[Quality demands on continuing differential diagnostic sonography in prenatal diagnostics (DEGUM stage II) during the 18th to 22nd weeks of gestation].
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Congenital Abnormalities↗
Biomedical subjects
K H Eichhorn
Publications and source records attributed to K H Eichhorn.
Does recombinant human erythropoietin not only treat anemia but reduce postpartum (emotional) distress as well?
Based on the established rhEPO treatment of anemia in endstage renal failure, which results in improved quality of life, and on the clinical observation that patients with postpartum anemia treated with rhEPO seemed to gain a more stable mood, we inferred that there is a beneficial side-effect of rhEPO on postpartum blues. The aim of this study was to test the hypotheses 1) that postpartum anemia aggravates, and 2) that treatment of postpartum anemia with rhEPO reduces maternity blues. The results show that on the fifth day postpartum anemic patients score consistently worse than nonanemic women on the Symptom Checklist SCL-90-R, indicating more symptoms and distress in general, and also more symptoms characteristic of maternity blues (p < 0.05). On a "Blues Questionnaire," postpartum anemia expresses itself with a reduced "well-being" (p < 0.001). Thus, our first hypothesis was verified. There were no differences by the fifth day postpartum between anemic patients receiving either rhEPO or placebo. Our second hypothesis was thus not confirmed within this limited time. We conclude as clinicians that postpartum anemia should be treated effectively to reduce distress and hence the risk for postpartum affective disorders. Follow-up studies after rhEPO treatment beyond the first week post partum are needed. In addition, in investigations on postpartum affective disorders, the hemoglobin concentration should be considered.
Anemia↗
Lack of associations between fetal and maternal serum-erythropoietin at birth.
Erythropoietin (EPO) is known to be the main regulator of erythropoiesis. We wanted to determine whether EPO production during pregnancy takes place independently in the mother and the fetus, and to identify the factors which set the EPO level. Endogenous EPO levels were determined in simultaneous samples from the umbilical vein, the umbilical artery and a maternal vein in 126 mother-child pairs and simultaneously from amniotic fluid (n = 14) in unselected births. Results were related to clinical and biochemical parameters of fetal well-being, mode of delivery, duration of labor, and infant parameters at birth. There was a weak correlation between maternal and fetal log EPO values (umbilical vein: r2 = 0.11; umbilical artery: r2 = 0.08), but a highly significant correlation between log EPO levels in the two umbilical vessels (r2 = 0.91) and between both umbilical blood and amniotic fluid (r2 = 0.41). Maternal EPO levels were lower than fetal levels in 76 cases, higher in 47, and nearly identical in 3. Increased fetal EPO levels were associated with clinical and biochemical indicators of fetal stress. These associations help to explain why EPO concentrations in fetal blood are independent of maternal levels and also indicate that EPO does not cross the placental barrier. These findings are discussed in the light of the animal experimental and in vitro evidence for placental transfer of EPO. Our data, and the work of others, make such a transfer in humans quite unlikely. This observation has therapeutical consequences for the treatment of maternal anemia with recombinant human EPO.
Amniotic Fluid↗
[Correlation between reduced amniotic fluid volume and Doppler spectra of fetal blood vessels at term].
The aim of this study was to determine, whether foetuses with reduced amniotic fluid in other-wise uncomplicated pregnancies at term show signs of redistribution of blood flow analogous to foetuses with intrauterine growth retardation. In 33 pregnancies > or = 37 gestational weeks with the largest pocket of amniotic fluid < 2 cm, flow velocity waveforms were recorded for the umbilical artery, middle cerebral artery and renal artery and compared with those of foetuses of the same gestational age and normal amniotic fluid volume. No difference was found in the resistance index (umbilical artery and middle cerebral artery), the pulsatility index (renal artery), or for the cerebral-placental ratio between these two collectives. We conclude, that Doppler examination of foetal vessels does not help to clarify the phenomenon of decreasing amniotic fluid volume during the final period of gestation. We suggest, that the decrease is not caused by renovascular changes, but has intra- or extrarenal causes.
Amniotic Fluid↗
Doppler ultrasound examination of fetal renal arteries.
This study used color Doppler imaging to establish the normal values of the pulsatility index in the fetal renal arteries in a group of 304 uncomplicated singleton pregnancies. The measurements were taken between 26 and 42 weeks of gestation. The median was 2.79 (95% confidence interval: 2.72-2.86) for 26 weeks' gestation, and it then fell linearly to 1.96 (95% confidence interval: 1.92-2.00) at 40 weeks. Compared with values published so far in the literature, the range was clearly smaller. These normal values could be used as a basis for further investigations on these vessels.
