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Biomedical subjects

M Butterwegge

Publications and source records attributed to M Butterwegge.

At least 19 recordsLinked to original sources
PubMed2005

[Comments on a report by the BQS on obstetric quality indicators].

When re-evaluating an epidemiologically oriented BQS expertise concerning the quality indicators in obstetrics, we examined three essential methods in obstetrics to verify their scientific evidence and their clinical relevance. In doing so we ascertained that recording the fetal heart rate sub part, analysing fetal blood and determining the blood gas of the umbilical blood are entirely appropriate quality indicators during delivery from a clinical and medical point of view -- although to varying extents. Above all, these three indicators prove to be essentially better evidence-based than described in the BQS expertise. The search for an optimum of evidence-based data in medicine ends in certain fields such as, for example, in obstetrics there where no further randomized studies can be carried out for methodological or ethical reasons. This lack of evidence for the optimum grade I which can clearly be understood from an epidemiological point of view, however, should not lead to an evidence nihilism that fails to accept or admit existing evidence of the weaker grades II and III.

Evidence-Based Medicine↗
PubMed2004

[Fetal monitoring intra partum with cardiotocography and fetal blood sampling analysis and its possible influence on the C-section rate].

In times of rising c-section rates worldwide the obstetricians feel a big responsibility in avoiding a secondary c-section for non-reassuring fetal heart rate. No other experimental method has been established beside the gold standard (cardiotocography and fetal blood sampling) in daily routine until today. The two cases presented demonstrate the fallibility of the "gold standard" in predicting fetal asphyxia and why methodology with better positive predictive value is needed.

Adult↗
PubMed1999

The prediction of fetal acidosis by means of intrapartum fetal pulse oximetry.

OBJECTIVES: The study's objectives were to verify a threshold value for fetal arterial oxygen saturation as the critical boundary for fetal compromise during labor and to investigate a method of predicting acidosis caused by hypoxemia. STUDY DESIGN: In a multicenter study involving 3 German obstetric centers, a total of 400 deliveries were monitored by fetal pulse oximetry (Nellcor-Puritan-Bennett Model N-400 Oxygen Saturation Monitor and FS-14 Sensor; Nellcor, Inc, Pleasanton, Calif). The durations of low (</=30%), medium (31%-60%), and high (>60%) fetal arterial oxygen saturations during the measurement were compared between neonates with a pH <7.15 versus >/=7.15 and a base excess <-12 mmol/L versus >-12 mmol/L in the umbilical artery post partum and in neonates with an Apgar score <7 versus >/=7 by Mann-Whitney U test. In 121 of the pulse oximetry measurements the durations of low, medium, and high fetal arterial oxygen saturations were measured from one fetal scalp blood sampling to the next and correlated with the change of scalp blood pH between samplings. Multiple regression analysis was performed to estimate the expected change of pH between 2 fetal scalp blood samplings, and receiver operating characteristic analysis was done to define a minimum duration of low fetal arterial oxygen saturation values to exclude or predict a significant decline of pH. RESULTS: Neonates with a 1-minute Apgar score <7 differed from those with 1-minute Apgar score >/=7 significantly in the duration of low fetal arterial oxygen saturation but not in the durations of medium and high fetal arterial oxygen saturations. The duration of low fetal arterial oxygen saturation had been significantly longer in children with pH <7.15 or base excess <-12 mmol/L in the umbilical artery compared with those with a pH >/=7.15 or base excess >/=-12 mmol/L. The duration of high fetal arterial oxygen saturation was significantly shorter for children with a pH <7.15 or base excess <12 mmol/L than for those with a pH >/=7.15 or base excess >/=12 mmol/L. There was no difference in the groups with respect to the duration of medium fetal arterial oxygen saturation values. The duration of low fetal arterial oxygen saturation proved to be the best predictor of a decline of scalp pH between 2 fetal scalp blood samples. The pH declined significantly with a longer duration of low fetal arterial oxygen saturation (0.02 per 10 minutes). No decrease of pH by more than 0.05 was observed unless fetal arterial oxygen saturation had remained at </=30% for >/=10 minutes. CONCLUSION: An arterial oxygen saturation of 30% was confirmed as the critical boundary for fetal compromise during labor. The development of acidosis seems to be predictable by the duration of hypoxemia, as indicated by fetal arterial oxygen saturation </=30%.

