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Biomedical subjects

C Brezinka

Publications and source records attributed to C Brezinka.

At least 19 recordsLinked to original sources
PubMed2006

Unusual manifestation of acute hepatic porphyria in pregnancy.

A 22-year-old para I/gravida II developed psychiatric symptoms at 8 weeks of gestation. Subsequently neurological symptoms with seizures developed leading to a status epilepticus with continuing seizures at week 14. Anticonvulsive therapy had little effect in alleviating the seizures and the condition of the patient rapidly deteriorated. A sudden reddening of her urine lead to the diagnosis of acute hepatic porphyria confirmed by laboratory tests. After extensive discussion with the patient's family it was decided to terminate the pregnancy at week 16. Within hours after pregnancy termination the seizures stopped and the patient recovered without any neurological deficits. Acute hepatic porphyria can be triggered by pregnancy and usually presents with gastrointestinal symptoms and personality changes. In its rare neurological manifestation it can lead to untreatable convulsions which leave no option but to terminate the pregnancy.

Abortion, Induced↗
PubMed2005

[Anonymous birth and neonaticide in Tyrol].

BACKGROUND: In 2001 the Austrian government provided the legal means that formally enabled "anonymous birth": a woman can now give birth in any hospital in Austria without giving her name or insurance number, the baby is taken into care by social services and placed with adoptive parents. The cost of the hospital stay is covered from public funds. These measures were put into effect after some highly publicized cases of infant abandonment and neonaticide in Austria. METHODS: In the mostly rural and small-town province of Tyrol province in western Austria (687,000 inhabitants, 7000 births per year) four cases of neonaticide were discovered in the years from 1996 to 2004. One child was abandoned inside a hospital. Since 2001 two women have made use of the "anonymous birth" option. Neither had had any pregnancy controls, both showed up at or near term with contractions. They delivered healthy infants that were then taken into care by local adoption services. Both women were extensively counselled by psychologists, social workers, medical and midwifery staff and both insisted on their original decision to remain anonymous. A few weeks later one of the women found herself at the centre of a criminal investigation for infanticide after anonymous letters were sent to family members insinuating she had done away with the child. Police stopped that investigation when hospital staff confirmed that the woman had had an "anonymous" delivery. RESULTS: Despite the option of legal "anonymous" birth free of charge in modern hospitals there are still cases of infant abandonment and neonaticide in Austria. It is proposed that the women who opt for anonymous birth may not be the women who would otherwise kill their babies. Instead, it appears that the women opted for anonymity to escape the probably well-intentioned but overbearing attention of their families and of social services. It is doubtful that the option of anonymous birth will lead to a complete disappearance of infanticide and infant abandonment in Austria.

Adoption↗
PubMed2004

Prenatal diagnosis of intrauterine premature closure of the ductus arteriosus following maternal diclofenac application.

We report a case of prenatal diagnosis of premature closure of the ductus arteriosus following maternal diclofenac therapy at 35 weeks of gestation. Fetal echocardiography at 37 weeks of gestation revealed a dilated right ventricle with moderate tricuspid regurgitation, pulmonary insufficiency and complete closure of the ductus arteriosus. Immediate Cesarean section resulted in an excellent neonatal outcome. Whereas the effect of indomethacin on prenatal ductal constriction is well known, widely prescribed non-steroidal anti-inflammatory drugs such as diclofenac can have an equally deleterious effect and are best avoided in the third trimester of pregnancy.

Adult↗
PubMed2003

[Water Birth: experience at a university clinic and a district hospital in Austria].

PURPOSE AND METHODS: In a retrospective case-control study, 265 water deliveries (with cephalic presentation) carried out at an Austrian university clinic and a district hospital were compared with a group of spontaneous births (without any surgical intervention) matched for age, gestational age and parity regarding the most important fetal and maternal obstetric parameters. RESULTS: 4.3% of all births at the university clinic and 13% of those at the district hospital took place in the water. Austrian women and women with a higher educational level were more numerous in this group. The duration of the different stages of birth was not essentially changed by the delivery in water. The cord blood pH of the water babies (median 7.29 and 7.35, respectively) was better than that of the control group (median 7.26), which may however be due to a positive selection of the women giving birth in the water. The number of episiotomies was markedly lower for water births (14 and 4%) than for land births (48%). In contrast, water births showed distinctly more first- and second-degree perineal tears (36 and 41%) and labial tears (23 and 21%) than the control group (perineal 23%; labial 7%). Women assigned to water birth needed fewer analgesics (8 and 9%) than the controls (64%). In puerperium, the haemoglobin values after water birth and after land birth did not differ. The infectious morbidity of the mother and child was not higher after water birth. CONCLUSIONS: Water birth is to be considered a safe method for a healthy mother and a healthy, full-term fetus with cephalic presentation (if the appropriate criteria are used at hospital wards with a specific infrastructure).

Adult↗
PubMed2001

Long-term follow-up of children with prenatally diagnosed omphalocele and gastroschisis.

