D.A. Beyer

University Medical Center Schleswig-Holstein, Kiel, Schleswig-Holstein, Germany

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Publications (35)22.69 Total impact

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    ABSTRACT: OBJECTIVE: To describe the varieties and ultrasound characteristics of prenatally diagnosed fetal abdominal tumors and to scrutinize the accuracy of prenatal diagnosis as well as the postnatal outcome and therapy of affected pregnancies. STUDY DESIGN: Retrospective study of 354 fetuses found to have abdominal tumors on prenatal sonogram, identified from 1993 to 2009 at a tertiary referral center for prenatal medicine. The cohort was classified into subgroups according to the sonographic appearance of the fetal tumor and the affected anatomic structure (urinary, gastrointestinal and genital tracts and other locations). Sensitivity, specificity, positive predictive value and false-positive rate of ultrasonography in identifying the system of origin were calculated. Relationships between relevant outcome domains and the different subgroups were assessed using the chi-square test and Fisher's exact test. RESULTS: Our cohort comprised 222 urinary tract lesions, 37 genital tract lesions, 80 gastrointestinal lesions and 15 tumors of other origins. The mean gestational age at diagnosis was 26+0 wks. The prenatally established diagnosis was exactly concordant with postnatal findings in 88.9%. Sensitivity, specificity, positive predictive value and false-positive rate of ultrasonography in identifying the system of origin (urinary, gastrointestinal, genital tracts and other locations) were 98.3%, 97.6%, 92.6% and 2.4%, respectively. The favorable postnatal outcome rate was highest among fetuses with genital tract lesions (95%) and lowest among those with tumors of the urinary tract (62%, p=<0.001). Twenty per cent of tumors regressed spontaneously, mostly gastrointestinal tumors (36%, p=<0.001). In 75/354 cases (21%) the parents opted to terminate the pregnancy: intra-uterine fetal demise and neonatal death were each noted in 4%. Prenatal therapy was performed in 24 of 354 cases (7%) and postnatal surgery in 64 cases (18%). CONCLUSION: The majority of fetal abdominal anomalies were accurately diagnosed and the vast majority of affected fetuses had a favorable outcome, some tumors even resolved with advancing pregnancy. Pre- and post-natal invasive surgical interventions were mandatory in only a small number of cases.
    European journal of obstetrics, gynecology, and reproductive biology 01/2013; · 1.97 Impact Factor
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    ABSTRACT: Das Zervixkarzinom ist das zweithäufigste in der Schwangerschaft diagnostizierte Karzinom. Während das invasive Zervixkarzinom in graviditate selten ist, sind auffällige PAP-Abstriche und Krebsvorstufen in der Schwangerschaft in der Praxis ein häufiges Problem. Der vorliegende Beitrag erläutert die praktische Vorgehensweise bei suspekter Zervixzytologie in der Schwangerschaft. Darüber hinaus werden Stadien- und Gestationsalter-abhängige Therapieoptionen beim invasiven Zervixkarzinom in der Schwangerschaft unter Rücksichtnahme auf den Erhalt der Schwangerschaft aufgezeigt.
    Der Gynäkologe 01/2012; 45(12).
  • Daniel Alexander Beyer, F Amari, K Diedrich, M K Bohlmann, J Weichert, A Hornemann
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    ABSTRACT: To evaluate the impact of young maternal age on labour, intrapartum assessment and delivery mode. A retrospective cohort analysis was conducted of 13,941 deliveries at a tertiary delivery unit between 2000 and 2009. Patients aged less than 18 years were compared with patients aged 18 years or older. The main outcome was defined as mode of delivery. Frequencies and odds ratios for adverse maternal-foetal outcomes were calculated for primiparous women. Of the deliveries occurring during the study period, 6,863 (49.2%) met the inclusion criteria. A total of 156 deliveries (2.3%) occurred among teenagers less than 18 years and 6,707 among patients 18 years and older. Compared with patients 18 years of age and older, younger maternal age was associated with a higher chance of spontaneous delivery [adjusted odds ratio (OR) 2.07, 95% confidence interval (CI) 1.45-2.93] than via operation (vaginal operative delivery: OR 0.98, 95% CI 0.48-2.03; secondary caesarean delivery: adjusted OR 0.51, 95% CI 0.32-0.82). Young maternal age at delivery does not represent a risk factor for high surgical delivery rates.
