterotaxy syndrome by three experienced examiners over a period of 14 years (1999-2013) were reviewed retrospectively. RESULTS In total, 165 fetuses with heterotaxy syndrome were diagnosed in the study period. One hundred and fifty (90.9%) had cardiac defects; extracardiac anomalies that did not involve the spleen were present in 26/165 (15.8%) cases. Of the total study cohort, termination of pregnancy was performed in 49 (29.7%) cases, intrauterine death occurred in 11 (6.7%), postnatal death occurred in 38 (23.0%) and 67 (40.6%) were alive at the latest follow-up, resulting in a total perinatal and pediatric mortality of 59.4%. Among the 105 liveborn neonates, 15 (14.3%) had extracardiac anomalies with significant impact on the postnatal course: one neonate died following repair of an encephalocele, six had successful treatment for various types of intestinal malrotation and/or atresia and one underwent hiatal hernia repair; the remaining seven had biliary atresia, of which five died and the two survivors are awaiting liver transplantation. The status of the spleen was assessed in 93/105 liveborn children and was found to be abnormal in 84/93 (90.3%). There were three cases of lethal sepsis, all associated with asplenia. Of the 38 postnatal deaths, 29 (76.3%) had a cardiac cause, seven (18.4%) had an extracardiac cause and in two (5.2%) the reason was uncertain. CONCLUSIONS Although the leading causes of death in fetuses and children with heterotaxy syndrome are cardiac, a small subset of fetuses have extracardiac anomalies with significant impact on outcome. These anomalies often escape prenatal detection, and therefore neonates at risk should be monitored for bowel obstruction, biliary atresia and immune dysfunction in order to allow timely intervention through a multidisciplinary approach. Copyright © 2015 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- I Gottschalk
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Gynecology and Obstetrics, University of Köln, Köln, Germany
| | - R Stressig
- praenatal.de, Prenatal Medicine and Genetics, Köln, Germany
- Congenital Cardiac Center ('Deutsches Kinderherzzentrum'), Sankt Augustin, Germany
| | - J Ritgen
- praenatal.de, Prenatal Medicine and Genetics, Köln, Germany
| | - U Herberg
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - J Breuer
- Department of Pediatric Cardiology, University of Bonn, Bonn, Germany
| | - A Vorndamme
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - B Strizek
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Willruth
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - A Geipel
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - C Berg
- Division of Prenatal Medicine and Gynecologic Sonography, Department of Gynecology and Obstetrics, University of Köln, Köln, Germany
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
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Wolter A, Nosbüsch S, Stressig R, Ritgen J, Kawecki A, Graupner O, Degenhardt J, Enzensberger C, Kohl T, Khalil M, Yerebakan C, Axt-Fliedner R. Evaluierung des 30-Tage Outcomes von Kindern mit pränatal diagnostiziertem funktionell univentrikulärem Herzen. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0035-1566663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gottschalk I, Jehle C, Stressig R, Herberg U, Breuer J, Gembruch U, Geipel A, Berg C. Pränatale Diagnose und postnataler Verlauf komplexer Fallot'scher Tetralogien. Z Geburtshilfe Neonatol 2015. [DOI: 10.1055/s-0034-1375707] [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]
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Klein T, Semaan A, Kellner M, Ritgen J, Boemers T, Stressig R. Coincidence of congenital left-sided diaphragmatic hernia and ductus venosus agenesis: Relation between altered hemodynamic flow and lung-to-head-ratio? Journal of Pediatric Surgery Case Reports 2015. [DOI: 10.1016/j.epsc.2015.04.002] [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: 11/25/2022] Open
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Kagan KO, Hoopmann M, Hammer R, Stressig R, Kozlowski P. Screening for chromosomal abnormalities by first trimester combined screening and noninvasive prenatal testing. Ultraschall Med 2015; 36:40-46. [PMID: 25255236 DOI: 10.1055/s-0034-1385059] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To examine combined first trimester screening (FTS), noninvasive prenatal testing (NIPT) and a two-step policy that combines FTS and NIPT in screening for aneuploidy. MATERIALS AND METHODS Retrospective study involving 21,052 pregnancies where FTS was performed at the Praxis Praenatal.de in Duesseldorf, Germany. In each case, the sum risk of trisomy 21, 18 and 13 was computed. We assumed that NIPT detects 99 %, 98 %, 90 % and 99 % of cases with trisomy 21, 18, 13 and sex chromosomal abnormalities and that the false-positive rate is 0.5 %. The following screening policies were examined: NIPT or FTS with sum risk cut-offs of 1 in 50 and 1 in 250 in all patients or a two-step-policy with FTS in all patients followed by NIPT in the intermediate sum risk group. For the intermediate risk group, sum risk cut-offs of 1 in 50 and 1 in 1000 and 1 in 150 and 1 in 500 were used. RESULTS There were 127, 34, 13 and 15 pregnancies with trisomy 21, 18, 13 and sex chromosomal abnormalities. 23 fetuses had other chromosomal abnormalities with an increased risk for adverse outcome that are not detectable by NIPT. 20,840 pregnancies were classified as normal as ante- and postnatal examinations did not show any signs of clinically significant chromosomal abnormalities. FTS with a sum risk cut-off of 1 in 50 and 1 in 250 detects 81 % and 91 % for all aneuploidies. NIPT detects 88 % of the respective pregnancies. The 2-step approach with sum risk cut-offs of 1 in 50 and 1 in 1000 detects 94 % of all aneuploidies. With sum risk cut-offs of 1 in 150 and 1 in 500, the detection rate is 93 %. CONCLUSION A 2-step policy with FTS for all patients and NIPT in the intermediate risk group results in the highest detection rate of all aneuploidies.
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Affiliation(s)
- K O Kagan
- Department of Obstetrics and Gynaecology, University of Tuebingen, Tübingen
| | - M Hoopmann
- Department of Obstetrics and Gynaecology, University of Tuebingen, Tübingen
| | - R Hammer
- Praenatal Medicine and Genetics, praenatal.de, Düsseldorf
| | - R Stressig
- Praenatal Medicine and Genetics, praenatal.de, Düsseldorf
| | - P Kozlowski
- Praenatal Medicine and Genetics, praenatal.de, Düsseldorf
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Gottschalk I, Jehle C, Stressig R, Herberg U, Breuer J, Gembruch U, Geipel A, Berg C. Pränatale Diagnose und postnataler Verlauf komplexer Fallot'scher Tetralogien. Geburtshilfe Frauenheilkd 2014. [DOI: 10.1055/s-0034-1388073] [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] Open
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Ritgen J, Kohl T, Enzensberger C, Axt-Fliedner R, Schaible T, Stressig R. [Prenatal diagnosis of and therapy for congenital diaphragmatic hernia]. Z Geburtshilfe Neonatol 2014; 218:6-17. [PMID: 24595910 DOI: 10.1055/s-0034-1367041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Congenital diaphragmatic hernia is a malformation presenting with varying degrees of severity. An accurate prediction of outcome is crucial for parental counselling and therapeutic planning. In selected cases, foetal endoscopic tracheal occlusion (FETO) can improve foetal outcome. Timely referral to a highly specialised centre is important when the requirement for extracorporeal membrane oxygenation (ECMO) is expected.
