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Biomedical subjects

R Rudelstorfer

Publications and source records attributed to R Rudelstorfer.

At least 19 recordsLinked to original sources
PubMed1992

Vaginosonographic velocimetry in uterine arteries before and after administration of beta-mimetics.

OBJECTIVE: To investigate the effect of surgical procedures at 15 weeks gestation (amniocentesis or cervical cerclage), with or without post-operative ritodrine prophylaxis, on uterine blood flow velocity waveforms and maternal heart rate. DESIGN: A quasi-randomized observational study. SETTING: University Department of Obstetrics and Gynaecology, Vienna. SUBJECTS: Sixty women having a genetic amniocentesis for advanced maternal age and 57 women having elective cervical cerclage for previous preterm labour or recurrent miscarriage. INTERVENTIONS: The women in each group were allocated either to receive prophylactic ritodrine postoperatively or to receive no ritodrine treatment. Allocation used the year of birth of the woman (odd years received ritodrine, even years received no treatment). All the women had vaginal ultrasound velocimetry studies in both mainstem uterine arteries through the parametrium before the surgical procedure and again after the procedure. The ritodrine-treated women in the cerclage group received intraveneous ritodrine hydrochloride (0.2 mg/min) and those in the amniocentesis group received 60 mg ritodrine/day orally. MAIN OUTCOME MEASURES: Uterine artery blood flow velocity waveform indices: A/B ratio and pulsatility index (PI) and maternal heart rate before and after the surgical procedure. RESULTS: The only statistically significant difference in haemodynamic values between those obtained before the procedure and those obtained after the procedure with or without prophylactic ritodrine was seen in the women who had cervical cerclage with postoperative intravenous ritodrine. The mean A/B ratio decreased from 2.69 (SD 1.17) to 2.11 (SD 0.44), and the mean PI from 1.62 (SD 0.47) to 1.21 (SD 0.3) and the mean maternal heart rate increased from 82.6 (SD 11.1) to 99.4 (SD 15.7). There were no other statistically significant differences between before and after haemodynamic values. CONCLUSIONS: There are no clinically relevant effects of amniocentesis and cervical cerclage on uterine blood flow velocity waveforms.

Adult↗
PubMed1991

Scalp heat flux in postmature and in growth-retarded fetuses.

Postterm and growth-retarded fetuses share a common problem which can be characterized by a discrepancy between the supply of oxygen and nutrients to, and the demand of the fetus. But, this "insufficient" placental exchange function may also extend to and affect its thermal homeostasis; e.g. when the capacity of convective (placenta) pathways is shifted towards conductive (surface) pathways for heat loss. Therefore, fetal scalp heat flux measurements, where heat serves as an intrinsic tracer for metabolic activity and placental exchange function, promised a new kind of information. In 81 pregnant women during labor we measured fetal scalp heat flux by means of an heat flux transducer attached to the fetal head and after the cervix had dilated to 3 cm. In the healthy fetuses we found a positive linear relationship between scalp heat flux and different anthropometric variables such as body length (r = 0.432, n = 65, P less than 0.01), head circumference and gestational age. In comparison, postmature and growth-retarded fetuses showed higher heat flux values than appropriately grown fetuses of the same length head size and gestational age. Moreover, in those fetuses scalp heat flux decreased by approximately 4 watt/m2 during the second stage and differed in this regard from the control group who showed stable values during labor and delivery. We conclude that scalp heat flux measurements may indicate disturbances of placental exchange before acute hypoxia occurs.

Adult↗
PubMed1991

Vaginosonographic Doppler velocimetry in both uterine arteries: elevated left-right differences and relationship to fetal haemodynamics and outcome.

Blood flow velocity was measured in both main stem uterine arteries by means of a transvaginally inserted Duplex scanner (240 degrees sector, pulsed Doppler) and visual vessel recognition to investigate normal and abnormal uterine perfusion. Its relationship to fetal circulation and fetal outcome was studied. Fetal vessels were investigated transabdominally. One hundred and seventy-six pregnancies with a high-risk for fetal malnutrition were examined between the 27th and the 40th week of gestation. In 113 (64%) patients we found normal uterine perfusion (A/B ratios in both uterine arteries less than 3, left-right difference less than 1) and in 63 (36%) cases the A/B ratios were outside our limits. A single abnormal A/B ratio in one of the uterine arteries or an abnormal left-right difference was classified as a mild form of abnormal uterine perfusion. Involvement of both uterine arteries was classified as a severe form. The severe form was associated with a higher frequency of pathological waveforms in fetal arteries and reduced fetal outcome. Clinically, velocimetry in both uterine arteries is of paramount importance when the degree of abnormal uterine perfusion is to be classified precisely.

