U Schneider

Universitätsklinikum Jena, Jena, Thuringia, Germany

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Publications (89)134.22 Total impact

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    ABSTRACT: During fetal development, different control systems mediated by the autonomic nervous system form functional connections over a wide range of time scales. Using multiscale multifractal analysis (MMA) of fetal heart rate variability (HRV), we describe fundamental relationships in the developing scale-wide adjustments within fetal behavior states as well as across state changes. MMA yields the local Hurst exponent surface h(q,s) with q as the multifractal parameter and s as the scale. In 30-minute recordings of healthy fetuses between 24 and 36weeks of gestation (n=25 in quiet sleep, n=29 in active sleep, n=30 changing sleep state) we investigated the dependency of h(q,s) on gestation age. In univariate models, we found a decreasing persistence for short scales and small amplitudes in the quiet (s1=39, q1=-0.7, R(2)=0.52) and in the active (s1=69, q1=-1.4, R(2)=0.23) sleep in contrast to an increasing persistency for long scales and large amplitudes (s1=147, q1=2.4, R(2)=0.29) in the mixed state. Bivariate models (additional scales considered) presented increased coefficients of determination R(2)=0.56, 0.4, and 0.43, respectively. Persistency increasing with age in connection with the sleep state changes (independent of the age related short range dependencies within the separate homogeneous sleep states) is reported here for the first time. The MMA indices obtained for the fetal HRV represent characteristics of the maturating scale-wide cardiovascular control in the context of the evolving sleep state dynamics, which have so far not been considered. They should be incorporated in the search for HRV indices for prenatal diagnosis of developmental disorders and risk assessment. Copyright © 2015 Elsevier B.V. All rights reserved.
    Autonomic neuroscience: basic & clinical 04/2015; DOI:10.1016/j.autneu.2015.03.007 · 1.37 Impact Factor
  • European Journal of Obstetrics & Gynecology and Reproductive Biology 11/2014; DOI:10.1016/j.ejogrb.2014.11.019 · 1.63 Impact Factor
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    ABSTRACT: Fetal movements (FM) related heart rate accelerations (AC) are an important maturation criterion. Since Doppler-based time resolution is not sufficient for accompanying heart rate variability analysis, the work is aimed at a comprehensive FM-AC analysis using magnetocardiographic recordings from fetuses during sleep. We identify FM and AC by independent component analysis and automatic recognition algorithms. We investigate associations between FM and AC of different magnitude by means of event coincidence and time series cross-correlation over the maturation period of 21-40 weeks of gestation (WGA). FM related AC appear with increasing AC magnitude and WGA. Vice versa, AC related FM appear independent of WGA, but more frequently with increasing AC amplitude. The FM-AC correlation exists already at 21 WGA and further increases with WGA while the variability of its time delay decreases. Hence, FM and AC are clearly associated over the whole investigated maturation period. The increase of FM related AC runs parallel to the increasing AC magnitude. The MCG methodology was confirmed and results from previous Doppler-based analyses reproduced. Hence, MCG recordings allow the collective analysis of heart rate variability based maturation indices and FM related AC. This synergism may improve the diagnosis of fetal developmental disorders.
    Physiological Measurement 09/2014; 35(10):1943. DOI:10.1088/0967-3334/35/10/1943 · 1.62 Impact Factor
  • Geburtshilfe und Frauenheilkunde 09/2014; 74(S 01). DOI:10.1055/s-0034-1388523 · 0.96 Impact Factor
  • U. Schneider, E. Schleußner
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    ABSTRACT: Pharmakotherapie in der Schwangerschaft bedarf einer konsequenten Nutzen-Risiko-Abwägung. Bei Patientinnen im reproduktiven Alter sollte generell die Frage nach Kinderwunsch in jedwede Therapieplanung einbezogen werden. Für chronische Erkrankungen gelten aufgrund des mitunter erheblichen Komplikationsrisikos im Grundsatz die gleichen Behandlungsindikationen wie außerhalb der Schwangerschaft, mitunter macht eine therapeutische Einstellung der Störung eine Schwangerschaft erst möglich. Bei einer stabil auf eine medikamentöse Therapie eingestellten Patientin sollte daher die Medikation zu Beginn der Schwangerschaft nicht abgesetzt, sondern, wenn überhaupt und noch nicht bereits