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ABSTRACT: Introduction: Cervical intraepithelial neoplasia (CIN) represents the precursor of invasive cervical cancer and is associated with human papillomavirus infection (HPV) against which two vaccines have been approved in the last years. Standard treatments of high-grade CIN are conisation procedures, which are associated with an increased risk of subsequent pregnancy complications like premature delivery and possible subsequent life-long disability. HPV vaccination has therefore the potential to decrease neonatal morbidity and mortality. This has not been taken into account in published cost-effectiveness models. Material and Methods: We calculated the possible reduction rate of conisations for different vaccination strategies for Germany. Using this rate, we computed the reduction of conisation-associated preterm deliveries, life-long disability and neonatal death due to prematurity. The number of life-years saved (LYS) and gain in quality-adjusted life-years (QALYs) was estimated. The incremental costs per LYS / additional QALY were calculated. Results: The reduction of conisation procedures was highest in scenario I (vaccination coverage 90% prior to HPV exposition) with about 50%. The costs per LYS or additional QALY were lowest in scenario I, II and III with 45,101 € or 43,505-47,855 € and rose up to 60,544 € or 58,401-64,240 € in scenario V (50% vaccinated prior to sexual activity + additional 20% catch-up at a mean age of 20 y). Conclusion: Regarding the HPV 16 / 18 vaccines as "vaccines against conisation-related neonatal morbidity and mortality" alone, they already have the potential to be cost-effective. This effect adds up to reduction of cervical cancer cases and decreased costs of screening for CIN. Further studies on cost-effectiveness of HPV vaccination should take the significant amount of neonatal morbidity and mortality into account.
Human vaccines & immunotherapeutics. 02/2012; 8(2):243-51.
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ABSTRACT: The incidence of ectopic pregnancy (EP) in the general population is 2%, whereas the EP rate following assisted reproductive technologies (ART) is between 2.1 and 11%. EP is also an adverse effect of tubal surgery with incidences up to 40% depending on the type, location, and severity of tubal disease and the surgical procedure.
This paper looks at the incidence of EP following tubal reconstructive microsurgery, analyzes risk factors for EP following own 1,295 ART cycles and looks on the incidence of EP in 128,314 pregnancies following ART according to the presence or absence of tubal infertility using data from the German IVF Registry (DIR).
In our clinic, the EP rate following resterilization was 6.7%. In the presence of acquired tubal disease, the EP rate following adhesiolysis, salpingostomy, salpingoneostomy, fimbrioplasty, and anastomosis was 7.9%. The EP rate following ART in our clinic was 5.6%. Previous abdominal surgeries, microsurgical procedures, hydro-/sactosalpinges, salpingitis, salpingitis isthmica nodosa, and periadnexal adhesions showed a significant positive correlation with EP as outcome. Data of DIR demonstrate a significantly increased incidence of EP in the presence of tubal pathology. The highest EP rate related to all clinical pregnancies was 4.5% (95% CI 3.0-6.0) in smoking women <30 years with tubal pathology following IVF.
In the presence of tubal infertility, the incidence of EP following ART and tubal microsurgery are approximately comparable with each other and higher than in women without tubal infertility. The success of infertility surgery depends on a careful selection of appropriate patients.
Archives of Gynecology 09/2011; 285(3):863-71. · 0.91 Impact Factor
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ABSTRACT: To examine the prevalence and outcome of absent ductus venosus (DV) diagnosed at 11-13 weeks' gestation.
Prospective screening study for aneuploidies in 65,840 singleton pregnancies, including measurement of nuchal translucency (NT) thickness and examination of the DV. Prenatal findings and outcome of fetuses with absent DV were examined.
Absent DV was diagnosed in 26 cases giving a prevalence of 1 in 2,532. In 15 (57.7%) cases the NT was above the 95th centile for crown-rump length. In 11 (42.3%) cases, there was an aneuploidy, mainly Turner syndrome. The incidence of aneuploidies was 66.7% (10 of 15) for those with NT above the 95th centile and 9.1% (1 of 11) in those with normal NT (p = 0.015). In addition to the aneuploidies, there were 3 cases with other abnormalities, including one case each of Ebstein anomaly, Noonan syndrome and Pierre Robin sequence. In 9 of the 11 (81.8%) fetuses with NT below the 95th centile, absent DV was an isolated finding and the pregnancies resulted in healthy live births.