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Affiliation(s)
- J Ritgen
- Praxis für Pränatalmedizin und Genetik Köln/Düsseldorf
| | - T Kohl
- Deutsches Zentrum für Fetalchirurgie & minimal-invasive Therapie (DZFT), Justus-Liebig Universität Gießen und Universitätsklinikum Gießen & -Marburg
| | - C Enzensberger
- Abteilung für Pränatalmedizin und gynäkologische Sonografie, Klinik für Frauenheilkunde und Geburtshilfe, Justus-Liebig Universität Gießen und Universitätsklinikum Gießen & Marburg
| | - R Axt-Fliedner
- Abteilung für Pränatalmedizin und gynäkologische Sonografie, Klinik für Frauenheilkunde und Geburtshilfe, Justus-Liebig Universität Gießen und Universitätsklinikum Gießen & Marburg
| | | | - R Stressig
- Praxis für Pränatalmedizin und Genetik Köln/Düsseldorf
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Bildau J, Enzensberger C, Degenhardt J, Kawecki A, Tenzer A, Kohl T, Stressig R, Ritgen J, Utsch B, Axt-Fliedner R. [Lower urinary tract obstruction (LUTO)--clinical picture, prenatal diagnostics and therapeutic options]. Z Geburtshilfe Neonatol 2014; 218:18-26. [PMID: 24595911 DOI: 10.1055/s-0034-1367042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The aetiology of urinary tract obstructions (LUTO) is heterogeneous. The most common entities are isolated posterior urethral valves or urethral atresia in male foetuses. In female foetuses LUTO is frequently a part of complex malformations. The natural history of LUTO is characterised by high morbidity and mortality due to the development of severe pulmonary hypoplasia caused by oligo- or anhydramnios affecting the cannalicular phase (16-24 weeks of gestation) of pulmonary development. The degree of renal damage is variable and ranges from mild renal impairment in infancy to end-stage renal insufficiency, necessitating dialysis and transplantation. Foetal interventions in order to bypass the obstruction are biologically plausible and technically feasible. Vesico-amniotic shunting as well as (currently less frequent) foetoscopic cystoscopy and laser ablation of posterior urethral valves are minimally invasive treatment options. Previous reports indicate that prenatal therapy is suitable to reduce perinatal mortality but does not improve postnatal renal function. Selection of foetuses who may profit from prenatal intervention is aggravated by the lack of reliable prognostic criteria for the prediction of postnatal renal function in both ultrasound and foetal urine analysis. Furthermore, there is no randomised trial available at the time of writing. Because of a relevant complication rate and still no clear evidence for foetal benefit, interventions should be performed in specialised centres. Further studies are necessary to improve case selection of affected foetuses and to evaluate the impact of interventions in earlier gestational weeks. The data from the PLUTO trial (percutaneous shunting in lower urinary tract obstruction) conducted by the University of Birmingham may help to answer these questions. In the meantime selection of foetuses for prenatal intervention puts high requirements on interdisciplinary counselling in every case. A general treatment algorithm for foetal therapy is not available at the moment.
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Affiliation(s)
- J Bildau
- Frauenklinik, Asklepios Klinik Lich, akademisches Lehrkrankenhaus der Justus-Liebig Universität Gießen
| | - C Enzensberger
- Abteilung für Pränatalmedizin und gynäkologische Sonografie, Zentrum für Frauenheilkunde und Geburtshilfe, Justus-Liebig Universität Gießen und UKGM
| | - J Degenhardt
- Abteilung für Pränatalmedizin und gynäkologische Sonografie, Zentrum für Frauenheilkunde und Geburtshilfe, Justus-Liebig Universität Gießen und UKGM
| | - A Kawecki
- Abteilung für Pränatalmedizin und gynäkologische Sonografie, Zentrum für Frauenheilkunde und Geburtshilfe, Justus-Liebig Universität Gießen und UKGM
| | - A Tenzer
- Abteilung für Pränatalmedizin und gynäkologische Sonografie, Zentrum für Frauenheilkunde und Geburtshilfe, Justus-Liebig Universität Gießen und UKGM
| | - T Kohl
- Deutsches Zentrum für Fetalchirurgie & minimal-invasive Therapie (DZFT)
| | - R Stressig
- Praxis für Praenatalmedizin und Genetik Köln/Düsseldorf, Praenatal.de
| | - J Ritgen
- Praxis für Praenatalmedizin und Genetik Köln/Düsseldorf, Praenatal.de
| | - B Utsch
- Zentrum für Kinderheilkunde und Jugendmedizin, Abteilung für Allgemeine Pädiatrie und Neonatologie, Jusustus-Liebig-Universität Gießen und UKGM
| | - R Axt-Fliedner
- Abteilung für Pränatalmedizin und gynäkologische Sonografie, Zentrum für Frauenheilkunde und Geburtshilfe, Justus-Liebig Universität Gießen und UKGM
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Stressig R, Fimmers R, Schaible T, Degenhardt J, Axt-Fliedner R, Gembruch U, Kohl T. Preferential streaming of the ductus venosus toward the right atrium is associated with a worse outcome despite a higher rate of invasive procedures in human fetuses with left diaphragmatic hernia. Ultraschall Med 2013; 34:568-572. [PMID: 23696063 DOI: 10.1055/s-0032-1330702] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
PURPOSE Preferential streaming of the ductus venosus (DV) toward the right atrium has been observed in fetuses with left diaphragmatic hernia (LDH). The purpose of this retrospective study was to compare survival rates to discharge between a group with preferential streaming of the DV toward the right heart and a group in which this abnormal flow pattern was not present. MATERIALS AND METHODS We retrospectively searched our patient records for fetuses with LDH in whom liver position, DV streaming and postnatal outcome information was available. 55 cases were found and divided into two groups: Group I fetuses exhibited abnormal DV streaming toward the right side of the heart; group II fetuses did not. Various prognostic and outcome parameters were compared. RESULTS 62 % of group I fetuses and 88 % of group II fetuses survived to discharge (p = 0.032). Fetoscopic tracheal balloon occlusion (FETO) was performed in 66 % of group I fetuses and 23 % of group II fetuses (p = 0.003). Postnatal ECMO therapy was performed in 55 % of group I fetuses and 23 % of group II infants (p = 0.025). Moderate to severe chronic lung disease in survivors was observed in 56 % of the survivors of group I and 9 % of the survivors of group II (p = 0.002). CONCLUSION Preferential streaming of the DV toward the right heart in human fetuses with left-sided diaphragmatic hernia was associated with a poorer postnatal outcome despite a higher rate of invasive pre- and postnatal procedures compared to fetuses without this flow abnormality. Specifically, abnormal DV streaming was found to be an independent predictor for FETO.