    Archives of Gynecology 09/2011; 284(3):535-8. · 0.91 Impact Factor
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    ABSTRACT: To evaluate the operative outcomes of patients managed by laparoscopic-assisted vaginal hysterectomy (LAVH) with and without laparoscopic transsection of the uterine artery for benign gynaecologic diseases. A retrospective analysis of 1,255 women from two different centers undergoing hysterectomy between 1998 and 2009 with benign indications is presented. 856 patients were treated by LAVH type I (vaginal transsection of the uterine artery) and 399 patients by LAVH type II (laparoscopic transsection of the uterine artery). Operative outcomes, intraoperative and postoperative complications, as well as laparoconversion rates were the main objectives of the study. Median operative time was similar between LAVH type I and II (136 vs. 126 min, respectively, P = NS). Intraoperative complication rate was not significantly different between the two groups of the study (LAVH type I: 1.5% vs. LAVH type II: 1.26%, respectively, P = NS). The injury of the urinary tract, especially of the bladder, was the most common intraoperative complication for both the groups of the study. Laparoconversion rate was similar in LAVH type I and II (0.5 vs. 0.35%, respectively, P = NS), while postoperative complications were significantly higher in LAVH type I (2.25%) compared to LAVH type II (1.16%), mainly because of postoperative vaginal and intrabdominal haemorrhage in the group of the LAVH type I. LAVH with laparoscopic transsection of the uterine artery is an effective and safe technique with less postoperative complication compared to LAVH with vaginal transsection of the uterine vessels.
    Archives of Gynecology 08/2011; 284(2):379-84. · 0.91 Impact Factor
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    ABSTRACT: Cornelia de Lange syndrome (CdLS) (also referred to as Brachmann-de Lange syndrome) constitutes a multisystem developmental anomaly which is characterized by facial dysmorphism, upper limb deformities, and mental retardation. We report on two subsequent pregnancies with antenatally diagnosed CdLS at 23 and 14 gestational weeks, respectively, of an otherwise healthy gravida. Molecular genetic testing revealed a rare case of gonadal mosaicism of a nonsense NIPBL gene mutation.
    The journal of maternal-fetal & neonatal medicine: the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 02/2011; 24(7):978-82. · 1.36 Impact Factor
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    ABSTRACT: Objective To assess embryo survival after vitrification of 2 PN oocytes and evaluate the impact of the duration of cold storage and patient age.
    Middle East Fertility Society Journal 01/2011; 16(1):45-49.
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    ABSTRACT: The radical surgery of the deep infiltrating endometriosis of the rectovaginal septum and the uterosacral ligaments with or without bowel resection can cause a serious damage of the pelvic autonomic nerves with urinary retention and the need of self-catheterization. Major goal of this review article is to compare different surgical techniques of deep infiltrating endometriosis and their follow-up results. The research strategy included the online search of databases [MEDLINE, EMBASE, SCOPUS] for the diagnosis of deep infiltrating endometriosis with the indication of an operative resection. The outcome of the follow-up terms were noticed and compared. All in all, 16 trials could be identified with included follow-up. In all patients at least single-sided resection of the uterosacral ligaments were performed. Follow-up was heterogeneous in all trials ranging from 1 to 92 months. Postoperative symptoms, such as dysmenorrhoea, pelvic pain, and dyspareunia were commonly described in the majority of trials. Nevertheless, a tendency towards lower comorbidity after nerve sparing resection of endometriosis could be observed. Identification of the inferior hypogastric nerve and plexus was feasible in the minority of trials. In comparison with non-nerve-sparing surgical technique, no cases of bladder self-catheterization for a long or even life time was observed, confirming the importance of the nerve-sparing surgical procedure.