Adult↗
PubMed1990

Vaginosonography and its diagnostic value in patients with postmenopausal bleeding.

Using a transvaginal 240 degrees "panorama" sector scanner (5.0 MHz) we performed a sonographic study in 106 women with postmenopausal bleeding before they had a diagnostic dilatation and curettage. Sonographic findings were classified as (1) normal thin endometrial echo, (2) pathologically thickened echo (i.e. more than 1/3 of the a.-p. diameter of the myometrial wall) and (3) spherical echoes representing myomas. We also looked carefully at the borders of the endometrium. 21 cases could not be included because of no histological specimen was available or because the vagina was too narrow for insertion of the probe. The histological and sonographic results were compared. Of 39 women with pathologically thickened endometrial echoes 12 had invasive carcinomas, 9 hyperplastic endometrium, 16 polyps and 2 had normal atrophic endometrium. In the 46 women with normal endometrial echoes 1 had a carcinoma (confined to the mucosa and obscured by a myoma), 1 had hyperplastic endometrium, 4 had small polyps (size below 5 mm) and 40 had normal atrophic endometrium.

Endometrium↗
PubMed1990

[Heat flux measurements of the fetal scalp and cardiotocography in predicting acidosis states sub partu--a comparison of 2 methods].

Although the efficacy of electronic foetal heart rate (FHR) monitoring and intermittent scalp blood sampling is well established, these methods still result in a considerable number of false positive and negative predictions. Consequently, methods, which improve the accuracy of prediction, are still under study. Heat flux measurements from the foetal scalp have been shown to relate to the metabolic condition of the foetus during delivery. In this study, we investigated the predictive power of measuring scalp heat flux and monitoring the FHR electronically, and the combination of both. In 136 foetuses the scalp heat flux was measured by means of a heat flux transducer, 2.5 cm in diameter, attached to the foetal scalp after the cervix had dilated to greater than 2.5 cm. Heat flux was regarded as abnormal, if the heat flux was less than 10 w/m2 or greater than 21 w/m2, or fell by more than 20% of its initial value during the last 30 min before delivery. FHR tracings were considered abnormal, if they resulted in therapeutic consequences like oxygen mask for the mother, scalp blood sampling or immediate operative delivery. Foetuses were considered acidotic, if their pH in the arterial cord blood was less than 7.20. Accuracy of prediction was described by appropriate parameters. The scalp heat flux method resulted in a higher specificity (80.4% vs. 72.5%), positive predictive value (59.2% vs. 51.7%), and overall accuracy (82% vs. 77%) than FHR monitoring. Sensitivity of FHR monitoring was slightly higher than the one of heat flux method (88.2% vs 85.3%). Combining both methods resulted in a sensitivity of 100% thus detecting all acidotic foetuses, but specificity fell to 62%.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMed1990

Serum laminin in pregnancy-induced hypertension--a marker for renal involvement?

Laminin, a noncollagenous glycoprotein, has been identified as a component of basement membranes. It serves as a multifunctional adhesion protein. Immunoreactive laminin levels determined by a radioimmunoassay were found to increase throughout gestation, obviously due to growth of the placenta, an organ rich in basement membranes. In this study of 92 pregnant women in the third trimester we compared the serum laminin levels of 69 women with an uneventful course of pregnancy to the levels of 23 women with symptoms of pregnancy-induced hypertension. Laminin concentrations were 2.6 U/ml in pregnant women with hypertension and proteinuria, which was significantly higher than in healthy pregnant women (2.0 U/ml). We supposed that immunologic reactions that damage the kidney account for an increase of laminin concentrations in these women. Therefore we suggest that measurements of serum laminin concentrations may serve as a potential marker of renal damage.