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MESH Headings
- Echocardiography, Doppler, Color
- Extracorporeal Membrane Oxygenation
- Female
- Gestational Age
- Heart Atria/abnormalities
- Heart Atria/diagnostic imaging
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/embryology
- Heart Defects, Congenital/mortality
- Heart Defects, Congenital/therapy
- Hernia, Diaphragmatic/diagnostic imaging
- Hernia, Diaphragmatic/embryology
- Hernia, Diaphragmatic/mortality
- Hernia, Diaphragmatic/therapy
- Humans
- Infant, Newborn
- Persistent Fetal Circulation Syndrome/diagnostic imaging
- Persistent Fetal Circulation Syndrome/embryology
- Persistent Fetal Circulation Syndrome/mortality
- Persistent Fetal Circulation Syndrome/therapy
- Pregnancy
- Prognosis
- Retrospective Studies
- Survival Rate
- Ultrasonography, Prenatal
- Umbilical Veins/diagnostic imaging
- Vena Cava, Inferior/diagnostic imaging
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Affiliation(s)
- R Stressig
- Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn
| | - R Fimmers
- Department of Biostatistics, University Hospital of Bonn
| | - T Schaible
- Department of Neonatology, University Hospital of Mannheim, Germany
| | - J Degenhardt
- Department of Obstetrics and Prenatal Medicine, University Hospital of Gießen, Germany
| | - R Axt-Fliedner
- Department of Obstetrics and Prenatal Medicine, University Hospital of Gießen, Germany
| | - U Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Germany
| | - T Kohl
- German Center for Fetal Surgery & Minimally Invasive Therapy (DZFT), University Hospital of Gießen, Germany
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Enzensberger C, Tenzer A, Degenhardt J, Ritgen J, Stressig R, Kohl T, Axt-Fliedner R. Cardiac function and pulmonary vasoreactivity to maternal hyperoxygenation (MH) in fetuses with Hypoplastic Left Heart (HLH). Z Geburtshilfe Neonatol 2013. [DOI: 10.1055/s-0033-1361256] [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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Lato K, Poellmann M, Knippel AJ, Bizjak G, Stressig R, Hammer R, Janni W, Kozlowski P. Fetal gastroschisis: a comparison of second vs. third-trimester bowel dilatation for predicting bowel atresia and neonatal outcomes. Ultraschall Med 2013; 34:157-161. [PMID: 22161619 DOI: 10.1055/s-0031-1281753] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To compare various gestational ages and thresholds for diagnosing bowel dilatation in fetuses with gastroschisis and to evaluate the prognostic value of bowel dilatation for predicting postnatal bowel atresia and neonatal outcomes. MATERIALS AND METHODS This was a retrospective observational study conducted from March 1997 to September 2009 that included 78 pregnancies with fetal gastroschisis. The predictive value of prenatal bowel dilatation for neonatal bowel atresia and postnatal complications was investigated in three subgroups: those with bowel dilatations ≥ 10 mm at a gestational age < 27 + 0 weeks, ≥ 10 mm at a gestational age < 30 + 0 weeks and ≥ 18 mm at a gestational age ≥ 30 weeks. RESULTS Prenatally, 6 %, 81 % and 13 % of the bowel malformations were identified in the first, second and third trimesters, respectively. There were three stillbirths and three neonatal deaths, and the mean gestational age at delivery was 35.4 weeks (range 31 + 4 to 41 + 6). Bowel atresia was significantly correlated with prenatal bowel dilatation in all three subgroups. Bowel dilatations of ≥ 10 mm before 30 + 0 gestational weeks achieved the best performance in predicting bowel atresia, with a sensitivity of 89 % (8 / 9) and a specificity of 79 % (30 / 38). A prenatal bowel diameter ≥ 10 mm through 30 completed weeks was also the best predictor of a prolonged neonatal hospital stay ≥ 8 weeks (sensitivity = 61.1, 11 / 18, p = 0.002). CONCLUSION Fetuses with isolated gastroschisis successfully underwent postnatal surgery in most cases (93.2 %), except for one termination, one intrauterine death and 3 cases of neonatal death. A fetal bowel dilatation > 10 mm before 30 + 0 weeks had the highest predictive value for postnatal bowel complications.
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Affiliation(s)
- K Lato
- Department of Obstetrics and Prenatal Medicine, Heinrich-Heine University, Germany
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Willruth AM, Dwinger N, Ritgen J, Stressig R, Geipel A, Gembruch U, Berg C. Fetal aberrant right subclavian artery (ARSA) - a potential new soft marker in the genetic scan? Ultraschall Med 2012; 33:E114-E118. [PMID: 21614745 DOI: 10.1055/s-0029-1245935] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
PURPOSE The aim of this study was to evaluate the prevalence of an aberrant right subclavian artery (ARSA) in a mixed-risk population in the second trimester and to assess its potential as a new soft marker in the genetic scan. MATERIALS AND METHODS Fetal echocardiography was performed prospectively in 1337 fetuses at 16 - 28 weeks of gestation during a 12-month period at two referral centers for prenatal diagnosis. The presence of ARSA was verified by visualization of the transverse 3-vessel trachea view with color Doppler sonography. RESULTS The total rate of fetuses with an ARSA was 1.05 % (14 / 1337). The spectrum of associated findings in affected fetuses included: one trisomy 21, one unbalanced inversion of chromosome 9, one triploidy and two non-chromosomally related structural defects. Nine fetuses had no anomalies. The calculated odds ratio for the presence of an ARSA in the case of Down syndrome compared with healthy fetuses was 12.6 (95 % CI, 1.93 - 86.10). CONCLUSION The presence of an ARSA is more common in fetuses with trisomy 21 and other chromosomal defects than in healthy fetuses. Although it can be considered as a weak marker, the second trimester diagnosis of an ARSA should prompt a detailed search for additional "soft markers" and structural defects.
