D W Luedders

Publications (8)4.47 Total impact

• Article: Anatomische Ursachen habitueller Aborte

  A. Hornemann, D.W. Luedders, M. Kumbartski, M. Thill, C. Altgassen, K. Diedrich, M.K. Bohlmann
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  ABSTRACT: Habituelle Aborte sind multifaktoriell bedingt. Ihnen können ursächlich uterine Veränderungen zugrundeliegen. Solche Fehlbildungen können angeboren oder erworben sein. Zu den angeborenen Formen zählen Uterusseptum, Uterus bicornis, Uterus unicornus, Uterus didelphys und Uterus arcuatus. Letztgenannter scheint allerdings keine Auswirkungen auf ein Abortgeschehen zu haben. Erworbene Veränderungen sind intrauterine Adhäsionen, Endometriumpolypen und Myome. Einige dieser uterinen Malformationen können operativ behoben werden und bei Patientinnen mit habituellen Aborten eine Erhöhung der Lebendgeburtrate bedingen. Recurrent miscarriage can be caused by multiple factors. This review focuses on uterine conditions responsible for recurrent miscarriage. Such anomalies can be either congenital or acquired. Among the former are septate, bicornuate, and unicornuate uterus and uterus didelphys, whereas arcuate uterus does not seem to be responsible for miscarriage. Acquired uterine malformations include intrauterine adhesions, endometrial polyps, and myomas. Some of these malformations can be treated surgically, improving the prognosis for future pregnancies in patients with histories of recurrent abortion.
  Der Gynäkologe 04/2012; 42(1):11-16.
• Article: Kinderwunsch nach tubarer Sterilisation

  M.K. Bohlmann, A. Schultze-Mosgau, G. Griesinger, K. Baumann, A. Hornemann, D.W. Luedders, K. Diedrich, A. Kavallaris
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  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.
  Der Gynäkologe 04/2012; 43(2):118-123.
• Article: Antikoagulation und assistierte Reproduktion

  M.K. Bohlmann, A. Hornemann, J. Ortmann, M. Thill, K. Diedrich, D.W. Luedders
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  ABSTRACT: Trotz signifikanter Verbesserungen der Behandlungsprotokolle sowie der Labortechniken beträgt die Schwangerschaftsrate bei Trotz signifikanter Verbesserungen der Behandlungsprotokolle sowie der Labortechniken beträgt die Schwangerschaftsrate bei Methoden der assistierten Reproduktion pro ICF/ICSI-Versuch in Deutschland maximal 40%, die „Baby-take-home-Rate“ liegt im Methoden der assistierten Reproduktion pro ICF/ICSI-Versuch in Deutschland maximal 40%, die „Baby-take-home-Rate“ liegt im Mittel bei etwa 20%. Es ist daher verständlich, dass Therapieversuche zur Verbesserung von Schwangerschafts- und Austragungsrate Mittel bei etwa 20%. Es ist daher verständlich, dass Therapieversuche zur Verbesserung von Schwangerschafts- und Austragungsrate zur Anwendung kommen. Dabei wird unter anderem auch die prophylaktische Gabe von Aspirin und/oder Heparin zur Vermeidung eines zur Anwendung kommen. Dabei wird unter anderem auch die prophylaktische Gabe von Aspirin und/oder Heparin zur Vermeidung eines Implantationsversagens – zum Teil unabhängig von einer möglichen Thrombophilie der Patientin – propagiert. Diese Anwendungen sollen im Rahmen dieser Übersicht dargestellt und unter Berücksichtigung aktueller Studien und Metaanalysen Implantationsversagens – zum Teil unabhängig von einer möglichen Thrombophilie der Patientin – propagiert. Diese Anwendungen sollen im Rahmen dieser Übersicht dargestellt und unter Berücksichtigung aktueller Studien und Metaanalysen kritisch diskutiert werden. Zudem sollen mögliche Zusammenhänge zwischen maternaler Thrombophilie und einem Implantationsversagen kritisch diskutiert werden. Zudem sollen mögliche Zusammenhänge zwischen maternaler Thrombophilie und einem Implantationsversagen untersucht werden. untersucht werden. The pregnancy rate after methods of assisted reproduction attains a maximum rate of 40% in Germany, despite significant improvements The pregnancy rate after methods of assisted reproduction attains a maximum rate of 40% in Germany, despite significant improvements in treatment protocols and laboratory techniques. The baby-take-home rate lies at a disappointing average rate of 20%. Understandably, in treatment protocols and laboratory techniques. The baby-take-home rate lies at a disappointing average rate of 20%. Understandably, therefore, various approaches pursued to improve the pregnancy and delivery rates after in vitro fertilization (IVF)/intracytoplasmic therefore, various approaches pursued to improve the pregnancy and delivery rates after in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). The use of aspirin and/or heparin has been suggested to help avoid implantation failure, partially sperm injection (ICSI). The use of aspirin and/or heparin has been suggested to help avoid implantation failure, partially irrespective of maternal thrombophilia. This approach is presented and critically discussed in this overview, taking account irrespective of maternal thrombophilia. This approach is presented and critically discussed in this overview, taking account of current studies and meta-analyses. Furthermore, possible associations between maternal thrombophilic disorders and implantation of current studies and meta-analyses. Furthermore, possible associations between maternal thrombophilic disorders and implantation failure are investigated. failure are investigated.
  Gynäkologische Endokrinologie 04/2012; 7(2):74-79.
• Article: [Prevention of complications in twin gestations and pregnancies after assisted reproduction].