Acidosis↗
PubMed1998

Predictive agreement between the fetal arterial oxygen saturation and fetal scalp pH: results of the German multicenter study.

OBJECTIVE: To discuss and substantiate the 30% critical threshold of fetal arterial oxygen saturation and to complete the puzzle with low fetal arterial oxygen saturation and low scalp pH data, scalp samples have been performed while fetal arterial oxygen saturation registration during labor was in place and while the saturation was < or = 30%. STUDY DESIGN: Between 1993 and 1996, 46 term fetuses during active labor had parallel arterial oxygen saturation registration by pulse oximetry combined with cardiotocograph. They include patients in whom the saturation was < or = 30% for at least 10 minutes. In these cases scalp pH sample values have been obtained simultaneously. Outcome data, Apgar scores, cord gases, and whether the infants were transferred to the neonatal intensive care unit have been examined. Compared with this, there were other cases during labor that had also parallel fetal arterial oxygen saturation and cardiotocographic registration, where the saturation was > 30%. Also in these cases scalp pH was determined to support and demonstrate the predictive value of fetal arterial oxygen saturation for scalp pH, especially in the low ranges. All 46 fetuses were evaluated during periods of nonreassuring cardiotocograph with Nellcor N-400 Fetal Oxygen Saturation Monitoring Systems and FS 14 B sensors in a multicenter study involving three German obstetric centers. Receiver operating characteristic analysis was done on all raw data, as well as the receiver operating characteristic curve from the preceding analysis. RESULTS: These data validate the critical threshold of 30% fetal arterial oxygen saturation and show an extremely good separation of "good" versus "bad" at a fetal arterial oxygen saturation of 30%, especially when seen in conjunction with data points that are > 7.20. Data at < or = 7.20 scalp pH and < 30% fetal arterial oxygen saturation can be a big help in calculating the sensitivity and specificity of fetal arterial oxygen saturation in predicting neonatal outcome (e.g., Apgar score, cord pH). CONCLUSION: Low fetal arterial oxygen saturation data of < 30% for at least 10 minutes or longer correlate significantly with low scalp pH values and have a predictive value concerning fetal outcome.

Arteries↗
PubMed1997

Fetal pulse oximetry and non-reassuring heart rate.

The aim of the study is to assess the continuous monitoring of fetal blood oxygen saturation (SpO2) during labour using a fetal pulse oximeter in cases of abnormal fetal heart rate (FHR). To determine whether pulse oximetry has the potential to replace scalp blood pH sampling in infants with abnormal heart rate tracings, the correlation between the Hammacher score and SpO2 during labour, scalp pH and arterial cord pH was evaluated. 34 fetal blood samples (FBS) were evaluated in cases of suspicious, pre-pathological or pathological heart rates. Using the FS-14 prototype, 24 fetal blood samples (FBS) were measured in cases of suspicious FHR with an average SpO2 of 42.3% and pH of 7.28, nine in cases of pre-pathological FHR with an average SpO2 of 34.1% and pH of 7.25 and one pathological FHR with an average SpO2 of 24% and pH of 7.162. In those cases where SpO2 was > 40% during labour, no neonate was observed to suffer on hypoxaemia or acidosis and no arterial cord pH was below 7.20. For the future we have the need of collecting more data to support the use of pulse oximetry as a replacement for fetal blood sampling or as a basis for deciding on operative intervention.

Female↗
PubMed1995

[The so-called adenomatoid tumor of the uterus: a case report of evaluation of primary sterility].

A description of the clinical diagnosis, localisation and the histological structure of an adenomatoid tumour of the uterus is presented. The tumour was diagnosed during investigation of sterility and localised in the uterus wall. Fallopian tubes and ovaries can also be affected. Adenomatoid tumours are small, slow growing and of benign origin, and hence organ-preserving tumourectomy is an adequate therapy. Histogenesis of this kind of tumour has been established by means of immunological techniques as being of mesothelial origin.

Adenomatoid Tumor↗
PubMed1995

[Clinical results of pulse oximetry sub partu for measuring fetal arterial oxygen saturation].