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MESH Headings
- Abnormalities, Multiple/diagnostic imaging
- Abnormalities, Multiple/genetics
- Adolescent
- Adult
- Aorta, Thoracic/abnormalities
- Aorta, Thoracic/diagnostic imaging
- Chromosome Aberrations
- Chromosome Disorders/diagnostic imaging
- Chromosome Disorders/genetics
- Chromosome Inversion/genetics
- Chromosomes, Human, Pair 9/genetics
- Down Syndrome/diagnostic imaging
- Down Syndrome/genetics
- Female
- Gestational Age
- Heart Defects, Congenital/diagnostic imaging
- Heart Defects, Congenital/genetics
- Humans
- Infant, Newborn
- Karyotyping
- Middle Aged
- Pregnancy
- Pregnancy Trimester, Second
- Pregnancy, Multiple/genetics
- Prospective Studies
- Subclavian Artery/abnormalities
- Subclavian Artery/diagnostic imaging
- Triploidy
- Ultrasonography, Prenatal
- Young Adult
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Affiliation(s)
- A M Willruth
- Deparment of Obstetrics and Prenatal Medicine, University of Bonn
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Degenhardt J, Kawecki A, Enzensberger C, Stressig R, Axt-Fliedner R, Kohl T. Geringgradige Blutungsereignisse beim fetoskopischen Verschluss einer Spina bifida resultieren in hämodynamisch unbedeutenden Flussgeschwindigkeitsanstiegen in der fetalen Arteria cerebri media. Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309106] [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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Degenhardt J, Schürg R, Kawecki A, Pawlik M, Enzensberger C, Stressig R, Tchatcheva K, Axt-Fliedner R, Kohl T. Mütterliches Outcome nach minimal-invasivem fetoskopischen Verschluss einer Spina bifida. Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309108] [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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Degenhardt J, Kawecki A, Enzensberger C, Stressig R, Axt-Fliedner R, Kohl T. Rückverlagerung der Chiari II-Malformation innerhalb weniger Tage nach minimal-invasivem Patchverschluss als Hinweis für eine effektiven Verschluss der Fehlbildung. Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309107] [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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Kohl T, Schürg R, Maxeiner H, Tchatcheva K, Degenhardt J, Kawecki A, Stressig R, Axt-Fliedner R, Weigand M, Gembruch U. Partielle amniotische Kohlendioxid-Insufflation (PACI) während fetoskopischer Operationen an Ungeborenen mit Spina bifida. Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309114] [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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Kohl T, Tchatcheva K, Stressig R, Gembruch U, Schaible T. Ergebnisse der späten perkutanen fetoskopischen Tracheal-Ballonokklusion bei Ungeborenen mit lebensbedrohlichen rechtsseitigen Zwerchfellhernien. Z Geburtshilfe Neonatol 2012. [DOI: 10.1055/s-0032-1309111] [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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Stressig R, Fimmers R, Axt-Fliedner R, Gembruch U, Kohl T. Association of intrathoracic herniation of the liver with left heart hypoplasia in fetuses with a left diaphragmatic hernia but not in fetuses with a right diaphragmatic hernia. Ultraschall Med 2011; 32 Suppl 2:E151-E156. [PMID: 21877318 DOI: 10.1055/s-0031-1281651] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Predominant left heart hypoplasia is commonly observed in human fetuses with left diaphragmatic hernia and intrathoracic liver herniation ("liver-up"). In contrast, marked left/right heart disproportion has not been described in fetuses with right diaphragmatic hernia, despite intrathoracic herniation of large parts of the liver. PATIENTS AND METHODS We analyzed the data of 15 fetuses with left diaphragmatic hernia and 10 fetuses with right diaphragmatic hernia and all with intrathoracic liver herniation ("liver-up") that were examined with fetal echocardiography between 21 weeks + 1 day and 35 weeks + 0 days of gestation. The inflow and outflow dimensions and Z-scores of the two groups were statistically compared. In addition, ductus venosus streaming patterns were examined. RESULTS Despite the presence of intrathoracic liver herniation, predominant left heart hypoplasia, defined as a mitral valve Z-score < - 2 in combination with a tricuspid valve Z-score that was at least 2 Z larger than the mitral valve Z-score in an individual fetus, was observed in 11 of the 15 fetuses with left diaphragmatic hernia but in none of the 10 fetuses (p < 0.001) with right diaphragmatic hernia. Preferential streaming to the right heart was observed in 14 of the 15 fetuses with left hernia but in none of the 7 fetuses with right diaphragmatic hernia in whom this flow information was available (p < 0.0001). CONCLUSION Intrathoracic herniation of the liver ("liver-up") is associated with predominant left heart hypoplasia in left diaphragmatic hernia but not right fetal diaphragmatic hernia. Our observations indicate that this difference may result from different ductus venosus streaming sites in these conditions.
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MESH Headings
- Comorbidity
- Dextrocardia/diagnostic imaging
- Echocardiography, Doppler, Color
- Female
- Heart Atria/diagnostic imaging
- Heart Ventricles/diagnostic imaging
- Hernia, Diaphragmatic/diagnostic imaging
- Hernias, Diaphragmatic, Congenital
- Humans
- Hypoplastic Left Heart Syndrome/diagnostic imaging
- Image Interpretation, Computer-Assisted
- Infant, Newborn
- Liver/abnormalities
- Liver/diagnostic imaging
- Male
- Pregnancy
- Pregnancy Trimester, Second
- Pregnancy Trimester, Third
- Reference Values
- Retrospective Studies
- Thorax/diagnostic imaging
- Ultrasonography, Prenatal
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Affiliation(s)
- R Stressig
- Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Bonn, Germany.
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Amann C, Geipel A, Müller A, Heep A, Ritgen J, Stressig R, Kozlowski P, Gembruch U, Berg C. Fetal anemia of unknown cause--a diagnostic challenge. Ultraschall Med 2011; 32 Suppl 2:E134-E140. [PMID: 22161617 DOI: 10.1055/s-0031-1281756] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE To assess the spectrum of underlying diseases in cases of fetal anemia in which the cause was unknown at the time of first and second transfusion or thereafter. MATERIALS AND METHODS All patients who underwent intrauterine transfusion were identified in the perinatal databases of two tertiary referral centers for prenatal medicine and treatment between 2002 and June 2010. RESULTS 82 fetuses received intrauterine transfusion in the study period. A total of 356 transfusions were performed in these patients. The causes of fetal anemia in our cohort were alloimmunization (32), parvovirus infection (23), feto-fetal transfusion syndrome (9), sacrococcygeal teratoma (2) and cytomegalovirus infection (1). In the remaining 15 cases, the cause of fetal anemia was unknown at the time of first and second transfusion, and could only be ascertained in the further course of pregnancy, in the postnatal period or was ultimately left in doubt. In all cases markedly elevated peak systolic velocities in the middle cerebral artery accurately predicted fetal anemia. The final diagnosis in these cases was fetomaternal hemorrhage (4), Blackfan-Diamond anemia (1), diffuse neonatal hemangiomatosis with chorangioma (1), kaposi-like hemangioendothelioma (1), elliptocytosis (1), neonatal hemochromatosis (1), mucopolysaccharidosis type VII (1) and in 5 cases the cause of fetal anemia remained unexplained. The latter 5 cases had an uneventful postnatal course and did not require further transfusions in infancy. CONCLUSION In cases of fetal anemia with negative indirect Coombs test and TORCH serology, rare causes of anemia have to be considered. Fetal studies should therefore include reticulocyte count, parameters of hemolysis, peripheral blood smear and fetal liver function tests. Maternal studies should involve a search for fetal red cells using flow cytometry rather than Kleihauer-Betke test.
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Affiliation(s)
- C Amann
- Gynecology and Obstetrics, University Bonn, Bonn, Germany.
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Uhden M, Knippel AJ, Stressig R, Hammer R, Siegmann H, Froehlich S, Kozlowski P. Impact of maternal obesity and maternal overweight on the detection rate of fetal heart defects and the image quality of prenatal echocardiography. Ultraschall Med 2011; 32 Suppl 2:E108-E114. [PMID: 21877317 DOI: 10.1055/s-0031-1281646] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE The purpose of this study was to compare the prenatal detection of four congenital heart defects (CHDs) and the image quality of five corresponding ultrasound planes among obese, overweight and normal-weight women. MATERIALS AND METHODS This was a retrospective cohort study of 54,846 pregnancies undergoing fetal echocardiography between 18 and 37 weeks of gestation in the years from 2000 to 2007. The women were categorized according to pre-pregnancy body mass index (BMI) as normal-weight (BMI < 25), overweight (BMI 25 - 29.9) and obese (BMI ≥ 30). Image quality and prenatal detection of atrioventricular septal defect (AVSD), double outlet right ventricle (DORV), tetralogy of fallot (TOF) and dextro transposition of the great arteries (D-TGA) were evaluated in the BMI strata. RESULTS 108 cases with one of the considered CHDs were identified. The prevalence was significantly higher (relative risk = 2.04) in overweight or obese women (57/19,404 vs. 51/35,442, p < 0.0002) than in normal-weight women. In total 86.1% of CHDs were correctly identified prenatally (93/108, CI: 79.6%-92.6%), 84.3% (43/51) in the normal weight group, 88.6% (39/44) in the overweight group and 84.6% (11/13) in the obese group. The rate of insufficient ultrasound images increased from 6.4% in normal-weight patients to 17.4% in obese women within the 108 CHD cases. CONCLUSION The prenatal detection of fetal AVSD, DORV, TOF and D-TGA was also satisfactory in overweight and obese patients, but image quality substantially decreases with an increasing maternal BMI. If there is a BMI-associated difference in the detection rate, it probably will not exceed 20%.