Journal Article↗
Recombinant human erythropoietin in the treatment of postpartum anemia.
Postpartum maternal anemia (hemoglobin concentration below 10 g/dL) is a common problem in obstetrics. Human recombinant erythropoietin, which has been shown to correct the anemia of end-stage renal disease and eliminate the need for transfusions, was used in a comparative study of women with postpartum hemoglobin concentrations below 10 g/dL. Five daily doses of 4000 IU were given. Hematologic and clinical data were compared on days 5, 14, and 42 after therapy in the treated women and in untreated women. Both groups received the same iron and folic acid supplements. Significantly greater increases in reticulocytes, hemoglobin, and hematocrit were seen by day 5 for the treated subjects compared with controls. Ferritin levels were significantly lower in the therapy group than in controls. No differences were seen between the groups in the platelet counts or clinical characteristics. No negative side effects were observed. As in other studies in populations without renal disease, recombinant human erythropoietin enhanced endogenous erythropoiesis over and above the normal physiologic recovery rate.
Anemia↗
[Fetal triploidy--diagnosis and sequelae].
A pregnancy in the 22nd week of gestation with severe asymmetric retardation of growth without malformations by ultrasonography is described. A triploidy was found by prenatal cytogenetic investigation. Possible signs for triploidy in pregnancy and the necessary conclusions are discussed.
Abnormalities, Multiple↗
[The correlation of reduced amniotic fluid volume, placental maturity and morphologic placental changes in placental insufficiency].
A reduced quantity of amniotic fluid is diagnosed semiquantitatively in 41 pregnant women in the 38th to 40th week of gestation. In 21 cases, the birth of a mature hypotrophic child below the 10th weight percentile is registered. Sonographically, the placentas of the mature eutrophic children significantly more frequently show a grade III maturity and the placentas of the mature hypotrophic children a grade II maturity. In contrast to the values found in the placentas of eutrophic children and in the placentas with grade III maturity, a significantly decreased villous vascularization is determined in the placentas of hypotrophic children and in placentas with grade II maturity. The area of attachment of the placenta is 301 cm2 for the eutrophic children and 222 cm2 for the hypotrophic children. All findings are discussed and compared with the relevant data of the pertinent literature.
Amniotic Fluid↗
[Movement and heart acceleration behavior of eutrophic fetuses in the early and late dilatation period].
The degree of fetal respiratory and body movements as well as of fetal heart rate reactivity was checked by synchronous ultrasonic and cardiographic monitoring of 18 normotrophic fetuses in the early and late dilation period. Apart from the fetal respiratory movements, which could no longer be observed in the late dilatation period, the degree of fetal body movements remained unaffected during the birth process. In the late dilatation period, the mean amplitude of heart rate accelerations occurring in association with fetal body movements was significantly lower than in the early dilatation period. In the unimpaired normotrophic fetus, however, the reactivity of the fetal cardiovascular system increased during the birth process in relation to the ratio of the amplitude of heart rate accelerations and the duration of associated fetal body movements. Hence, a decrease in fetal heart rate reactivity signals intranatal disturbance of the materno-utero-placento-fetal entity.
Cardiotocography↗
[Perinatal management of fetal ovarian cysts].
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Female↗
[Synchronous cardiotocographic registration of fetal body and respiratory movements in placenta insufficiency].
The extent of fetal movements and their reflections in the cardiogramme were studied in 44 normotrophic and 39 hypotrophic fetuses under standardized conditions using real time ultrasound examination of fetal body and respiratory movements and synchronous registration of fetal cardiogrammes from a uterus without labour. Altogether, hypotrophic fetuses exhibited fewer movements than normotrophic fetuses did. Numbers and parameters of accelerations in fetal heart rate occurring in connection with fetal body movements were less marked, too. The acceleration amplitude was particularly significant. Further comparisons between fetuses born with pHa greater than or equal to 7.20 and less than 7.20 or 1- and 5-minute Apgar scores greater than or equal to 8 points and less than or equal to 7 points revealed statistically significant (alpha = 0.05) differences in the frequency of movements and movement-associated accelerations in fetal heart rate only in fetuses with a body weight less than or equal to the 5th weight percentile according to Kyank (n = 21). Fetuses with a body weight between the 6th and the 10th weight percentiles (n = 18) and normotrophic fetuses did not, or did only faintly, reveal these differences. A ratio calculated from the acceleration amplitudes and the durations of associated body movements differed significantly between impaired and unimpaired born fetuses during defined intervals of the duration of fetal body movements.