    Archives of Gynecology 01/2011; 283(5):1021-6. · 0.91 Impact Factor
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    ABSTRACT: Vitrifikation ist eine Methode der Kryokonservierung, die Zellen in einen glasähnlichen und amorphen Zustand versetzt. Ihre im Vergleich zum Verfahren des „slow rate freezing“ kosten- und zeitstabile Handhabung hat sie in der Routine der modernen Reproduktionsmedizin fest etabliert. Zahlreiche Studien konnten reproduzierbare Zellüberlebensraten nach Auftauen zeigen. Die Schwangerschaftsraten nach einem Kryotransferzyklus liegen Angaben des Deutschem IVF-Registers zufolge knapp unter 20%. Die Indikationen der Vitrifikation reichen von der Herbeiführung eines kontrollierten elektiven Single-Embryo-Transfer (eSet) durch Tiefkühllagerung überzähliger 2PN-Eizellen bis zum Fertilitätserhalt für junge Frauen durch Tiefkühllagerung von Eizellen, 2PN-Eizellen oder Eierstockgewebe. Follow-up-Studien zum kindlichen Outcome nach Kryotransfer liegen noch in nicht aussagekräftiger Zahl vor und werden erwartet. Vitrification is a method of cryopreservation which leads to a glass-like amorphous solidification of the cell. Due to its easy handling concerning cost-effectiveness and cell survival, it has become well established in modern assisted reproduction techniques. Multiple studies have demonstrated reproducible cell survival rates after thawing. According to the German IVF survey pregnancy rates now reach nearly 20%. The indications for vitrification vary from classical cold storage of supernumerary zygotes to cryopreservation of oocytes or ovarian tissue for fertility preservation strategies in young women. Until now, follow-up studies concerning fetal health after cryopreservation have not been available in sufficient number and results are still awaited. SchlüsselwörterFertilität–Elektiver Single-Embryo-Transfer–In-vitro-Fertilisation–Reproduktionsmedizin–Mehrlingsschwangerschaft KeywordsFertility–Elective single embryo transfer–In vitro fertilization–Reproduction medicine–Multiple pregnancy
    Der Gynäkologe 01/2011; 44(2):122-127.
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    ABSTRACT: Kennzeichnend für die Late-onset-Form des adrenogenitalen Syndroms ist das Auftreten von Symptomen nach der Pubertät. Hierzu zählen der unerfüllte Kinderwunsch, Zyklusstörungen sowie Anzeichen einer Hyperandrogenämie mit Hirsutismus, Akne und Alopezie. Ursächlich ist in 95% der Fälle ein heterozygoter Enzymdefekt der 21-Hydroxylase, der zu einer vermehrten Bildung von Kortisol- und Androgenvorstufen führt. Laborchemische und molekulargenetische Tests führen zur Diagnosestellung. Eine wichtige therapeutische Option bei Patientinnen mit Kinderwunsch ist die Gabe von Dexamethason. Stehen bei einer Patientin Symptome einer Hyperandrogenämie, wie z.B. Alopezie und Hirsutismus, im Vordergrund der Beschwerden, ist in den meisten Fällen die Gabe eines oralen Kontrazeptivums mit antiandrogener Gestagenkomponente ausreichend. Late-onset adrenal hyperplasia is characterized by occurrence after puberty with symptoms such as unfulfilled wish to conceive, amenorrhea, hirsutism, acne and alopecia. Predominantly, it is caused by the deficiency of the steroid 21-hydroxylase with abnormalities in adrenal steroid biosynthesis. Diagnosis is confirmed by laboratory and molecular genetic tests. An important therapeutic option when treating women suffering from infertility may be the use of dexamethasone. However, in many cases oral contraceptives containing antiandrogenic compounds alone may be sufficient for the treatment of symptoms of hyperandrogenism. SchlüsselwörterAdrenogenitales Syndrom, Late-onset-Form–Kinderwunschbehandlung–21-Hydroxylasemangel–Hyperandrogenämie–Dexamethason–Sterilität KeywordsLate-onset adrenal hyperplasia–Infertility treatment–21-Hydroxylase deficiency–Hyperandrogenism–Dexamethasone–Sterility
    Gynäkologische Endokrinologie 01/2011; 9(2):93-96.
