Uwe Schneider

West Georgia Obstetrics and Gynecology, Georgetown, Georgia, United States

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Publications (60)79.11 Total impact

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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; · 0.91 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; · 1.95 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; · 4.12 Impact Factor
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    ABSTRACT: During fetal development a complex system grows and coordination over multiple time scales is formed towards an integrated behavior of the organism. Since essential cardiovascular and associated coordination is mediated by the autonomic nervous system (ANS) and the ANS activity is reflected in recordable heart rate patterns, multiscale heart rate analysis is a tool predestinated for the diagnosis of prenatal maturation. The analyses over multiple time scales requires sufficiently long data sets while the recordings of fetal heart rate as well as the behavioral states studied are themselves short. Care must be taken that the analysis methods used are appropriate for short data lengths. We investigated multiscale entropy and multifractal scaling exponents from 30minute recordings of 27 normal fetuses, aged between 23 and 38weeks of gestational age (WGA) during the quiet state. In multiscale entropy, we found complexity lower than that of non-correlated white noise over all 20 coarse graining time scales investigated. Significant maturation age related complexity increase was strongest expressed at scale 2, both using sample entropy and generalized mutual information as complexity estimates. Multiscale multifractal analysis (MMA) in which the Hurst surface h(q,s) is calculated, where q is the multifractal parameter and s is the scale, was applied to the fetal heart rate data. MMA is a method derived from detrended fluctuation analysis (DFA). We modified the base algorithm of MMA to be applicable for short time series analysis using overlapping data windows and a reduction of the scale range. We looked for such q and s for which the Hurst exponent h(q,s) is most correlated with gestational age. We used this value of the Hurst exponent to predict the gestational age based only on fetal heart rate variability properties. Comparison with the true age of the fetus gave satisfying results (error 2.17±3.29weeks; p<0.001; R2=0.52). In addition, we found that the normally used DFA scale range is non-optimal for fetal age evaluation. We conclude that 30min recordings are appropriate and sufficient for assessing fetal age by multiscale entropy and multiscale multifractal analysis. The predominant prognostic role of scale 2 heart beats for MSE and scale 39 heart beats (at q=-0.7) for MMA cannot be explored neither by single scale complexity measures nor by standard detrended fluctuation analysis.
    Autonomic neuroscience: basic & clinical 02/2013; · 1.82 Impact Factor
  • Journal of Critical Care. 02/2013; 28(1):e17.
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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 01/2013; 8(9):e74431. · 3.73 Impact Factor
  • Dirk Hoyer, Uwe Schneider
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    ABSTRACT: Fetal heart rate patterns provide valuable information about normal fetal maturation. For heart rate variability (HRV) analysis to be successful in prenatal diagnosis the selection of appropriate HRV indices is required. Those indices were organized according to universal principles of developmental biology. Key characteristics of evolution and self-organization are increasing fluctuation amplitude, increasing complexity and pattern formation. Related HRV indices were used to propose a fetal autonomic brain age score (fABAS). We estimated fABAS from magnetocardiographic recordings (21.4–40.3 weeks of gestation) preclassified in quiet (n=113, 63 females) and active sleep (n=286, 145 females) by cross-validated multivariate linear regression models in a cross-sectional study. fABAS explained 66/63% (training / validation set) of the variance by age in quiet and 51/50% in active sleep. We conclude that functional autonomic brain age can be assessed based on universal developmental indices obtained from fetal heart rate patterns.
    Computing in Cardiology Conference (CinC), 2013; 01/2013
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    ABSTRACT: The two lowest bands (very low frequencies and ultralow frequencies) of human heart rate variability (HRV) account for 95% of the total signal power. The underlying physiological processes are heterogeneous and complex. Hence, frequency band power analysis can be expected to be an over-simplification. Recently fractal scaling methods, such as DFA have been used to analyze fetal heart rate fluctuations [1].
    Computing in Cardiology Conference (CinC), 2013; 01/2013
