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Moehrlen U, Ochsenbein-Kölble N, Stricker S, Moehrlen T, Mazzone L, Krähenmann F, Vonzun L, Zimmermann R, Meuli M. Prenatal Spina Bifida Repair: Defendable Trespassing of MOMS Criteria Results in Commendable Personalized Medicine. Fetal Diagn Ther 2023; 50:454-463. [PMID: 37544297 DOI: 10.1159/000533181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 07/03/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION We hypothesize that after publication of the quintessence of the MOMS trial, eligibility criteria for prenatal spina bifida (SB) repair may be modified if a tenable argumentation underlies this decision. METHODS Our first 154 fetal surgery patients were analyzed with particular focus on how many, which, and why the original eligibility criteria, set forth by the MOMS Trial Protocol, were disobeyed, and what the eventually detectable, negative and positive impacts of these deviations on outcomes were. RESULTS A total of 152 patients (2 missing consent) were included (100%). In 69 patients (45.4%), a total of 89 eligibility criteria were disobeyed. In 54 (35.6%) cases, the following maternal criteria were concerned: gestational age at operation of >25+6 weeks in 17 (11.2%), uterine pathologies in 13 (8.6%) women, preoperative BMI ≥35 kg/m2 in 12 (7.9%), previous hysterotomy in 7 (4.6%), previous prematurity in 3 (2%), HIV/hepatitis B in 2 (1.3%), psychosocial issues in 2 (1.3%), and placenta praevia in 1 (0.7%). In 32 (21.1%) cases, fetal criteria were disobeyed 34 times: Fetal anomaly unrelated to SB in 19 (12.5%), no/minimal evidence of hindbrain herniation in 13 (8.6%), and severe kyphosis in 2 (1.3%). We could not identify cases where non-observation of criteria led to clear-cut maternal and/or fetal disadvantages. CONCLUSION This study shows that MOMS trial eligibility criteria for prenatal SB repair should be modified or even abandoned with adequate medical and ethical argumentation, and with written parental informed consent after non-directive, full disclosure counseling. This clear-cut change of paradigm is a necessity as it leads toward personalized medicine, allowing more fetuses to benefit from fetal surgery than would have benefitted with the former, published, MOMS criteria in place.
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Affiliation(s)
- Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Spina Bifida Academy, University Children's Hospital and University Hospital Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Spina Bifida Academy, University Children's Hospital and University Hospital Zurich, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Sarah Stricker
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland
| | - Theres Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland
- Spina Bifida Academy, University Children's Hospital and University Hospital Zurich, Zurich, Switzerland
| | - Luca Mazzone
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland,
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland,
- Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland,
- Spina Bifida Academy, University Children's Hospital and University Hospital Zurich, Zurich, Switzerland,
| | - Franziska Krähenmann
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Academy, University Children's Hospital and University Hospital Zurich, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Ladina Vonzun
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Academy, University Children's Hospital and University Hospital Zurich, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Spina Bifida Academy, University Children's Hospital and University Hospital Zurich, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Martin Meuli
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Spina Bifida Academy, University Children's Hospital and University Hospital Zurich, Zurich, Switzerland
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Kapfhammer E, Pfammatter T, Brun R, Zimmermann R, Haslinger C. Success Rate and Long-Term Effects of Embolization of Pelvic Arteries for the Treatment of Postpartum Hemorrhage. Transfus Med Hemother 2023; 50:226-233. [PMID: 37434998 PMCID: PMC10331153 DOI: 10.1159/000527614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 10/11/2022] [Indexed: 10/26/2023] Open
Abstract
Introduction Postpartum hemorrhage (PPH) is the leading cause of peripartal maternal mortality and accounts for 25% of all maternal deaths worldwide. The most common reasons of PPH are uterine atony, retained placenta, or placenta accreta spectrum. Treatment of PPH depends on the etiology and corresponds to a stepwise approach, which follows the German, Austrian and Swiss guideline for the diagnosis and therapy of PPH in Switzerland. In severe ongoing PPH, hysterectomy has been the ultima ratio for many decades. Nowadays, interventional embolization of the pelvic arteries (PAE) has become a popular alternative. Besides being a highly effective minimally invasive method, PAE avoids hysterectomy with consecutively reduced morbidity and mortality. However, data on the long-term effects of PAE on fertility and menstrual cycle are scarce. Methods We performed a monocentric study consisting of a retro- and a prospective part including all women who had undergone a PAE between 2012 and 2016 at University Hospital Zurich. Descriptive characteristics of patients and efficacy of PAE defined as cessation of bleeding were analyzed retrospectively. In the prospective part, all patients were contacted for a follow-up questionnaire regarding menstruation and fertility after embolization. Results Twenty patients with PAE were evaluated. Our data showed a success rate of PAE in 95% of patients with PPH; only 1 patient needed a second, then successful, PAE. No patient needed a hysterectomy or any other surgical intervention. In our study, an association between mode of delivery and identified etiology of PPH is observed. After spontaneous delivery (n = 6), the main reason of severe PPH was retained placenta (n = 4), while after cesarean section (n = 14), uterine atony was identified in most cases (n = 8). Regarding menstruation after embolization, all women reported regular menstruation after the breastfeeding period (100%). The majority reported a regular pattern with a shorter or similar duration (73%) and lower or similar intensity (64%). Dysmenorrhea decreased in 67% of patients. Four patients planned another pregnancy, of whom only one had become pregnant with assisted reproductive technology and ended up in a miscarriage. Discussion Our study confirms the efficacy of PAE in PPH, thus obviating complex surgical interventions and associated morbidity. The success of PAE does not depend on the primary cause of PPH. Our results may encourage the prompt decision to perform PAE in the management of severe PPH in case of failure of conservative management and help physicians in the post-interventional counseling regarding menstruation patterns and fertility.
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Affiliation(s)
| | - Thomas Pfammatter
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, Zürich, Switzerland
| | - Romana Brun
- Department of Obstetrics, University Hospital Zurich, Zürich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Zürich, Switzerland
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Geldenhuys G, Orasche J, Jakobi G, Zimmermann R, Forbes PBC. Characterization of Gaseous and Particulate Phase Polycyclic Aromatic Hydrocarbons Emitted During Preharvest Burning of Sugar Cane in Different Regions of Kwa-Zulu Natal, South Africa. Environ Toxicol Chem 2023; 42:778-792. [PMID: 36718764 DOI: 10.1002/etc.5579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/16/2022] [Accepted: 01/25/2023] [Indexed: 06/18/2023]
Abstract
Biomass burning is a significant anthropogenic source of air pollution, including the preharvest burning of sugar cane. These burn events result in atmospheric emissions, including semivolatile organic compounds, that may have adverse impacts on air quality and human health on a local, regional, and even a global scale. Gaseous and particulate polycyclic aromatic hydrocarbon (PAH) emissions from various sugar cane burn events in the province of Kwa-Zulu Natal in South Africa were simultaneously sampled using a portable denuder sampling technology, consisting of a quartz fiber filter sandwiched between two polydimethylsiloxane multichannel traps. Total gas and particle phase PAH concentrations ranged from 0.05 to 9.85 µg m-3 per individual burn event, and nine PAHs were quantified. Over 85% of all PAHs were found to exist in the gas phase, with smaller two- and three-ring PAHs, primarily naphthalene, 1-methyl naphthalene, and acenaphthylene, being the most dominant and causing the majority of variance between the burn sites. The PAH profiles differed between the different burn events at different sites, emphasizing the significant influence that the crop variety, prevailing weather conditions, and geographical location has on the type and number of pollutants emitted. The potential carcinogenicity of the PAH exposure was estimated based on toxic equivalency factors that showed varying risk potentials per burn event, with the highest value of 5.97 ng m-3 . Environ Toxicol Chem 2023;42:778-792. © 2023 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC.
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Affiliation(s)
- G Geldenhuys
- Department of Chemistry, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
- Processing Laboratory, Impala Platinum, Rustenburg, South Africa
- Skin Rejuvenation Technologies, Irene, South Africa
| | - J Orasche
- Joint Mass Spectrometry Centre, Cooperation Group "Comprehensive Molecular Analytics," Helmholtz Zentrum München, Neuherberg, Germany
| | - G Jakobi
- Joint Mass Spectrometry Centre, Cooperation Group "Comprehensive Molecular Analytics," Helmholtz Zentrum München, Neuherberg, Germany
| | - R Zimmermann
- Joint Mass Spectrometry Centre, Cooperation Group "Comprehensive Molecular Analytics," Helmholtz Zentrum München, Neuherberg, Germany
- Joint Mass Spectrometry Centre, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - Patricia B C Forbes
- Department of Chemistry, Faculty of Natural and Agricultural Sciences, University of Pretoria, Pretoria, South Africa
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Koliwer‐Brandl H, Nil A, Birri J, Sachs M, Zimmermann R, Zbinden R, Balsyte D. Evaluation of two rapid commercial assays for detection of Streptococcus agalactiae from vaginal samples. Acta Obstet Gynecol Scand 2023; 102:450-456. [PMID: 36772902 PMCID: PMC10008276 DOI: 10.1111/aogs.14519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/14/2023] [Accepted: 01/17/2023] [Indexed: 02/12/2023]
Abstract
INTRODUCTION Streptococcus agalactiae, also known as group B streptococci (GBS), is associated with invasive infections in neonates. Identification of GBS vaginal colonization in pregnant women before delivery is essential for treatment with antibiotics to prevent intrapartum vertical transmission to the newborn. This study was designed to evaluate applicability of two rapid real-time PCRs in comparison to standard culture identification. MATERIAL AND METHODS We compared the Xpert GBS assay, hereafter referred to as Xpert, and GenomEra GBS PCR, hereafter referred to as GenomEra. The standard culture identification consisted of two different agar plates as well as an enrichment broth. RESULTS We analyzed vaginal samples of 260 pregnant women; 42 samples were tested GBS-positive by using standard culture as a gold standard, 30 by Xpert, and 37 by GenomEra. Xpert and GenomEra assays performed with sensitivities of 71.4% and 88.1% as well as specificities of 98.6% and 99.1%, respectively. Twelve vaginal samples were false-negative by Xpert and five samples by GenomEra. Interestingly, three negative Xpert results of standard culture-positive samples exhibited high Ct-values indicating the presence of GBS. If higher Ct-values are taken into consideration, the sensitivity of Xpert increases up to 78.6%. Moreover, only three Xpert PCRs had to be repeated, whereas two Genomera were invalid even after repetition and further 15 GenomEra PCRs were repeated because of borderline results or inhibition of the PCR test. CONCLUSIONS In this study, GenomEra assay performed with a higher sensitivity than the Xpert PCR. On the other hand, the Xpert assay needs less hands-on-time for a sample preparation and requires approximately four-fold less repetitions as compared to the GenomEra assay. This robust performance of the Xpert assay make it applicable as a rapid intrapartum point-of-care test, although a higher sensitivity would be desirable. Therefore, culture in the 35-37 week of gestation remains the gold standard to detect vaginal colonization.
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Affiliation(s)
| | - Ahmed Nil
- Institute of Medical MicrobiologyUniversity of ZurichZurichSwitzerland
| | - Jana Birri
- Division of ObstetricsUniversity Hospital of ZurichZurichSwitzerland
| | - Maike Sachs
- Division of ObstetricsUniversity Hospital of ZurichZurichSwitzerland
| | - Roland Zimmermann
- Division of ObstetricsUniversity Hospital of ZurichZurichSwitzerland
| | - Reinhard Zbinden
- Institute of Medical MicrobiologyUniversity of ZurichZurichSwitzerland
| | - Dalia Balsyte
- Division of ObstetricsUniversity Hospital of ZurichZurichSwitzerland
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Oyman O, Fest J, Zimmermann R, Ochsenbein-Kölble N, Vonzun L. Information Gathering about Pregnancy, Birth, and Puerperium-Good and Fake Information. Int J Environ Res Public Health 2023; 20:4848. [PMID: 36981757 PMCID: PMC10049475 DOI: 10.3390/ijerph20064848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 06/18/2023]
Abstract
UNLABELLED Recent research on the subject of information-gathering processes among pregnant women has revealed a shift towards online sources. Health professionals' knowledge about sources of information has been shown to improve the understanding and counseling of patients. The objective of this study was to create an overview of all types of sources relevant to information gathering and to put their role and perception into perspective. METHODS A total of 249 women were included in this study and recruited over a period of one month at the University Hospital of Zurich (USZ). Exclusion criteria included cases of fetal demise and late abortions. The survey on information-gathering processes was divided into three stages: pregnancy, birth, and puerperium. The different sources of information were compared based on women's characteristics. RESULTS The response rate was 78% (n = 197). The main findings include a significant difference in information gathering based on varying levels of education, with women at the lowest educational level using the Internet the least during pregnancy (p = 0.029). During puerperium, significant differences could be observed in the involvement of the gynecologist. Primipara women as well as women of lower educational levels contacted their gynecologist less in contrast to multipara women (p = 0.006) and women of higher educational levels (p = 0.011). Overall, health professionals were considered to be the most important source of information. CONCLUSIONS This study demonstrates that parity and educational level influence the information-gathering process. As the most important source for information gathering, health professionals must use this advantage to better assist their patients in accessing reliable information.