Adult↗
PubMed1989

Transvaginal pulsed Doppler velocimetry in fetal arteries.

Transabdominal pulsed Doppler velocimetry in fetal arteries might be difficult with extreme obesity, anhydramnios, cord presentation and an unfavourable position of the fetal head. A vaginal transducer gets closer to the presenting part of the fetus and therefore has advantages for Doppler velocimetry in fetal arteries.

Adult↗
PubMed1989

[Comparison of transvaginal and transabdominal Doppler flow measurements in uterine vessels in the normal course of pregnancy].

Despite physiological and methodical drawbacks Doppler velocimetry in the arcuate arteries has become a standard for examination during pregnancy. Arcuate arteries are terminal branches of the uterine vaculature and supply only a circumscript area. Local vasoconstriction (due to contractions) and placental infarction may give erroneus results. Measurements in arcuate arteries at the site of placental insertion showed flow patterns different from those in the rest of the uterus. Since continuous wave Doppler systems were mostly applied, the received echoes could have originated from any part along the sound beam. Signals from arteries of the anterior abdominal wall may lead to "false pathological" waveforms. All these drawbacks have been overcome by Doppler velocimetry of the main stem uterine artery on its course through the parametrium by a transvaginal inserted probe that combines a 240 degrees "panorama" sector scanner with a pulsed Doppler system. Both main vessels supplying the uterus, i.e. left and right uterine artery, could be visually identified and pulsed Doppler velocimetry could be applied. This provided us with information about perfusion of the whole organ and showed us also the physiological range of left to right discrepancy in the flow patterns. In 63 pregnant women with a single foetus and an uneventful course of pregnancy we compared transabdominal measurements of the arcuate arteries with transvaginal measurements in both main uterine arteries. In 56 women we found pathological wave forms in the arcuate arteries (A/B ratio greater than 2) despite lack of clinical or transvaginal measured evidence of malnutrition.(ABSTRACT TRUNCATED AT 250 WORDS)

Arteries↗
PubMed1989

[Assessment of edema in pregnancy].

The clinical evaluation of oedemata during pregnancy is more or less subjective and not reproducible. There is no common factor to the relevance of its presence. The aim of this investigation was to check systematically the frequency and degree of generalised Oedemata and their clinical relevance. 184 pregnant women were examined for their finger circumference between the 16th and 36th week of gestation. According to the change in the circumference, three significantly different groups of oedemata were found. The group with strongly marked oedemata showed increased hypertensive complications and the highest rate of growth retarded children. This objective and simple method of measuring the finger circumference, is suggested for antenatal care.

Adult↗
PubMed1989

[Transvaginal pulsed Doppler measurement of flow velocities in pelvic vessels following cycle stimulation].

The availability of pulsed Doppler probes has made it possible to sample signals at a chosen depth and thus to detect the flow in any selected deep vessel. Pulsed Doppler signal processing combined with real-time imaging, the so-called "duplex" method, is now also available for transvaginal transducers. The advantage of endosonographic ultrasound investigation is the possibility of using higher frequencies leading to a better resolution of anatomical structures of the small pelvis. Therefore this method allows the precise localisation of a deep vessel and the positioning of the Doppler sample volume within it. The transvaginal approach enables one to position the transducer close to the artery for better measurements. For our study we used a vaginal probe with 7.5 MHz with a pulsed Doppler equipment linked to a Combison 320 (Kretztechnik, Zipf, Austria). The integrated pulsed Doppler is not attached at a fixed angle but can be moved in the whole sector of 240 degrees. We investigated, if during follicle phase of the cycle changes of the pelvic blood flow velocity could be observed. 14 patients undergoing in vitro fertilization for sterility reasons participated in our study. We performed daily measurements of the blood-flow velocity of the ovarian artery and the internal iliac artery from cycle day 8 until the day of induction of ovulation. During cycle stimulation the observed decrease of the A/B ratio was dependent on cycle day and number of follicles. We found a decrease of the A/B ratio in the ovarian artery from 3.85 in cases with 2 follicles to 2.71 in cases with 5 follicles.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Flow Velocity↗
PubMed1988

Vaginal sonography versus serum human chorionic gonadotropin in early detection of pregnancy.