präkonzeptionell geschehen, auf eine für die Schwangerschaft risikoärmere Alternative mit der niedrigstmöglichen Dosis angepasst werden. Dies kann in Einzelfällen die Inkaufnahme spezifischer medikamentenassoziierter Risiken bedeuten, über die das Elternpaar ergebnisoffen, aber differenziert am besten präkonzeptionell aufzuklären ist. Off-label-Use in der Schwangerschaft ist nicht der Ausnahme-, sondern der Regelfall. Dies gilt auch für die Pharmakotherapie bei schwangerschaftsassoziierten Problemen, bei denen die Verordnung von Medikamenten nur einen Baustein in einem multimodalen Konzept darstellt. Der Artikel erläutert dies beispielhaft für die Hyperemesis gravidarum, die drohende Frühgeburt und hypertensive Erkrankungen in der Schwangerschaft und gibt einen Überblick über Entwicklungen bei der medikamentösen Geburtseinleitung. Abstract Pharmacotherapy during pregnancy requires a thorough assessment of benefits and risks; therefore, during the reproductive years a current or future pregnancy should generally be taken into consideration when therapeutic decisions are made. Chronic illnesses may have a considerable impact on pregnancy outcome and sometimes a stable disease may constitute a basic requirement to even achieve successful conception. In such cases, the therapeutic indications do not differ from those for non-pregnant women. In addition, a patient in a stable situation under ongoing medication becoming pregnant should not be deferred from treatment, but medication should either be continued or switched to a medical alternative by balancing the risk to pregnancy and the lowest effective dose possible. This may in individual cases require medication implying specific reproductive risks, intensive counselling and informed consent with the parents to be. Off-label use medication is not the exception to the rule but the most common situation. This also applies to defined pregnancy-associated medical problems where pharmacotherapy usually constitutes one of several modalities in a therapeutic concept. In this article we discuss these issues with respect to typical examples, such as hyperemesis gravidarum, the threat of preterm delivery and hypertensive treatment during pregnancy and give a short overview on current developments in the field of medical induction of labor.
    Der Gynäkologe 07/2014; 47(7):472-476. DOI:10.1007/s00129-013-3282-z
  • Senologie - Zeitschrift für Mammadiagnostik und -therapie 05/2014; 11(02). DOI:10.1055/s-0034-1375425
  • Dirk Hoyer, Alexander Schmidt, Uwe Schneider
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    ABSTRACT: The developing coordination in the fetal nervous system can be evaluated from heart rate and movement patterns. According to universal principles of development and self-organization heart rate indices of fluctuation amplitude, complexity, and pattern formation constitute a fetal autonomic brain age score (fABAS). The formation of fetal body movement related heart rate accelerations represents a particular aspect of the developing central nervous coordination. The work aims at the analysis of those types of maturation characteristics based on magnetocardiographic recordings of normal fetuses.
    2014 8th Conference of the European Study Group on Cardiovascular Oscillations (ESGCO); 05/2014
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    ABSTRACT: To evaluate fertility, pregnancy and delivery outcomes after laparoscopic myomectomy (LM) during long-term follow-up. In this single-center retrospective observational study, data were analyzed from 59 women aged 23-42 years with the desire to have children and who underwent LM for symptomatic uterine leiomyoma between January 2001 and December 2006 and subsequently delivered at our hospital. During a mean follow-up period of 73.55 months, the post-LM conception rate was 68 %. The proportion of miscarriages (n = 16) among all pregnancies (n = 55) was lower after (24 %) than before (43 %) LM. Thirty-nine (46 %) deliveries were primary cesarean sections (CSs). CS was performed due to patients' preference, placental complications, and uterine rupture (UR). Labor was successful in 62 % of all vaginal delivery trials. UR and placental complications occurred in 10 and 13 % of all pregnancies, respectively. LM reduced the abortion rate and increased the CS rate in our cohort. UR risk may have been affected by suturing technique, the size and location of myomas removed.
    Archives of Gynecology 02/2014; 290(1). DOI:10.1007/s00404-014-3155-2 · 1.28 Impact Factor
