Robert Armbrust

The Charité cesarean birth: a family orientated approach of cesarean section

Abstract Objective: To evaluate the safety and patients delivery experience of the Charité Cesarean Birth (CCB), a modified cesarean section (CS). Parents are actively integrated in the delivery process by direct visualization of the birth, cutting the umbilical cord and early skin-to-skin contact (STS). Methods: Women with an indication for a planned primary CS at term were included. Trial was conducted at the Charité University Hospital Berlin as a prospectively randomized controlled trial. Parameters of perinatal outcome for both mother and infant were assessed using modified Likert-Scales and a standardized questionnaire. Primary outcome measures were birth experience and satisfaction for parents. Parameters of breast feeding and consecutive problems. APGAR Scores, blood loss, perioperative complications were secondary outcome measures. Results: Birth experiences were rated significantly higher in the CCB group compared to a classical caesarean section (p < 0.05). There were no significant differences between APGAR Scores, need for admission to an intensive care unit. Also perioperative blood loss and cardiovascular disorders did not differ between the two groups. Early STS was achieved in the 72% of the cases with higher rates of breast-feeding in the CCB group. Conclusions: The CCB leads to a significantly better birth experience. The procedure seems to be safe for both mother and infant. Patients become an active part of the CS by direct visualization of the birth and cutting the umbilical cord. The presented modification is a useful and safe option when a CS is medically indicated and necessary. It improves the breast-feeding and the early mother-infant interaction.

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.

Case report of severe maternal hyponatremia complicating preeclampsia

Abstract The incidence of preeclampsia associated maternal and neonatal hyponatremia is reportedly rare and can be life threatening in severe cases. The timely diagnosis and careful management requires a multidisciplinary approach between obstetric, neonatal, endocrinology, and intensive care teams. We report firstly, on a case of severe hyponatremia associated with preeclampsia, secondary to inappropriate Anti-Diuretic Hormone secretion, followed by a review of cases over a one year period at our institution.

The growth of uterine myomas in untreated women: influence factors and ultrasound monitoring

PurposeUntil now there are no systematic studies about the long-term course of myoma growth. Therefore, the aims of the present study were: (1) ultrasound monitoring of the natural course of growth of uterine leiomyomas; (2) assessment of whether the growth of myomas depends on the age of the patients, the location, or the initial size (possible co-factors/predictor criteria for increase of growth); influence of oral contraceptives (OC).MethodsPatient records (2010–May 2016) were retrospectively and systematically evaluated in regards to their growth and clinical course. The patients received a follow-up questionnaire by mail about the further history. Linear regression analysis and generalized regression analysis were performed to determine the influence of various factors on the growth of myomas.ResultsOverall, 152 met the further inclusion criteria. Most of the myomas increased in size but 10% of the myomas became smaller without therapy. There is a significant dependency between the initial myoma size, and the first and second measurements, but not between those measures and myoma localization. In regression analysis, there was also a significant association between the growth of the myomas and the initial size but no association with age, complaint symptoms, and use of OC. However, the use of OC waas significantly associated with myoma growth in GEE.ConclusionsThe course of growth of myomas has large variance, so this should not be taken as a sign for a malignant event (sarcoma or the so-called STUMP). The growth takes place with considerable individual variability and ultimately is not predictable.

From design to adoption

Transition from design to adoption of innovations must be evidence‐based and inform product development, regulatory approval and adoption

Advanced Topics on Three-dimensional Ultrasound in Obstetrics and Gynecology

It is important to know how three-dimensional ultrasound (3DUS) works and its functions for making the best use of 3DUS. 3DUS shows various kinds of images through following processes: 1. Acquisition of 3D data (3D scanning) A large number of consecutive tomographic (2D) images are obtained through 3D scanning with a 3D probe; 2. Construction of a 3D data set A 3D data set is constructed from the acquired 2D images. A gated technique called STIC (spatiotemporal image correlation) is used for construction of 3D data sets of the fetal heart; 3. Volume visualization A computer constructs 2D and 3D images from the 3D data set. 3DUS shows multiplanar images, such as a multi-parallel-plane image and a three-orthogonal-plane image. Each plane can be selected arbitrarily by translation and rotation of the 3D data set. Most of 3D images are constructed by volume rendering. Proper settings of ROI (region of interest) and threshold are important for obtaining a clear surface rendered image. Electrical scalpel (or “MagiCut”) is used to eliminate unfavorable structures around the object. Various kinds of 3D images as well as a surface rendered image can be obtained by volume rendering. Surface rendering is also used for 3D image construction. Boundaries of the object should be outlined strictly and it takes a lot of time to get a 3D image in surface rendering. But once the object is extracted, the volume of the object can be calculated.

The O-Sign: early recognition of O-shaped abdominal distension avoids drastic surgical intervention in Ogilvie Syndrome after caesarean section.

fetal blood flow ceases, this leads to the sagging of placental villi and the filling of intervilli spaces, resulting in a reduction in placental blood supply. Ruano et al. [4] described a clear reduction in placental flow 48 h after feticide. We encourage the reporting of similar cases, as professional experience is particularly useful for decision-making discussions in such exceptional circumstances.