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    ABSTRACT: Die häufigste Ursache eines Ikterus in graviditate ist eine Virushepatitis, die häufig mit einer passageren Funktionsstörung der Leber einhergeht. Während akute virale Hepatitiden in der Schwangerschaft häufig asymptomatisch verlaufen, ohne Beeinträchtigung des Feten, sind einige der Hepatitisviren für eine erhöhte neonatale Morbidität verantwortlich, insbesondere, wenn die Infektion um den errechneten Termin oder unter der Geburt stattgefunden hat. Nichtsdestotrotz konnte in den letzten Jahren die Zahl der akuten neonatalen Infektionen deutlich gesenkt werden (Hepatitis-B-Simultanimpfung). Im Gegensatz dazu steht eine entsprechende Immunprophylaxe gegen Hepatitis C bislang nicht zu Verfügung. Das vertikale Übertragungsrisiko ist eher gering. Die perinatale Transmission der Hepatitis E ist als gering einzustufen, allerdings sind schwere maternale Krankheitsverläufe beschrieben. Die klinische Bedeutung einer Hepatitis-G-Infektion ist unklar. Entzündliche Leberveränderungen durch andere Viren, toxische Substanzen oder Autoimmunhepatitiden sind vergleichsweise selten. The most common cause of jaundice in pregnancy is viral hepatitis, potentially accompanied by temporary dysfunction of the liver. Whereas acute viral hepatitis in pregnancy frequently describes an asymptomatic course, thereby only rarely affecting the fetus, some of the known hepatitis viruses might cause severe morbidity in the neonatal period particularly when the infection is noted near term or sub partu. However, efforts have been made in order to reduce the number of acute neonatal infections (hepatitis B immune globulin and vaccine). Conversely, no immunoprophylaxis for hepatitis C is available yet, although the vertical transmission rate is low. Perinatal transmission of hepatitis E is unusual, but maternal disease is often severe. The clinical relevance of the commonly found hepatitis G virus remains unknown. Liver inflammation caused by other viruses, toxic agents or autoimmune hepatitis are rare conditions in pregnancy. SchlüsselwörterHepatitisviren–Viruslast–Immunisierung–Transmission–Neonatale Risiken KeywordsHepatitis viruses–Viral load–Immunisation–Transmission–Neonatal risks
    Der Gynäkologe 01/2011; 44(8):615-622.
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    ABSTRACT: INTRODUCTION: Gonadotropin-releasing hormone agonist analogs (GnRHa) are peptides that mimic the action of gonadotropin-releasing hormone (GnRH) and are used to suppress subsequent sex steroid production. Although the analogs are a rather defined group of drugs, there have been developments in the past decades and there is still ample room for improvement. New therapeutic strategies in the use of GnRHs are discussed. AREAS COVERED: Major points of discussion include: i) the use of concomitant treatment of early breast cancer in premenopausal estrogen-positive and -negative patients, ii) the use of GnRHa for fertility preservation in young female patients with malignant diseases and iii) the use of GnRH analogs in assisted reproduction. The manuscript provides a better understanding of GnRH agonists as well as an explanation of their major indications, biochemical pathways and concluding therapeutic strategies. Recent results from international meetings and debates are described to explain current controversies. EXPERT OPINION: This paper highlights the need for more complex GnRH analogs. In the next few years, there will be longer acting GnRHas that may improve adherence. New therapeutic targets in oncological concepts may go beyond fertility preservation and focus on the antiproliferative effects of GnRH analogs.
    Expert Opinion on Emerging Drugs 01/2011; 16(2):323-40. · 2.48 Impact Factor
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    ABSTRACT: Möglichkeiten des Fertilitätserhaltes sollten als Bestandteil jeder onkologischen Therapieplanung mit dem Patienten/der Patientin besprochen werden. Nach Auslegung des deutschen ESchG stehen neben der Kryokonservierung von 2PN-Zygoten die Tiefkühllagerung von Oozyten und Spermien zur Verfügung. Andere Methoden sind viel versprechend, befinden sich aber bislang noch im experimentellen Stadium. Der vorliegende Beitrag soll dem Leser aktuelle Therapieempfehlungen zum Fertilitätserhalt junger Patienten bei onkologischen Erkrankungen aufzeigen und in die aktuelle Studienlage einführen.
    best practice onkologie 01/2011; 6(2):4-13.