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Affiliation(s)
- M Uhden
- praenatal.de, Praenatal Medizin und Genetik, Düsseldorf.
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Stressig R, Axt-Fliedner R, Gembruch U, Kohl T. Preferential ductus venosus streaming toward the right heart is associated with left heart underdevelopment and aortic arch hypoplasia in human fetuses. Ultraschall Med 2011; 32 Suppl 2:E115-E121. [PMID: 22179800 DOI: 10.1055/s-0031-1281861] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
PURPOSE Preferential left heart underdevelopment in human fetuses with diaphragmatic hernia is almost uniformly associated with preferential streaming of the ductus venosus toward the right side of the heart. The purpose of our study was to examine whether this flow anomaly might also be present in other fetuses with hypoplasia of left-sided cardiovascular structures. MATERIALS AND METHODS We studied 32 fetuses with left heart hypoplasia as defined by gestational age-related Z-scores by echocardiography. Apart from defining cardiovascular morphology as detailed as possible, particular focus was put on the presence or absence of preferential streaming of the ductus venosus and inferior caval vein toward the right side of the heart. RESULTS 8 of 32 fetuses with hypoplasia of one or more left-sided cardiovascular structures exhibited preferential streaming of the ductus venosus toward the right side of the heart. In all eight fetuses, this finding was associated with additional cardiovascular anomalies like aortic valve stenosis, ventricular septal defect, left superior caval vein-to-coronary sinus, pulmonary vein stenosis and/or aortic arch hypoplasia. CONCLUSION As in human fetuses with left diaphragmatic hernia, preferential ductus venosus streaming toward the right side of the heart can be found in a subgroup of fetuses with hypoplasia of left-sided cardiovascular structures.
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MESH Headings
- Aorta, Thoracic/abnormalities
- Aorta, Thoracic/diagnostic imaging
- Aortic Coarctation/diagnostic imaging
- Echocardiography
- Female
- Heart Defects, Congenital/diagnostic imaging
- Heart Valves/abnormalities
- Heart Valves/diagnostic imaging
- Hernia, Diaphragmatic/diagnostic imaging
- Hernias, Diaphragmatic, Congenital
- Humans
- Hypoplastic Left Heart Syndrome/diagnostic imaging
- Infant, Newborn
- Persistent Fetal Circulation Syndrome/diagnostic imaging
- Pregnancy
- Pregnancy Trimester, Third
- Ultrasonography, Prenatal
- Vena Cava, Inferior/abnormalities
- Vena Cava, Inferior/diagnostic imaging
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Affiliation(s)
- R Stressig
- Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Bonn, Germany.
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Requadt B, Schiffers A, Stressig R, Bryan C. Case-Report VACTERL-Assoziation. Z Geburtshilfe Neonatol 2011. [DOI: 10.1055/s-0031-1293366] [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: 10/15/2022]
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Stressig R, Kozlowski P, Froehlich S, Siegmann HJ, Hammer R, Blumenstock G, Kagan KO. Assessment of the ductus venosus, tricuspid blood flow and the nasal bone in second-trimester screening for trisomy 21. Ultrasound Obstet Gynecol 2011; 37:444-449. [PMID: 20645398 DOI: 10.1002/uog.7749] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To examine the prevalence of reversed a-wave in the ductus venosus, tricuspid regurgitation and absent nasal bone, in a second-trimester population undergoing amniocentesis, after exclusion of major fetal defects and to estimate the performance in screening for trisomy 21 based on maternal age and these markers in a general population. METHODS This was a retrospective study involving pregnancies undergoing amniocentesis due to increased risk for trisomy 21, mainly because of advanced maternal age. Before the invasive procedure, an ultrasound examination was carried out to exclude major fetal defects and to examine the ductus venosus, tricuspid blood flow and the presence of the fetal nasal bone. Modeling techniques were used based on 20 000 euploid pregnancies and 20 000 pregnancies with trisomy 21 to assess the screening performance in a general population. RESULTS The study population consisted of 3613 euploid pregnancies and 35 cases with trisomy 21. In the euploid group, reversed flow in the ductus venosus, tricuspid regurgitation and an absent nasal bone was observed in 1.7%, 1.5% and 0.1% of cases, respectively. In the trisomic group, these markers were found in 14.3%, 11.4% and 14.3% of cases, respectively. For a 5% false-positive rate, the detection rate in screening for trisomy 21, based on maternal age and either ductus venosus, tricuspid blood flow or nasal bone would be 33.8%, 32.4% or 31.4%, respectively. Screening by maternal age alone would detect 29.0% of the fetuses with trisomy 21. Receiver-operating characteristics curve analysis showed a slight but significant improvement in screening performance for trisomy 21 based on the inclusion of these markers. CONCLUSION Second-trimester ultrasound screening for trisomy 21 based on maternal age with additional assessment of the ductus venosus, tricuspid blood flow and the fetal nasal bone in otherwise normal-appearing fetuses is only marginally better than is screening by maternal age alone.
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Affiliation(s)
- R Stressig
- Praenatal.de - Praenatal Medicine and Genetics, Duesseldorf/Cologne, Germany
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Stressig R, Fimmers R, Eising K, Gembruch U, Kohl T. Intrathoracic herniation of the liver ('liver-up') is associated with predominant left heart hypoplasia in human fetuses with left diaphragmatic hernia. Ultrasound Obstet Gynecol 2011; 37:272-276. [PMID: 20632307 DOI: 10.1002/uog.7747] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVES Left heart hypoplasia is commonly observed in fetuses with left diaphragmatic hernia. Because in this condition intrathoracic herniation of the liver serves as an important predictor for postnatal disease severity, we studied its potential association with left heart hypoplasia. METHODS We prospectively assessed 32 fetuses with left diaphragmatic hernia between 19 + 6 and 38 + 6 weeks of gestation using echocardiography. The fetuses were divided into two groups: Group I exhibited an intrathoracic liver position ('liver-up') and Group II an intra-abdominal liver position ('liver-down'). Cardiac inflow and outflow diameter ratios and cardiac Z-scores were compared between the two groups. RESULTS Eleven of the 15 Group I (liver-up) fetuses, but only three of the 17 Group II (liver-down) fetuses with left diaphragmatic hernia exhibited predominant left heart hypoplasia with disproportionately smaller left than right heart dimensions (P = 0.0036). In addition, 14 of the 15 Group I fetuses, but only five of the 17 Group II fetuses exhibited preferential streaming of the ductus venosus towards the right heart (P = 0.0003). CONCLUSIONS In fetuses with left diaphragmatic hernia, intrathoracic liver herniation is commonly associated with predominant left heart hypoplasia, whereas an intra-abdominal liver position is not. This observation may be explained by preferential ductus venosus streaming towards the right heart from elevation and leftward distortion of the normal course of the ductus venosus and inferior vena cava.
