Jan-Peter Siedentopf

Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks. A retrospective, comparative study of 161 women.

OBJECTIVE The objective of the study is to compare outcomes after conservative management alone versus conservative management with cerclage in the treatment of amniotic sac prolapse in the second trimester. STUDY DESIGN Retrospective, comparative study at a university hospital/tertiary referral centre. The medical data was provided by the files of 182 women who were in-patients between December 1989 and June 2005 as a result of prolapse of the amniotic sac during live pregnancies between the 17+0 and 26+0 weeks of gestation. The women were assigned to different groups on the basis of the type of treatment received (Group I: operative procedure=emergency cerclage or Group II: conservative procedure=bed rest, tocolysis, administration of antibiotics). Specified level of significance: p<0.05. MAIN OUTCOME MEASURES prolongation of pregnancy, pregnancy outcome/infant mortality, and birth weight. RESULTS The investigation covered 161 women with amniotic sac prolapse (operative management: n=89, conservative procedure: n=72). With operative procedures it was possible to prolong the pregnancy by 41 days (from the day of admission), compared with 3 days when conservative therapy was used (p<0.001, median values). In the group that received operative treatment, live births occurred in 72% of cases as opposed to 25% of cases in the group of women that received conservative therapy (p<0.001). There was also a significant difference in the median weight at birth of all live-born children: 1340g with operative therapy, 750g by conservative procedures (p<0.001). CONCLUSIONS In the second trimester operative management of the amniotic sac was associated with improved perinatal outcomes including improved live-born rate, increased birth weight and prolonged pregnancy.

Ethnic Turkish fathers in birth support roles in a Berlin labour and delivery room – motives, preparation and incidence in a 10-year comparison

Purpose. Have there been changes among German (G) or ethnic Turkish (T) fathers with respect to birth preparation or motivation to participate in a birth support role? In a 10-year comparison is it possible to identify an increase among ethnic Turkish fathers in birth support roles in Germany? Methods. (1) In 1995/96 and 2003, structured interviews were conducted with German and ethnic Turkish fathers on the second or third post-natal day, focusing on the following topics: birth preparation, motives for participating in the birth, anxieties experienced by the father in the labour and delivery room, the fathers assessment of his role in the birth, information deficits. (2) In 1995 and 2006, the birth support roles of family members (partners, sisters, mothers-in-law etc.) were documented per 1000 consecutive hospital births and analysed according to parity and ethnicity. Results. (1) Structured interviews based on guidelines: In comparing 1995/96 (G/T n = 100, in each case) to 2003 (G/ n = 54, T/ n = 42) there is a significant increase among both Germans and ethnic Turks in the number of fathers participating in courses preparing for birth; ethnic Turkish men attended birthing courses noticeably less often (1995/96 and 2003: 8%; G approx. 40%, respectively). During both interview cycles the most common motivation given for providing birth support was ‘to solidify the relationship with the partner’. (2) Data on birth support roles: In the comparison between 1995/96 and 2006, more German fathers, as well as more ethnic Turkish fathers, were by the side of their wives/partners in the labour and delivery room; however, in contrast to the Germans, ethnic Turkish men more commonly tended to participate in a birth support role together with female family members, either simultaneously or by turns. Conclusions. The birth support role of the father has gained significant ground in the last 10 years, and is now also accepted among ethnic Turkish couples despite cultural differences. This is possibly the result of an acculturation process, in which a phenomenon within the host culture (fathers in the labour and delivery room) mixes with ancestral tradition (the birth support role of women).

Correlation of intrapartum translabial ultrasound parameters with computed tomographic 3D reconstruction of the female pelvis.

Abstract Aims: Intrapartum translabial ultrasound [ITU] can be an objective, reproducible and more reliable method than digital vaginal examination when evaluating fetal head position and station in prolonged second stage of labor. However, two-dimensional (2D) ultrasound is not sufficient to demonstrate the ischial spines and other important “landmarks” of the female pelvis. Therefore, the purpose of this study was to evaluate the distance of the interspinous plane as a parallel line to the infrapubic line in 2D ITU with the help of 3D computed tomography and digital reconstruction. Results: Mean distance between the infrapubic plane and the tip of the ischiadic spine was 32.35 (±4.46) mm. The mean height was 166 (±7) cm; the mean weight was 67.5 (±18.4) kg. Body height and the measured distance were significantly correlated (P=0.025; correlation coefficient of 0.5), whereas body weight was not (P=0.37; correlation coefficient of –0.214). Conclusions: With the present results, clinicians were enabled to transfer the reproducible measurements of the “head station” by ITU to the widespread but observer-depending vaginal examination. Furthermore, ITU can be verified as an objective method in comparison to subjective palpation with the ability to optimize the evaluation of the head station according to bony structures as landmarks in a standardized application.

