M Mörtl

New approaches to obstetric hemorrhage: the postpartum hemorrhage consensus algorithm.

Purpose of review Postpartum hemorrhage is increasingly frequent and a major contributor to maternal morbidity and mortality. Although individual steps, such as coagulation or surgical management, have been reviewed, there is little information on treatment algorithms. Recent findings A treatment algorithm for postpartum hemorrhage was developed by the experts from three different specialties and from three countries. The algorithm describes symptoms, diagnosis, general measurements, medication, and organizational aspects. Summary The algorithm is thought to serve as a template for local adaptation. It will hopefully improve the management of postpartum hemorrhage.

The vitamin E-binding protein afamin increases in maternal serum during pregnancy

Background Afamin is a liver-derived plasma glycoprotein with vitamin E-binding properties and a putative function in fertility. This study evaluated serum afamin concentrations during and postpartum to uncomplicated pregnancies and investigated a potential association between afamin concentrations and pregnancy outcome. Methods Afamin serum concentrations were measured in women with uncomplicated pregnancies in a retrospective cohort (n = 466) at different gestational ages and a prospective observational study (n = 76) in the first, second and third trimester. Furthermore, afamin was determined in the first trimester in a cross-sectional pilot study including women with preeclampsia (PE), pregnancy-induced hypertension (PIH) and women without pregnancy complications (n = 13 each). Finally, expression of afamin was investigated in human placental tissue by RT-PCR and immunohistochemistry. Results Afamin concentrations increased linearly almost two-fold during pregnancy in both retrospective and prospective studies in women without pregnancy complications with median afamin serum concentrations of 61.9 mg/l, 79.6 mg/l, and 98.6 mg/l in the first, second, and third trimester, respectively. After delivery, median afamin concentrations decreased to baseline values of 54.6 mg/l. In the pilot study with pregnancy complications, women with PE displayed significantly higher median afamin concentrations than did women with uncomplicated pregnancy (70.0 mg/l vs. 55.4 mg/l, P = 0.007). Expression analyses revealed no placental afamin expression at either mRNA or protein level in uncomplicated pregnancy. Conclusion A linear increase in the maternally expressed glycoprotein afamin during pregnancy may serve as basic reference for subsequent investigations of afamin in pregnancy-related disorders.

Has there been a change in peripartal maternal mortality in a tertiary care obstetric European center over the last five decades

OBJECTIVE Maternal mortality still remains a significant problem in obstetrics worldwide. Unchanged or even rising maternal mortality has been reported in several countries. The present study analyzed whether the pattern of maternal mortality has changed over the last five decades at the Department of Obstetrics and Gynecology of the Medical University of Graz. STUDY DESIGN Starting in 1981, a registry of maternal deaths was established and regularly updated at our institution based on retrospective data. Between 1963 and 2012, a total of 187,917 women delivered. Thirty-five consecutive maternal deaths were observed and subdivided into 10 year cohorts. METHODS The registry of maternal deaths included deliveries after 28+0 weeks of gestation. Puerperal deaths were defined as deaths up to day 42 post partum. MAIN OUTCOME MEASURES Clinical data from maternal deaths were extracted from hospital records and autopsy reports. RESULTS Maternal mortality rates declined from 35.0, 29.0, 2.4, 13.1 to 3.6 per 100,000 deliveries in the five subsequent periods, respectively. Sixty-six percent of women who died were 30 years or older. The cesarean section rate was 49%. Ninety-one percent of the 35 maternal deaths occurred in women with no significant medical history or risk factors. Seventy-five percent of deaths occurred after the 37+0 weeks of gestation. During all study periods, the prevalence of infections and hemorrhage was highest. The main causes of bleeding were uterine rupture and placental abruption, respectively. CONCLUSION Even nowadays, peripartal maternal deaths occur mainly due to infections and hemorrhage and also in women with no significant medical history.

Lebensqualität durch Früherkennung und Vorsorge gynäkologischer Tumoren

Alter ist der wichtigste Risikofaktor fur die Entstehung einer Krebskrankheit. Dies gilt auch fur das Mammakarzinom und Genitaltumoren. Deshalb kommt der Beachtung von Risikofaktoren, Symptomen sowie der Vorsorge gerade in diesem Lebensabschnitt besondere Bedeutung zu.

Hämostaseologisch Relevantes aus der Geburtshilfe

Wahrend einerseits eine gute Durchblutung der Plazenta in der Schwangerschaft fur die normale Entwicklung des Kindes notig ist, soll andererseits peri- und postpartal ein ausreichendes hamostaseologisches Potenzial einen schnellen Blutungsstopp und einen minimalen mutterlichen Blutverlust gewahrleisten.

Orbital hemorrhage as a primary manifestation of disseminated intravascular coagulation (DIC) associated with intrauterine fetal death and placental abruption

Abstract Introduction: Disseminated intravascular coagulation (DIC) is a serious complication of obstetric emergencies, and its clinical manifestation occurs in various organs and tissues. Ocular and orbital involvement has been reported only rarely. Presentation of the case: A 15-year-old primigravida complained about loss of vision in the right eye for 3 days. Magnetic resonance imaging showed a retrobulbar hemorrhage. A first diagnosis of pregnancy (estimated gestational age of 23 weeks) was made, and intrauterine fetal death was diagnosed by ultrasound examination. Laboratory workup revealed the diagnosis of DIC. Due to massive vaginal bleeding a cesarean section was performed, and placental abruption was diagnosed intraoperatively. Discussion: The concomitance of intrauterine fetal death and other obstetric complications such as placental abruption might induce a fulminant coagulopathy with severe consequences even with uncommon organ localization.

Lebensqualität im Alter aus der Sicht der Frauenheilkunde

Die Lebenserwartung von Frauen in den industrialisierten Landern ist derzeit noch um ca. funf Jahre hoher als jene von Mannern, jedoch zeigt sich im letzten Jahrzehnt eine deutlich erkennbare nivellierende Tendenz. Bei Sistieren der Ovarialfunktion steht der Frau durchschnittlich noch ein Viertel ihrer Lebensspanne zur Verfugung. Als logische Konsequenz aus diesem Faktum gilt die Vision der vitalen Seniorin mit der Aussicht auf einen beschwerdearmen Alterungsprozesses bei guter geistiger und korperlicher Aktivitat. Erkenntnisse der letzten Jahre, welche Bezug auf stattgefundene Schwangerschaftskomplikationen nehmen, weisen neue Wege zur Beratung und Interventionen fur das weitere Leben, moglicherweise auch in eine Beeinflussung der Lebensqualitat im Alter der betroffenen Frauen.