[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. · 0.91 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. · 0.91 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. · 0.91 Impact Factor
[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. · 0.91 Impact Factor
[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. · 0.91 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. · 0.91 Impact Factor
[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: 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: 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
[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
[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
[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.
[Show abstract][Hide abstract] 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
[Show abstract][Hide abstract] ABSTRACT: Die tubare Sterilisation ist weltweit eine der häufigsten Methoden der Kontrazeption. Ein nicht unbedeutender Teil sterilisierter
Frauen bedauert im Nachhinein den Eingriff und hat erneuten Kinderwunsch, insbesondere, wenn sich die Partnerschaftsverhältnisse
nach der Operation geändert haben. Als therapeutische Optionen stehen dabei einerseits Methoden der assistierten Reproduktion
unter Umgehung der destruierten Tuben, andererseits operative Wege zur Tubenrekonstruktion zur Verfügung. Beim operativen
Vorgehen wird der Zugang per Minilaparotomie von der laparoskopischen Methode unterschieden. Die Übersicht fasst den aktuellen
Kenntnisstand in Hinblick auf die verschiedenen Therapieoptionen bei Kinderwunsch nach tubarer Sterilisation unter Berücksichtigung
spezifischer Risiken und Erfolgsaussichten zusammen.
Worldwide, tubal sterilization is one of the most frequently used methods of contraception. However, a significant number
of patients subsequently regret their decision, especially after a change in family circumstances. Therapeutic options for
women with a renewed wish for a child after tubal sterilization include methods of assisted reproduction, bypassing of the
destroyed Fallopian tubes, and operative tubal reconstruction. Such refertilization procedures include approaches by laparoscopy
or minilaparotomy. This review summarizes the current knowledge concerning the different therapeutic options, with special
emphasis on the specific risks and chances of success.
[Show abstract][Hide abstract] ABSTRACT: Frauen, die an einem Mammakarzinom behandelt wurden, leiden unter dem konsekutiven Östrogenmangel einer Chemo- oder antiendokrinen
Therapie. Diese Frauen würden erheblich von einer Hormonsubstitution profitieren. Die Datenlage dazu ist allerdings inkonsistent.
Zahlreiche Beobachtungsstudien konnten kein erhöhtes Rezidivrisiko unter Hormonersatztherapie (HRT) zeigen, allerdings waren
viele dieser Arbeiten sehr heterogen, retrospektiv und hatten eine zu geringe Fallzahl. Die wenigen prospektiven Studien suggerieren
eine Erhöhung des Rezidivrisikos unter HRT. Auch das Ovarialkarzinom ist ein hormonabhängiges Malignom, weshalb eine HRT in
der Peri- und Postmenopause einen Einfluss auf das Erkrankungsrisiko haben kann, insbesondere nach behandelter Erkrankung.
Die Datenlage zur Wirkung einer HRT auf das Ovarialkarzinom ist dünn. Epidemiologische Studien zeigen, dass eine langfristige
HRT das Ovarialkarzinomrisiko möglicherweise erhöht. Noch spärlicher sind die Daten zum Einsatz einer HRT nach Ovarialkarzinombehandlung.
Zuverlässige Empfehlungen lassen sich daraus nicht ableiten. Ziel dieser Arbeit ist es, aus der aktuellen Datenlage die Frage
nach der Durchführbarkeit einer HRT zu eruieren und möglicherweise neue Empfehlungen daraus zu erhalten.
Breast cancer patients undergoing chemotherapy or anti-endocrine treatment suffer from a subsequent lack of estrogen. While
these women would benefit substantially by estrogen replacement, the pertinent data are sparse and inconsistent. Observational
studies have not shown an increased risk of recurrence under hormone replacement therapy (HRT); however, the studies are heterogeneous,
retrospective and mostly underpowered. The few randomized prospective studies suggest an increased recurrence rate with HRT
regimens. Since ovarian cancer is a hormone-related malignancy as well, HRT in perimenopausal and postmenopausal women may
have an impact on ovarian cancer risk, especially after primary treatment, but data are scanty. Epidemiological studies have
shown that long-term HRT might even increase the risk of ovarian cancer The data on HRT after ovarian cancer treatment are
even scantier ; thus, there are no reliable recommendations. This paper reviews the current literature concerning the feasibility
of HRT in order to develop new recommendations.
KeywordsBreast cancer-Ovarian cancer-Hormone replacement therapy-Recurrence risk-Menopause
[Show abstract][Hide abstract] ABSTRACT: Twin pregnancies and gestations after assisted reproductive therapy (ART) are of special obstetric significance with regard to their associated risks. However, little is known about preventive approaches specifically evaluated for these constellations.
A selective literature search was conducted to examine possible preventive approaches for complications such as hypertensive disorders, anaemia, gestational diabetes, prematurity, and others, seen significantly more often in twin gestations and pregnancies after ART.
For both constellations, preventive approaches are not specifically evaluated for the majority of complications. For some preventive methods a possible detrimental effect cannot even be ruled out.
The knowledge about specific preventive approaches against complications in twin pregnancies and gestations after ART is scarce. More prospective trials are urgently needed to assess the risks and benefits of prophylactic approaches for these risk constellations.
Zeitschrift für Geburtshilfe und Neonatologie 12/2009; 213(6):228-33. · 0.56 Impact Factor