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    ABSTRACT: The present study analyzed the epidemiology and outcome of ectopic pregnancy during a 9-year period on a total of 473 women. Our follow-up shows that laparoscopic salpingostomy, performed in 84.9% of the patients, is a safe and effective treatment for ectopic pregnancy.
    Fertility and sterility 12/2010; 94(7):2780-2. · 3.97 Impact Factor
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    ABSTRACT: To verify a seasonal variation in the incidence of spina bifida and thus to identify possible environmental triggers leading to its developement. An interdisciplinary approach has been taken to develop a better understanding of spina bifida through collaborative efforts from investigators specializing in genetics, fetal pathology, paediatrics, neuro-surgery and prenatal ultrasonographic diagnosis. All pregnancies with fetal spina bifida were retrospectively analyzed from May 1 1993 through May 1 2010 at Luebeck University Fetal Health Center. Results were used to construct a model to predict the occurrence of fetal spina bifida based on seasonal variation and environmental influence reflected by climatic changes and environmental pollution. Furthermore, data were categorized in respect to the date of conception and subdivided into date of conception during summer (April-September) and winter months (October-March). Neither a seasonal distribution of conception for fetuses with spina bifida in the defined time frame could be verified nor a relevant influence of the analyzed environmental factors on the prevalence of spina bifida could be proved. The incidence of spina bifida has remained relatively stable within the last 17 years at 2.5 per 1,000 screened pregnancies. Since we were unable to demonstrate a relationship between seasonal variation and certain environmental factors on the incidence of fetal spina bifida, other factors should be investigated for a possible association with the onset of fetal spina bifida.
    Archives of Gynecology 11/2010; 284(4):849-54. · 0.91 Impact Factor
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    ABSTRACT: To investigate the prenatal course and functional outcome for fetuses with spina bifida according to the level of the spinal lesion at prenatal ultrasound examination. Retrospective, descriptive study. Tertiary referral center, Germany. A total of 103 fetuses with spina bifida identified between 1993 and 2008. The antenatal course and postnatal outcome for affected fetuses were reviewed. The relation of relevant outcome domains to the anatomical level was assessed using Fisher's exact test and the χ(2)-test. Level and type of spinal lesion, pregnancy outcome, psychomotor development, bladder and bowel function. Our cohort included a total of 31 live born infants, 68 terminated pregnancies, four intrauterine fetal deaths and five postnatal deaths. Four cases were excluded from follow-up. Twenty of the remaining 22 infants had normal or only slightly impaired mental development (91%). Thirteen children (59%) were able to walk, but nine (41%) needed wheelchairs or were paraplegic. The rate of poor motor outcome varied strongly in dependence on the level of the lesion (22.2% at lower lumbosacral levels to 80% at thoracic level). The majority of the affected children (16/22, 72.7%) suffered from impairment of bladder function. In 36% of cases (8/22) anal incontinence was documented. Spina bifida can result in a spectrum of disabilities that frequently lead to an impairment of bladder, bowel and motor function. The motor function depended on level of the lesion.