The prognosis of fetuses with absent DV depends on the measurement of NT thickness, being poor if the NT is increased and good if the NT is normal.
Fetal Diagnosis and Therapy 02/2011; 30(1):35-40. · 1.05 Impact Factor
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ABSTRACT: To examine the distribution of fetal nuchal translucency (NT) thickness in dichorionic twins and investigate the effect of the correlation between NT measurements in each twin pair on the performance of screening for trisomies.
The distribution of fetal NT for crown-rump length (CRL) was examined in 5646 dichorionic twin pregnancies, including 103 with fetal trisomies 21, 18 or 13. The correlation in fetal NT in each euploid twin pregnancy was estimated.
The distribution of NT in both euploid and trisomic fetuses was consistent with the mixture model in singleton pregnancies. In the euploid pregnancies, there was a correlation in log NT measurements in each twin pair (r = 0.42, 95% CI: 0.39-0.45) and, after removal of the effect of the operator, this correlation was reduced to 0.34. Allowing for this correlation in risk assessment for trisomies had a major impact on the estimated patient-specific risk but had little effect on the overall performance of screening.
In dichorionic twin pregnancies, the mixture model of distributions of NT can be applied as in singletons. In screening for trisomies, the correlation in NT measurements between the fetuses should be taken into account in the estimation of patient-specific risks.
Prenatal Diagnosis 01/2011; 31(1):16-21. · 2.11 Impact Factor
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ABSTRACT: Firstly, to establish a reference range of birth weight with gestation at delivery; secondly, to identify maternal characteristics that are significantly associated with birth weight; and thirdly, to determine if combinations of maternal characteristics, fetal nuchal translucency thickness (NT), and serum concentrations of free beta-human chorionic gonadotrophin (β-hCG) and pregnancy-associated plasma protein-A (PAPP-A) are significant predictors of small-for-gestational-age (SGA) neonates in the absence of preeclampsia.
Maternal characteristics were recorded; fetal NT, maternal serum free β-hCG and PAPP-A were measured at 11 weeks to 13 weeks 6 days in 33,602 women with singleton pregnancies. Regression analysis was used to determine the association of birth weight with gestation at delivery and to establish a reference range with gestation. Logistic regression analysis was used to determine if maternal factors, fetal NT, free β-hCG, and PAPP-A contribute significantly in predicting SGA in the absence of preeclampsia.
Birth weight increased with maternal weight and height; it was higher in parous than in nulliparous women and in those with a medical history of pre-pregnancy diabetes mellitus, and it was lower in cigarette smokers, in all racial groups other than in Caucasian women, and in those with a medical history of chronic hypertension and in those who previously delivered SGA neonates. In the SGA group compared with the unaffected group, there were lower median delta NT (0.10 vs 0.12 mm), free β-hCG [0.9 vs 1.0 MoM (multiples of median)], and PAPP-A (0.8 vs 1.0 MoM). The prediction of SGA provided by maternal factors was significantly improved by the addition of fetal NT and PAPP-A (34.0 vs 37.0% at a false-positive rate of 10%).
Prediction of the birth of SGA neonates in the absence of preeclampsia can be provided in the first trimester of pregnancy by a combination of maternal characteristics and measurements of parameters used in early screening for aneuploidies.
Prenatal Diagnosis 01/2011; 31(1):58-65. · 2.11 Impact Factor
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ABSTRACT: To describe the outcome of pregnancies with trisomy 2 in cultures of first-trimester chorionic villous samples (CVS) and determine whether amniocentesis is necessary in the management of such cases.
Cultures of chorionic villi were performed at 11-13 weeks in 37 474 pregnancies. In those with trisomy 2 cells, amniocentesis was performed at 16 weeks. Pregnancy outcome was obtained from maternity records.