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Affiliation(s)
- R Stressig
- Department of Obstetrics and Prenatal Medicine, University Hospital of Bonn, Bonn, Germany.
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Stressig R, Fimmers R, Eising K, Gembruch U, Kohl T. Preferential streaming of the ductus venosus and inferior caval vein towards the right heart is associated with left heart underdevelopment in human fetuses with left-sided diaphragmatic hernia. Heart 2010; 96:1564-8. [DOI: 10.1136/hrt.2010.196550] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Kohl T, Stressig R. Preferential ductus venosus streaming towards the right side of the heart may contribute to poorer outcomes in fetuses with left diaphragmatic hernia and intrathoracic liver herniation ('liver-up'). Ultrasound Obstet Gynecol 2010; 36:259. [PMID: 20632381 DOI: 10.1002/uog.7693] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Berg C, Lachmann R, Kaiser C, Kozlowski P, Stressig R, Schneider M, Asfour B, Herberg U, Breuer J, Gembruch U, Geipel A. Prenatal diagnosis of tricuspid atresia: intrauterine course and outcome. Ultrasound Obstet Gynecol 2010; 35:183-190. [PMID: 20101636 DOI: 10.1002/uog.7499] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE To evaluate the intrauterine course and outcome of tricuspid atresia detected in the fetus. METHODS This was a retrospective review of all confirmed cases of tricuspid atresia detected prenatally between 1998 and 2006 in three tertiary referral centers in Germany. RESULTS Fifty-four cases of tricuspid atresia were detected prenatally during the study period and confirmed postnatally: 28 (51.9%) cases had a concordant ventriculoarterial connection of which 14 also had pulmonary outflow obstruction; 25 (46.3%) cases had a discordant ventriculoarterial connection of which 14 also had aortic outflow obstruction, six had pulmonary outflow tract obstruction and two had other associated intracardiac anomalies; and one (1.9%) had a common arterial trunk. The peak velocity index for veins in the ductus venosus was significantly elevated in 19 of the 37 (51.4%) cases assessed; however, this finding did not correlate with adverse intrauterine outcome. There were associated extracardiac anomalies in 12 cases: five with chromosomal anomalies, two with VACTERL association, one with unilateral renal agenesis, one with hypospadia, one with hydrothorax, one with megacystis and one with agenesis of the ductus venosus. Seventeen of the 54 (31.5%) cases underwent termination of pregnancy, two (3.7%) died in utero, two (3.7%) died in infancy and 33 (61.1%) children survived with a median follow-up of 26 (range, 12-120) months. Prenatal echocardiography correctly anticipated the postnatal course and the need for neonatal intervention in 29/35 (82.9%) continued pregnancies; in the remaining six (17.1%) cases the right outflow tract obstruction had been underestimated. CONCLUSIONS Tricuspid atresia and the frequently associated intracardiac anomalies can be diagnosed in the fetus with considerable accuracy. A thorough search for extracardiac malformations should be performed in order to rule out chromosomal anomalies and multiple malformation syndromes. Elevated pulsatility in the ductus venosus does not indicate cardiac failure. The short-term overall survival in continued pregnancies in our study exceeded 89%, with the greatest rate of loss being in the first year of postnatal life.
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Affiliation(s)
- C Berg
- Department of Obstetrics and Prenatal Medicine University of Bonn, Bonn, Germany.
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Bizjak G, Blondin D, Hammer R, Kozlowski P, Siegmann HJ, Stressig R. Acute infection with parvovirus B19 in early pregnancy. Ultrasound Obstet Gynecol 2009; 34:234-235. [PMID: 19644946 DOI: 10.1002/uog.6454] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Stressig R, Gembruch U, Eising K, Kohl T. Ein bevorzugtes venöses Streaming zum rechten Herzen führt zur Linksherzhypoplasie bei Feten mit linksseitiger Zwerchfellhernie. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kohl T, Stressig R, Eising K, Gembruch U. Ductus venosus Streaming zum rechten Herzen führt zu Lungendurchblutungsanomalien bei Feten mit linksseitigen Zwerchfellhernien. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kohl T, Tchatcheva K, Stressig R, Weinbach J, Kozlowski P, Gembruch U. Frühe klinische Erfahrungen mit der partiellen amniotischen Kohlendioxid-Insufflation (PACI) während fetoskopischer Fetalchirurgie. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kohl T, Stressig R, Tchatcheva K, Kozlowski P, Gembruch U. Materno-fetale Hyperoxygenierung führt zur Größenzunahme hypoplastischer Linksherzstrukturen bei Ungeborenen. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stressig R, Gembruch U, Ziemann M, Kohl T. Radiofrequenzablation von Umbilikalgefäßen bei komplizierten Zwillingsschwangerschaften. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stressig R, Gembruch U, Germer U, Kozlowski P, Kohl T. Fetoskopische Fetalchirurgie beim Amnionbandsyndrom – Schlussfolgerungen zur Behandlungsindikation anhand dreier Fälle. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stressig R, Gembruch U, Heep A, Müller A, Bartmann P, Kohl T. Fetoskopische Dekompression der fetalen Lungen bei Congenital High Airway Obstruction Syndrome (CHAOS) bei Fetem mit Larynxatresie. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1223088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stressig R, Eising K, Gembruch U, Kohl T. Ductus venosus Streaming bei Ungeborenen mit „liver-up“ und „liver-down“ Zwerchfellhernie. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Ritgen J, Kozlowski P, Stressig R. Tissue Doppler Imaging: Die Messung fetaler kardialer Zeitintervalle – Korrelation mit magnetokardiographischen Daten. Z Geburtshilfe Neonatol 2009. [DOI: 10.1055/s-0029-1222916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hering R, Hoeft A, Putensen C, Tchatcheva K, Stressig R, Gembruch U, Kohl T. Maternal haemodynamics and lung water content during percutaneous fetoscopic interventions under general anaesthesia. Br J Anaesth 2009; 102:523-7. [DOI: 10.1093/bja/aep016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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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Messing-Jünger AM, Röhrig A, Stressig R, Schaper J, Turowski B, Blondin D. Fetal MRI of the central nervous system: clinical relevance. Childs Nerv Syst 2009; 25:165-71. [PMID: 19039594 DOI: 10.1007/s00381-008-0745-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Specific conditions of the mother sometimes reduce the quality of ultrasound. In these cases, fetal magnetic resonance imaging (MRI) can be performed after gestational week (GW) 18. Interpretation of subtle disorders or malformations becomes safe not before GW 23. Clinical development of children with central nervous system (CNS) disorders is not predictable with imaging alone. Statistical evidence and personal experience of the medical team are essential in counseling, but optimized imaging is helpful in being more precise. The value of fetal MRI (fMRI) is evaluated. MATERIALS AND METHODS Twenty-five pregnant women (30.5 +/- 4.5 years) were investigated by additional fMRI. TECHNIQUE Breath-hold technique with T2 half-Fourier acquisition single-shot turbo spin-echo and T1 FLASH-2D images in three dimensions with field of view of 350 x 400 mm. All cases have been correlated with postnatal MRI, ultrasound, and clinical follow-up. RESULTS In all fetuses, diagnostic MRI was performed 3-10 days after ultrasound between GW 22 and 34 (GW 26.1 +/- 3.6). Sedation was not necessary. In eight cases of suspicious ultrasound, fMRI confirmed ultrasound findings. In 13 cases, additional diagnoses or exclusions of suspected findings could be established. Complete revision of diagnosis was realized in four cases. Findings could be confirmed by postnatal MRI in 11 patients. The clinical course was not predictable in cases with ambivalent prognosis. CONCLUSIONS Prenatal diagnosis of CNS pathologies should result in parental counseling. Sufficient diagnostic information, statistical data, and experience of the involved professionals are essential. These results show that in detecting congenital CNS abnormalities fMRI is superior to ultrasound and should be considered in difficult cases.