By means of reflexion pulse oximetry the arterial oxygen saturation (SpO2) of 100 fetuses intrapartum was measured in a high-risk group and compared with clinical parameters. There is a connection between the duration of SpO2 measurements below 30%, the delivery mode and reduced pH-values in the umbilical artery measured post partum. SpO2 values below 30% also occur temporarily with uneventful deliveries but they occur with increased frequency within the group of operatively delivered children with a duration of more than 20 minutes. On the other hand the group with SpO2 values ranging between 40 and 60% showed less operative deliveries and a better condition of the newborn (Apgar, pH-metry). If prognostically unfavourable additional criteria with variable decelerations increase, a tendency towards decreasing fetal oxygen saturation values is recognisable. In the case of suspicious heart rate patterns or patterns difficult to assess the continuous registration of saturation values is both medically and forensically of inestimable value. There were no increases in fetal morbidity or signs of amnion infection syndrome. By means of a new sensor, a longer registration time with a reliable signal quality is achieved, so that assessment of the oxygen saturation in relation to labour activity becomes possible.

Acid-Base Equilibrium↗
PubMed1995

[Chorioangiomatosis of the placenta--diagnosis and obstetrical management].

Chorioangiomas are the most common benign tumors of the placenta. The pathologist is able to recognize these tumors in 1% of all examined specimens, but 80% of them are small and of no clinical significance. The larger chorioangiomas are very rare and often associated with complications such as placental abruption, fetal anemia, premature labor and preterm delivery. Early diagnosis of such a large placental tumor is necessary for the obstetrician to adjust the management of pregnancy to reduce fetal and maternal mortality and morbidity. We present a case of multiple placental chorioangiomas, in which the largest was 8 cm in diameter, detected in the 33rd week of pregnancy and associated with polyhydramnion and fetal anemia because of fetomaternal transfusion. Early diagnosis and well-timed delivery avoided severe complications for mother and neonate.

Adult↗
PubMed1993

[Clinical documentation in obstetrics and collection of relevant data with reference to the structural reform law. Results of a survey of 72 clinics].

This study was conducted on the spread and usage of computer-aided software programme (GDS) in 72 obstetric departments. Standardised questionnaires were sent to universities and hospitals to ask for information on registered perinatal data. The record with the hand-written delivery book cannot record all data needed for quality protection as the PC is able to list. 89% of the obstetricians evaluate their clinical data regularly by statistical survey and classification. By analysing the general trend they can critically assess their actual obstetrical management. The PC is established in 83%, functions without technical problems in 92% and is optimal in the sequence of operation in 57% of all departments questioned. Overtime hours for the staff could be reduced in 11%, if a computer was used, and in 13% the nurses could take more care of mother and child because of less official red tape. Independent of the size of the department and the data processing knowledge of the staff, the software programme runs efficiently. The comprehensive basis data documentation with all perinatal and neonatal data is used to its full extent in 100% of the cases and documents the clinical effectivity. With regard to the standardised hospital quality control process by the modified requirements in the public health legislation, the directors of the hospital departments are able to assess the quality control and show economic independence.

Attitude of Health Personnel↗
PubMed1993

[Integration of Doppler ultrasound into the obstetric department of a gynecologic clinic].

This study was performed to evaluate the time interval for Doppler ultrasound and sonographic diagnostic measurement at 267 patients during antenatal risk screening. Time for biometry, screening of malformation, Doppler ultrasound, documentation and discussion with the patients were measured. Although experienced colleagues used an standardized inquiry a mean time interval of 52 minutes were needed under optimal conditions. It is interesting to note that outstanding disturbance factors extend the examination time considerable. Many data must be calculated and recorded by the obstetrician. Several proposals are drawn up and discussed in this paper on the basis of this results. This study shows that high special knowledge and a large time expense is necessary to establish Doppler technology in the routine antenatal screening.

Appointments and Schedules↗
PubMed1993

[Ileus in pregnancy induced by a gastric balloon].

Complications during a pregnancy caused by a gastric balloon as a weight reduction device are presented. We refer about a patient in the 35th week of pregnancy who suffered with abdominal cramping. She was studied for hours before the decision for a laparotomy and cesarean section was made. Just before starting, a gastric balloon which was implanted in the early pregnancy for loss of body weight was expelled and the patient was healthy.

Adult↗