OBJECTIVE: The aim of this study was to follow up the 19 infants born in Tyrol province with abdominal wall defects between 1985 and 1996 whose malformation had been diagnosed prenatally, who were operated on immediately postpartum and who are alive today. METHOD: There were seven children in the omphalocele group and 12 in the gastroschisis group; 18 parents of affected infants took part in the study. RESULTS: Four out of seven children with omphalocele had major associated malformations (two Beckwith-Wiedemann syndrome, one porencephalic cyst, one with skeletal defects). These children presented handicaps related to the associated malformations but not to the abdominal wall defect. The three other children with omphalocele are developing normally. Five out of 11 children with gastroschisis had associated intestinal but no extraintestinal malformations. After discharge, ten of 11 children with gastroschisis were developing normally; one child shows signs of mental retardation. Of 14 mothers who had originally planned another pregnancy prior to the birth of the malformed child, nine decided against becoming pregnant again; the others delayed a further pregnancy for several years. CONCLUSIONS: In our group, associated malformations were the main factor affecting the long-term quality of life of children with omphalocele and gastroschisis. Although most of the children were developing normally, fear of a repetition of the malformation in a subsequent pregnancy dominated reproductive choices in all couples.

Abortion, Induced↗
PubMed2001

Fetal hemodynamics.

Starting in the left cardiac ventricle the reader is taken on a guided tour on a fetal erythrocyte as measured by Doppler ultrasound. Up in the ascending aorta we move through the aortic isthmus to the descending aorta and the internal umbilical arteries, which fuse around the umbilical cord. With fresh oxygen from the placenta our erythrocyte moves in an accelerating continuous flow along the umbilical vein to the ductus venosus. After having reached the left ventricle again it now passes through a coronary artery to the right atrium and eventually the ductus arteriosus or the pulmonary circulation. Concepts of pulsatility, impedance and resistance are presente in the context of their clinical applicability in Doppler waveforms of various fetal vessels.

Aorta, Thoracic↗
PubMed2000

Superfecundation and dual paternity in a twin pregnancy ending with placental abruption.

A case of superfecundation and dual paternity in a twin pregnancy is presented. Placental abruption developed at week 33 of gestation and the two boys had to be saved by emergency cesarean section. As they shared one placenta, had almost identical weight and had the same sex, they were assumed to be monozygotic. However, a subsequent paternity suit led to the conclusion, based on DNA-analysis, that the twin brothers had been fathered by two different men. Obstetrical implications are discussed.

Abruptio Placentae↗
PubMed1999

Fetal pulmonary venous flow into the left atrium relative to diastolic and systolic cardiac time intervals.

OBJECTIVE: To establish the nature and gestational age dependency of the pulmonary venous flow velocity pattern into the left atrium relative to systolic and diastolic phases of the cardiac cycle. DESIGN: This was a cross-sectional study of Doppler measurements of fetal pulmonary venous inflow velocities, which were correlated with simultaneous recordings of transmitral and aortic flow velocity waveforms based on an equal cardiac cycle length (+/- 5%). RESULTS: Successful recordings were obtained in 28 out of 60 (47%) normal singleton pregnancies at 20-36 weeks of gestation. Reproducibility of waveform analysis of the various phases of the cardiac cycle was satisfactory, within-patient variance ranging between 1.7% and 6.5%. A statistically significant increase (p < 0.05) in pulmonary venous time average velocity and velocity integral with advancing gestational age was established. A statistically significant increase (p < 0.05) of the pulmonary flow velocity integral was also found when related to each of the systolic and diastolic segments of the cardiac cycle, with the exception of isovolemic relaxation time. The duration of each of the diastolic and systolic segments of the cardiac cycle, as well as the pulmonary venous velocity integral expressed as a percentage of the cardiac cycle, remained constant with advancing gestational age. CONCLUSIONS: The second half of pregnancy is characterized by pulmonary venous inflow into the left atrium throughout the cardiac cycle. Pulmonary venous inflow into the left atrium occurs predominantly during the filling and ejection phases of the cardiac cycle. Absolute cardiac diastolic and systolic time intervals as well as the percentage distribution of pulmonary venous flow velocity integrals between these cardiac time intervals remain unchanged with advancing gestational age.

Adolescent↗
PubMed1998

[Precautionary maternity leave in Tirol].