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    ABSTRACT: Development of the fetal autonomic nervous system's integrative capacity in relation to gestational age and emerging behavioural pattern is reflected in fetal heart rate patterns. Conventional indices of vagal and sympathetic rhythms cannot sufficiently reflect their complex interrelationship. Universal behavioural indices of developing complex systems may provide additional information regarding the maturating complex autonomic control. We investigated fetal magnetocardiographic recordings undertaken at 10 min intervals in active (n=248) and quiet (n=111) states between 22 and 39 weeks gestational age. Standard deviation of heart beat intervals, skewness, contribution of particular rhythms to the total power, and multiscale entropy were analysed. The multiscale entropy methodology was validated for 10 min data sets. Age dependence was analysed by linear regression. In the quite state, contribution of sympatho-vagal rhythms and their complexity over a range of corresponding short scales increased with rising age and skewness shifted from negative to positive values. In the active state, age dependencies were weaker. Skewness as the strongest parameter shifted in the same direction. Fluctuation amplitude and the complexity of scales associated with sympatho-vagal rhythms increased. We conclude that in the quiet state, stable complex organised rhythms develop. In the active state, however, increasing behavioural variability due to multiple internal co-ordinations, such as movement related heart rate accelerations and external influences develop. Hence, the state selective assessment in association with developmental indices used herein may substantially improve evaluation of maturation age and early detection and interpretation of developmental problems in prenatal diagnosis.
    AJP Regulatory Integrative and Comparative Physiology 12/2012; · 3.28 Impact Factor
  • Biomedizinische Technik/Biomedical Engineering 08/2012; · 1.16 Impact Factor
  • Biomedizinische Technik/Biomedical Engineering 08/2012; · 1.16 Impact Factor
  • Biomedizinische Technik/Biomedical Engineering 08/2012; · 1.16 Impact Factor
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    ABSTRACT: Abstract Objective: To describe the development of the integrative capacity of the fetal autonomic nervous system (ANS) accor\xadding to gestational age and emerging behavioral states, assuming that developing integrative ANS functions are reflected in increasing autocorrelation of fetal heart rate and fetal heart rate variability markers. Methods: Magnetocardiograms of 114 healthy fetuses (21-40 weeks of gestation) were recorded. Level of fetal activity (quiet/active sleep) was estimated according to characteristic heart rate patterns. Autocorrelation functions of (i) fetal heart rate and (ii) time patterns of SDNN (standard deviation of normal-to-normal intervals) and RMSSD (root mean square of successive differences in normal-to-normal intervals) were calculated and autocorrelation was determined over different time scales. Age and activity related changes were examined using linear regression and non-parametric tests. Results: During pregnancy, autocorrelation increased in fetal heart rate signals and time patterns of SDNN and RMSSD. Short-time correlation (0-20 s) changed between 21 and 31 gestational weeks. Long-time correlation (75-300 s) accelerated later in pregnancy and did not increase in quiet heart rate patterns. Strong state-dependent changes were found with time patterns of SDNN. Conclusions: Emerging integrative ANS functions are reflected in increasing autocorrelation of fetal heart rate fluctuations over increasing time scales. The period from 21 to 31 gestational weeks seems to be critical to ANS development. Increasing long-time correlation is specific to active sleep states.
    Journal of Perinatal Medicine 07/2012; · 1.95 Impact Factor
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    ABSTRACT: Introduction NO-donors reduce the impedance in uteroplacental vessels. Consequently Lees et al. pilot study demonstrated that transdermal nitroglycerin positively influences pregnancy outcome within a high-risk collective. Furthermore the NO-donor pentaerythriltetranitrate additionally expresses cell stabilizing effects in endothelial cells. Objectives Hypothesizing an effect on endothelial health and uterine perfusion in pregnancies presented with pathological uterine perfusion at 20 weeks of gestation we performed a randomized, prospective, and placebo-controlled, double-blind study implemented with the aim to investigate whether the oral NO-donor Pentalong® (PETN) is suitable as a prophylactic drug in abnormal placentation. Methods We included 111 pregnancies presenting with abnormal placental perfusion (bilateral notch or mean RI > 0.7) between the 19th and 24th week of gestation (w.o.g.). Further risk factors (high-risk group: history of HELLP/preeclampsia/IUGR/IUFD/placental abruption, type I diabetes mellitus, hypertension, thrombosis/thrombophilia) were identified in 78 study participants. Fifty-four women received PETN 57 received placebo. Doppler velocimetry measurements of uteroplacental and fetal vessels and fetal growth scans were monitored biweekly with primary endpoints being the occurrence of preeclampsia, IUGR and/or premature birth. Results Within the first week of intake, PETN improved uteroplacental perfusion significantly in comparison to placebo (mean PI 1.26 ± 0.36 vs. 1.49 ± 0.44; p< 0.01). Overall frequency of premature birth <32nd w.o.g.(4 vs. 12), IUGR <10th percentile (15 vs. 29) and preeclampsia (11 vs. 14) were reduced. Although reduction in preeclampsia was comparably low in those 25 patients developing preeclampsia the outcome was markedly improved in the PETN study group by reducing the frequency of IUGR (4 vs. 10), diagnosis of preeclampsia before 32 w.o.g. (3 vs. 7) and premature birth before 32 w.o.g. (1 vs. 6). Furthermore 4 fetal losses occurred in the study group all in the placebo group. Conclusion NO-donors constitute an interesting option in the prophylaxis of adverse pregnancy outcome related to abnormal placentation.
    Pregnancy Hypertension: An International Journal of Women's Cardiovascular Health. 07/2012; 2(3):181.
