[Show abstract][Hide abstract] ABSTRACT: Hantavirus infection in humans usually occurs via inhalation of infectious aerosolized excreta of rodents. Horizontal human-to-human transmission was reported only for the highly virulent Andes virus. The likelihood of vertical transmission and the clinical outcome of hantavirus infections in pregnancy is still unpredictable.
Very few data were published about the impact of hantaviruses in pregnancy. Here we present four cases of pregnant women infected by European hantaviruses. The risk of vertical virus transmission was investigated.
Four pregnant women with clinical signs of acute hantavirus disease were investigated for hantavirus IgM and IgG after onset of clinical symptoms. Furthermore, the newborns were tested for presence of viral RNA and antibodies in cord blood and, if any parameter was found positive, 8-12 months after delivery.
Four women suffered from a hantavirus infection, two of them due to infection by Puumala virus and two by Dobrava-Belgrade virus. Three women delivered healthy babies by vaginal route and one woman by Caesarean section (week 28). In no case hantavirus RNA was detected in cord blood after delivery or in the 8-12 month old babies. Hantavirus IgG was detectable in the cord blood of 3 babies (but not in the preterm child); these antibodies disappeared after 8-12 months indicating a passive transfer of immunoglobulins. No child had any clinical sign of hantavirus infection.
In this study, the absence of vertical hantavirus transmission was demonstrated for pregnant women with onset of hantavirus disease between gestation weeks 14 and 28.
Journal of clinical virology: the official publication of the Pan American Society for Clinical Virology 08/2012; 55(3):266-9. DOI:10.1016/j.jcv.2012.07.011 · 3.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In case of non-gynecological solid tumors and hematological malignancies diagnosed during pregnancy, individual diagnostic and treatment options must be established by an interdisciplinary team.
In part II of the present review we report on diagnostic and therapeutic principles in distinct entities of solid and hematological malignancies.
On the basis of a review of the current literature, clinical guidelines and algorithms have been established for diagnosis and therapy of maternal cancer during pregnancy.
The prognosis of the malignancy and the patient's informed consent must be taken into consideration when the well-being of the expectant mother is weighed against the well-being of the unborn child in case of maternal cancer during pregnancy.
Archives of Gynecology 08/2011; 284(6):1481-94. DOI:10.1007/s00404-011-2059-7 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Cancer in pregnancy is a rare circumstance. However, the coincidence of pregnancy and malignancy is supposed to increase due to a general tendency of postponing childbearing to older age. To date, clinical guidelines are scarce and experience regarding therapeutic management is limited to case reports.
This review focuses on general diagnostic and therapeutic principles including systemic therapy for malignancies in pregnancy.
In part I, we report on diagnosis and therapy of gynecological tumors.
The diagnosis of gestational cancer faces both oncologist and obstetrician to the dilemma of applying appropriate diagnostic techniques and adequate local and systemic therapy to an expectant mother without harming the fetus.
Archives of Gynecology 08/2011; 285(1):195-205. DOI:10.1007/s00404-011-2058-8 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prevalence of diabetic disorders in pregnancy is rising, which goes along with increased risks for maternal and foetal complications during pregnancy and delivery. The expression of the endo-β-D: -glucuronidase, heparanase (HPSE), may increase under hyperglycaemic conditions, is believed to play an important role in diabetes associated morbidity outside the female reproductive tract and is expressed in the placenta throughout gestation. However, the placental expression of HPSE has not been investigated in diabetic patients.
Placental biopsies of 30 patients with pre-existing or gestational diabetes and 30 healthy controls were analysed by real-time PCR and immunohistochemistry with regard to the presence of HPSE at term.
Patients and controls were comparable with respect to foetal outcome and maternal characteristics except for maternal body mass index. We were unable to show significant differences in placental HPSE expression between diabetic patients and healthy controls.
This study suggests that HPSE expression in term placentas is not affected by maternal diabetes and thus does not contribute to pathological processes in diabetic pregnancies with deliveries at term.