Under Austrian law, precautionary maternity leave is a decree issued by the district public health physician. It forbids a pregnant woman to work and mandates immediate maternity leave. Regular maternity leave for all women employed in all jobs begins at 32 weeks of gestation. Women who work in workplaces deemed dangerous and women with a history of obstetric problems such as premature or growth-retarded babies from previous pregnancies are regularly 'sent' into precautionary maternity leave. The public health physicians of Tirol's nine administrative districts were interviewed and supplied data on precautionary maternity leave from their districts. In 100 women who attended the clinic for pregnancies at risk of the Obstetrics/Gynecology Department of Innsbruck University Hospital and who had already obtained precautionary maternity leave, the medical/administrative procedure was studied in each case and correlated with pregnancy outcome. The town district of Innsbruck and the district that comprises the suburbs of the provincial capital had the highest rates of precautionary maternity leave. The town district of Innsbruck had a rate of 24.3% of all pregnant women (employed and not employed) in precautionary maternity leave in 1997, whereas the whole province of Tirol had 13.4%. More than 80% of decrees for precautionary maternity leave are issued by district public health physicians on the basis of written recommendations from gynecologists. One third of women who are sent into precautionary maternity leave are issued the decree prior to 12 weeks of gestation - mostly cases of multiple pregnancies and women with previous miscarriages. The present system of precautionary maternity leave appears to work in the sense that most working pregnant women with risk factors are correctly identified - with most errors on the side of caution. As the system also helps employers - the employee's pay is paid from the federal family support fund and state insurance once she is in precautionary maternity leave - little effort is made to find a low-risk workplace for a pregnant employee.

Austria↗
PubMed1998

[Omphalocele and gastroschisis in Tirol-incidence and epidemiology 1985-1996].

There are basic differences between the Dutch and the Austrian systems of prenatal care, care during birth and postpartum care: whereas in the Netherlands every effort is made to keep care within the bounds of the eerste lijn - primary health care with midwives and general practitioners as primary providers - in Austria the federal 'family relief fund' and the 'mother and child passport' program have created an elaborate system in which care during pregnancy is not only free but providing antenatal care brings extra payments to the doctor and taking it brings extra money to the pregnant woman. The workings of both systems and the roles of midwives, doctors, hospitals and health insurers are explained and discussed.

Adolescent↗
PubMed1998

[Epidermal growth factor during pregnancy- a predictor of fetal growth retardation?].

Epidermal growth factor (EGF) in urine was measured at 4-week intervals in 83 women referred for suspected intrauterine growth retardation (IUGR); 138 women with normal singleton pregnancies and newborns of normal weight served as controls. Of the 83 women, 30 delivered babies with weight below the 10th percentile after week 37. During pregnancy these women had shown significantly lower EGF levels than women who delivered normal-weight babies. However, due to the wide distribution of individual EGF data, no clear clinical cut-off point between normal and IUGR values could be established.

Epidermal Growth Factor↗
PubMed1998

Vibroacoustic Stimulation of the Fetus Using a Conventional Mechanical Alarm Clock.

> Objective: For more than 20 years, vibroacoustic stimulation testing (VAST) using an artificial larynx has been used worldwide when fetal heart rate monitoring produced patterns with absent or very low variability. In addition to the artificial larynx many other appliances have been used to stimulate a seemingly dormant fetus, but these have rarely been evaluated properly. In this study we tried to evaluate the use of standard mechanical wind-up alarm clocks for VAST. Methods: VAST with an alarm clock was performed successfully in 80 women with normal pregnancies from 36 weeks to term. It was tested by placing the alarm clock on the maternal abdomen just above the fetal head or on the controlateral side of the maternal abdomen to see whether position made any difference and whether coupling with ultrasound gel applied between the alarm clock and the maternal abdomen would affect the degree of fetal reaction to VAST as expressed in heart rate acceleration. Similarly, the effect of the alarm clock VAST on subjective and objective fetal movement patterns as registered by kineto-cardiotocotraphy (K-CTG) in addition to heart rate patterns was investigated. Results: All fetuses showed heart rate acceleration, an increase in heart variability, and increase in movement patterns in the 6 min after the application of alarm clock VAST. No statistically significant difference was found which would favor a particular placement of the alarm clock on the maternal abdomen or the use of ultrasound coupling gel. When K-CTG was performed, patient-perceived fetal movements as expressed with an event marker showed agreement with the machine-registered movements only when patients could see the tracing during registration and no accordance when the K-CTG was turned toward the wall during registation. Conclusion: In keeping with the ALARA principle a conventional wind-up alarm clock appears to be an inexpensive and effective alternative to the electrolarynx.

Journal Article↗
PubMed1997

[The fetus and noise].

From 23 weeks of gestation some and from 28 weeks all healthy fetuses are capable of reacting to sound stimulation. The intrauterine acoustic environment is dominated by maternal sounds--heartbeat, breathing, the mother's voice, borborygmi and sounds caused by body movements. Background noise is never below 28 dB and can rise to 84 dB when the mother is singing. Noises that are meant to reach the fetus must be louder than the background noise and must be of low frequency as high frequency sounds are damped by maternal tissue. Vibroacoustic stimulation tests (VAST) have become popular in pregnancy surveillance over the last 20 years, mostly using an artificial larynx. Advantages and problems of the various VAST protocols in fetal monitoring are discussed in the light of animal experiments and clinical studies. Health legislation laws in most countries forbid pregnant women to work in surroundings with a high noise level (80 dB continuous noise and/or rapid impulse noise changes of 40 dB). Whereas regulations for pregnant women are easy to enforce in industry, pregnant women employed in discos or performing as musicians spend most of their working day exposed to noise impact higher than the recommended limit.

Animals↗