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    ABSTRACT: The maturation of fetal auditory evoked cortical responses (fAECRs) is an important aspect of developmental medicine, but their reliable identification is limited due to the technical restrictions in prenatal diagnosis. The signal-to-noise ratio of the fAECRs extracted exclusively from fetal magnetoencephalography is a known issue which limits their analysis as markers of brain development. The objective of this work was to develop a signal analysis strategy to address these problems and find appropriate processing steps. In this study, a group of 147 normal fetuses with gestations between 26 and 41 weeks underwent auditory evoked response testing. We combine different approaches that address data cleaning, fAECR determination and statistical fAECR validation to reduce the uncertainty in the detection of the auditory evoked responses. For the statistical validation of the evoked responses, we use parameters computed from bootstrap-based test statistics and the correlation between different averaging modes. Appropriate thresholds for those parameters are identified using linear regression analyses by looking at the maximum correlation coefficients. The results show that by using different validation parameters, the selected fAECRs conduct to similar regression slopes with an average of −13.6 ms/week gestational age which agree with previous studies. Our novel processing framework provides an objective way to identify and eliminate non-physiological variation in the data induced by artifacts. This approach has the potential to produce more reliable data needed in clinical studies for fetal brain maturation as well as extending the investigations to high-risk groups.
    Physiological Measurement 11/2011; 32(11):1847-68. · 1.50 Impact Factor
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    Dirk Hoyer, Samuel Nowack, Uwe Schneider
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    ABSTRACT: The increasing functional integrity of the organism during fetal maturation is connected with increasing complex internal coordination mediated by the autonomic nervous system. We hypothesize that time scales of complex and dynamic inter-dependencies over more than one heart beat interval reflect the increasing complex adjustments within the fetal organism during its prenatal development. We investigated multi-scale complexity and time irreversibility from equidistantly resampled heart rate time series of 73 fetal magnetocardiographic recordings over the third trimester. We found scale dependent changes in complexity and time irreversibility. The functions obtained from equidistantly resampled heart rate time series showed qualitatively similar curves compared to those obtained from heart beat intervals series previously reported. Time scales of fetal heart rate characteristics may provide novel information for the identification of developmental disorders in prenatal diagnosis.
    Conference proceedings: ... Annual International Conference of the IEEE Engineering in Medicine and Biology Society. IEEE Engineering in Medicine and Biology Society. Conference 08/2011; 2011:1451-4.
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    ABSTRACT: The increasing functional integrity of the organism during fetal maturation is connected with increasing complex internal coordination. We hypothesize that time scales of complexity and dynamics of heart rate patterns reflect the increasing inter-dependencies within the fetal organism during its prenatal development. We investigated multi-scale complexity, time irreversibility and fractal scaling from 73 fetal magnetocardiographic 30min recordings over the third trimester. We found different scale dependent complexity changes, increasing medium scale time irreversibility, and increasing long scale fractal correlations (all changes p<0.05). The results confirm the importance of time scales to be considered in fetal heart rate based developmental indices.
    Computers in biology and medicine 05/2011; 42(3):335-41. · 1.27 Impact Factor
  • Ultrasound in Medicine and Biology - ULTRASOUND MED BIOL. 01/2011; 37(8).
  • Ultrasound in Medicine and Biology - ULTRASOUND MED BIOL. 01/2011; 37(8).
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    ABSTRACT: To investigate whether steroids that induce lung maturation have acute effects on higher cortical function in the human fetus. Cortical auditory-evoked responses (CAERs) were recorded from 10 singleton fetuses between 29 and 34 gestational weeks by fetal magnetoencephalography (fMEG) using transabdominal auditory stimulation prior to and within 3 hours after administering 2 × 12 mg of betamethasone, at an interval of 18 and 24 hours. The components of the CAER complex were categorized according to their latency: P2pm (186 + 20 ms, 90%), N2pm (260 + 34 ms, 50%), P3pm (474 + 36, 50%). In almost all of these cases the peak latencies of the fetal P2pm (P = .042) and P3pm (P = .043) were delayed after exposure to betamethasone (Wilcoxon rank test). The trend was also observable in N2pm (P = .08). Administration of betamethasone to expectant mothers was associated with acute change in higher cortical functions in the exposed fetuses. Implications regarding functional brain development need further evaluation.
    Reproductive sciences (Thousand Oaks, Calif.) 09/2010; 18(1):99-106. · 2.31 Impact Factor

Publication Stats

357 Citations
79.11 Total Impact Points

Institutions

  • 2013
    • West Georgia Obstetrics and Gynecology
      Georgetown, Georgia, United States
  • 2001–2013
    • Friedrich-Schiller-University Jena
      • • Biomagnetic Center
      • • Klinik für Neurologie
      • • Clinic of Obstetrics and Gynecology
      Jena, Thuringia, Germany