Archives of Gynecology 08/2011; 284(2):287-92. DOI:10.1007/s00404-010-1636-5 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Zusammenfassung Eine maternale Thrombophilie erhöht das Risiko thromboembolischer Ereignisse während der Schwangerschaft. Auch das Risiko
für rezidivierende Aborte, intrauterine Wachstumsretardierung und hypertensive Schwangerschaftserkrankungen (Präeklampsie,
Eklampsie) scheint erhöht. Abhängig von der individuellen Risikokonstellation sollte eine antikoagulatorische Therapie gewählt
werden. Sofern kein akutes thromboembolisches Ereignis vorliegt, wird eine Antikoagulation erst nach Feststellung der Gravidität
begonnen. Ein Thrombophiliescreening sollte bei Patientinnen mit positiver thromboembolischer Familien- oder Eigenanamnese
und/oder rezidivierenden Aborten angestrebt werden. Ein generelles Thrombophiliescreening bei Kinderwunsch wird nicht empfohlen.
Eine prophylaktische Antikoagulation zur Erhöhung der Schwangerschaftsrate im Rahmen einer Kinderwunschbehandlung ist nicht
indiziert, die Datenlage zur Heparinisierung bei anamnestischen habituellen Aborten und Ausschluss eines Antiphospholipid-Syndroms
Der Gynäkologe 07/2011; 44(7):509-514. DOI:10.1007/s00129-010-2734-y
[Show abstract][Hide abstract] 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.
We introduce a case series report of 16 patients with laparoscopic nerve-sparing surgery of deep infiltrating endometriosis. We describe the technique step by step and compare the patients' outcome with patients who had undergone a non-nerve-sparing surgical technique. In 12 patients, a double-sided and in four patients, a single-sided identification of the inferior hypogastric nerve and plexus were performed.
In all patients at least single-sided resection of the uterosacral ligaments were performed. Postoperatively dysmenorrhoea, pelvic pain, and dyspareunia disappeared in all patients. The average operating time was 82 min (range 45-185). Postoperatively, the overall time to resume voiding function was 2 days. The residual urine volume was in all patients <50 ml at two ultrasound measurements.
Identification of the inferior hypogastric nerve and plexus was feasible. 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 07/2011; 284(1):131-5. DOI:10.1007/s00404-010-1624-9 · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In aktuellen Studien konnte der Zusammenhang zwischen hereditären oder angeborenen maternalen Thrombophilien und geburtshilflichen
Komplikationen, wie habituelle Aborte, Präeklampsie, intrauterine Wachstumsrestriktion und vorzeitige Plazentalösung, nachgewiesen
werden. Es gibt zunehmend Hinweise darauf, dass auch fetale Thrombophilien ursächlich sein können für schwere perinatale Störungen,
insbesondere für die Entstehung einer Zerebralparese als Folge einer zerebralen Ischämie oder Gangräne der Extremitäten, Sinusvenen-
bzw. Nierenvenenthrombosen. Auch direkte Schwangerschaftskomplikationen zeigen eine Assoziation zu fetalen hyperkoagulativen
Störungen. Pathomorphologisches Korrelat ist eine fetale thrombotische Vaskulopathie mit entsprechenden plazentaren Veränderungen
und z.T. schwerwiegenden neonatalen Auswirkungen. In dieser Übersicht sollen alle relevanten Fakten hinsichtlich der Wertigkeit
einer fetalen Thrombophilie und ihrer Assoziation zu geburtshilflichen wie neonatalen Komplikationen aufgeführt und diskutiert
Recent findings suggest that inherited or acquired maternal thrombophilic disorders lead to recurrent fetal loss, preeclampsia,
intrauterine growth restriction and placental abruption. On the fetal side, there is a growing body of evidence that fetal
thrombophilia is closely related to catastrophic perinatal events, such as stroke (resulting in cerebral palsy) or limb ischemia
via arterial thrombosis, cerebral sinus venosus thrombosis or renal vein thrombosis. Furthermore, an association between fetal
thrombophilia and adverse pregnancy outcome has been reported. Fetal thrombotic vasculopathy has been assumed to be a plausible
underlying cause for placental lesions and neonatal sequelae. This review aims to tabulate and discuss the findings regarding
the weight of fetal thrombophilic factors and the potential association with obstetric and neonatal complications derived
from the current literature.