Surgical site infection in cesarean sections with the use of a plastic sheath wound retractor compared to the traditional self-retaining metal retractor.

OBJECTIVE A cesarean section rate of up to 19.4% is reported worldwide. Surgical site infection occurs with rates of up to 13.5%. Plastic-sheath wound retractors show reduced rates of surgical site infections in abdominal surgery. There is limited evidence in women having cesarean sections. This study evaluates the use of the Alexis(®) O C-Section Retractor in the prevention of surgical site infection in patients undergoing their first planned cesarean section compared to the traditional Collins self-retaining metal retractor. STUDY DESIGN A single center, prospective, randomized, controlled, observational trial. The primary outcome is surgical site infection as defined by the Centers for Disease Control and Prevention. The secondary outcomes included intraoperative surgical parameters, postoperative pain scores and the short and long-term satisfaction with wound healing. From October 2013 to December 2015 at the Charité University Hospital, Berlin. 98 patients to the Alexis(®) O C-Section Retractor group and 100 to the traditional Collins self-retaining metal retractor group. RESULTS A statistically significant reduction in the rate of surgical site infections, when the Alexis(®) O C-Section Retractor was used for wound retraction compared to the traditional Collins metal self-retaining wound retractor, 1% vs. 8% (RR 7.84, 95% CI (2.45-70.71) p=0.035). CONCLUSIONS The use of plastic-sheath wound retractors compared to the traditional self-retaining metal retractor in low risk women, having the first cesarean section is associated with a significantly reduced risk of surgical site infection.

Intrauterine therapy of cytomegalovirus infection with valganciclovir: review of the literature

Congenital cytomegalovirus (CMV) infection is the leading cause for sensorineural hearing loss and mental retardation in children without genetic diseases worldwide. There is little evidence guiding therapeutic strategies during pregnancy when intrauterine fetal CMV infection is confirmed. We provide a systematic review of the use of ganciclovir (GCV) or VGCV during pregnancy discussing safety of its use for mother and fetus and describe two cases of intrauterine therapy of fetal CMV infection with valganciclovir (VGCV). A PubMed database search was done up to November 16, 2016 without any restrictions of publication date or journal, using the following keywords: “valganciclovir” or “ganciclovir” and “pregnan*”. Furthermore, citations were searched and expert references were obtained. Reported cases were considered if therapy was in humans and initiation of treatment of the CMV infection was during pregnancy. In total, seven case reports were retrieved which described GCV or VGCV use during pregnancy for fetal or maternal CMV infection. In the four cases of treatment for maternal CMV infection, no negative effects on the fetus were reported. Three cases of GCV administration to pregnant woman with the intention of fetal treatment after proven fetal infection were found. We additionally present two cases of VGCV treatment in pregnancy from our center of tertiary care. VGCV seems to be a safe treatment for congenital CMV infection for the mother and the fetus. Therapeutic concentrations can be achieved in the fetus by oral intake of the mother and CMV replication can be suppressed. Larger studies are needed to evaluate this therapeutic intervention and the long-term effects.

Influence of transvaginal ultrasound examination on quantitative vaginal fibronectin measurements: a prospective evaluation study

Abstract Objective: The most important parameter in prediction of preterm birth is the cervical length measured by transvaginal ultrasound. In cases with mid-range cervical length (10–30 mm), prediction of preterm birth is difficult. In these cases, testing for cervicovaginal fluid fetal fibronectin (fFN) can improve prediction. However, it is unclear whether transvaginal ultrasound itself influences the fFN result. The purpose of this study was to evaluate this issue independent of gestational age and cervical length. Methods: A prospective evaluation study with 96 cases of pregnant women at 20–41 weeks of gestation was conducted in a tertiary perinatal center. A comparison of cervicovaginal fFN samples before and immediately after transvaginal ultrasound was performed. Fetal fibronectin was measured using the Hologic Rapid fFN 10Q system. It was analyzed quantitatively and qualitatively with ≥50 ng/mL as threshold for “positive”. Changes in fFN values following transvaginal ultrasound were measured. Results: Ninety-six percent (69/72) of women with a fFN concentration of <26 ng/mL before ultrasound had a corresponding fFN value <26 ng/mL after ultrasound. Ninety-three percent (13/14) of women with a fFN concentration of ≥100 ng/mL before ultrasound had a corresponding fFN value ≥100 ng/mL after ultrasound. In 80% (4/5) of women with a positive fFN sample but with a value <100 ng/mL, it turned negative (<50 ng/mL) after ultrasound. For fFN concentrations ≥100 ng/mL, there are high random fluctuations in the measurement results. Conclusions: Fetal fibronectin values of <26 ng/mL (for “negative”) and ≥100 ng/mL (for “positive”) from samples taken after ultrasound provide the same qualitative information as when sampled before ultrasound. For the correct interpretation however, quantitative analysis is necessary.