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Affiliation(s)
- A M Messing-Jünger
- Abteilung für Neurochirurgie, Asklepios Kinderklinik Sankt Augustin, Universität Bonn, Sankt Augustin, Germany.
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Kozlowski P, Knippel A, Stressig R. Individual risk of fetal loss following routine second trimester amniocentesis: a controlled study of 20,460 cases. Ultraschall Med 2008; 29:165-72. [PMID: 17602371 DOI: 10.1055/s-2007-963217] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE The aim of this study was to evaluate the impact of maternal risk factors on excess fetal loss related to amniocentesis. MATERIALS AND METHODS We compared fetal outcome and details of risk factors for fetal loss in 20,460 patients undergoing amniocenteses between April 1997 and March 2005 to 11,017 controls given ultrasound during the same period in our tertiary level prenatal unit. The risk factors were recorded before the procedure. Spontaneous fetal loss was defined as spontaneous miscarriage and intrauterine fetal demise at any gestational age. RESULTS The excess rate of spontaneous loss attributed to the amniocentesis procedure averaged 0.49 % (CI: 0.26 - 0.72) for all pregnancies under routine care (1.31 % 268/20,460 versus 0.82 % 90/11,017). The fetal loss rate was increased in the intervention group for the following isolated risk factors: vaginal bleeding before procedure (19/647, 2.9 % CI: 1.6 - 4.2 %); vaginal bleeding at date of procedure (3/33, 9.1 % CI: - 0.7 - 18.9 %); a history of 3 or more spontaneous abortions (6/257, 2.3 % CI: 0.5 - 4.2 %); body mass index > 40 (5/160, 3.1 % CI: 0.4 - 5.8 %) and cigarette consumption > 10/day (13/671, 1.94 % CI: 0.9 - 3.0). If none of these risk factors was present, the abortion rate in the intervention group was 1.18 % (219/18,617) and 0.63 % (61/9,677) in the control group. Maternal age > 40 at birth did not alter the rate of loss in the intervention group, but did in the control group (1.4 % 38/2,717 and 1.69 % 7/414). CONCLUSION After routine amniocentesis patients have an additional procedure-related risk of spontaneous pregnancy loss equivalent to 0.5 %. The absence of risk factors in the patient's history does not reduce this additional risk.
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Kozlowski P, Knippel AJ, Stressig R. Comparing first trimester screening performance: routine care gynaecologists' practices vs. prenatal centre. Ultraschall Med 2007; 28:291-5. [PMID: 17315110 DOI: 10.1055/s-2006-926714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE To evaluate and compare the screening performance for fetal trisomy 21 in the first trimester of pregnancy in general gynaecologists' practices and specialised centres for prenatal care in Germany. METHODS This study included 15,026 serum samples analysed in our laboratory for free beta-human chorionic gonadotropin (hCG) and pregnancy-associated plasma protein-A (PAPP-A) at 11-14 weeks of gestation between 1.1.2000 and 31.12.2003. Fetal risk for trisomy 21 was calculated using nuchal translucency (NT) values and crown-rump-lengths (CRL), measured either in general gynaecologists' practices or in a tertiary level prenatal centre. The detection rate for a fixed risk cut-off (1:300) and a fixed false-positive rate (5 %) was calculated for NT, serum biochemistry, maternal age and the combination of these components. RESULTS The estimated risk for trisomy 21 based on maternal age, fetal NT and maternal serum free beta-hCG and PAPP-A was 1 in 300 or greater in 5.1 % (362 of 6897) and 8 % (329 of 3840) of normal pregnancies, and in 78.9 % (15 of 19) and 88.5 % (23 of 26) of those with trisomy 21. For a fixed false-positive rate of 5 %, the respective detection rates of screening for fetal Down's syndrome by maternal age and serum free beta-hCG and PAAP-A, maternal age and fetal NT and by maternal age, fetal NT and maternal serum biochemistry were (general gynaecologists' practices/prenatal centre) 68.4/69.2 %, 42.1/65.4 % and 78.9/88.5 %, respectively. CONCLUSION The screening results are satisfactory in both general gynaecologists' practices and a prenatal centre.
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Kozlowski P, Knippel AJ, Froehlich S, Stressig R. Additional performance of nasal bone in first trimester screening. Ultraschall Med 2006; 27:336-9. [PMID: 16596511 DOI: 10.1055/s-2005-858880] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To evaluate and compare the screening performance for fetal trisomy 21 in the first trimester of pregnancy either with or without inclusion of fetal nasal bone using two separate risk-algorithms of the Fetal Medicine Foundation London (FMF). METHODS This study included 3174 patients self-referred to our tertiary level prenatal centre for first trimester screening at 11-14 weeks of gestation between December 1, 2002 and November 30, 2004. Fetal risk for trisomy 21 was calculated using either the old FMF-algorithm including maternal age, nuchal translucency (NT), free ss-human chorionic gonadotropin (hCG), pregnancy-associated plasma protein-A (PAPP-A) or the new FMF-algorithm using additionally the presence or absence of fetal nasal bone (NB). All ultrasonographers were certified for measurement of nuchal translucency and nasal bone by the Fetal Medicine Foundation Germany. The detection rate for a fixed risk cut-off (1:300) and a fixed false-positive rate (5 %) was calculated for ultrasound (single NT or NT and NB), serum biochemistry, maternal age and the combination of these components. RESULTS Pregnancy outcome was obtained in 2973 (93.6 %) cases. Nasal bone was absent in 5 of 18 (27.8 %) cases with fetal trisomy 21 and in 2 of 2961 (0.1 %) normal cases. The estimated risks for trisomy 21 based on maternal age, fetal ultrasound and maternal serum free ss-hCG and PAPP-A was 1 in 300 or greater in (old algorithm without NB/new algorithm including NB) 5.5 % (179 of 2961) and 2.8 % (97 of 2961) normal pregnancies and in 94.4 % (17 of 18) and 77.8 % (14 of 18) of those with trisomy 21. For a fixed false-positive rate of 5 % the respective detection rates of screening for fetal Down's syndrome by maternal age and serum free ss-hCG and PAAP-A, maternal age and fetal ultrasound and by maternal age, fetal ultrasound and maternal serum biochemistry were (old algorithm without NB/new algorithm including NB) 72.2 %/66.7 %, 83.3 %/77.8 % and 88.9 %/83.3 %, respectively. CONCLUSION Our data show no additional performance of including presence or absence of fetal nasal bone in calculation of risk for fetal Down's syndrome between 11 and 14 weeks of gestation. Individual risk-orientated two-stage screening could be an alternative approach for integration of additional ultrasound markers in first trimester screening.