Trisomy 2 cells in CVS cultures were observed in 45 of 37 474 pregnancies (1.2 per 1000). In 43 cases ultrasound examination at 16-20 weeks showed no fetal abnormalities, amniocentesis demonstrated the presence of only normal cells, and all 43 pregnancies ended in normal healthy live births. The birth weight was below the 5th centile in six neonates (13.9%). There was a significant association between the birth weight centile and the percentage of trisomic cells in the CVS culture (r = 0.409, p = 0.010). In one case, there was fetal death at 15 weeks. In a second case, amniocentesis showed one cell with trisomy 2 in a total of 53 cells, and ultrasound examination at 18 weeks showed severe fetal growth restriction and coarctation of the aorta.
In at least 95% of cases with trisomy 2 in CVS cultures there is confined placental mosaicism (CPM). The prognosis is good, but in about 15% of cases there is fetal growth restriction.
Prenatal Diagnosis 04/2010; 30(4):329-32. · 2.11 Impact Factor
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ABSTRACT: Sonographic training in obstetrics differs broadly in Germany, although there are clearly defined quality-oriented requirements. In order to improve professional education, a training concept was devised utilizing an ultrasound simulator system.
Between October 2004 and May 2006, 100 obstetric ultrasound training courses were held in 12 federal states of Germany. In these daily courses, doctors were trained in the detection of the most common malformations.
One hundred training courses with a total of 1,266 participants.
As a measure of quality assurance, a standardized questionnaire focusing on testing sonographic proficiency before and after the courses was issued in order to analyze the effect of these simulator-based ultrasound courses.
Effectiveness of the method with reference to its potential role in structured sonographic training.
The concept found prevailing approval (90%) at the level of principle, practical implementation, and clinical usefulness. Of the participants, 91% estimated their subjective training effect as good. The questionnaire analysis showed significant improvement. On average, 75.3% of the questions relating to sonographic proficiency were answered correctly at the end of the course as opposed to 48.6% at the beginning.
Structured ultrasound training courses based on an ultrasound simulator system seem to be useful for defining a basic standardized quality of training and significantly improving examiners' skills. This is a suitable additional instrument to improve the education in obstetric ultrasound.
Acta Obstetricia Et Gynecologica Scandinavica 03/2010; 89(3):350-4. · 1.77 Impact Factor
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ABSTRACT: To re-evaluate in a larger cohort of patients if the maternal serum biochemical markers used in first trimester aneuploidy screening have the same marker distributions in pregnancies with a previous history of aneuploidy compared with those that have no previous history.
Information related to previous pregnancy history is routinely recorded as part of first trimester screening in three centres King George, Kings College and Fetal Medicine Centre, London. From the database, records were extracted for women who had a previous pregnancy diagnosed with trisomies 13, 18 or 21. For each woman with a previous aneuploidy, five unaffected pregnancies in women of the same maternal age and with no previous aneuploidy pregnancy were selected as controls. A comparison was made between the marker distributions for pregnancy associated plasma protein-A (PAPP-A) and free beta-human chronic gonadotrophin (beta-hCG) amongst the cases and controls using nonparametric statistical tests.
A series of 8240 controls were compared against group of 1032 cases with a previous trisomy 21, 293 with a previous trisomy 18 and 158 with a previous trisomy 13. Cases with multiple previous trisomies were excluded. There were no significant differences in the level of free beta-hCG; however, in cases of trisomy 21 and trisomy 13 the levels of PAPP-A were increased by 5 and 16%, respectively.
Risk calculation algorithms may need to take account of the increased PAPP-A levels in women with a previous trisomy 21 or trisomy 13.
Prenatal Diagnosis 10/2009; 29(13):1242-3. · 2.11 Impact Factor
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ABSTRACT: Cervical intraepithelial neoplasia (CIN) is the precursor of invasive cervical cancer. Previous studies indicated that photodynamic therapy (PDT) represents an effective treatment modality in CIN. In 28 patients with CIN 1 - 3, 1 - 2 cycles of PDT were conducted using hexaminolevulinate (HAL) or methylaminolevulinate (MAL) and a special light delivery system. After 6 months, biopsies were obtained to assess response. The overall response rate for complete or partial response was 65%. Photodynamic therapy using new ALA esters is effective and may offer unique advantages in the therapy of CIN.© (2009) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.
06/2009;
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ABSTRACT: To examine the independent contribution of abnormal flow in the ductus venosus at 11 to 13 weeks of gestation in the prediction of adverse pregnancy outcome in relation to chorionicity.