    Acta Obstetricia Et Gynecologica Scandinavica 10/2010; 89(10):1276-83. · 1.85 Impact Factor
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    Ultrasound in Obstetrics and Gynecology 10/2010; 36(S1):297-298. · 3.56 Impact Factor
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    ABSTRACT: To evaluate the impact of maternal obesity on labour, intrapartual assessment and delivery. Retrospective cohort analysis of n = 11,681 deliveries supervised between 01 January 2000 and 31 December 2009. Results were analysed dividing the patients into two main groups according to their body mass index (BMI): group 1, control: BMI 18-24.9 and group 2 BMI, test >25. Subgroups were built: (0) BMI 25-29.9, (I) BMI 30-34.9, (II) BMI 35-39.9, (III) BMI >40. Exclusion criteria were defined as: delivery <37 + 0 weeks p.m., multiple pregnancy, comorbidity other than GDM, abnormal presentation, BMI <18.5, and incomplete data. The main outcome parameter was defined as secondary caesarean delivery rate and mode of delivery. N = 8,379 patients met the inclusion criteria and were divided in two groups: 1, n = 4,464 patients and 2, n = 3,915. Basic maternal characteristics including foetal vital parameters were equal in all groups. GDM occurred more frequently in obese patients (P < 0.001). For the main outcome parameter a significant decrease in the rate of spontaneous delivery between control/test groups (72-66%, P < 0.001) and control/I-III groups (72 vs. 50%, P < 0.001) could be observed. The rate of secondary c-section increased significantly according to a higher BMI (>40: OR 2.5, 95% CI 1.84-3.61, χ (2) P < 0.001). The groups showed no difference in the rate of injuries during delivery though foetal birth weight increased significantly with a higher BMI (3,412-3,681 g; P < 0.001). Obesity decreases the chance to deliver spontaneously. Moreover, the obese patient suffers from a significantly longer trial of labour (7.9 vs. 9.5 h) and an elevated risk of surgical delivery.
    Archives of Gynecology 05/2010; 283(5):981-8. · 0.91 Impact Factor
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    ABSTRACT: Aus der minimal-invasiven Diagnostik hat sich die minimal-invasive Chirurgie entwickelt. Kleinere Eingriffe wie Arthroskopien mit ggf. Resektion von Knorpel, Cholezystektomien und Eingriffe an den weiblichen Geschlechtsorganen gehören heute zum operativen Standard. Um das kosmetische Ergebnis weiter zu verbessern und die Invasivität noch mehr zu senken, wurde ein Trokar entwickelt, mit welchem nur noch eine einzige laparoskopische Inzision notwendig ist. Die Technik und erste Erfahrungen sollen in diesem Artikel beschrieben werden. Minimally invasive diagnostic procedures have led to minimally invasive surgery. Its low morbidity and high diagnostic accuracy have altered the status of traditional laparotomy. Minor operations such as cholecystectomy, arthroscopy with resection of cartilage, and pelvic surgery have become standard procedures. To improve cosmetic results and render operations even less invasive, a trocar was developed that allows the need for only a single incision. This new technique and first experiences are described in this paper.
    Der Gynäkologe 01/2010; 43(2):149-153.
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    ABSTRACT: Die Reproduktionsmedizin gewinnt in der westlichen Welt zunehmend an Bedeutung. Nach wie vor wird jedoch die Chance auf eine Schwangerschaft mit einem nicht unerheblichen Mehrlings- und somit Gesundheitsrisiko der werdenden Mutter erkauft. Methoden der Embryoselektion und der Präimplantationsdiagnostik bieten eine Lösung für dieses Problem. Nach wie vor gestattet das seit 1991 bestehende Embryonenschutzgesetz (EschG) nur einen relativ kleinen Rahmen der Methodenwahl. Eine Gesetzesreform ist dringend notwendig und seit langem überfällig. Reproductive medicine is gaining importance in the western world. Unfortunately the improved chances of pregnancy are still associated with a higher risk of multiple pregnancy and thus danger to the mother’s health. New embryo selection methods and preimplantation diagnostics could solve this problem. Germany’s Embryo Protection Law of 1991 (Embryonenschutzgesetz) still allows only some of the numerous medical improvements made since then. In this respect German legal reform is urgent and long overdue.
    Der Gynäkologe 01/2010; 43(1):9-14.
  • Geburtshilfe Und Frauenheilkunde - GEBURTSH FRAUENHEILK. 01/2010; 70(01):30-35.

Publication Stats

52 Citations
22.69 Total Impact Points

Institutions

  • 2010–2013
    • University Medical Center Schleswig-Holstein
      • Department of Pediatrics
      Kiel, Schleswig-Holstein, Germany
  • 2009–2012
    • Universitätsklinikum Schleswig - Holstein
      • Klinik für Gynäkologie und Geburtshilfe (Kiel)
      Kiel, Schleswig-Holstein, Germany