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Affiliation(s)
- P Kozlowski
- Praenatal-Medizin und Genetik Düsseldorf, 40210 Düsseldorf, Germany.
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Kozlowski P, Grund I, Hickmann G, Stressig R, Knippel AJ. Quantitative Fluorescent Polymerase Chain Reaction versus Cytogenetics: Risk-Related Indication and Clinical Implication of Nondetected Chromosomal Disorders. Fetal Diagn Ther 2006; 21:217-23. [PMID: 16491006 DOI: 10.1159/000089306] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2004] [Accepted: 03/17/2005] [Indexed: 11/19/2022]
Abstract
BACKGROUND The rapid detection of aneuploidies by quantitative fluorescent polymerase chain reaction (QF-PCR) allows reliable prenatal diagnosis of trisomies 21, 18, and 13. Discussion has been raised as to whether single QF-PCR could be an alternative to traditional cytogenetic karyotyping for certain referral categories. OBJECTIVE To evaluate an indication-based classification of cases at risk of missing clinically relevant chromosomal disorders by QF-PCR. METHODS From October 1999 to November 2003, 4,682 of 14,123 patients referred for amniocentesis decided to have QF-PCR as a rapid adjunct to conventional cytogenetic evaluation. Patients were classified according to the risk of missing chromosomal abnormalities by QF-PCR based on anamnestic risk and ultrasound prior to amniocentesis. The results in these two defined categories were compared in relation to the clinical significance of cytogenetic results. RESULTS QF-PCR and conventional cytogenetic analysis had concordant results in 4,617 of 4,682 (98.6%) cases. Thirty-six of 110 (32.2%) clinically significant chromosomal abnormalities were missed by QF-PCR. Patients classified not to be at risk of missing chromosomal abnormalities using QF-PCR had a residual risk of 1/166 (0.6%) for chromosomal distortions of clinical significance. CONCLUSION Classification by anamnestic and sonographic data does not specifically identify patients at risk of structural abnormalities. Clinical relevance of the nondetected anomalies essentially justifies traditional karyotyping regardless of risk classification.
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Affiliation(s)
- P Kozlowski
- Praenatal-Medizin und Genetik Dusseldorf, Dusseldorf, Germany.
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Thiel M, Klumpp H, Kaup R, Stressig R, Bartel H, von Lilien-Waldau T. Sinus urogenitalis: Prä- und postpartale Sonographie, postpartales MRT und intraoperativer Befund. Z Geburtshilfe Neonatol 2004. [DOI: 10.1055/s-2004-829232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kohl T, Hartlage MG, Kienitz D, Westphal M, Brentrup A, Aryee S, Achenbach S, Buller T, Bizjak GI, Stressig R, Van Aken H, Gembruch U. Percutaneous fetoscopic tracheal balloon occlusion in sheep. Surg Endosc 2003; 17:1454-60. [PMID: 12802651 DOI: 10.1007/s00464-002-9191-1] [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] [Received: 08/22/2002] [Accepted: 11/21/2002] [Indexed: 11/26/2022]
Abstract
BACKGROUND In order to minimize maternal trauma from current techniques for temporary fetoscopic tracheal occlusion, we tried to develop a percutaneous fetoscopic technique in sheep. METHODS In nine ewes between 77 and 128 days of gestation, the amniotic cavity was entered percutaneously. Each fetus was positioned and the feasibility of fetal laryngoscopy and percutaneous fetoscopic tracheal balloon occlusion was assessed. RESULTS Percutaneous intraamniotic access, fetal positioning, oropharyngeal sheath insertion, and fetoscopic laryngoscopy were achieved in all nine fetal sheep. Following some technical modifications to the working channel of the fetoscope, percutaneous fetoscopic tracheal balloon occlusion was successfully achieved in the last seven sheep. CONCLUSION Percutaneous fetoscopic balloon occlusion of the fetal trachea can effectively and safely be achieved in sheep. Because intraamniotic spatial relationships, fetal position, and umbilical cord length are technically less favorable in sheep, our operative techniques might be feasible in humans even if difficult intraamniotic conditions are encountered.
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Affiliation(s)
- T Kohl
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Sigmund Freud Str 25, 53105 Bonn, Germany.
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Marquet KL, Wolter M, Handt S, Rath W, Stressig R, Kozlowski P, Funk A. [Criteria of dignity in ultrasound mammography using a 10-MHz-transducer, also with regard to tumor size]. Ultraschall Med 2002; 23:383-387. [PMID: 12514754 DOI: 10.1055/s-2002-36172] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
AIM Ongoing technical progress has increased the accuracy of imaging in ultrasound mammography. Using a 10-MHz-transducer, eight different criteria of dignity were evaluated for validity, also with regard to the size of a tumor. MATERIALS AND METHODS Over a period of three years, 446 breast tumors were ultrasonographically examined by two experienced medical doctors. The study comprised only suspicious lesions detected by mammography and/or manual palpation. Diagnostic validity was quantified by means of sensitivity, specificity, positive and negative predictive value, as well as the ODDS-ratio. RESULTS Ultrasound mammography demonstrated a sensitivity of 94.0 %, specificity of 91.4 %, positive predictive value of 95.9 %, and a negative predictive value of 99.1 %. Eight different sonographic criteria were validated separately. The most important signs of malignancy were (in descending order): a highly echogenic halo, spikes, jagged contour, posterior acoustic shadowing, and discontinuity of tissue structure. Features of benign disease were: smooth edge, posterior acoustic enhancement, displacement margin, bilateral acoustic shadowing and continuity of tissue structure. Furthermore, it appeared that the size of a tumor only had consequences on posterior shadowing (p = 0.017). All other features did not show significant variation in relation to tumor size. CONCLUSION We were able to prove that ultrasound mammography is an excellent medium for the differentiation of benign and malignant breast lesions, when precise indication criteria were adhered to, even in cases of small tumor size.
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Affiliation(s)
- K L Marquet
- Frauenklinik für Gynäkologie und Geburtshilfe, Medizinische Fakultät der RWTH Aachen, Germany
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Harms E, Stressig R, Friol K. [Unusual course of an advanced extra-uterine pregnancy]. Z Geburtshilfe Neonatol 1999; 203:86-9. [PMID: 10420517] [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: 02/13/2023]
Abstract
We report about the course of an advanced ectopic pregnancy in case of uterine leiomyomata, which was diagnosed after surgery. A vaginal bleeding appeared in the first trimester. Vaginal ultrascan was missing in those early time of pregnancy. Finally prenatal diagnosis in a center of perinatal medicine led to a suspicious fetal morphology and gave the indication for medical abortion. The induction of abortion with Gemeprost remained without success. Meanwhile abdominal pain increased and a laparoscopic exploration was carried out and showed a big vital ectopic pregnancy. This indicated laparotomy. This case showed the difficulties in diagnosis of ectopic pregnancy in the second trimester and discusses possibilities of the therapeutic procedures.
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Affiliation(s)
- E Harms
- Kreiskrankenhaus St. Elisabeth Grevenbroich, Akadem, Lehrkrankenhaus der RWTH Aachen
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