This was a prospective study in 516 dichorionic and 179 monochorionic twin pregnancies in which the fetal ductus venosus flow was assessed at 11 0/7 to 13 6/7 weeks of gestation. The prevalence of reversed a-wave in the fetal ductus venosus was compared between monochorionic and dichorionic pregnancies and between those with and without pregnancy complications. Comparisons between each of the pregnancy outcomes and the normal outcome group and between monochorionic and dichorionic pregnancies were made using the Mann-Whitney U-test for continuous variables and the chi2 test and Fisher exact test for categorical variables.
The prevalence of reversed a-wave in at least one of the fetuses was significantly higher in monochorionic than in dichorionic pregnancies (18.4% compared with 8.3%, P<.001) and in pregnancies complicated by miscarriage (28.6%, P=.005), fetal aneuploidy (70.0%, P<.001), and twin-twin transfusion syndrome (38.5%, P<.001) compared with the pregnancies with two healthy live births (7.7%). Pregnancy outcome was normal in 33 of the 43 (76.7%) dichorionic and in 14 of the 33 (42.4%) monochorionic twins with reversed a-wave in at least one of the fetuses.
In twins, reversed a-wave in the ductus venosus at 11 to 13 weeks of gestation is associated with increased risk for aneuploidies, miscarriage, and development of severe twin-twin transfusion syndrome. However, in about 75% of dichorionic twins and 40% of monochorionic twins with reversed a-wave, the pregnancy outcome is normal.
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Obstetrics and Gynecology 05/2009; 113(4):860-5. · 4.73 Impact Factor
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ABSTRACT: We examined the potential value of the uterine artery pulsatility index (PI) in pregnancies with fetal aneuploidies and in those that developed preeclampsia (PE) with the aim of distinguishing between these complications in pregnancies with low pregnancy-associated plasma protein-A (PAPP-A).
Uterine artery PI and serum PAPP-A at 11-13 weeks were measured in 165 cases of PE, including 33 that required delivery before 34 weeks (early PE) and 132 with late PE, and in 301 cases with aneuploidies, including 200 with trisomy 21. Each case of aneuploidy and PE was matched with 4 unaffected controls.
Serum PAPP-A was lower in early PE (0.58 multiples of the normal median, MoM) and in trisomy 21 (0.54 MoM), trisomy 18 (0.22 MoM) and Turner syndrome (0.51 MoM) - but not in late PE (0.90 MoM) - than in controls (1.01 MoM). Uterine artery PI was higher in early PE (1.52 MoM), late PE (1.20 MoM), trisomy 18 (1.20 MoM) and Turner syndrome (1.29 MoM) - but not in trisomy 21 (1.02 MoM) - than in controls (1.0 MoM).
The uterine artery PI at 11-13 weeks may be useful in distinguishing between low PAPP-A due to trisomy 21 and early PE.
Fetal Diagnosis and Therapy 01/2009; 25(3):336-9. · 1.05 Impact Factor
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ABSTRACT: Epignathus is a rare form of congenital teratoma, originating from the base of the skull, most commonly the hard palate, or mandible. It has been associated with a poor prognosis due to complications including polyhydramnios and respiratory compromise at birth as a consequence of upper airway obstructions. It is usually not associated with chromosomal aberrations. We present a case of prenatally diagnosed epignathus associated with a gonosomal pentasomy 49,XXXXY.
A 34-year-old gravida 1, para 0 was referred to our unit with a sonographically suspected gastroschisis at 26+6 weeks' gestation. A detailed ultrasound scan revealed a large mixed echogenic mass seen in continuation with the mouth in the midline. Based on the appearance, an epignathus was suspected. No other fetal anomalies were detected. Karyotyping showed a 49,XXXXY karyotype of the fetus. The couple decided to continue the pregnancy after detailed counseling about results and prognosis. A cesarean section was necessary and performed at 29+0 weeks' gestation due to a pathological Doppler and cardiotocogram. Because of the enormous epignathus intubation of the newborn was not possible. A tracheostomy was performed for ventilation and oxygenation, which failed and the newborn died 30 min after birth.