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Affiliation(s)
- Oezden Oyman
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
| | - Joy Fest
- Department of Obstetrics and Gynecology, Baden Regional Hospital, 5404 Baden, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Obstetrics, University Hospital of Zurich, 8091 Zurich, Switzerland
| | - Ladina Vonzun
- Faculty of Medicine, University of Zurich, 8006 Zurich, Switzerland
- Department of Obstetrics, University Hospital of Zurich, 8091 Zurich, Switzerland
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Tergast TL, Protzer U, Zeuzem S, Heitmann L, Sarrazin C, Lehmann M, Ingiliz P, Cornberg M, Zimmermann R, Gerlich MG, Buggisch P, Wiebner B, Wedemeyer H. [Strategietreffen: Virushepatitis in Deutschland eliminieren]. Z Gastroenterol 2023; 61:198-201. [PMID: 36736343 PMCID: PMC9897951 DOI: 10.1055/a-1978-9021] [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] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
- T L Tergast
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover
| | - U Protzer
- Institut für Virologie, Technische Universität München/Helmholtz Zentrum München, München
| | - S Zeuzem
- Medizinische Klinik I Gastroenterologie, Hepatologie, Pneumologie, Endokrinologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - L Heitmann
- Mitglied des deutschen Bundestages, Platz der Republik 1, 11011 Berlin
| | - C Sarrazin
- Medizinische Klinik II, Innere Medizin, St. Josefs-Hospital Wiesbaden, Germany
| | - M Lehmann
- Justizvollzugskrankenhaus JVA Plötzensee, Saatwinkler Damm 1A, 13627 Berlin, Germany
| | - P Ingiliz
- Hôpitaux Universitaires Henri Mondor
| | - M Cornberg
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover
- Deutsche Leberstiftung, Hannover, Germany
| | - R Zimmermann
- Abteilung für Infektionsepidemiologie, Robert Koch-Institut, Berlin, Germany
| | - M G Gerlich
- Bundeszentrale für gesundheitliche Aufklärung, Köln
| | - P Buggisch
- ifi-Institut für interdisziplinäre Medizin, Hamburg
| | - B Wiebner
- Deutsche Leberstiftung, Hannover, Germany
| | - H Wedemeyer
- Klinik für Gastroenterologie, Hepatologie und Endokrinologie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625 Hannover
- Deutsche Leberstiftung, Hannover, Germany
- Hepatitis B and C Public Policy Association (HepBCPPA)
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Vonzun L, Gonser M, Moehrlen U, Mazzone L, Meuli M, Kandler L, Wille D, Kraehenmann F, Zimmermann R, Ochsenbein-Kölble N. M-Sign in Middle Cerebral Artery Doppler Waveforms: A Sign of Fetal Vasoconstriction Before and After Open Fetal Spina Bifida Repair. Ultraschall Med 2023; 44:68-74. [PMID: 35135034 DOI: 10.1055/a-1722-2721] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Increased pulse wave reflection in the fetal arterial system, illustrated by a second systolic peak (M-sign) in middle cerebral artery (MCA) Doppler waveforms, allows interpretation of fetal systemic vasoconstriction. Little is known about fetal vascular regulation during fetal spina bifida (fSB) repair. Therefore, the aim of this study was to analyze MCA-Doppler waveform changes before, during, and after fSB repair. PATIENTS AND METHODS 31 pregnant women who underwent fSB repair were included. Fetal MCA-Doppler waveforms were prospectively analyzed before, during and after fSB repair, and categorized as follows: normal systolic downslope, systolic shoulder, second systolic peak (M-sign), and concave systolic downslope. These MCA waveforms were related to maternal and fetal characteristics, to anesthetic medication, and to umbilical artery (UA) waveforms. RESULTS Before fSB repair, all fetuses repeatedly presented M-signs. After initiation of desflurane for general anesthesia, systolic shoulder and the M-sign vanished in 24/31 (78%) fetuses and 19/31 (61%) showed transient UA ARED flow. A significant association between these two Doppler findings was found (p=0.007). After fSB repair, signs of increased pulse wave reflection reappeared but resolved over time (23 days ± 20, SD) in all fetuses. CONCLUSION Both fSB and intrauterine repair influence fetal vascular regulation. This phenomenon can be illustrated by MCA-Doppler waveforms. While anesthetic agents transiently eliminated M-signs and often provoked a UA ARED flow, fSB repair finally led to normalization of MCA-Doppler waveforms indicating return to normal fetal vascular regulation.
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Affiliation(s)
- Ladina Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Markus Gonser
- Obsterics and Prenatal Medicine, HELIOS HSK Wiesbaden, Wiesbaden, Germany
| | - Ueli Moehrlen
- Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Luca Mazzone
- Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Martin Meuli
- Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Lukas Kandler
- Anesthiesiology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - David Wille
- Department of Pediatric Neurology, Baden Cantonal Hospital, Baden, Switzerland
- Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Franziska Kraehenmann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- University of Zurich, The Zurich Center for Fetal Diangosis and Therapy, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
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Brun R, Hothorn T, Eigenmann E, Frevert ML, Zimmermann R, Korte W, Haslinger C. The Impact of Prepartum Platelet Count on Postpartum Blood Loss and Its Association with Coagulation Factor XIII Activity. Transfus Med Hemother 2023; 50:2-9. [PMID: 36818769 PMCID: PMC9911997 DOI: 10.1159/000529020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 01/03/2023] [Indexed: 01/19/2023] Open
Abstract
Background Postpartum hemorrhage is a leading cause of maternal morbidity and mortality worldwide. Contradictory information exists regarding the relevance of prepartum platelet count on postpartum hemorrhage. We have shown prepartum coagulation factor XIII to be associated with postpartum blood loss; however, little is known about the association of platelet count with factor XIII activity. Our objectives were, first, to evaluate the impact of prepartum platelet count on measured postpartum blood loss in the context of prepartum measurements of coagulation factors I, II, and XIII and, second, to evaluate the association of platelet count with coagulation factor XIII, both pre- and postpartum. Material and Methods This is a secondary analysis of a prospective cohort study (PPH 1,300 study) which analyzed the impact of prepartum blood coagulation factors on postpartum blood loss in 1,300 women. Blood loss was quantified using a validated technique. The impact of prepartum platelet count on measured blood loss was assessed by continuous outcome logistic regression; the association of platelet count with factor XIII activity by Spearman rank correlation. Results Prepartum platelet count was significantly associated with measured postpartum blood loss: every one unit (G/L) increase in prepartum thrombocytes was associated with an odds ratio of 1.002 (95% confidence interval, 1.001-1.004, p = 0.005) to keep blood loss below any given cut-off level. This means that the probability of postpartum hemorrhage decreases with increasing prepartum platelet levels. Moreover, a significant association of platelet count with factor XIII activity was shown (Spearman rank correlation coefficient for prepartum values 0.228, p < 0.001, and for postpartum values 0.293, p < 0.001). Discussion/Conclusion The significant association of prepartum platelet count and postpartum blood loss as well as the association of platelet count with blood coagulation factor XIII activity support the likely role of platelets in preventing postpartum hemorrhage and support the new guidelines for the treatment of postpartum hemorrhage in Germany, Austria, and Switzerland, which calls for optimizing platelet counts peripartally in case of postpartum hemorrhage. A possible effect of platelets on the level of circulating factor XIII cannot be ruled out and should prompt further investigation.
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Affiliation(s)
- Romana Brun
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland,*Romana Brun,
| | - Torsten Hothorn
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | | | - Roland Zimmermann
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - Wolfgang Korte
- Center for Laboratory Medicine, Hemostasis and Hemophilia Center, St. Gallen, Switzerland
| | - Christian Haslinger
- Department of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
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Vonzun L, Ochsenbein-Kölble N, Balsyte D, Zimmermann R, Gonser M. Second systolic peak in fetal middle cerebral artery Doppler after intrauterine transfusion. Arch Gynecol Obstet 2023; 307:241-248. [PMID: 35348831 PMCID: PMC9837016 DOI: 10.1007/s00404-022-06517-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/08/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate functional relationship between fetal circulatory response to intrauterine transfusion (IUT) as a circulatory challenge and appearance of second systolic peak (P2) in middle cerebral artery (MCA) based on hemodynamic principles. METHODS According to the concept of pulse wave (PW) propagation and reflection in adults, PWs arrive twice at cerebral circulation, as primary wave caused by left ventricle ejection and secondary after reflection in peripheral arteries. Thus adults show a biphasic contour of systolic blood flow in cerebral arteries. Similar waveforms may appear in fetal MCA-Doppler, as a response to IUT as a circulatory challenge. This is a proof-of-principle study, applying classical hemodynamic principles to fetal circulation. Accordingly, appearance of MCA-P2 may indicate vasoconstriction with increased PW reflection and timing of P2(Δt) should agree with the additional PW travel time down to reflection and return (Tr). To test this agreement, we searched our database for IUTs performed for severe fetal anemia, and compared Δt, obtained by Doppler, with Tr, obtained by hemodynamic calculation using human fetal data. Level of agreement was assessed using Bland-Altman-Plots. RESULTS We identified 21 fetuses with adequate Doppler quality for Δt evaluation. In four cases (19%) MCA-P2 was observed before the intervention, and in 17 interventions (81%) thereafter; a highly significant association between IUT and P2 appearance (p < 0.001). In these 17 interventions good agreement of P2 timing was found between Doppler assessment: Δt = 80 ± 8 ms, and hemodynamic calculation: Tr = 76 ± 4 ms. CONCLUSION P2 appearance in fetal MCA-Doppler seems to indicate PW reflection due to increased vasoconstriction after IUT. Thus hemodynamic considerations might enable Doppler monitoring of fetal vasoconstriction.
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Affiliation(s)
- Ladina Vonzun
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8006, Zurich, Switzerland.
- University of Zurich, Zurich, Switzerland.
| | - Nicole Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8006, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Dalia Balsyte
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8006, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8006, Zurich, Switzerland
- University of Zurich, Zurich, Switzerland
| | - Markus Gonser
- Department of Obstetrics and Prenatal Medicine, Helios-HSK Kliniken Wiesbaden, Wiesbaden, Germany
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10
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Münch F, Purbojo A, Wenzel F, Kohl M, Dittrich S, Rauh M, Zimmermann R, Kwapil N. [Improved quality of stored packed red blood cells by mechanical rinsing]. Anaesthesiologie 2022; 71:882-892. [PMID: 35969253 PMCID: PMC9636120 DOI: 10.1007/s00101-022-01189-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 07/03/2022] [Accepted: 07/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The transfusion of packed red blood cells (PRBC) is associated with various side effects, including storage damage to PRBCs. The cells change their structure, releasing potassium as well as lactate. Mechanical rinsing, available in many hospitals, is able to remove toxic substances and possibly minimizes the negative side effects of transfusion. OBJECTIVE The primary aim of our study was to improve the quality of PRBCs before transfusion. The effects of different washing solutions on PRBC quality were analyzed. MATERIAL AND METHODS This in vitro study compares 30 mechanically washed PRBCs. They were either processed with standard normal saline 0.9% (n = 15, N group) or a hemofiltration solution containing 4 mmol/l potassium (n = 15, HF group) by a mechanical rinsing device (Xtra, LivaNova, Munich, Germany). A subgroup analysis was performed based on the storage duration of the processed PRBCs (7, 14, 37 days). Samples were taken before washing (EKprä), immediately after washing (EKpost) and 10 h later (EKpost10h), after storage in the "wash medium" at room temperature. Concentrations of ATP (probability of survival in transfused erythrocytes), lactate, citrate and electrolytes (potassium, sodium, chloride, calcium) were tested. RESULTS AND CONCLUSION Mechanical rinsing improves pretransfusion quality of PRBC. Washing with a hemofiltration solution results in a more physiological electrolyte composition. Even 10 h after mechanical rinsing with a hemofiltration solution, the quality of 37-day-old PRBC is comparable to young PRBC that have been stored for 7 days and have not been washed. Washing stored PRBC increases the ATP content, which subsequently leads to an increased probability of survival of red cells after transfusion.