Acid-Base Equilibrium↗
[Description of cardiogram potentials of fetal movements in labor].
Examples of cardiographic reflections of intranatal fetal movements (body movements) in 130 normotrophic and 26 hypotrophic fetuses (body weight less than or equal to 10th percentile) are presented. Labour-synchronous accelerations of fetal heart rate occurred in 95% associated with fetal body movements. About 83% of the body movements associated with fetal heart rate accelerations occurred periodically. Strikingly, labour with fetal body movements resulted in accelerations, whereas labour alone hardly ever produced medium-term heart rate changes or variable decelerations. In contrast to periodical accelerations with associated body movements, periodical accelerations without associated fetal body movements, which are mainly of hemodynamic origin, indicated potential fetal risk. Even with medium-degree or severe variable decelerations in the expulsive period, fetal body movements with associated heart rate accelerations indicated a good actual fetal condition. The importance of cardiogram synchronous real-time ultrasonic examination of intranatal fetal movements is discussed.
Cardiotocography↗
[Qualitative description of cardiogram potentials of fetal body and respiratory movements in the non-contracting uterus].
Cardiographic reflections of fetal movements were assessed using cardiogram synchronous ultrasonic examination in 44 normotrophic and 40 hypotrophic fetuses with body weights less than or equal to 10th percentile. The study showed that 90% of the fetal body movements were associated with accelerations in fetal heart rate. The degree of associated accelerations depended on the duration of the fetal body movements. In the hypotrophic fetuses the associated heart rate accelerations had a lower amplitude and a relatively longer duration. In impaired fetuses body movements were associated with decelerations in heart rate. Fetal respiratory movements resulted in an increasing beat-to-beat variability in the CTG. This effect did not occur constantly. During prolonged fetal respiratory segments no fetal body movements were observed and vice versa. Possible causes for the association between fetal movements and cardiogram are discussed.
Cardiotocography↗
[Comparison of the progesterone test and uterus sonography as screening procedures in the detection of patients at risk of endometrial cancer].
The increasing incidence of endometrial cancer requires more attention to early detection. Postmenopausal women without symptoms were examined by progesterone challenge test (96 diabetics, 111 without diabetes) and by sonography (44 diabetics, 74 without diabetes) in order to recognize proliferation of the endometrium. The application of progesterone induced a bleeding in 4% of the women. The diagnostic curettage performed 4-6 weeks after this test revealed almost always atrophic endometrium. We found a good correspondence between abnormalities of the uterine cavity detected by sonography and the results of the pathological examination after notice pathological changes of the endometrium.
17 alpha-Hydroxyprogesterone Caproate↗
[Clinical and ultrasonic diagnosis of hematometra following curettage].
By hands of a case report we describe our diagnostic management in a patient suffering from hematometra 3 months after legal abortion. Sonography plays an important role in such cases to detect and explain the symptoms "metrorrhagy and uterine cramps monthly connected with small inflammatory signs". For curing we did a probing of the uterine cavity to eliminate the residual blood coagulas. 3 months after curing the hematometra the patient was clinically and sonographically without bodily ailments. Hypotheses about etiology and treatment of this rare condition are reviewed.
Adult↗
[Twin pregnancy with fetal hydrocephalus].
There is a case report on twin pregnancy with fetal hydrocephalus, recognized in the 24th week of gestation. Course of pregnancy and management during labour are described. The peculiarity of our observation is for the constellation mother--healthy fetus--fetus with hydrocephalus. Taking care for the pregnant woman and the healthy fetus are most important.
Abnormalities, Multiple↗
[Clinical contribution to the sonographic diagnosis and perinatal treatment of fetal ovarian cysts].
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Adolescent↗
[Fetal heart rate accelerations and fetal oxygen pressure sub partu].
By means of tcPO2 measurement, a total of 297 FHR accelerations from 55 oxygen cardiotocograms were analysed with regard to their association with changes in fetal oxygen pressure sub partu. It could be demonstrated that the transcutaneous oxygen pressure of 2.3 kPa (17.1 mmHg) with occasional accelerations was significantly (alpha less than 0.05) higher than that of 2.2 kPa (16.6 mmHg) with periodic accelerations. Oxygen pressure with occasional accelerations with "classical parameters" (amplitude greater than or equal to 15 bpm, duration greater than or equal to 15 sec) did not significantly differ from that with one or both parameters below these minimal values. Furthermore, our results suggest the production of periodic accelerations by pressorreceptor reflex due to intermittent disturbance in umbilico-placental perfusion.
Blood Gas Monitoring, Transcutaneous↗