Prenatal diagnosis by ultrasound has improved perinatal management. This should include assessment of the tumor size and spread in order to establish an accurate prognosis and to anticipate likely problems which are to be encountered during pregnancy or at the time of delivery. To our knowledge, this is the first reported case of a prenatally diagnosed epignathus with a gonosomal pentasomy 49,XXXXY.
Fetal Diagnosis and Therapy 11/2008; 24(3):313-7. · 1.05 Impact Factor
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ABSTRACT: To estimate the independent contribution of abnormal flow in the ductus venosus at 11 to 13+6 weeks of gestation in the prediction of major fetal abnormalities and fetal death.
This was a prospective assessment of singleton pregnancies by maternal history, serum free beta-hCG, pregnancy-associated plasma protein A (PAPP-A), fetal nuchal translucency thickness, and ductus venosus Doppler. The patients were subdivided into five groups: normal outcome (n=10,120), miscarriage or fetal death (n=185), abnormal karyotype (n=95), and major cardiac (n=20) or noncardiac defect (n=70). Regression analysis was performed to determine the significance of the contribution to adverse outcome of reversed a-wave in the ductus venosus, maternal characteristics, fetal delta nuchal translucency, maternal serum log PAPP-A multiples of the median, and log free beta-hCG multiples of the median.
The prevalence of reversed a-wave was significantly higher in the groups with miscarriage or fetal death (10.8%), abnormal karyotype (62.1%), and fetal cardiac defect (25.0%) than in the normal outcome group (3.7%), but not noncardiac defect (4.3%). An adverse outcome was observed in 2.7% of the fetuses with nuchal translucency at or below the 95th centile (in 2.6% of those with normal a-wave and in 7.0% of those with reversed a-wave) and in 19.3% of the fetuses with nuchal translucency above the 95th centile (in 8.9% of those with normal a-wave and in 70.9% of those with reversed a-wave).
Reversed a-wave is associated with increased risk for chromosomal abnormalities, cardiac defects, and fetal death. However, in about 80% of cases with reversed a-wave, the pregnancy outcome is normal.
Obstetrics and Gynecology 10/2008; 112(3):598-605. · 4.73 Impact Factor
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ABSTRACT: The relation of lunar phases to the birth rate has been the focus of considerable research with still controversial results. The purpose of this study was to examine the influence of the lunar cycle on the frequency of birth, on instrumental delivery, neonatal outcome as well as a possible relationship between lunar position at time of conception and the gender of the child.
Six thousand seven hundred and twenty five deliveries were retrospectively analyzed from 01 January 2000 to 31 December 2006 at the Department of Obstetrics and Gynaecology of the University Medical School of Hannover. Inclusion criteria were: spontaneous vaginal births without induction, vacuum and forceps extractions as well as non-elective cesarean sections, all cases without labor induction. Exact lunar phases were determined by means of birthday and birth time by a specific computer software.
The analysis revealed no significant correlation of birth rate to lunar phases. There were also no significant differences regarding birth complications, neonatal outcome and gender to the lunar cycle at the time of conception.
There is no predictable influence of the lunar cycle on deliveries or delivery complications nor to the gender of the baby. As expected and in agreement with some recent studies this pervasive myth is not evidence based.
Acta Obstetricia Et Gynecologica Scandinavica 07/2008; 87(8):875-9. · 1.77 Impact Factor
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ABSTRACT: Photodynamic diagnosis (PDD) and therapy (PDT) are modern methods that are evaluated in different fields in gynecology. PDD is currently under investigation in gynecologic conditions such as cervical intraepithelial neoplasia (CIN), vulvar intraepithelial neoplasia (VIN), endometriosis, and ovarian cancer. PDT has been successfully evaluated in HPV-related genital dysplasia such as CIN and VIN, in genital warts, in local recurrent breast cancer, and for endometrial ablation. The aim of this review is to give an overview about current applications.
Journal of Environmental Pathology Toxicology and Oncology 02/2008; 27(4):307-20. · 1.00 Impact Factor
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ABSTRACT: First-trimester screening according to Nicolaides uses maternal age to obtain a common background risk for trisomy 21. The likelihood ratios by nuchal translucency, free beta-human chorionic gonadotropin and pregnancy-associated plasma protein-A are not with respect to maternal age. It was the aim of this study to investigate if likelihood ratios should better take care of it.