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Affiliation(s)
- F Münch
- Kinderherzchirurgische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestraße 15, 91054, Erlangen, Deutschland.
| | - A Purbojo
- Kinderherzchirurgische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestraße 15, 91054, Erlangen, Deutschland
| | - F Wenzel
- Fakultät Medical and Life Science, Hochschule Furtwangen University Campus Villingen-Schwenningen, Jakob-Kienzle-Str. 17, 78054, Villingen-Schwenningen, Deutschland
| | - M Kohl
- Fakultät Medical and Life Science, Hochschule Furtwangen University Campus Villingen-Schwenningen, Jakob-Kienzle-Str. 17, 78054, Villingen-Schwenningen, Deutschland
| | - S Dittrich
- Kinderkardiologische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestraße 15, 91054, Erlangen, Deutschland
| | - M Rauh
- Klinisches Labor der Kinder- und Jugendklinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestraße 15, 91054, Erlangen, Deutschland
| | - R Zimmermann
- Transfusionsmedizinische und Hämostaseologische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 12, 91054, Erlangen, Deutschland
| | - N Kwapil
- Kinderherzchirurgische Abteilung, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Loschgestraße 15, 91054, Erlangen, Deutschland
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11
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Steffen G, Krings A, Zimmermann R. Prevalence of hepatitis B and C, HIV, and syphilis among people who inject drugs in Germany. Eur J Public Health 2022. [DOI: 10.1093/eurpub/ckac131.200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We piloted a future monitoring system among people who inject drugs (PWID) in Germany (DRUCK2.0). Monitoring is needed to inform and support the viral hepatitis/HIV/STI elimination process in Germany by providing regular up-to-date prevalence and behavioural data for this key population.
Methods
PWID aged 16+ years who injected drugs within the last 12 months were recruited by time location sampling via low threshold drug services and opioid substitution treatment (OST) practices during routine services in Berlin and Bavaria between 01/06/2021 and 28/02/2022. All participants filled a questionnaire on sociodemographics, behaviour and access to care and were tested for hepatitis B and C (HBV, HCV), HIV and syphilis using capillary dried blood spots. All received a 10 Euro incentive voucher.
Results
In total, 495 PWID were included, median age was 39 years [range 18-66], 68% (336/494) were male, and 23% (114/492) born outside Germany, mostly in eastern Europe. Of all participants, 58% (275/477) reported recent use of unsafe needles/syringes and 77% (372/485) detention experience. Current OST was reported by 62% (304/487). Prevalence was 46% (229/495) for cured HCV, 26% (130/495) for active HCV, 17% (80/482) for cured HBV, 1.2% (6/483) for active HBV, 2.7% (13/482) for HIV and 2.1% (10/473) for previous Syphilis. Serological HBV vaccination coverage was 24% (115/475). Of all, 95% (453/475) reported previous HCV testing. Of those with cured/active HCV infection 88% (296/337) knew about their infection and 56% (161/285) of them reported previous/current treatment.
Conclusions
To decrease the heavy burden of infection among PWID in Germany, targeted measures regarding access to HCV treatment, HBV vaccination, and harm reduction (safer use measures, OST) need to be implemented and rolled out. Nationwide regular monitoring of indicators in this key population is needed to guide the elimination progress of viral hepatitis and HIV in Germany.
Key messages
• High burden of active Hepatitis C infection and low Hepatitis B vaccination coverage among people who inject drugs in Berlin and Bavaria require improved access to treatment and prevention efforts.
• National Monitoring is needed to inform and support the viral hepatitis/HIV/STI elimination process among people who inject drugs in Germany.
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Affiliation(s)
- G Steffen
- Department of Infectious Disease Epidemiology, Robert Koch Institute , Berlin, Germany
| | - A Krings
- Department of Infectious Disease Epidemiology, Robert Koch Institute , Berlin, Germany
| | - R Zimmermann
- Department of Infectious Disease Epidemiology, Robert Koch Institute , Berlin, Germany
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12
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Zimmermann R. Mental Health and Information Reporting Assistant: technological innovation including low- and middle-income countries - an update. Eur Psychiatry 2022. [PMCID: PMC9567345 DOI: 10.1192/j.eurpsy.2022.1456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction
According to the World Health Organization, addressing the mental health care gap for adolescents, especially in low-resource contexts, is a priority. Evidence-based assessment is crucial for selecting treatment strategies and for quality management. Objectives To develop a digital platform for evidence-based assessments and implement it in different low-resource settings. Methods The project operates according to the principles of digital development (https://digitalprinciples.org/), including designing with the user, user testing, understanding the ecosystem, resusing software and being open source, think about sustainability and addressing privacy and security. Results Different implementation contexts (in Tanzania, Kosovo and Chile) will be presented. The learned lessons will be presented to the audience. Conclusions MHIRA is a promising tool that helps bridge the gap regarding adolescent mental health in low-resource settings. Challenges include the clinicans attitude towards evidence based assessment, sustainability of the project and integration with the existing information technology eco-system and regulations. Disclosure No significant relationships.
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13
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Kreft M, Cai P, Furrer E, Richter A, Zimmermann R, Kimmich N. 2D pelvic floor ultrasound imaging in identifying levator ani muscle trauma agrees highly with 4D ultrasound imaging. Int Urogynecol J 2022; 33:2781-2790. [PMID: 35503120 DOI: 10.1007/s00192-022-05198-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Accepted: 03/21/2022] [Indexed: 12/31/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to evaluate the agreement between 2D and 4D translabial ultrasound (TLUS) technique in showing levator ani muscle (LAM) states after vaginal birth. METHODS In a prospective observational cohort study between March 2017 and April 2019 we evaluated LAM states (intact, hematoma, partial, complete avulsion) of primiparous women having given birth vaginally with singletons in vertex presentation ≥ 36+0 gestational weeks by using 2D and 4D TLUS within 1-4 days postpartum (assessment A1) and again 6-10 weeks postpartum (assessment A2). Cohen's Kappa analysis was performed for each side separately to evaluate the test agreement between the two ultrasound techniques at every assessment period. RESULTS A total of 224 women participated at A1 and 213 at A2. The agreement between the two ultrasound techniques was good to very good at A1 (Cohen`s kappa right-sided 0.78, left-sided 0.82) and very good at A2 (Cohen`s kappa both sides 0.88). The agreement was best when assessing an intact LAM or a complete avulsion (Cohen`s kappa between 0.78-0.92 for complete avulsions). CONCLUSIONS The comparison between 2D and 4D TLUS showed a good to very good agreement in LAM trauma immediately after birth as well as 6-10 weeks postpartum. Therefore, 2D ultrasound could also be a valuable method for demonstrating a LAM abnormality and could be used in settings where 3D/4D ultrasound equipment is not available.
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Affiliation(s)
- Martina Kreft
- Department of Gynecology and Obstetrics, Triemli Hospital, Birmensdorferstrasse 497, 8063, Zurich, Switzerland.
| | - Peiying Cai
- Master Program in Biostatistics, University of Zurich, Am Hirschengraben 84, 8001, Zurich, Switzerland
| | - Eva Furrer
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Am Hirschengraben 84, 8001, Zurich, Switzerland
| | - Anne Richter
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Nina Kimmich
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
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14
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Klaic K, Zimmermann R, Simões-Wüst AP. Acceptability and further potential of an app for maternal notes, the eMutterPass: A patient-centered online survey at the University Hospital Zurich. Eur J Obstet Gynecol Reprod Biol 2022; 271:31-37. [DOI: 10.1016/j.ejogrb.2022.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/21/2022] [Accepted: 01/27/2022] [Indexed: 11/28/2022]
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15
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Vonzun L, Kahr MK, Wille D, Kottke R, Moehrlen U, Meuli M, Ochsenbein-Kölble N, Kraehenmann F, Zimmermann R, Mazzone L. Determination of Anatomical Levels in Spina Bifida Fetuses with Ultrasound and MRI. Ultraschall Med 2022; 43:181-185. [PMID: 33007788 DOI: 10.1055/a-1264-7785] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
PURPOSE The goal of this study was to assess the accuracy of prenatal anatomical level determination by ultrasound (US) and magnetic resonance imaging (MRI) by analyzing the congruence with the "true" anatomical level identified by postnatal MRI. PATIENTS AND METHODS The first 60 patients undergoing fetal myelomeningocele surgery at The Zurich Center for Fetal Diangosis and Therapy were included in this study. Anatomical levels (i. e., first dysraphic vertebra) determined by prenatal US and MRI were compared to postnatal MRI. The level of agreement between the imaging modalities was evaluated with a Cohen's kappa test. Results > 0.6 were interpreted as good agreement, > 0.8 as excellent. RESULTS The exact congruence between prenatal US and MRI compared to postnatal MRI was 33 % and 48 %, respectively, for an accuracy within one level difference of 80 % and 90 %, and within two levels difference of 95 % and 98 %, respectively. The level of agreement of prenatal US and MRI compared to postnatal MRI was 0.62 and 0.79, respectively. Most of the prenatally incorrectly assigned levels were assigned too high (worse) than the "true" level (US 88 % vs. MRI 65 %). CONCLUSION Reliable exact prenatal level determination by US and MRI is not possible. However, the prenatal determination of the anatomical level of the lesion is good within one level margin of error. Prenatal US as well as MRI demonstrate a systematic error towards higher levels. The above considerations must be integrated into prenatal counselling.
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Affiliation(s)
- Ladina Vonzun
- Department of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8006 Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch), University of Zurich, Zurich, Switzerland
| | - Maike Katja Kahr
- Department of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8006 Zurich, Switzerland
| | - David Wille
- Department of Pediatric Neurology, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Raimund Kottke
- Department of Diagnostic Imaging, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch), University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Martin Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch), University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Department of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8006 Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch), University of Zurich, Zurich, Switzerland
| | - Franziska Kraehenmann
- Department of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8006 Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch), University of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8006 Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch), University of Zurich, Zurich, Switzerland
| | - Luca Mazzone
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch), University of Zurich, Zurich, Switzerland
- Spina Bifida Center, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032 Zurich, Switzerland
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Riegler-Berket L, Wechselberger L, Cerk IK, Padmanabha Das KM, Viertlmayr R, Kulminskaya N, Rodriguez Gamez CF, Schweiger M, Zechner R, Zimmermann R, Oberer M. Residues of the minimal sequence of G0S2 collectively contribute to ATGL inhibition while C-and N-terminal extensions promote binding to ATGL. Biochim Biophys Acta Mol Cell Biol Lipids 2022; 1867:159105. [PMID: 35026402 DOI: 10.1016/j.bbalip.2021.159105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 11/29/2021] [Accepted: 12/17/2021] [Indexed: 11/25/2022]
Abstract
The protein encoded by the G0/G1 switch gene 2 (G0S2) is a potent inhibitor of adipose triglyceride lipase (ATGL) and thus an important regulator of intracellular lipolysis. Since dysfunction of lipolysis is associated with metabolic diseases including diabetes and obesity, inhibition of ATGL is considered a therapeutic strategy. G0S2 interacts with ATGL's patatin-domain to mediate non-competitive inhibition, however atomic details of the inhibition mechanism are incompletely understood. Sequences of G0S2 from higher organisms show a highly conserved N-terminal part, including a hydrophobic region covering amino acids 27 to 42. We show that predicted G0S2 orthologs from platypus, chicken and Japanese rice-fish are able to inhibit human and mouse ATGL, emphasizing the contribution of conserved amino acid to ATGL inhibition. Our site directed mutagenesis and truncation studies give insights in the protein-protein interaction on a per-residue level. We determine that the minimal sequence required for ATGL inhibition ranges from amino acids 20 to 44. Residues Y27, V28, G30, A34 G37, V39 or L42 within this sequence play a substantial role in ATGL inhibition. Furthermore, we show that unspecific interactions of the N-terminal part (amino acids 20-27) of the minimal sequence facilitate the interaction to ATGL. Our studies also demonstrate that full-length G0S2 shows higher tolerance to specific single amino acid exchanges in the hydrophobic region due to the stronger contributions of unspecific interactions. However, exchanges of more than one amino-acid in the hydrophobic region also result in the loss of function as ATGL inhibitor even in the full-length protein.
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Affiliation(s)
- L Riegler-Berket
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria
| | - L Wechselberger
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria
| | - I K Cerk
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria
| | - K M Padmanabha Das
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria; Department of Cancer Biology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
| | - R Viertlmayr
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria
| | - N Kulminskaya
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria
| | | | - M Schweiger
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria; BioTechMed Graz, 8010 Graz, Austria
| | - R Zechner
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria; BioTechMed Graz, 8010 Graz, Austria; BioHealth Field of Excellence, University of Graz, 8010 Graz, Austria
| | - R Zimmermann
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria; BioTechMed Graz, 8010 Graz, Austria; BioHealth Field of Excellence, University of Graz, 8010 Graz, Austria
| | - M Oberer
- Institute of Molecular Biosciences, University of Graz, 8010 Graz, Austria; BioTechMed Graz, 8010 Graz, Austria; BioHealth Field of Excellence, University of Graz, 8010 Graz, Austria.