We first performed a vaginosonic scan and then determined the serum human chorionic gonadotropin (beta-hCG) concentration (Second International Standard) in 52 women at an early gestational age to establish criteria for the earliest possible identification of an intrauterine pregnancy by this new ultrasound technique. The smallest diameter of a gestational sac detected was 2 mm, and the lowest beta-hCG concentration was 141 mIU/ml when an intrauterine pregnancy was correctly diagnosed. Between 50 and 280 mIU/ml, six out of eight pregnancies in this range were not seen. However, all pregnancies associated with beta-hCG concentrations greater than 300 mIU/ml were correctly identified. Taking into account the rapid growth of the conceptus and the exponential increase of serum beta-hCG by a factor of 1.7 per day at this early gestational age, we presume that a gestational sac at beta-hCG concentrations of 750 mIU/ml should not be missed by vaginosonography (safety margin of the discriminatory zone), even in instances of a retroverted uterus. No false-positive vaginosonographic findings were observed in this study. A vaginosonographic examination is a short and well-tolerated procedure that can be performed in a physician's office. The use of a 5 MHz transducer placed in the vagina provides better resolution and image quality. This overcomes imperfect anatomy and other physical factors that interfere with good imaging. The vaginosonographic examination provides information on the anatomic location of the gestational sac, with the highest reliability and accuracy around the time a woman misses her menstrual period. It can be very useful in the differential diagnosis of an ectopic pregnancy.

Chorionic Gonadotropin↗
PubMed1988

Vaginosonographic velocimetry of both main uterine arteries by visual vessel recognition and pulsed Doppler method during pregnancy.

In 88 pregnant women (7 to 40 weeks' gestation) we performed Doppler velocimetric studies of the uterine artery on its course through the parametrium by means of the newly developed, frontally radiating duplex sector scanner. This device enabled us to visually recognize the vessel and apply the more refined pulsed wave system. In 71 of 88 women, we were able to obtain measurements from both uterine arteries. We found significant differences in the maximum systolic to minimum diastolic frequency shift (A/B ratio) up to 4 between the right and left vessels in the first and second trimester. In the third trimester, the differences almost disappeared (mean +/- SD A/B ratio difference 0.4 +/- 0.3) in these uncomplicated pregnancies. We also report our mean values (first, second, and third trimesters) of the A/B ratio and the pulsatility index as an average from the right and left side measurements. Both values declined during the course of pregnancy (A/B ratio, 5.5, 2.9, and 2.1; pulsatility index, 2.5, 1.7, and 1.3). We conclude that, with some experience, this scanner has the advantage of visually recognizing the vessel under study and allows measurements in both main uterine arteries. The average of the right and left measurements provides a better summary of uterine perfusion. Due to the significant right/left difference in the A/B ratio, unilateral measurements of the uterine artery may give erroneous results during the first and second trimesters. Theoretically, the pulsed system provides a "cleaner" signal, but the values are comparable to those of devices that apply a continuous wave system.

Arteries↗
PubMed1988

[Pulsed Doppler flow measurements using a vaginal ultrasound probe--integration into fetomaternal hemodynamics].

A recently developed "Panorama" sector scanner emitting in frontal direction (KretzTechnik, Zipf, Austria), combined with pulsed Doppler signal processing, makes it possible to visualize the main branch of the uterine artery already during its passage through the parametrium, and to adjust the Doppler beam under visual control. This makes it possible for the first time to receive flow signals that are free from superimpositions and are reliable, from both vessels supplying the pregnant uterus. It was the aim of our study to describe the haemodynamic changes at the uterine arteries in the course of pregnancy and to collect first experiences on the blood flow of the entire uterus. 42 women with an uneventful course of pregnancy were examined between the 8th and the 40th week of pregnancy. Angle-independent parameters such as the A/B ratio and pulsatility index dropped significantly during the course of pregnancy. The A/B ratio dropped from 5.4 during the first trimenon to 2.2 during the third trimenon, and the pulsatility from 2.6 to 1.3. This new method makes it possible to receive at more reliable and in respect of the total blood flow of the uterus more representative values for insertion into the second part of the haemodynamic equation for the pregnant uterus.

Arteries↗