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    ABSTRACT: Abstract Intrauterine growth restriction (IUGR) and preeclampsia (PE) are associated with impaired placentation. Patients who are at risk of developing both these disorders can be identified by abnormal uterine artery Doppler at mid-trimester pregnancy. Nitric oxide (NO)-donors like pentaerithrityl-tetranitrate (PETN) reduce the impedance in the uteroplacental vessels and possess protecting effects on the endothelium. We tested the effectiveness of the NO-donor PETN for secondary prevention of IUGR, PE, and preterm birth in pregnancies at risk. Some 111 women who presented with abnormal placental perfusion at 19-24 weeks of gestation (w.o.g.) were included into a prospective, randomized, placebo-controlled, double-blinded study. The primary endpoint was IUGR and/or perinatal death. Secondary endpoints were preterm birth, PE, and placental abruption. Pentaerithrityl-tetranitrate significantly decreased the risk for IUGR and/or perinatal death [adjusted relative risk (RR) 0.410; 95% confidence interval, CI, 0.184-0.914] and for IUGR (adjusted RR 0.436; 95% CI 0.196-0.970). Preterm birth before 32 w.o.g. (adjusted RR 0.204; 95% CI 0.052-0.801) was reduced, but not the risk for PE. No placental abruption occurred in the PETN, but five occurred in the placebo group. These results suggest that secondary prophylaxis of adverse pregnancy outcome might be feasible in pregnancies exhibiting abnormal placentation using PETN.
    Journal of Perinatal Medicine 01/2014; 42(4):1-8. DOI:10.1515/jpm-2013-0212 · 1.43 Impact Factor
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    ABSTRACT: Disturbances of fetal autonomic brain development can be evaluated from fetal heart rate patterns (HRP) reflecting the activity of the autonomic nervous system. Although HRP analysis from cardiotocographic (CTG) recordings is established for fetal surveillance, temporal resolution is low. Fetal magnetocardiography (MCG), however, provides stable continuous recordings at a higher temporal resolution combined with a more precise heart rate variability (HRV) analysis. A direct comparison of CTG and MCG based HRV analysis is pending. The aims of the present study are: (i) to compare the fetal maturation age predicting value of the MCG based fetal Autonomic Brain Age Score (fABAS) approach with that of CTG based Dawes-Redman methodology; and (ii) to elaborate fABAS methodology by segmentation according to fetal behavioral states and HRP. We investigated MCG recordings from 418 normal fetuses, aged between 21 and 40 weeks of gestation. In linear regression models we obtained an age predicting value of CTG compatible short term variability (STV) of R (2) = 0.200 (coefficient of determination) in contrast to MCG/fABAS related multivariate models with R (2) = 0.648 in 30 min recordings, R (2) = 0.610 in active sleep segments of 10 min, and R (2) = 0.626 in quiet sleep segments of 10 min. Additionally segmented analysis under particular exclusion of accelerations (AC) and decelerations (DC) in quiet sleep resulted in a novel multivariate model with R (2) = 0.706. According to our results, fMCG based fABAS may provide a promising tool for the estimation of fetal autonomic brain age. Beside other traditional and novel HRV indices as possible indicators of developmental disturbances, the establishment of a fABAS score normogram may represent a specific reference. The present results are intended to contribute to further exploration and validation using independent data sets and multicenter research structures.
    Frontiers in Human Neuroscience 01/2014; 8:948. DOI:10.3389/fnhum.2014.00948 · 2.90 Impact Factor
  • Zeitschrift für Geburtshilfe und Neonatologie 11/2013; 217(S 01). DOI:10.1055/s-0033-1361366 · 0.46 Impact Factor
  • A Mehlhorn, D Hoyer, U Schneider, A Hübler
    Zeitschrift für Geburtshilfe und Neonatologie 11/2013; 217(S 01). DOI:10.1055/s-0033-1361293 · 0.46 Impact Factor
  • Zeitschrift für Geburtshilfe und Neonatologie 11/2013; 217(S 01). DOI:10.1055/s-0033-1361418 · 0.46 Impact Factor
  • Zeitschrift für Geburtshilfe und Neonatologie 11/2013; 217(S 01). DOI:10.1055/s-0033-1361340 · 0.46 Impact Factor
  • Zeitschrift für Geburtshilfe und Neonatologie 11/2013; 217(S 01). DOI:10.1055/s-0033-1361441 · 0.46 Impact Factor
  • Ultraschall in der Medizin 10/2013; 34(S 01). DOI:10.1055/s-0033-1354994 · 4.65 Impact Factor