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Kreft M, Cai P, Furrer E, Richter A, Zimmermann R, Kimmich N. The evolution of levator ani muscle trauma over the first 9 months after vaginal birth. Int Urogynecol J 2022; 33:2445-2453. [PMID: 35034163 DOI: 10.1007/s00192-021-05034-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/27/2021] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to investigate the evolution of levator ani muscle (LAM) trauma over the first 9 months after birth and to evaluate their agreement between different assessment periods. METHODS From March 2017 to April 2019 we prospectively evaluated LAM states (intact, hematoma, partial or complete avulsion) of primiparous women after vaginal birth by using 4D translabial ultrasound (TLUS) at three different assessment periods. All women were examined 1-4 days (A1) and 6-10 weeks (A2) postpartum, and women with a trauma additionally 6-9 months postpartum (A3). Cohen's Kappa analysis was performed to evaluate the test agreement between the assessment periods. RESULTS Thirty-two percent of the women at A1 had a LAM trauma and 24% at A2. The higher number of LAM injuries at A1 can be explained by hematomas (14%), of which 51% spontaneously resolved at A2, 35% revealed themselves as partial, and 12% as complete avulsions. At A3, we observed anatomical improvement from complete to partial avulsions (23%) and few partial avulsions changed into an intact LAM (3%); none of the complete avulsions changed into an intact LAM. The agreement of 4D TLUS between A1 and A2 was moderate to good (0.64 for the right-sided LAM/0.60 for the left-sided LAM) and between A2 and A3 good to very good (0.76 right-sided/0.84 left-sided). CONCLUSIONS Levator ani muscle trauma can reliably be diagnosed during all assessment periods. However, the agreement between A1 and A2 was only moderate to good. This can be explained by hematomas inside the LAM that were only observed early postpartum. We observed some anatomical improvement at A3, but no complete avulsion improved to an intact LAM.
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Affiliation(s)
- Martina Kreft
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
| | - Peiying Cai
- Master Program in Biostatistics, University of Zurich, Am Hirschengraben 84, 8001, Zurich, Switzerland
| | - Eva Furrer
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Am Hirschengraben 84, 8001, Zurich, Switzerland
| | - Anne Richter
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Nina Kimmich
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
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18
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Elrod J, Ochsenbein-Kölble N, Mazzone L, Zimmermann R, Berger C, Speck RF, Strübing N, Mohr C, Moehrlen U, Meuli M. Fetal-maternal surgery for spina bifida in a HIV-infected mother. Fetal Diagn Ther 2022; 49:25-28. [PMID: 34991089 DOI: 10.1159/000521788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/03/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In select cases, in utero surgery for MMC leads to better outcomes than postnatal repair. However, maternal HIV infection constitutes a formal exclusion criterion due to the potential of vertical HIV transmission. Encouraged by a previous case of a successful fetal spina bifida repair in a Hepatitis Bs antigen positive woman, a plan was devised allowing for fetal surgery. CASE REPORT In utero MMC repair was performed although the mother was HIV-infected. To minimize the risk of in utero HIV transmission, the mother was treated by HAART throughout gestation as well as intravenous zidovudine administration during maternal-fetal surgery. The mother tolerated all procedures very well without any sequelae. The currently 20 month-old toddler, is HIV negative and has significantly benefitted from fetal surgery. DISCUSSION/CONCLUSION This case shows that maternal HIV is not a priori a diagnosis that excludes fetal surgery. Rather, it might be a surrogate for moving towards personalized medicine and away from applying too rigorous exclusion criteria in the selection of candidates for maternal-fetal surgery.
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Affiliation(s)
- Julia Elrod
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Luca Mazzone
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Berger
- Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Roberto F Speck
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Nele Strübing
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Christoph Mohr
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland
| | - Martin Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland
- The Zurich Center for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
- Children's Research Center (CRC), University Children's Hospital Zurich, Zurich, Switzerland
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19
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Heide J, Ehlert S, Koziorowski T, Rüger CP, Walte A, Zimmermann R. Simultaneous on-line vacuum single- and multi-photon ionization on an orthogonal acceleration time-of-flight mass spectrometer platform. Analyst 2022; 147:3662-3674. [DOI: 10.1039/d2an00774f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
New instrumental development for robust process monitoring with two soft ionization methods working in parallel.
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Affiliation(s)
- J. Heide
- Joint Mass Spectrometry Centre, Chair of Analytical Chemistry, Institute of Chemistry, University of Rostock, 18059 Rostock, Germany
| | - S. Ehlert
- Joint Mass Spectrometry Centre, Chair of Analytical Chemistry, Institute of Chemistry, University of Rostock, 18059 Rostock, Germany
- Photonion GmbH, 19061 Schwerin, Germany
| | - T. Koziorowski
- PROBAT-Werke von Gimborn Maschinenfabrik GmbH, Emmerich am Rhein, Germany
| | - C. P. Rüger
- Joint Mass Spectrometry Centre, Chair of Analytical Chemistry, Institute of Chemistry, University of Rostock, 18059 Rostock, Germany
| | - A. Walte
- Photonion GmbH, 19061 Schwerin, Germany
| | - R. Zimmermann
- Joint Mass Spectrometry Centre, Chair of Analytical Chemistry, Institute of Chemistry, University of Rostock, 18059 Rostock, Germany
- Joint Mass Spectrometry Centre, Cooperation Group “Comprehensive Molecular Analytics”, Helmholtz Zentrum München, 85764 Neuherberg, Germany
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20
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Devaud YR, Stäuble S, Moehrlen U, Weisskopf M, Vonzun L, Zimmermann R, Ehrbar M, Ochsenbein-Kölble N. Minimally Invasive Precise Application of Bioadhesives to Prevent IPPROM on a Pregnant Sheep Model. Fetal Diagn Ther 2021; 48:785-793. [PMID: 34814145 DOI: 10.1159/000519910] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 09/10/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Iatrogenic preterm premature rupture of the membrane remains the Achille's heel of fetoscopy. The aim of this study was to show in vivo feasibility of fetal membrane (FM) defect sealing by the application of tissue glues with umbrella-shaped receptors. METHODS First, we adapted our previously described ex vivo strategy and evaluated the adhesion strength of different tissue glues, Histoacryl® and Glubran2®, by bonding polytetrafluoroethylene or silicone encapsulated nitinol glue receptor to human FM. Then, we exposed pregnant sheep uterus through a laparotomy and placed a 10-French trocar into the amniotic cavity through which the umbrella-shaped glue receptor (n = 9) was inserted and fixated onto the FM with the tissue glues (n = 8). The tightness of the sealed defects was assessed 4 h post-surgery. RESULTS Both tissue glues tested resulted in adhesion of the glue receptors to the FM ex vivo. In vivo, all glue receptors opened in the amniotic cavity (n = 9) and all successfully placed glue receptors sealed the FM defect (n = 8). Four hours post-surgery, 2 treatment sites showed minimal leakage whereas the negative control without glue (n = 1) showed substantial leakage. DISCUSSION This in vivo study confirms that fetoscopically induced FM defects can be sealed by the application of tissue adhesives.
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Affiliation(s)
- Yannick R Devaud
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Senta Stäuble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Ueli Moehrlen
- University of Zurich, Zurich, Switzerland.,Pediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Miriam Weisskopf
- University of Zurich, Zurich, Switzerland.,Center of Surgical Research, University Hospital Zurich, Zurich, Switzerland
| | - Ladina Vonzun
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Martin Ehrbar
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
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21
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Avilla-Royo E, Gegenschatz-Schmid K, Grossmann J, Kockmann T, Zimmermann R, Snedeker JG, Ochsenbein-Kölble N, Ehrbar M. Comprehensive quantitative characterization of the human term amnion proteome. Matrix Biol Plus 2021; 12:100084. [PMID: 34765964 PMCID: PMC8572956 DOI: 10.1016/j.mbplus.2021.100084] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 09/03/2021] [Accepted: 09/16/2021] [Indexed: 12/20/2022] Open
Abstract
We report an unprecedented quantitative high coverage of the human amnion proteome. We identified novel proteins that hold great promise for understanding fetal membrane biology. Together, this comprehensive proteome provides a basis for the evaluation of pre-term or diseased fetal membranes.
The loss of fetal membrane (FM) integrity and function at an early time point during pregnancy can have devastating consequences for the fetus and the newborn. However, biomaterials for preventive sealing and healing of FMs are currently non-existing, which can be partly attributed to the current fragmentary knowledge of FM biology. Despite recent advances in proteomics analysis, a robust and comprehensive description of the amnion proteome is currently lacking. Here, by an optimized protein sample preparation and offline fractionation before liquid chromatography coupled to mass spectrometry (LC-MS) analysis, we present a characterization of the healthy human term amnion proteome, which covers more than 40% of the previously reported transcripts in similar RNA sequencing datasets and, with more than 5000 identifications, greatly outnumbers previous reports. Together, beyond providing a basis for the study of compromised and preterm ruptured FMs, this comprehensive human amnion proteome is a stepping-stone for the development of novel healing-inducing biomaterials. The proteomic dataset has been deposited in the ProteomeXchange Consortium with the identifier PXD019410.
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Affiliation(s)
- Eva Avilla-Royo
- Department of Obstetrics, University and University Hospital of Zurich, 8091 Zurich, Switzerland.,Institute for Biomechanics, Swiss Federal Institute of Technology, 8093 Zurich, Switzerland
| | | | - Jonas Grossmann
- Functional Genomics Center, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland.,SIB Swiss Institute of Bioinformatics, 1015 792 Lausanne, Switzerland
| | - Tobias Kockmann
- Functional Genomics Center, University of Zurich and ETH Zurich, 8057 Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University and University Hospital of Zurich, 8091 Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, 8032 Zurich, Switzerland
| | - Jess Gerrit Snedeker
- Institute for Biomechanics, Swiss Federal Institute of Technology, 8093 Zurich, Switzerland.,Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Department of Obstetrics, University and University Hospital of Zurich, 8091 Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, 8032 Zurich, Switzerland
| | - Martin Ehrbar
- Department of Obstetrics, University and University Hospital of Zurich, 8091 Zurich, Switzerland.,University of Zurich, 8006 Zurich, Switzerland
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22
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Mah A, Moustapha A, Roberts L, Leach A, Kaban G, Zimmermann R, Shavadia J, Orvold J, Mondal P, Martin L. CAN PATIENTS PRESENTING TO THE ED WITH CHEST PAIN WHO HAVE INTERMEDIATE-RISK HEART SCORES BE MANAGED AS OUTPATIENTS? A RETROSPECTIVE REVIEW OF TWO RAPID ACCESS CHEST PAIN CLINICS. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Vonzun L, Winder FM, Meuli M, Moehrlen U, Mazzone L, Kraehenmann F, Huesler M, Zimmermann R, Ochsenbein-Kölble N. Hindbrain Herniation and Banana and Lemon Sign After Open Fetal Myelomeningocele Repair - When Do These Signs Disappear and is Shunting Predictable? Ultraschall Med 2021; 42:514-519. [PMID: 32330995 DOI: 10.1055/a-1112-7096] [Citation(s) in RCA: 1] [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: 06/11/2023]
Abstract
PURPOSE The aim was to describe the sonographic follow-up of hindbrain herniation (HH), the banana and lemon sign after fetal myelomeningocele (fMMC) repair, and the time of disappearance of these signs after the intervention, and to investigate any predictive value for the necessity of shunting during the infant's first year of life. Additionally, the sonographic evolution of the transcerebellar diameter (TCD) before and after fetal intervention was assessed. PATIENTS AND METHODS The first 50 patients that underwent fMMC repair at Zurich Center for Fetal Diagnosis and Therapy (www.swissfetus.ch) were included in this study. Sonographic scans performed weekly after fMMC repair focusing on HH and banana and lemon signs were analyzed and compared between the shunted and the non-shunted group. ROC curves were generated for the time intervals of resolution of the signs in order to show their predictive accuracy for the need for shunting until 1 year of age. RESULTS HH resolved in 48 fetuses (96 %) before delivery. The sonographic disappearance of HH within the first two weeks after fMMC repair was associated with a significantly lower incidence of shunt placement (OR 0.19; 95 % CI 0.4-0.9) during the first year of life (p = 0.03). All fetuses with persistent HH before delivery received a shunt. TCD growth was observed in all fetuses. CONCLUSION The reversibility of HH within two weeks after fMMC repair is associated with an 80 % lower incidence of shunt placement during the infant's first year of life. Moreover, it allows the cerebellum to grow and to normalize its configuration.