  D W Luedders, A Hornemann, B Fritzsching, M Thill, D A Beyer, K Diedrich, M K Bohlmann
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  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.
• Article: [Spontaneously conceived twins and twins after ART: are there any differences regarding direct financial costs of delivery].

  A Hornemann, K Diedrich, D Beyer, A Dawson, D W Luedders, M Thill, G Griesinger, M K Bohlmann
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  ABSTRACT: Healthcare expenditures are rising steadily. There are no data on delivery expenses of twin pregnancies. This study aims to provide data on expenses of twin deliveries and to compare expenditures of deliveries after spontaneous conception with deliveries after infertility treatment. Retrospective cohort-analysis on obstetrical data of twin deliveries at the Department of Obstetrics and Gynaecology of the University Hospital Schleswig-Holstein, Campus Luebeck between January 2000 and December 2008. A comparison of delivery expenses of spontaneous twin pregnancies and after infertility treatment. Patients delivering twins after infertility treatment stay 1.1 days longer at the hospital, are 2.5 years older and the number of previous pregnancies and deliveries are significantly lower compared to women after spontaneous conception of twins. In our setting fetal outcome (weeks of gestation, birthweight, APGAR, umbilical arterial pH, admission to neonatal intensive care unit etc.) and other maternal data (maternal height, maternal weight, length of surgery etc.) were not significantly different. The prolonged time spent in hospital leads to a 250 Euro higher expense per patient. Additional expenses of twin deliveries after assisted reproduction are due to a longer stay at the hospital. This prolonged stay of an average of 1.1 days was not obvious to medical reasons. Main delivery expenses for the substantial outcome-parameters are not significantly different between both groups.
  Zeitschrift für Geburtshilfe und Neonatologie 12/2009; 213(6):267-71.
• Article: [Impact of assisted reproduction on obstetrics and neonatology].

  M K Bohlmann, B Fritzsching, D W Luedders, A Hornemann, W Göpel, J Pöschl, K Diedrich, G Griesinger
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  ABSTRACT: In industrialised countries, 1-4% of all children are born as a result of assisted reproductive therapies (ART), such as IVF and ICSI. Possible associations of these ARTs with obstetric and neonatal risk constellations are analysed critically in the context of this review. A selective literature search was conducted to examine the influence of ART on obstetric and neonatal aspects. Multiple gestations, occurring more frequently after ART, are of special significance with regard to their associated risks. In comparison to spontaneous pregnancies, singleton gestations after ART are associated with higher rates of complications, such as preeclampsia, prematurity, low birth weight, foetal malformations and a higher rate of Caesarean sections. Although causal associations between extracorporeal fertilisation methods and health risks for mothers and infants in singleton pregnancies cannot be ruled out, these complications are rather attributed to the underlying causes of infertility than to the methods of assisted reproduction themselves. Pregnancies after ART are to be regarded as risk constellations with a need for closer surveillance during gestation - irrespective of the number of developing foetuses. Couples seeking advice about infertility should be informed in detail before the onset of ART.
  Zeitschrift für Geburtshilfe und Neonatologie 12/2009; 213(6):221-7.
• Article: Thrombophile Gerinnungsstörungen als Risikofaktoren für habituelle Aborte

  M.K. Bohlmann, D.W. Luedders, J. Weichert, K. Baumann, M. Thill, K. Diedrich, E. Schleussner, A. Hornemann
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  ABSTRACT: Als Ursachen für habituelle Aborte – drei und mehr konsekutive Fehlgeburten in einer Partnerschaft – wurden neben genetischen, anatomischen, immunologischen, endokrinen und fraglich infektionsbedingten Faktoren in den letzten Jahren zunehmend hämostaseologische Veränderungen etabliert. Insbesondere eine maternale Thrombophilie kann dabei mit einem signifikant erhöhten Fehlgeburtsrisiko einhergehen. Neben hereditären Veränderungen des Gerinnungssystems (z.B. Faktor-V-Leiden-, Prothrombin-Mutation, Protein-S-Mangel) stellt insbesondere das Antiphospholipid-Syndrom als erworbene Thrombophilie einen bedeutenden Risikofaktor für Schwangerschaftskomplikationen dar. Letzterer kann durch eine antikoagulatorische Kombinationstherapie adäquat behandelt werden. Zusammengefasst wird der aktuelle Kenntnisstand in Hinblick auf Diagnostik und Therapieoptionen bei habituellen Aborten und maternaler Thrombophilie. Recurrent spontaneous abortions – three or more consecutive miscarriages of the same couple – are traditionally associated with genetic, anatomic, immunologic, endocrine, and questionable infectious factors. However, there is growing evidence that changes in the haemostaseologic maternal pathway may play a role in the development of pregnancy complications. Maternal thrombophilic disorders, whether hereditary or acquired, can be associated with a significantly elevated risk for miscarriage. Besides hereditary changes of the coagulation system (e.g. factorV Leiden mutation, prothrombin mutation, proteinS deficiency), it is the acquired thrombophilic disorder of the antiphospholipid syndrome that especially symbolizes a major risk factor for recurrent miscarriages; however, it can be treated adequately with combination anticoagulant therapy. This review summarizes the current knowledge concerning the diagnosis and therapeutic options in patients with recurrent abortions and maternal thrombophilic disorders.
  Der Gynäkologe 12/2008; 42(1):17-24.
• Article: Evidence-based guidelines for the investigation and medical treatment of recurrent miscarriage.

  M K Bohlmann, D W Luedders, M von Wolff
  Human Reproduction 02/2007; 22(1):309; author reply 309-11. · 4.47 Impact Factor