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    ABSTRACT: Fetal brain development involves the development of the neuro-vegetative (autonomic) control that is mediated by the autonomic nervous system (ANS). Disturbances of the fetal brain development have implications for diseases in later postnatal life. In that context, the fetal functional brain age can be altered. Universal principles of developmental biology applied to patterns of autonomic control may allow a functional age assessment. The work aims at the development of a fetal autonomic brain age score (fABAS) based on heart rate patterns. We analysed n = 113 recordings in quiet sleep, n = 286 in active sleep, and n = 29 in active awakeness from normals. We estimated fABAS from magnetocardiographic recordings (21.4-40.3 weeks of gestation) preclassified in quiet sleep (n = 113, 63 females) and active sleep (n = 286, 145 females) state by cross-validated multivariate linear regression models in a cross-sectional study. According to universal system developmental principles, we included indices that address increasing fluctuation range, increasing complexity, and pattern formation (skewness, power spectral ratio VLF/LF, pNN5). The resulting models constituted fABAS. fABAS explained 66/63% (coefficient of determination R(2) of training and validation set) of the variance by age in quiet, while 51/50% in active sleep. By means of a logistic regression model using fluctuation range and fetal age, quiet and active sleep were automatically reclassified (94.3/93.1% correct classifications). We did not find relevant gender differences. We conclude that functional brain age can be assessed based on universal developmental indices obtained from autonomic control patterns. fABAS reflect normal complex functional brain maturation. The presented normative data are supplemented by an explorative study of 19 fetuses compromised by intrauterine growth restriction. We observed a shift in the state distribution towards active awakeness. The lower WGA dependent fABAS values found in active sleep may reflect alterations in the universal developmental indices, namely fluctuation amplitude, complexity, and pattern formation that constitute fABAS.
    PLoS ONE 09/2013; 8(9):e74431. DOI:10.1371/journal.pone.0074431 · 3.53 Impact Factor
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    ABSTRACT: Purpose: The aim of this study was to assess the diagnostic value of sonographic pattern recognition by experts, a standardized morphological scoring system, the risk malignancy index (RMI) and CA 125 assay for the preoperative assessment of ovarian lesions in premenopausal patients.Material and methods: Diagnostic work-up of 1320 patients who underwent surgical exploration due to an adnexal mass at a tertiary referral center were included. We assessed the discriminative value of pattern recognition, a sonographic morphological scoring system, RMI and CA 125 by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen's kappa for each diagnostic approach while using histopathology as the reference standard.Results: Pattern recognition showed the highest discriminative power with an observed kappa of 0.53. Sensitivity and specificity yielded 0.76 and 0.97 respectively. Combining pattern recognition with CA 125 serum measurement in the context of a triage system diminished the diagnostic value (kappa: 0.24; sensitivity: 0.29 specificity: 0.97). For the RMI we observed a sensitivity of 0.54 and a specificity of 0.96 and estimated kappa value yielded 0.37. Omitting the CA 125 assay and using a morphological sonographic assessment system increased the kappa value to 0.45 with sensitivity and specificity observed at 0.61 and 0.97 respectively.Conclusion: Expert pattern recognition was found to be the method with the highest discriminative power in assessing an adnexal mass during premenopause. Additional assessment of serum CA 125 diminished the diagnostic accuracy. Standardized morphological sonographic assessment resulted in a moderate diagnostic accuracy. Supplementing the morphological sonographic assessment with CA 125 by using the RMI algorithm did not improve the diagnostic value.
    Ultraschall in der Medizin 06/2013; 35(4). DOI:10.1055/s-0033-1335728 · 4.65 Impact Factor
  • Geburtshilfe und Frauenheilkunde 05/2013; 73(04). DOI:10.1055/s-0033-1343560 · 0.96 Impact Factor
  • Geburtshilfe und Frauenheilkunde 05/2013; 73(04). DOI:10.1055/s-0033-1343539 · 0.96 Impact Factor

Publication Stats

510 Citations
134.22 Total Impact Points

Institutions

  • 2008–2014
    • Universitätsklinikum Jena
      Jena, Thuringia, Germany
  • 2001–2014
    • Friedrich Schiller University Jena
      • • Biomagnetic Center
      • • Institute of Medical Statistics, Computer Sciences and Documentation
      • • Clinic of Obstetrics and Gynecology
      • • Klinik für Neurologie
      Jena, Thuringia, Germany