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Affiliation(s)
- Ladina Vonzun
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | | | - Martin Meuli
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- University Children's Hospital Zurich, Spina-Bifida-Center, Zurich, Switzerland
| | - Ueli Moehrlen
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- University Children's Hospital Zurich, Spina-Bifida-Center, Zurich, Switzerland
| | - Luca Mazzone
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- University Children's Hospital Zurich, Spina-Bifida-Center, Zurich, Switzerland
| | - Franziska Kraehenmann
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Margaret Huesler
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- University Hospital Zurich, The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
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24
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Abstract
Vacuum-induced tamponade appears to be an easy-to-use, promising method for the treatment of postpartum hemorrhage, particularly in women with uterine atony. BACKGROUND: Postpartum hemorrhage is a main cause of maternal mortality worldwide, with rising incidence, thus demanding new treatment approaches. Intrauterine balloon systems with application of intrauterine vacuum are a promising new method. METHOD: All women treated with vacuum-induced tamponade using a modified balloon system were included in this single-center study. Aiming to reduce uterine size for control of postpartum hemorrhage, the intrauterine balloon was filled to 50–100 mL and connected to a vacuum device. Success rate of vacuum-induced tamponade, defined as no need for additional interventional treatment, was analyzed by etiology of postpartum hemorrhage and time period of use. EXPERIENCE: Vacuum-induced tamponade was applied in 66 women. Success rate was 86% in women with uterine atony (n=44) and 73% in women with postpartum hemorrhage due to placental pathology (n=22). Success rate improved over the study period, culminating in a success rate of 100% in women with postpartum hemorrhage due to uterine atony in the second half of the observation period (n=22). CONCLUSION: This observational study supports our pathophysiologic understanding of uterine atony: to treat an atonic uterus, uterine volume must be reduced, leading to coiling of the uterine spiral arteries and, hence, reduced blood loss.
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Affiliation(s)
- Christian Haslinger
- Department of Obstetrics, University Hospital Zurich, and the University of Zurich, Zurich, Switzerland
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25
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Zimmermann R, Zimmermann I, Bornschlegl P, Günther K. Wellenreiten im Gesundheitsamt – Digitaler Wandel im Corona-Containment. HMD 2021. [PMCID: PMC8147579 DOI: 10.1365/s40702-021-00735-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Das „Brechen von Infektionsketten“ ist das Ziel für den Öffentlichen Gesundheitsdienst (ÖGD) in der Pandemiebekämpfung. Diese komplexe Aufgabe benötigt digitale Unterstützung in den Gesundheitsämtern. Entgegen der landläufigen Meinung ist in den meisten Fällen dafür geeignete Software schon seit Sommer 2020 verfügbar – allerdings als nicht-standardisierte, lokale Lösungen. Viel entscheidender für die Zielerreichung ist es, die richtige Arbeitsteilung und die dazu passenden Prozesse zu definieren sowie ein enges Controlling des Kontaktmanagements zu realisieren. Erst dadurch können in kurzer Zeit viele Unterstützer in den Ämtern entsprechend der Pandemiesituation zusätzlich produktiv eingesetzt werden. In dem vorliegenden Erfahrungsbericht wird anhand eines Fallbeispiels des Gesundheitsamtes der Stadt Nürnberg aufgezeigt, wie Prozessorganisation, IT und Controlling aufeinander abgestimmt werden sollten. Diese Erkenntnisse helfen auch bei der anstehenden Vernetzung der föderal strukturierten Gesundheitsämter in Deutschland über eine zentrale Lösung (SORMAS). Denn es zeigt sich, dass lediglich die politische Vorgabe zentraler Lösungen noch lange nicht zu ihrer effektiven Nutzbarkeit führt und wiederum der Zusammenhang aus Software und Organisation berücksichtigt werden muss, um nicht Schiffbruch zu erleiden.
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26
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Heide J, Adam TW, Jacobs E, Wolter JM, Ehlert S, Walte A, Zimmermann R. Puff-resolved analysis and selected quantification of chemicals in the gas phase of E-Cigarettes, Heat-not-Burn devices and conventional cigarettes using single photon ionization time-of-flight mass spectrometry (SPI-TOFMS): A comparative study. Nicotine Tob Res 2021; 23:2135-2144. [PMID: 33993304 DOI: 10.1093/ntr/ntab091] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 05/14/2021] [Indexed: 01/14/2023]
Abstract
INTRODUCTION A wide array of alternative nicotine delivery devices (ANDD) has been developed and they are often described as less harmful than combustible cigarettes. This work compares the chemical emissions of three ANDD in comparison to cigarette smoke. All the tested ANDD are characterized by not involving combustion of tobacco. METHOD Single photon ionization time-of-flight mass spectrometry (SPI-TOFMS) is coupled to a linear smoking machine, which allows a comprehensive, online analysis of the gaseous phase of the ANDD aerosol and the conventional cigarette smoke (CC). The following devices were investigated in this study: a tobacco cigarette with a glowing piece of coal as a heating source, an electric device for heating tobacco and a first-generation electronic cigarette. Data obtained from a standard 2R4F research cigarette are taken as a reference. RESULTS The puff-by-puff profile of all products was recorded. The ANDD show a substantial reduction or complete absence of known harmful and potentially harmful substances compared to the CC. In addition, tar substances (i.e. semivolatile and low volatile aromatic and phenolic compounds) are formed to a much lower extent. Nicotine, however, is supplied in comparable amounts except for the investigated electronic cigarette. CONCLUSIONS The data shows that consumers switching from CC to ANDD are exposed to lower concentrations of harmful and potentially harmful substances. However, toxicological and epidemiological studies must deliver conclusive results if these reduced exposures are beneficial for users. IMPLICATION The comparison of puff-resolved profiles of emissions from different tobacco products, traditional and alternative, may help users switch to lower emission products. Puff-resolved comparison overcomes technical changes, use modes between products and may help in their regulation.
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Affiliation(s)
- J Heide
- Joint Mass Spectrometry Centre, Chair of Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - T W Adam
- Joint Mass Spectrometry Centre, Cooperation Group "Comprehensive Molecular Analytics", Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany.,Bundeswehr University Munich, Neubiberg, Germany
| | - E Jacobs
- Joint Mass Spectrometry Centre, Chair of Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - J-M Wolter
- Joint Mass Spectrometry Centre, Chair of Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany
| | - S Ehlert
- Joint Mass Spectrometry Centre, Chair of Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany.,Photonion GmbH, Schwerin, Germany
| | - A Walte
- Photonion GmbH, Schwerin, Germany
| | - R Zimmermann
- Joint Mass Spectrometry Centre, Chair of Analytical Chemistry, Institute of Chemistry, University of Rostock, Rostock, Germany.,Joint Mass Spectrometry Centre, Cooperation Group "Comprehensive Molecular Analytics", Helmholtz Zentrum München - German Research Center for Environmental Health, Neuherberg, Germany
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27
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Schoppmann S, Spiess D, Müller D, Burch A, Zimmermann R, Simões-Wüst AP. Nalbuphine: a candidate for treatment of women overwhelmed with sudden, intense labor pain? J Matern Fetal Neonatal Med 2021; 35:6112-6114. [PMID: 33899644 DOI: 10.1080/14767058.2021.1906859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM On very rare occasions, women are overwhelmed with sudden, intense labor pain in the context of ultra-rapid late second stage of labor, especially when the head is crowning. The consequences may comprise serious pelvic floor damage for the mother and hypoxia for the fetus. Drugs like nalbuphine for immediate maternal analgesia and sedation would be helpful. This mixed opioid agonist-antagonist, that was used in obstetric anesthesia in the 1980s, acts quickly while side effects for the mother are minor. To better estimate possible complications for the fetus of a use shortly before birth, it is important to find out how quickly i.v. administered nalbuphine reaches fetal circulation. Therefore, we characterized the transplacental transfer of nalbuphine using an ex vivo model. METHODS Placentas were obtained from cesarean sections after mothers gave their informed consent. Upon cannulation of one cotyledon, nalbuphine was added to the maternal circuit (calculated final concentration 100 ng/mL) and the ex vivo placenta perfusions were performed. To determine nalbuphine transfer from maternal to fetal circuit in the successful perfusions (n = 5), samples were collected at different time points. RESULTS At perfusion start, the measured initial nalbuphine concentrations in the maternal and fetal circuits are 93.1 and <0.1 ng/mL, respectively. After 5 min of placenta perfusion, 2.5 ng/mL nalbuphine (i.e. 3% of the initial nalbuphine concentration in the maternal circuit) is reached in the fetal circuit; after 15 and 30 min, 9.7 and 15.8 ng/mL (approximately 10 and 16% of initial maternal, respectively). CONCLUSIONS Only a small amount of nalbuphine is likely to reach the fetus during the first minutes after (i.v.) maternal administration. Nalbuphine might be a valuable candidate for clinical use in the i.v. analgesia and sedation of women overwhelmed with sudden labor pain in the context of ultra-rapid second stage of labor.
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Affiliation(s)
- Seraina Schoppmann
- Department of Obstetrics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Deborah Spiess
- Department of Obstetrics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Daniel Müller
- Institute of Clinical Chemistry, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ana Paula Simões-Wüst
- Department of Obstetrics, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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28
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Franke D, Zepf J, Burkhardt T, Stein P, Zimmermann R, Haslinger C. Retained placenta and postpartum hemorrhage: time is not everything. Arch Gynecol Obstet 2021; 304:903-911. [PMID: 33743043 PMCID: PMC8429398 DOI: 10.1007/s00404-021-06027-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/11/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE Postpartum hemorrhage is the major cause of maternal mortality worldwide. Retained placenta accounts for nearly 20% of severe cases. We investigated the influence of the time factor and retained placenta etiology on postpartum hemorrhage dynamics. METHODS Our retrospective study analyzed a single-center cohort of 296 women with retained placenta. Blood loss was measured using a validated and accurate technique based on calibrated blood collection bags, backed by the post- vs pre-partum decrease in hemoglobin. We evaluated the relationship between these two blood loss parameters and the duration of the third stage of labor using Spearman rank correlation, followed by subgroup analysis stratified by third stage duration and retained placenta etiology. RESULTS Correlation analysis revealed no association between third stage duration and measured blood loss or decrease in hemoglobin. A shorter third stage (< 60 min) was associated with significantly increased uterine atony (p = 0.001) and need for blood transfusion (p = 0.006). Uterine atony was significantly associated with greater decrease in hemoglobin (p < 0.001), higher measured blood loss (p < 0.001), postpartum hemorrhage (p = 0.048), and need for blood transfusion (p < 0.001). CONCLUSION Postpartum blood loss does not correlate with third stage duration in women with retained placenta. Our results suggest that there is neither a safe time window preceding postpartum hemorrhage, nor justification for an early cut-off for manual removal of the placenta. The prompt detection of uterine atony and immediate prerequisites for manual removal of the placenta are key factors in the management of postpartum hemorrhage.
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Affiliation(s)
- Denise Franke
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Julia Zepf
- University of Zurich, Zurich, Switzerland
| | - Tilo Burkhardt
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Philipp Stein
- University of Zurich, Zurich, Switzerland.,Institute of Anesthesiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland
| | - Christian Haslinger
- Department of Obstetrics, University Hospital Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland.
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29
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Tra S, Ochsenbein-Kölble N, Stein P, Meuli M, Moehrlen U, Mazzone L, Kraehenmann F, Zimmermann R, Biro P. Association of uterine activity and maternal volatile anesthetic exposure during open fetal surgery for spina bifida: a retrospective analysis. Int J Obstet Anesth 2021; 46:102974. [PMID: 33780714 DOI: 10.1016/j.ijoa.2021.102974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 11/22/2020] [Accepted: 02/19/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recent warnings postulate a possible damaging effect of volatile anesthetics on the fetus. In our archive of fetal surgeries, we found wide variation in dosing of volatile anesthetics during spina bifida surgeries. We hypothesized that there was an association between volatile anesthetic exposure and uterine activity. METHODS Sixty anesthesia records from spina bifida operations were assessed. We analyzed the course of the administered volatile anesthetic during surgery and calculated from each patient's anesthesia record the volatile anesthetic exposure expressed in vol%h. We divided the records into two post hoc groups of the 20 lowest exposure (Group L) versus the 20 highest exposure (Group H), and compared them for uterine activity and fetal heart rate. RESULTS The number of contractions per hour was significantly greater in Group H (mean 1.3, SD ± 1.2) compared with Group L (mean 0.5, SD ± 0.6, P=0.049). There was no difference between the groups for the administration of the tocolytic drug atosiban (P=0.29). The course of the mean arterial pressure did not significantly differ but group H needed significantly more vasoactive medication (P <0.05). CONCLUSIONS We found that a lower intra-operative volatile anesthetic exposure than recommended in the MOMS-trial (i.e. <2.0 minimum alveolar concentration [MAC]) was not associated with an increase in intra-operative uterine activity. This is an indication that during spina bifida surgery, 2.0 MAC may not be necessary to avoid potentially harmful uterine activity.