SchlüsselwörterKoagulation–Zerebralparese–Thrombotische Vaskulopathie–Schwangerschaftskomplikationen–Abnorme Plazentation
KeywordsBlood coagulation–Cerebral palsy–Thrombotic vasculopathy–Adverse pregnancy outcome–Abnormal placentation
Der Gynäkologe 07/2011; 44(7):521-526. DOI:10.1007/s00129-010-2738-7
[Show abstract][Hide abstract] ABSTRACT: Thrombozytenzahl und -funktion sind nicht nur der in Schwangerschaft eine wichtige Grundlage für eine adäquate Hämostase.
Thrombozytopenien jeglicher Ausprägung treten bei bis zu 15% aller Schwangerschaften auf. Die weitaus häufigste Form, die
Gestationsthrombozytopenie, ist aufgrund ihres meist milden Verlaufs häufig nur von untergeordneter klinischer Bedeutung.
Komplexere Formen eines Plättchenmangels, wie auch die wesentlich seltener auftretenden genuinen Thrombozytopathien, dagegen
bedürfen einer risikoadaptierten Überwachung von Gravidität wie Geburtsverlauf und stellen Paradebeispiele einer interdisziplinären
Vorgangsweise bei (Hoch-)Risikoschwangeren dar.
Sufficient concentration and function of thrombocytes constitute an important part of adequate haemostasis in both pregnant
and non-pregnant individuals. Any form of thrombocytopaenia may occur in up to 15% of pregnancies with its most frequent form—gestational
thrombocytopaenia—being of rather minor importance due to its mild clinical course. Complex variants of thrombocytopaenia
as well as rarely encountered genuine thrombocytopathic diseases, however, require risk-adjusted monitoring both during pregnancy
and delivery and constitute a prime example of an interdisciplinary approach for (high) risk patients.
KeywordsHaemostasis–Blood coagulation disorders–Thrombosis–Prenatal care–Immune disorders
Der Gynäkologe 07/2011; 44(7):527-532. DOI:10.1007/s00129-010-2736-9
[Show abstract][Hide abstract] ABSTRACT: Although non-puerperal mastitis is rare and its cause is rather unclear, the number of patients diagnosed with this defect is increasing. In some cases, standard therapy fails and it progresses to a chronic disease. Vacuum-assisted closure (VAC) therapy has shown good results in healing complex wounds.
The goal of this study was to evaluate our experiences with VAC therapy and to answer the question whether or not should be accepted as an effective treatment in healing chronic wounds caused by non-puerperal mastitis. Retrospectively, we identified five patients with a non-puerperal mastitis chronic wound that was treated using VAC and report on their outcome.
We reached both wound control and closure of the breast wounds in all patients.
According to our findings, the VAC therapy can be considered when managing challenging breast wounds, particularly when other therapeutic options have failed. The role of VAC therapy as a primary therapeutic option has not yet been evaluated.
Archives of Gynecology 06/2011; 283(6):1357-62. DOI:10.1007/s00404-010-1594-y · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Breast cancer is the most common malignancy in women with increasing incidence. The occurrence of metastatic disease to the breast in both females and males is relatively rare, constituting 0.5-6% of all breast malignancies. The therapy of secondary breast cancer is usually completely different from that of primary malignant lesions. Thus, early confirmation of secondary involvement is crucial to direct appropriate and to avoid potentially harmful treatment. The main focus remains to include secondary breast involvement in the differential diagnosis of breast tumours. In recent years, a number of new or improved imaging modalities have been introduced in the diagnosis of breast neoplasm. Current diagnostic concepts of metastatic neoplasm to the breast, including latest imaging modalities and their possible future applications, are presented in this review with special emphasis on possible pitfalls.