Vaginal omentum prolapse due to uterine anterior wall necrosis after prophylactic compression suture for postpartum hemorrhage: case report and review of the literature

Abstract Introduction Postpartum or peripartum hemorrhage (PPH) is a major cause of maternal death in Western industrialized countries. Fertility preserving second stage interventions following uterotonic drugs include embolization or ligation of relevant arteries, uterine tamponade or compression sutures. Little is known about the complications due to uterine compression sutures. We describe a case report in association with uterine compression sutures and provide a systematic review on necrosis due to compression sutures (CSU). Data sources A PubMed database search was done up to October 1, 2016 without any restrictions of publication date or journal, using the following key words: “compression suture” and “postpartum hemorrhage” or “peripartum hemorrhage”. Reported cases were considered eligible when reason for postpartum hemorrhage (PPH), type of compression suture, suture material and type of complication were described. Results Among 199 publications a total of 11 reported on uterus necrosis after CSU applied for PPH. B-Lynch and modifications were applied in seven cases, Cho compression sutures in three cases and in one case B-Lynch and Cho techniques were combined. In six cases no additional measures were applied, in two cases vessel ligation, in one case embolization and in one case intrauterine balloon application were applied. In one case of partial necrosis it is not reported if additional measures were applied. Discussion and conclusion Uterine compression sutures are a useful method for fertility preserving management of postpartum hemorrhage. The risk of serious complications demands the careful consideration of its use. More research is necessary to improve the technique.

Kreißende mit Substanzkonsum – Bedeutung in der geburtshilflichen Anästhesie

Most of the female consumers of legal and illegal substances are of childbearing age. Occasional use, use disorder and addiction commonly devolve into each other. A lot of young women quit consuming when planning a family or at the latest with the knowledge of pregnancy. The ongoing substance abuse during pregnancy requires a coordinated interdisciplinary collaboration for a sufficient care of these highly complex and individual cases.

Therapieempfehlungen für opiatkonsumierende Schwangere

Der Konsum von Opiaten und Opioiden in der Schwangerschaft stellt einen Risikofaktor fur den Schwangerschaftsverlauf, die Neugeborenenzeit und die weitere Entwicklung des Kindes dar. Von Opiaten und Opioiden geht off enbar kein Fehlbildungsrisiko aus, so dass – anders als bei bekannt embryotoxischen oder teratogenen Substanzen wie Alkohol oder Kokain – bei Eintritt einer Schwangerschaft keine Notwendigkeit fur ein sofortiges Absetzen entsteht [26].

P34.15: Evaluation of the new pocket-size ultrasound system ‘ACUSON P10 TM’ in routine obstetric use

following laparascopic myomectomy. This is believed to be secondary to inadequate healing of the uterine incision. There are no reports however of pregnancy management following a history of such an event. We report a case of a 30yo 2/0100 with a history of laparoscopic myomectomy in June 2005. She subsequently underwent intrauterine insemination and became pregnant in Aug 2005. In January 2006 she underwent an emergent laparotomy for a spontaneous uterine rupture with fetal demise at 25 weeks. In Aug 2006 she underwent a laparatomy for uterine scar revision, and in April 2007 she conceived again. She was admitted to the antepartum unit at our institution at 24 weeks. Uterine scar thickness was sonographically monitored by the same physician at frequent intervals. At 24 weeks the myometrium measured 5.6 mm. She received antenatal steroids at 25 weeks. Our plan was for cesarean delivery at 32 weeks. At 30 weeks the fundal myometrial thickness measured 3.3 mm. At 31 weeks she complained of increased tenderness at the fundus; an urgent ultrasound was performed consistent with possible uterine dehiscence. Only an intact uterine serosa was noted measuring 1.8 mm and a myometrial defect measuring 13 mm wide. The patient was taken for emergent cesarean section where the above findings were confirmed. A viable female neonate was delivered with Apgars of 7.8. The patient did well and was discharged home on post operative day number 3. Ultrasound monitoring of the uterine scar thickness is a novel approach for following these high risk patients status post laparoscopic myomectomy. Based on our findings the decision for inpatient close monitoring and evaluation should be considered when the myometrial thickness approaches 2 mm.