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Affiliation(s)
- S Tra
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland.
| | - N Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland; The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - P Stein
- Institute of Anesthesiology, Emergency Medical Service, Perioperative Medicine, Pain Therapy, Cantonal Hospital Winterthur, Switzerland
| | - M Meuli
- Department of Surgery, University Childrens' Hospital Zurich, Zurich, Switzerland; The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - U Moehrlen
- Department of Surgery, University Childrens' Hospital Zurich, Zurich, Switzerland; The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - L Mazzone
- Department of Surgery, University Childrens' Hospital Zurich, Zurich, Switzerland; The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - F Kraehenmann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland; The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - R Zimmermann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland; The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - P Biro
- Institute of Anesthesiology, University Hospital Zurich, Zurich, Switzerland; The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
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La Marca-Ghaemmaghami P, Zimmermann R, Haller M, Ehlert U. Cortisol and estriol responses to awakening in the first pregnancy trimester: Associations with maternal stress and resilience factors. Psychoneuroendocrinology 2021; 125:105120. [PMID: 33385739 DOI: 10.1016/j.psyneuen.2020.105120] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 11/08/2020] [Accepted: 12/18/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Little is known about the maternal cortisol awakening response (CAR) in the first pregnancy trimester. Similarly unknown is how the CAR in early gestation relates to other steroid hormones, such as estriol. Maternal estriol in blood and urine is used to monitor fetal well-being since it is produced by the fetoplacental unit from fetal precursors. Low levels have been associated with maternal-fetal complications. We were recently able to show that estriol is measurable in maternal saliva from 6 weeks' gestation onwards. However, its pattern following morning awakening and potential links with salivary cortisol in early gestation is relatively unknown. In this prospective study, we explored the cortisol and estriol responses to morning awakening in first-trimester pregnant women, the potential association of these endocrine variables with maternal stress and resilience factors, and their predictive value for the further pregnancy course. METHODS Fifty-one women with an uncomplicated, singleton pregnancy responded to questionnaires measuring chronic and pregnancy-specific stress, emotional support, and daily uplifts at 6 weeks' gestation. At 8 and 10 weeks, the women collected saliva samples immediately, 30, and 60 min after morning awakening. After 12 weeks, 40 women reported on the further pregnancy course, of whom 6 had developed complications. RESULTS In response to morning awakening, cortisol levels increased significantly at 10 weeks (p = .04), while estriol levels decreased significantly at both 8 and 10 weeks (p < .001). A stronger cortisol increase was linked to a stronger estriol decrease at 8 (p = .03), but not at 10 weeks. Then, perceived emotional support at 6 weeks was negatively associated with cortisol baseline at 8 (p = .01) and positively with estriol baseline at 10 weeks (p = .03). Moreover, higher pregnancy-specific stress was related to a lower estriol baseline at 8 weeks (p = .047). Furthermore, compared to healthy women, those with complications at follow-up had already reported less emotional support (p = .03) and fewer daily uplifts (p = .03) at 6 weeks. These women also seemed to lack a significant estriol response to morning awakening at 8 weeks (p > .10). DISCUSSION These findings advance our knowledge of cortisol and estriol secretion following morning awakening and encourage the investigation of E3 in addition to cortisol when researching prenatal stress and its consequences for maternal and fetal health.
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Affiliation(s)
- Pearl La Marca-Ghaemmaghami
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Binzmuehlestrasse 14/Box 26, Zurich 8050, Switzerland.
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, Zurich 8091, Switzerland.
| | - Marina Haller
- Department of Psychological Methods, Evaluation and Statistics, University of Zurich, Binzmuelestrasse 14/Box 27, Zurich 8050, Switzerland.
| | - Ulrike Ehlert
- Department of Clinical Psychology and Psychotherapy, University of Zurich, Binzmuehlestrasse 14/Box 26, Zurich 8050, Switzerland.
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Moehrlen U, Ochsenbein N, Vonzun L, Mazzone L, Horst M, Schauer S, Wille DA, Hagmann C, Kottke R, Grehten P, Casanova B, Strübing N, Moehrlen T, Tharakan S, Padden B, Bassler D, Zimmermann R, Meuli M. Fetal surgery for spina bifida in Zurich: results from 150 cases. Pediatr Surg Int 2021; 37:311-316. [PMID: 33432393 DOI: 10.1007/s00383-020-04824-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE Over the past 10 years, over 150 fetal spina bifida surgeries were performed at the Zurich Center for Fetal Diagnosis and Therapy. This study looks at surrogates for success and failure of this approach. METHODS We focused on key outcome parameters including hydrocephalus shunt rate at one year, bladder control at 4, independent ambulation at 3 years, and maternal, fetal, and neonatal complications. RESULTS From the first 150 patients undergoing fetal surgery for spina bifida, 148 (98.7%) were included in the study. Maternal-fetal surgery was uneventful in 143/148 (97%) cases. Intraoperative problems included resuscitation in 4/148 fetuses (2.7%). 1/148 fetuses (0.7%) died on postoperative day 4. Maternal complications included chorioamniotic membrane separation in 22/148 (15%), lung embolism in 3/148 (2.1%), chorioamnionitis in 2/148 (1.4%), AV-block III and uterine rupture in 1/148 each (0.7%). 1/148 (0.7%) newborn death was recorded. Hindbrain herniation was identified preoperatively in 132/148 (90%) fetuses and resolved completely in 119/132 (90%). At one year, 39/106 (37%) children had required a CSF diversion. At 4 years, 4/34 patients (12%) had normal bladder control. At 3 years, 48/57 (84%) walked independently. CONCLUSION A majority of patients benefitted from prenatal intervention, in that the shunt rate was lower and the rates of continent and walking patients were higher than reported with postnatal care.
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Affiliation(s)
- Ueli Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland. .,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland. .,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland. .,University of Zurich, Zurich, Switzerland.
| | - Nicole Ochsenbein
- The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Ladina Vonzun
- The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Luca Mazzone
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Zurich Center for Spina Bifida, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Maya Horst
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Zurich Center for Spina Bifida, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Sonja Schauer
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,Zurich Center for Spina Bifida, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - David Alexander Wille
- Division of Pediatric Neurology, University Children's Hospital Zurich, Zurich, Switzerland.,Zurich Center for Spina Bifida, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Cornelia Hagmann
- Division of Intensive Care and Neonatology, University Children' Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Raimund Kottke
- Division of Diagnostic Imaging, MR-Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Patrice Grehten
- Division of Diagnostic Imaging, MR-Center, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Barbara Casanova
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Nele Strübing
- The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland
| | - Theres Moehrlen
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Sasha Tharakan
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Beth Padden
- Division of Pediatric Rehabilitation, University Children's Hospital Zurich, Zurich, Switzerland.,Zurich Center for Spina Bifida, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
| | - Martin Meuli
- Department of Pediatric Surgery, University Children's Hospital Zurich, Steinwiesstrasse 75, 8032, Zurich, Switzerland.,The Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland.,Children's Research Center, University Children's Hospital of Zurich, University of Zurich, Zurich, Switzerland.,University of Zurich, Zurich, Switzerland
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Gaertner VD, Bassler D, Zimmermann R, Fontijn JR. Reference Values for Umbilical Artery Lactate by Mode of Delivery and Gestational Age: A Retrospective Observational Study. Neonatology 2021; 118:609-616. [PMID: 34515182 DOI: 10.1159/000518748] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/20/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Umbilical artery cord blood provides information about the intrauterine metabolism during labor. Umbilical artery lactate is a useful parameter in predicting neonatal morbidity, but data on normal values are limited. We aimed to provide reference ranges of umbilical artery lactate values across the combination of gestational age and mode of delivery. METHODS A single-center retrospective observational study of liveborn infants born between 23 and 42 completed weeks gestation was conducted. Lactate, base deficit (BD), and pH from arterial cord blood were assessed between June 2018 and November 2020 and compared across gestational ages and modes of delivery. RESULTS Overall, there were 3,353 infants with evaluable data. Lactate values at the 50th, 90th, and 97th percentile were 3.4, 7.0, and 9.0 mmol/L. Lactate was inversely correlated with pH (r = -0.77, p < 0.001) and positively correlated with BD (r = 0.63, p < 0.001). Lactate values changed significantly across gestational age (Kruskal-Wallis test, p < 0.001) which was attributable to an increase in lactate at 39-41 weeks gestational age. Also, lactate values were different across modes of delivery (Kruskal-Wallis test, p < 0.001) with lowest values in elective CS and highest values in vaginal instrumental deliveries. Comprehensive reference ranges across modes of delivery and gestational ages could be established. DISCUSSION Mode of delivery and gestational age contribute to lactate levels with highest values occurring in vaginal instrumental deliveries and between 39 and 41 weeks gestational age. Based on these observations, we provide detailed reference ranges for clinical use.
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Affiliation(s)
- Vincent D Gaertner
- Department of Neonatology, Newborn Research Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Dirk Bassler
- Department of Neonatology, Newborn Research Zurich, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics and Gynecology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Jehudith R Fontijn
- Department of Neonatology, Newborn Research Zurich, University Hospital and University of Zurich, Zurich, Switzerland
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Vonzun L, Kahr MK, Noll F, Mazzone L, Moehrlen U, Meuli M, Hüsler M, Krähenmann F, Zimmermann R, Ochsenbein-Kölble N. Systematic classification of maternal and fetal intervention-related complications following open fetal myelomeningocele repair - results from a large prospective cohort. BJOG 2020; 128:1184-1191. [PMID: 33152167 DOI: 10.1111/1471-0528.16593] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To systematically categorise all maternal and fetal intervention-related complications after open fetal myelomeningocele (fMMC) repair of the first 124 cases operated at the Zurich Centre for Fetal Diagnosis and Therapy. DESIGN A prospective cohort study. SETTING Single centre. POPULATION Mothers and fetuses after fMMC repair. METHODS Between 2010 and 2019, we collected and entered all maternal complications following fMMC repair into the Clavien-Dindo classification. For fetal complications, a classification system based on the Medical Dictionary for Regulatory Activities terminology of Adverse Events was used including the preterm definitions of the World Health Organization. MAIN OUTCOME MEASURES Systematic classification of maternal and fetal complications following fMMC repair. RESULTS Gestational ages at surgery and birth were 25.0 ± 0.8 and 35.4 ± 2.0 weeks, respectively. In 17% of all cases, no maternal complications occurred. Maternal intervention-related complications were observed as follows: 69% grade 1, 36% grade 2, 25% grade 3, 6% grade 4 and 0% grade 5. In 34%, no fetal complications were noted; however, 43% of the fetuses developed a grade 1, 14% a grade 2, 8% a grade 3, 2% a grade 4 and 2% a grade 5 complication. CONCLUSION This study raises awareness of complications following open fMMC repair; 6% of mothers and 2% of fetuses experienced a severe complication (grade 4) and perinatal death rate of 2% was observed (grade 5). These data are useful for prenatal counselling, they help to improve the system of fetal surgical care, and they allow benchmarking with other centres as well as comparison with fetoscopic approaches. TWEETABLE ABSTRACT Systematic classification of all maternal and fetal intervention-related complications following open fMMC repair.