Pearson's correlation and different models of regression analysis had been performed on the results of 8,116 first-trimester screenings. The total number of pregnancies was subdivided into three subgroups of healthy fetuses (n = 8,038); fetuses with Down's syndrome (n = 46) and fetuses with other genetic abnormalities (n = 32). Statistical testing was applied to each of the three groups.
Strong independence from maternal age could be found for each of the first-trimester screening measurement parameter, as well for healthy and as for affected fetuses. Neither Pearson's test nor nonlinear regression models could detect a correlation. Accordingly significance of Pearson's test is not given.
First-trimester screening would not be improved by considering the maternal age in the calculation of the likelihood ratios. Therefore the currently used algorithm is adequate. According, to the results, it seems to be proper as well to disregard the maternal age in newer test strategies advanced first-trimester screening (AFS) at all.
Archives of Gynecology and Obstetrics 10/2007; 276(3):259-62. · 1.28 Impact Factor
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ABSTRACT: Doppler sonography of maternal vessels as a predictor for preeclampsia is an established screening method in the second trimester. Considering the first trimester its benefit has not been conclusively proven so far. Up to now the flow pattern of maternal vessels in the first trimester has only been insufficiently characterized and documented. Thus, there are only few pieces of information concerning the predictive value of the different kinds of flow patterns during the early pregnancy as regards the pathological and physiological outcome of the pregnancy. This survey aimed at evaluating the significance and the clinical importance of Doppler sonographical examinations of the Aa. uterinae during early pregnancy. It had to be analyzed whether various perfusions can be applied as a predictive value for the specific development during the pregnancy and whether therefore a risk group for pregnancy-associated hypertension can already be detected during the early pregnancy.
A non-selected collective of 104 pregnant patients was examined with Doppler sonography and retrospectively divided into a standard collective and a high-risk collective. The standard collective contained 89 patients, who in the course of their pregnancy remained without any pathological findings. Fifteen patients, who were assigned to the high-risk collective, either developed a pregnancy-induced hypertension during their pregnancy or an intrauterine fetal growth retardation. The Doppler-sonographic examination of the Aa. uterinae was applied for the first time between the 6 and 8 weeks gestation (WG), then in the 9 WG, 10 WG, 11 WG, between the 12 and 14 WG, as well as between the 20 and 24 WG.
Contrary to published data, there can be traced a completely transformed flow pattern in the Aa. uterinae already during the first trimester to an increasing extent. This correlates with a positive outcome of the pregnancy. There is a definite association between pathological Doppler sonography in the first third of the pregnancy and the development of a uteroplacental insufficiency as well as a pregnancy-associated hypertension (SIH) in the further course of the pregnancy.
Doppler sonography is an approved method in order to become early attentive of a reduced uterine blood flow. Applying Doppler sonographic treatment of the maternal vessels, uteroplacental insufficiency can be traced at an early stage. Pregnancies, which might develop a pregnancy-associated hypertension (SIH) or a placental insufficiency, can be detected during the early pregnancy to decrease the morbidity rate and the mortality of premature newborns. Further studies in larger collectives are necessary to obtain adequate solid datasets and to further evaluate the clinical meaning and the significance concerning pathological maternal Doppler parameters.
Archives of Gynecology and Obstetrics 08/2007; 276(1):21-8. · 1.28 Impact Factor
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ABSTRACT: The individual risk assessment of fetal Down's syndrome based on measurement of nuchal translucency (NT) according to Nicolaides, optionally complemented by the determination of PAPP-A and free beta HCG has progressively supplanted other search strategies for fetal aneuploidies. It could be shown that this diagnostic strategy equally detects other numeric aneuploidies at a comparable rate. A positive test result is also predictive for the presence of a fetal malformation. In this field, several computer programs are available for clinical use. The objective of our study was to re-evaluate the first consecutive 1463 NT-risk calculations determined by Nicolaides' method and to compare the risk calculation to the JOY software (NT-risk calculation module, JOY Patient Database) introduced in 2002.