Archives of Gynecology 04/2011; 284(3):687-94. DOI:10.1007/s00404-011-1904-z · 1.28 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Increases in technical expertise in gynecological surgery and advances in surgical instrumentation have led to the development of laparoendoscopic single-site surgery (LESS). Between March and September 2009, 24 patients underwent adnexal surgery at our institution with laparoendoscopic single-site surgery. The LESS technique was performed using the TriPort through an umbilical incision of 10 mm and bent laparoscopic instruments. We furthermore compared the LESS technique with a control group of 24 patients operated consecutively in the same period and for the same procedures with conventional multiport laparoscopy. Comparing the two techniques we found differences between the operation time and mean hospital stay. The surgeon must master the use of novel bent instruments in close proximity to each another. The LESS technique for benign adnexal surgery is technically feasible and safe, representing a reproducible alternative to conventional multiport laparoscopy.
[Show abstract][Hide abstract] ABSTRACT: To determine the accuracy and characteristics of prenatally detected fetal micrognathia.
A retrospective analysis of all pregnancies with the suspicion of fetal micrognathia was performed. The affected fetuses were reassessed by estimation of the inferior facial angle (IFA) and the frontal nasomental angle on stored gray scale images to objectively establish the diagnosis.
Of the 28.935 ultrasounds (USs) reviewed, 58 cases were eligible and 4 were excluded because of inconclusive data. The mean values for IFA and frontal nasomental angle were 44.8° and 123.3°, respectively. In 33 cases, the pregnancy was terminated. Four fetuses died sub partu or immediately after birth, five were stillborn. Invasive testing in 40/54 cases revealed aneuploidies in 35%. Associated anomalies comprised musculoskeletal disorders (43%) and non-skeletal anomalies (15%). Less than one fifth (9/54) were alive beyond postnatal period. Four fetuses had an isolated micrognathia, one of which was found to have a cleft palate postnatally.
The diagnosis of micrognathia has a crucial impact on both prenatal and postnatal outcomes of affected individuals due to its association with additional abnormalities. A detailed sonographic survey using objective criteria for defining micrognathia is mandatory. Once the diagnosis is confirmed, an intensive interdisciplinary counseling of the parents is needed.
[Show abstract][Hide abstract] ABSTRACT: The radical hysterectomy type three can be accompanied by postoperative morbidity, such as dysfunction of the lower urinary tract with loss of bladder or rectum sensation. We describe the technique of laparoscopic nerve-sparing radical hysterectomy and patient's outcome.
Thirty-two patients underwent laparoscopic nerve-sparing radical hysterectomy with pelvic lymphadenectomy. Both the hypogastric and the splanchnic nerves were identified bilaterally during pelvic lymphadenectomy.
The median age of the patients was 52 years, and the average operating time was 221 min. There were no intraoperative or postoperative complications considering the nerve-spring radical hysterectomy. Postoperatively, in all patients spontaneous voiding was possible on the third postoperative day with a median residual urine volume of <50 ml.
Laparoscopic identification (neurolysis) of the inferior hypogastric nerve and inferior hypogastric plexus is a feasible procedure for trained laparoscopic surgeons who have a good knowledge not only of the retroperitoneal anatomy but also of the pelvic neuro-anatomy as this qualification could prohibit long-term bladder and voiding dysfunction during nerve-sparing radical hysterectomy.
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to analyse hysteroscopic results in patients with recurrent miscarriages and to compare the frequency of uterine anomalies in women with a history of exactly two and with more than two consecutive miscarriages. A retrospective analysis of 206 patients undergoing hysteroscopy for repeated early pregnancy losses was performed at two university centres. Late miscarriages were excluded, terminations of pregnancy were not counted. Eighty-seven patients had suffered from exactly two early miscarriages and 119 from more than two. Both groups were comparable with respect to age at admission (32.95+/-4.46 versus 34.06+/-5.02 years) and at first miscarriage (30.43+/-4.24 versus 29.08+/-5.38 years). The prevalence of acquired (adhesions, polyps, fibroids) and congenital uterine anomalies (septate or bicornuate uterus, etc.) did not differ significantly (acquired: 28.7 versus 27.7%; congenital: 9.2 versus 16.8%). The rates of uterine anomalies did not differ significantly overall (36.8 versus 42.9%). In conclusion, uterine anomalies are frequently found in patients with two and with more than two early miscarriages. Due to the high rate of anomalies, their risk for adverse pregnancy outcome and a possible therapeutic approach, hysteroscopy might be a diagnostic option even after two early miscarriages.