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Affiliation(s)
- L Vonzun
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - M K Kahr
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - F Noll
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland
| | - L Mazzone
- The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.,Department of Paediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - U Moehrlen
- The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.,Department of Paediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Meuli
- The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland.,Department of Paediatric Surgery, University Children's Hospital Zurich, Zurich, Switzerland.,Spina Bifida Centre, University Children's Hospital Zurich, Zurich, Switzerland.,Children's Research Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - M Hüsler
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - F Krähenmann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - R Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
| | - N Ochsenbein-Kölble
- Division of Obstetrics, University Hospital of Zurich, Zurich, Switzerland.,The Zurich Centre for Fetal Diagnosis and Therapy, University of Zurich, Zurich, Switzerland
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Maticic M, Pirnat Z, Leicht A, Zimmermann R, Windelinck T, Jauffret-Roustide M, Duffell E, Tammi T, Schatz E. The civil society monitoring of hepatitis C response related to the WHO 2030 elimination goals in 35 European countries. Harm Reduct J 2020; 17:89. [PMID: 33213481 PMCID: PMC7678126 DOI: 10.1186/s12954-020-00439-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People who inject drugs (PWID) account for the majority of new cases of hepatitis C virus (HCV) infection in Europe; however, HCV testing, and treatment for PWID remain suboptimal. With the advent of direct acting antivirals (DAAs) the World Health Organization (WHO) adopted a strategy to eliminate HCV as public health threat by 2030. To achieve this, key policies for PWID must be implemented and HCV continuum of care needs to be monitored. This study presents results of the first monitoring led by civil society that provide harm reduction services for PWID. METHODS In 2019, harm reduction civil society organizations representing focal points of Correlation-European Harm Reduction Network in 36 European countries were invited to complete a 27-item online survey on four strategic fields: use/impact of guidelines on HCV testing and treatment for PWID, availability/functioning of continuum of care, changes compared to the previous year and, the role of harm reduction services and non-governmental organizations (NGOs) of PWID. A descriptive analysis of the responses was undertaken. RESULTS The response rate was 97.2%. Six countries reported having no guidelines on HCV treatment (17.1%). Twenty-three (65.7%) reported having treatment guidelines with specific measures for PWID; guidelines that impact on accessibility to HCV testing/treatment and improve access to harm reduction services in 95.6% and 86.3% of them, respectively. DAAs were available in 97.1% of countries; in 26.4% of them they were contraindicated for active drug users. HCV screening/confirmatory tests performed at harm reduction services/community centers, prisons and drug dependence clinics were reported from 80.0%/25.7%, 60.0%/48.6%, and 62.9%/34.3% of countries, respectively. Provision of DAAs at drug dependence clinics and prisons was reported from 34.3 to 42.9% of countries, respectively. Compared to the previous year, HCV awareness campaigns, testing and treatment on service providers' own locations were reported to increase in 42.9%, 51.4% and 42.9% of countries, respectively. NGOs of PWID conducted awareness campaigns on HCV interventions in 68.9% of countries, and 25.7% of countries had no such support. CONCLUSION Further improvements in continuum-of-care interventions for PWID are needed, which could be achieved by including harm reduction and PWID organizations in strategic planning of testing and treatment and in efforts to monitor progress toward WHO 2030 elimination goal.
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Affiliation(s)
- M Maticic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia. .,Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia.
| | - Z Pirnat
- Clinic for Infectious Diseases and Febrile Illnesses, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | | | - R Zimmermann
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | - E Duffell
- European Centre for Disease Prevention and Control, Stockholm, Sweden
| | | | - E Schatz
- Correlation-European Harm Reduction Network, Amsterdam, The Netherlands
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Meuli M, Zimmermann R. IFMSS-Dedicated Issue Launched after 38th Annual IFMSS Meeting in Sils, Switzerland. Fetal Diagn Ther 2020; 47:857-858. [PMID: 33147590 DOI: 10.1159/000512198] [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] [Received: 09/15/2020] [Accepted: 09/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Martin Meuli
- Department of Surgery, University Children's Hospital Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Zurich, Switzerland,
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Abstract
INTRODUCTION Maternal mortality is an important indicator for quality control in obstetrics. To improve clinical care, maternal mortality should be assessed periodically. In this study, we analysed maternal mortality cases between 2005 and 2014 in Switzerland and compared them with those in earlier periods. METHODS The Federal Statistical Office (FSO) provided all death certificates between 2005 and 2014 with an ICD-10 code in the obstetric field (indicated with the letter O). Additionally, we included all death certificates that gave a positive answer about pregnancy or birth within the last 42 days. We also included cases where death occurred within 365 days after delivery. For an analysis of underreporting, cases from the Institute of Forensic Medicine (IRM), Zurich, were included. The cases were classified according to ICD-10 as “direct”, “indirect”, “non-pregnancy-related”, and “late” deaths. The direct maternal mortality rate (MMR), and indirect and combined MMRs were calculated. RESULTS We received 117 cases from the FSO, and one additional case was found in the archives of the IRM. Ninety-six cases were eligible for detailed evaluation. As 787,025 live births were recorded between 2005 and 2014 in Switzerland, the direct MMR was 3.30/100,000 live births (26 cases). It has decreased by 20.5% compared with the MMR in 1995–2004 (4.15/100,000 live births, 32 cases; p = n.s.) and by 40.4% compared with the MMR in 1985–1994 (5.54/100,000 live births, 45 cases; odds ratio [OR] 0.6, p = 0.04, 95% confidence interval [CI] 0.37–0.97). The leading cause for direct maternal mortality in the current study period was haemorrhage (nine cases), followed by amniotic fluid embolisms and preeclampsia (five cases each). The indirect MMR was 3.68/100,000 live births. In this group, 13 women committed suicide and 8 women died of complications of pre-existing cardiac pathologies. Suicide was the leading cause of maternal deaths, had suicides been classified as direct obstetric cases. The combined MMR (direct and indirect) was 6.61/100,000 live births (52 cases) (OR 4.8–8.4). Of 41 non-pregnancy-related cases, almost half (20 cases) died of cancer within the first year after delivery. Lethality after caesarean section was 0.008‰ (2/231,385). CONCLUSIONS The trend of reducing direct maternal mortality as well as lethality after caesarean section continues. Haemorrhage is still the leading cause of direct maternal mortality; the rate is similar to what it was in the early 1990s. Indirect maternal mortality is increasing and specifically suicides need special attention. Precise documentation of all maternal deaths is essential to improve outcomes for future mothers.
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Affiliation(s)
- Laura Perotto
- Klinik für Geburtshilfe, Universitätsspital Zürich, Switzerland
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Vonzun L, Winder FM, Meuli M, Moerlen U, Mazzone L, Kraehenmann F, Huesler M, Zimmermann R, Ochsenbein N. Prenatal Sonographic Head Circumference and Cerebral Ventricle Width Measurements Before and After Open Fetal Myelomeningocele Repair - Prediction of Shunting During the First Year of Life. Ultraschall Med 2020; 41:544-549. [PMID: 30347419 DOI: 10.1055/a-0756-8417] [Citation(s) in RCA: 5] [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: 06/08/2023]
Abstract
PURPOSE The aim of this study was to describe the sonographic evolution of fetal head circumference (HC) and width of the posterior horn of the lateral ventricle (Vp) after open fetal myelomeningocele (fMMC) repair and to assess whether pre- or postoperative measurements are helpful to predict the need for shunting during the first year of life. PATIENTS & METHODS All 30 children older than one year by January 2017 who previously had fMMC repair at the Zurich Center for Fetal Diagnosis and Therapy were included. Sonographic evolution of fetal HC and Vp before and after fMMC repair was assessed and compared between the non-shunted (N = 16) and the shunted group (N = 14). ROC curves were generated for the fetal HC Z-score and Vp in order to show their predictive accuracy for the need for shunting until 1 year of age. RESULTS HC was not an independent factor for predicting shunting. However, the need for shunting was directly dependent on the preoperative Vp as well as the Vp before delivery. A Vp > 10 mm at evaluation for fMMC repair or > 15 mm before delivery identifies 100 % of the infants needing shunt placement at a false-positive rate of 44 % and 25 %, respectively. All fetuses with a Vp > 15 mm at first evaluation received a shunt. CONCLUSION Fetuses demonstrating a Vp of > 15 mm before in utero MMC repair are extremely likely to develop hydrocephalus requiring a shunt during the first year of life. This compelling piece of evidence must be appropriately integrated into prenatal counseling.
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Affiliation(s)
- Ladina Vonzun
- Department of Obstetrics, University-Hospital Zürich, Zürich, Switzerland
| | | | - Martin Meuli
- Department of Pediatric Surgery, University-Children's-Hospital Zürich, Zürich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
| | - Ueli Moerlen
- Department of Pediatric Surgery, University-Children's-Hospital Zürich, Zürich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
| | - Luca Mazzone
- Department of Pediatric Surgery, University-Children's-Hospital Zürich, Zürich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
| | - Franziska Kraehenmann
- Department of Obstetrics, University-Hospital Zürich, Zürich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
| | - Margareth Huesler
- Department of Obstetrics, University-Hospital Zürich, Zürich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University-Hospital Zürich, Zürich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
| | - Nicole Ochsenbein
- Department of Obstetrics, University-Hospital Zürich, Zürich Center for Fetal Diagnosis and Therapy, Zürich, Switzerland
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Gromann J, Mancino I, Manegold-Brauer G, Arlettaz R, Zimmermann R, Wellmann S, Burkhardt T. Inzidenz der neonatalen respiratorischen Morbidität nach Spontangeburt und Sectio caesarea bei late-preterm sowie termingeborenen Kindern. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Gromann
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | | | | | - R Arlettaz
- Universitätsspital Zürich, Klinik für Neonatologie
| | - R Zimmermann
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - S Wellmann
- Klinik St. Hedwig, Universitätskinderklinik Regensburg (KUNO), Klinik für Neonatologie
| | - T Burkhardt
- Universitätsspital Zürich, Klinik für Geburtshilfe
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Vonzun L, Mazzone L, Moehrlen U, Meuli M, Krähenmann F, Zimmermann R, Ochsenbein-Kölble N, Horst M. Systematic sonographic bladder volume measurements at evaluation and directly after fetal myelomeningocele repair – is bladder function predictable? Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L Vonzun
- Universität Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
| | - L Mazzone
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
- Kinderspital Zürich, Chirurgische Klinik
- Spina Bifida Center, University Children’s Hospital
| | - U Moehrlen
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
- Kinderspital Zürich, Chirurgische Klinik
- Spina Bifida Center, University Children’s Hospital
| | - M Meuli
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
- Kinderspital Zürich, Chirurgische Klinik
- Spina Bifida Center, University Children’s Hospital
| | - F Krähenmann
- Universität Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
| | - R Zimmermann
- Universität Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
| | - N Ochsenbein-Kölble
- Universität Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy, Univeristy of Zurich
| | - M Horst
- Kinderspital Zürich, Chirurgische Klinik
- Spina Bifida Center, University Children’s Hospital
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Zupan R, Meuli M, Möhrlen U, Mazzone L, Krähenmann F, Hüsler M, Zimmermann R, Ochsenbein-Kölble N. Reproductive outcomes after fetal myelomeningocele repair. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- R Zupan
- Klinik für Geburtshilfe, UniversitätsSpital Zürich
| | | | | | | | - F Krähenmann
- Klinik für Geburtshilfe, UniversitätsSpital Zürich
| | - M Hüsler
- Klinik für Geburtshilfe, UniversitätsSpital Zürich
| | - R Zimmermann
- Klinik für Geburtshilfe, UniversitätsSpital Zürich
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Rüegg L, Hüsler M, Krähenmann F, Zimmermann R, Natalucci G, Ochsenbein-Kölble N. Long-term outcome of monochorionic twins after fetoscopic laser therapy compared to matched dichorionic twins. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- L Rüegg
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - M Hüsler
- Universitätsspital Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy
| | - F Krähenmann
- Universitätsspital Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy
| | - R Zimmermann
- Universitätsspital Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy
| | - G Natalucci
- Universitätsspital Zürich, Klinik für Neonatologie
- Universität Zürich, Larsson-Rosenquist Centre for Neurodevelopment, Growth and Nutrition of the Newborn
- Kinderspital Zürich, Child Development Centre
| | - N Ochsenbein-Kölble
- Universitätsspital Zürich, Klinik für Geburtshilfe
- Zurich Center for Fetal Diagnosis and Therapy
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Birri J, Kreft M, Zimmermann R, Kimmich N. Assoziation zwischen der betroffenen Seite der Levatormuskelverletzung und der fetalen Position bei Geburt – eine prospektive Observationsstudie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- J Birri
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - M Kreft
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - R Zimmermann
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - N Kimmich
- Universitätsspital Zürich, Klinik für Geburtshilfe
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Noll F, Taran FA, Schmid M, Fontijn J, Zimmermann R, Ochsenbein-Kölble N. SARS-CoV-2 in der Frauenklinik des UniversitätsSpital Zürich. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- F Noll
- Klinik für Geburtshilfe, Universitätsspital Zürich
| | - F.-A Taran
- Klnik für Gynäkologie, Universitätsspital Zürich
| | - M Schmid
- Klinik für Neonatologie, Universitätsspital Zürich
| | - J Fontijn
- Klinik für Neonatologie, Universitätsspital Zürich
| | - R Zimmermann
- Klinik für Geburtshilfe, Universitätsspital Zürich
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Richter A, Birri J, Kreft M, Zimmermann R, Kimmich N. Prädiktion von Levatoravulsionen anhand sichtbarer Geburtsverletzungen – eine prospektive Kohortenstudie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- A Richter
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - J Birri
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - M Kreft
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - R Zimmermann
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - N Kimmich
- Universitätsspital Zürich, Klinik für Geburtshilfe
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45
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Kimmich N, Birri J, Kreft M, Zimmermann R. Assoziation zwischen Levatoravulsionen und der technischen Ausführung von Vakuumextraktionen – eine prospektive Observationsstudie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- N Kimmich
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - J Birri
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - M Kreft
- Universitätsspital Zürich, Klinik für Geburtshilfe
| | - R Zimmermann
- Universitätsspital Zürich, Klinik für Geburtshilfe
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Rüegg L, Hüsler M, Krähenmann F, Zimmermann R, Natalucci G, Ochsenbein-Kölble N. Long-Term Outcome of Monochorionic Twins after Fetoscopic Laser Therapy Compared to Matched Dichorionic Twins. Fetal Diagn Ther 2020; 47:947-954. [PMID: 32877900 DOI: 10.1159/000509400] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 06/06/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The only causal therapy is fetoscopic laser surgery (FLS). The aims of this study were to analyze the long-term outcome of monochorionic twins treated by FLS, including their school career, need for therapy and special aid equipment, and free-time activities, and compare their outcome to matched dichorionic twins. MATERIAL AND METHODS Among the 57 women treated at a single fetal treatment center between 2008 and 2017 with FLS because of twin-to-twin transfusion syndrome, 25 women with 42 children were included in the FLS group. The control group consisted of 16 dichorionic twin pairs matched for birth year, gestational age (GA), birth weight, and sex. The long-term outcome was assessed by a parental questionnaire and a standardized neurodevelopmental examination for children born before 32 gestational weeks or with a birth weight lower than 1500 g. They were also registered into the Swiss Neonatal Network database. The primary outcome was event-free survival, defined as normal neurology, behavior, vision, and hearing. The secondary outcomes were school career, need for therapy and special aid equipment, and free-time activities. RESULTS An event-free survival was found in 32 children (76%) in the laser and in 24 children (75%) in the control group (p = 0.91). Neurological anomalies were found in 5 children (12%) in the laser group and 3 children (9%) in the control group (p = 1.00). Multiple logistic regression analysis showed that GA at delivery was the only predictive factor for event-free survival. There were no significant differences regarding school career, therapies, or special aid equipment between the 2 groups. We found that children without FLS were involved in more free-time activities and needed fewer breaks during physical activity than children with FLS during pregnancy. CONCLUSION The outcome of monochorionic twins treated with FLS is comparable to the outcome of dichorionic twins. Long-term neurodevelopment in the cohort was mainly dependent on GA at birth.