At the Department of Obstetrics and Gynecology, Hannover Medical School, 1463 consecutive complete data sets comprising first trimester screening performed between May 2, 2000 and June 26, 2003 and corresponding fetal outcome were analysed using risk assessment based on the Nicolaides method (PIA Fetal Database NT-Module) and compared with the risk evaluation as determined by the JOY software (JOY Patient Database NT module). A risk exceeding 1:300 was considered to indicate the need for further invasive testing. In a first step, only cytogenetically detectable chromosomal aberrations were analysed. Then, a second evaluation including fetal malformations was performed.
Among the 1463 cases, 1445 (98.77%) fetuses revealed to be cytogenetically healthy. Both softwares showed identical detection rates at the genetic and somatic level:13 cases of Down-Syndrome (0.89%), 2 cases of trisomy 18 (0.14%), one case of triploidy, one Turner-Syndrome, one Klinefelter-Syndrome (0.07% each) were detected. A positive test result was found in 15 cases ending in a spontaneous abortion, intrauterine death or peripartum death (1.03%) and in 22 cases of fetal malformation (1.50%). At the level of genetic detection the test positive rate dropped from 92 (PIA) to 71 (JOY) (-22.8%). At the level of combined adverse outcome the test positive rate was reduced from 100 (PIA) to 76 (JOY) (-22.0%), thus yielding in a marked improvement of the characteristic test performance parameters.
The novel, recently developed JOY software package allowed reliable evaluation of the risk for aneuploidy with increased specificity whereas sensitivity was unchanged. Our data suggest an improvement of the screening for aneuploidy when using this novel software: With an identical detection rate, the number of unnecessary invasive measures may be reduced.
Archives of Gynecology and Obstetrics 07/2007; 275(6):469-74. · 1.28 Impact Factor
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ABSTRACT: The proper function of the fetal heart is indispensable for the fetal development and the normal fetal growth. For prenatal medicine, Doppler sonography offers the possibility of a non-invasive method to examine the fetal cardiovascular function under normal and pathological circumstances. The role of the Doppler sonography is to identify those fetuses who have a high risk factor for developing a pre- or intrapartual asphyxia and therefore have to be delivered promptly. This study aimed at evaluating the clinical value of the intracardiac Doppler sonography (IDS) and at scrutinizing its usefulness during the supervision of the pregnancy of intrauterine growth restricted (IUGR) fetuses.
In a prospective research at the Medical School of Hanover, fetal IDS was applied to 174 pregnant women between the 21 and 37 weeks of gestation (WG). The e-wave and the a-wave, the E/A ratio, and the TVI (time velocity integral) were measured at the atrioventricular (AV) valves. The PV (peak velocity) as well as the TVI were determined at both the aortic and the pulmonary valve. Normal range curves were compiled for all measured parameters.
Alongside a control group with untroubled gravidity, which consisted of 153 patients, IUGR fetuses, who formed a collective of 21 patients, were Doppler sonographically examined. While the gestational age advanced, an increase of both the e-wave and the a-wave above the AV-valves could be ascertained, which lead to an E/A ratio <1. Above the semilunar valves there was indicated a slight steady increase of the TPV, the PV as well as the TVI. Normal range curves, which largely correspond to those described in the literature, were compiled for the collective of the pregnancies without pathological findings (n = 153). In comparison to the standard collective, there were no significant differences from the collective of the growth restricted fetuses (n = 21).
A temporal informational advantage of pathological intracardiac Doppler values for high risk pregnancies (IUGR) could not be retraced in the examined collective. Doppler sonography traces acute and chronic deficits, which are indicated by hemodynamic changes of the fetus's blood supply. The clinical importance of IDS as regards dystrophic fetuses has to be ascertained in continuative studies: In the stage of compensatory placental insufficiency (IUGR, arterial Doppler without ARED-flow, venous Doppler without pathological findings) the IDS cannot provide an informational advantage. Contrastingly, the diagnostic potential of the IDS as a screening method of fetal cardiac insufficiency during decompensative placental insufficiency (IUGR, arterial Doppler with ARED-flow, venous Doppler normal or pathological) remains indistinct and should therefore be prospectively evaluated within this high risk group and contrastingly compared to the significance of the venous Doppler sonography (informational advantage?).
Archives of Gynecology and Obstetrics 07/2007; 276(1):35-42. · 1.28 Impact Factor