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Affiliation(s)
- Ladina Rüegg
- Department of Obstetrics, University Hospital Zurich, Zurich City, Switzerland
| | - Margaret Hüsler
- Department of Obstetrics, University Hospital Zurich, Zurich City, Switzerland.,Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Franziska Krähenmann
- Department of Obstetrics, University Hospital Zurich, Zurich City, Switzerland.,Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Roland Zimmermann
- Department of Obstetrics, University Hospital Zurich, Zurich City, Switzerland.,Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland
| | - Giancarlo Natalucci
- Department of Neonatology, University of Zurich and University Hospital Zurich, Zurich, Switzerland.,Larsson-Rosenquist Centre for Neurodevelopment, Growth and Nutrition of the Newborn, University of Zurich, Zurich, Switzerland.,Child Development Centre, University Children's Hospital Zurich, Zurich, Switzerland
| | - Nicole Ochsenbein-Kölble
- Department of Obstetrics, University Hospital Zurich, Zurich City, Switzerland, .,Zurich Center for Fetal Diagnosis and Therapy, Zurich, Switzerland,
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Kreft M, Zimmermann R, Kimmich N. Birth tears after spontaneous and vacuum-assisted births with different vacuum cup systems - a retrospective cohort study. J Perinat Med 2020; 48:575-581. [PMID: 32333651 DOI: 10.1515/jpm-2019-0477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 03/23/2020] [Indexed: 11/15/2022]
Abstract
Objectives Birth tears are a common complication of vaginal childbirth. We aimed to evaluate the outcomes of birth tears first by comparing the mode of vaginal birth (VB) and then comparing different vacuum cups in instrumental VBs in order to better advise childbearing women and obstetrical professionals. Methods In a retrospective cohort study, we analyzed nulliparous and multiparous women with a singleton pregnancy in vertex presentation at ≥37 + 0 gestational weeks who gave birth vaginally at our tertiary care center between 06/2012 and 12/2016. We compared the distribution of tear types in spontaneous births (SBs) vs. vacuum-assisted VBs. We then compared the tear distribution in the vacuum group when using the Kiwi Omnicup or Bird's anterior metal cup. Outcome parameters were the incidence and distribution of the different tear types dependent on the mode of delivery and type of vacuum cup. Results A total of 4549 SBs and 907 VBs were analyzed. Birth tear distribution differed significantly between the birth modes. In 15.2% of women with an SB an episiotomy was performed vs. 58.5% in women with a VB. Any kind of perineal tear was seen in 45.7% after SB and in 32.7% after VB. High-grade obstetric anal sphincter injuries (OASIS) appeared in 1.1% after SB and in 3.1% after VB. No significant changes in tear distribution were found between the two different VB modes. Conclusions There were more episiotomies, vaginal tears and OASIS after VB than after SB. In contrast, there were more low-grade perineal and labial tears after SB. No significant differences were found between different vacuum cup systems, just a slight trend toward different tear patterns.
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Affiliation(s)
- Martina Kreft
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
| | - Nina Kimmich
- Division of Obstetrics, University Hospital of Zurich, Frauenklinikstrasse 10, 8091 Zurich, Switzerland
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Kimmich N, Birri J, Zimmermann R, Kreft M. Association between levator ani muscle avulsions and technique of vacuum extraction - a prospective exploratory study. Swiss Med Wkly 2020; 150:w20280. [PMID: 32658301 DOI: 10.4414/smw.2020.20280] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY Trauma of the levator ani muscle in the form of partial or complete avulsions is common after vaginal births, especially after vaginal-operative births. As there is little information available regarding associations between the technique of vaginal-operative births and levator ani muscle trauma, we aimed to evaluate the association between the process of vacuum extraction and the occurrence of levator ani muscle trauma. METHODS As part of a prospective cohort study at the University Hospital of Zurich between March 2017 and April 2019, we sub-analysed vacuum extractions in nulliparous women with singletons in vertex presentation ≥36+0 gestational weeks. We evaluated their pelvic floor for partial and complete levator ani muscle avulsions using translabial ultrasound 6–10 weeks postpartum and calculated the association of the vacuum procedure itself, along with other fetal, maternal and obstetrical characteristics, with levator ani muscle trauma. RESULTS Levator ani muscle trauma was present in 17 (34.7%) out of 49 women. There were no associations between the different factors evaluated and levator ani muscle trauma in vacuum-assisted births, except that the levator ani muscle group had insufficient uterine contractions. CONCLUSIONS We found no fetal, maternal or obstetrical characteristics or parameters of vacuum technique that were associated with the occurrence of levator ani muscle trauma after vacuum extraction, except for insufficient uterine contractions. Nevertheless, there might be influencing factors that have not yet been evaluated, or are not easily accessible for evaluation, like the adaptations of the fetus inside the birth canal and within the hiatus of the levator ani muscle, and the adaptations of the birth canal to the fetus passing through. This should be the subject of further research with a sample size adequately powered to answer this question properly. (Trial registration number: BASEC-Nr.2016-00908.)  .
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Affiliation(s)
- Nina Kimmich
- Division of Obstetrics, University Hospital Zurich, Switzerland
| | - Jana Birri
- Division of Obstetrics, University Hospital Zurich, Switzerland
| | | | - Martina Kreft
- Division of Obstetrics, University Hospital Zurich, Switzerland
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Egli C, Kimmich N, Zimmermann R, Kreft M. [Placental Locations in Subsequent Pregnancies - A Retrospective Study]. Z Geburtshilfe Neonatol 2020; 225:60-69. [PMID: 32590876 DOI: 10.1055/a-1174-8659] [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: 10/24/2022]
Abstract
INTRODUCTION Different locations of the placenta are associated with specific risks during pregnancy and labor. Knowledge of the placental location helps to provide better care for the expectant mother and her unborn child. Whereas multiple studies show a higher risk for a recurrent placenta previa, hardly any such data is available for any other placental location. The aim of this study was to analyze the frequency of distribution of different placental locations and to evaluate correlations between placental locations in subsequent pregnancies. MATERIAL AND METHODS In a retrospective cohort study women with singleton pregnancies ≥ 24 gestational weeks who had at least one ultrasound with identification of the placental location and gave birth to their firstborn and at least one more following child at our hospital between 2007 and 2016 were evaluated. Exclusion criteria were multiple pregnancies, abortions, intrauterine fetal death, and fetal malformations. Placental locations were classified into anterior, posterior, fundal, right, left, and previa. RESULTS Data of 1657 women were analyzed. The most frequent location was anterior, followed by posterior, fundal and lateral, and previa. Statistical analysis showed no significant correlations in subsequent pregnancies regarding placental locations. CONCLUSION Placental locations in subsequent pregnancies seem not to be influenced by previous pregnancies. Therefore no prognosis for placental location can be made concerning future pregnancies.
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Affiliation(s)
- Corina Egli
- Klinik für Geburtshilfe, UniversitätsSpital Zürich, Zürich, Schweiz
| | - Nina Kimmich
- Klinik für Geburtshilfe, UniversitätsSpital Zürich, Zürich, Schweiz
| | | | - Martina Kreft
- Klinik für Geburtshilfe, UniversitätsSpital Zürich, Zürich, Schweiz
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Oneda B, Sirleto P, Baldinger R, Taralczak M, Joset P, Zweier M, Niedrist D, Azzarello-Burri S, Britschgi C, Breymann C, Ochsenbein-Kölble N, Burkhardt T, Wisser J, Zimmermann R, Steindl K, Rauch A. Genome-wide non-invasive prenatal testing in single- and multiple-pregnancies at any risk: Identification of maternal polymorphisms to reduce the number of unnecessary invasive confirmation testing. Eur J Obstet Gynecol Reprod Biol 2020; 252:19-29. [PMID: 32619881 DOI: 10.1016/j.ejogrb.2020.05.070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 05/29/2020] [Accepted: 05/31/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Non-invasive prenatal testing by targeted or genome-wide copy number profiling (cnNIPT) has the potential to outperform standard NIPT targeting the common trisomies 13, 18, and 21, only. Nevertheless, prospective results and outcome data on cnNIPT are still scarce and there is increasing evidence for maternal copy number variants (CNVs) interfering with results of both, standard and cnNIPT. STUDY DESIGN We assessed the performance of cnNIPT in 3053 prospective and 116 retrospective cases with special consideration of maternal CNVs in singleton and multiple gestational pregnancies at any risk, as well as comprehensive follow-up. RESULTS A result was achieved in 2998 (98.2%) of total prospective cases (89.2% analyzed genome-wide). Confirmed fetal chromosomal abnormalities were detected in 45 (1.5%) cases, of which five (11%) would have remained undetected in standard NIPTs. Additionally, we observed 4 likely fetal trisomies without follow-up and a likely phenotype associated placental partial trisomy 16. Moreover, we observed clinically relevant confirmed maternal CNVs in 9 (0.3%) cases and likely maternal clonal hematopoiesis in 3 (0.1%). For common fetal trisomies we prospectively observed a very high sensitivity (100% [95% CI: 91.96-100%]) and specificity (>99.9% [95% CI: 99.8-100%]), and positive predictive value (PPV) (97.8% [95% CI: 86.1-99.7%]), but our retrospective control cases demonstrated that due to cases of fetal restricted mosaicism the true sensitivity of NIPT is lower. After showing that 97.3% of small CNVs prospectively observed in 8.3% of genome-wide tests were mostly benign maternal variants, sensitivity (75.0% [95% CI: 19.4%-99.4%]), specificity (99.7% [99.5%-99.9%]) and PPV (30.0% [14.5%-52.1%]) for relevant fetal CNVs were relatively high, too. Maternal autoimmune disorders and medication, such as dalteparin, seem to impair assay quality. CONCLUSION When maternal CNVs are recognized as such, cnNIPT showed a very high sensitivity, specificity and PPV for common trisomies in single and multiple pregnancies at any risk and very good values genome-wide. We found that the resolution for segmental aberrations is generally comparable to standard karyotyping, and exceeds the latter if the fetal fraction is above 10%, which allows detection of the 2.5 Mb 22q11.2 microdeletion associated with the velocardiofacial syndrome, even if the mother is not a carrier.
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Affiliation(s)
- Beatrice Oneda
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland.
| | - Pietro Sirleto
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Rosa Baldinger
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | | | - Pascal Joset
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Markus Zweier
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Dunja Niedrist
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | | | - Christian Britschgi
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | | | - Nicole Ochsenbein-Kölble
- Division of Obstetrics, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Tilo Burkhardt
- Division of Obstetrics, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Josef Wisser
- Division of Obstetrics, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Roland Zimmermann
- Division of Obstetrics, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Katharina Steindl
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
| | - Anita Rauch
- Institute of Medical Genetics, University of Zurich, Zurich, Switzerland
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