Richard Berger

Richard Berger
Marienhausklinikum Neuwied · Obstetrics and Gynecology

Prof. Dr. med.

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224
Publications
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Publications

Publications (224)
Article
The authors hypothesize that particularly severely compromised and asphyctic term infants in need of resuscitation may benefit from delayed umbilical cord clamping (after several minutes). Although evidence is sparse, the underlying pathophysiological mechanisms support this assumption. For this review the authors have analyzed the available resear...
Article
The administration of a single course of corticosteroids before week 34 + 0 of gestation in cases with impending preterm birth is now standard procedure in obstetric care and firmly established in the guidelines of different countries. But despite the apparently convincing data, numerous aspects of this intervention have not yet been properly studi...
Article
Full-text available
Around 3% of all pregnancies are complicated by preterm prelabor rupture of membranes (PPROM) before 37 + 0 weeks of gestation. Since PPROM is likely to be associated with microbial invasion of the amniotic cavity (MIAC)—either before or secondary to PPROM—the risk of developing intraamniotic inflammation (IAI) is high. IAI is associated with short...
Article
Full-text available
Background The rate of preterm births in Germany is 8.6%, which is very high compared to other European countries. As preterm birth contributes significantly to perinatal morbidity and mortality rates, the existing prevention strategies need to be optimized and expanded further. About ⅔ of all women with preterm birth have preterm labor or prematur...
Article
Full-text available
Background Prior spontaneous preterm birth is a strong risk factor for the recurrence of spontaneous preterm birth in a subsequent pregnancy and has been evaluated in prevention studies using progesterone (natural progesterone administered orally or vaginally, and 17-hydroxyprogesterone caproate [17-OHPC]) as a selection criterion. Based on the fin...
Conference Paper
Zielsetzung Bei einem erhöhten Frühgeburtsrisiko vor der 34. Woche werden Cortikosteroide zur fetalen Lungenreife verabreicht, durch welche ein Infant Respiratory Distress Syndrom verhindern werden soll. Die Wirkung von Corticosteroid (ACS) kann jedoch nur entfaltet werden, wenn das Anwendungsintervall zwischen Gabe und Geburt mindestens 24 Stunde...
Article
Premature birth makes a substantial contribution to the perinatal morbidity and mortality and is one of the main risk factors for disability-adjusted life years (DALYs). Since 2008 the incidence in Germany has been stable at slightly over 8 %. Germany therefore occupies one of the lowest places in Europe. The condition after premature birth is the...
Article
Full-text available
Background: The preterm birth rate in Germany has remained unchanged at 8-9% since 2009. Preterm birth is the most common cause of neonatal morbidity and mortality. In the absence of a causal treatment, it is important to lower the risk of preterm birth by preventive measures in prenatal outpatient care. Methods: This review is based on pertinen...
Article
Aims: This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from rece...
Article
Full-text available
This position paper describes clinically important, practical aspects of cervical pessary treatment. Transvaginal ultrasound is standard for the assessment of cervical length and selection of patients who may benefit from pessary treatment. Similar to other treatment modalities, the clinical use and placement of pessaries requires regular training....
Data
This is a subsection from a review in which the concept that oxygen delivery determines cellular oxygen consumption was first presented before the cells' oxygen sensing discovery was made (HIF mechanism - Nobel Prize 2019). Fetal circulatory responses to oxygen lack. Jensen A, Berger R. J Dev Physiol. 1991 Oct;16(4):181-207. Department of Obstetr...
Article
Zusammenfassung Ziel Offizielle Leitlinie der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe (DGGG), der Österreichischen Gesellschaft für Gynäkologie und Geburtshilfe (ÖGGG) und der Schweizerischen Gesellschaft für Gynäkologie und Geburtshilfe (SGGG). Ziel der Leitlinie ist es, die Prädiktion, die Prävention und das Management der Frühgeb...
Article
Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent...
Article
Aims This is an official guideline of the German Society for Gynecology and Obstetrics (DGGG), the Austrian Society for Gynecology and Obstetrics (ÖGGG) and the Swiss Society for Gynecology and Obstetrics (SGGG). The aim of this guideline is to improve the prediction, prevention and management of preterm birth based on evidence obtained from recent...
Chapter
Sehr frühgeborene Kinder sind überproportional häufig von intra- bzw. periventrikulären Hirnblutungen oder einer periventrikulären Leukomalazie betroffen. Magnesiumsulfat vermag das unreife Gehirn vor einer infantilen Zentralparese und Dysfunktionen der Grobmotorik zu schützen. Darüber hinaus reduziert eine verzögerte Abnabelung bei frühgeborenen K...
Article
Eine asymptomatische Bakteriurie kann das Risiko für eine Frühgeburt erhöhen. Ob eine antibiotische Behandlung wirksam ist, um dieses Risiko zu verringern, wird im Folgenden dargelegt.
Article
Frühchen, die vor der 30. Schwangerschaftswoche zur Welt kommen, sind in besonderem Maße von perinatalen Hirnschäden betroffen. Viele dieser Kinder sind schwerbehindert. Dies gilt es zu vermeiden.
Article
Hintergrund: Die Prävention und Behandlung der Frühgeburt gehört auch heute noch zu den ungelösten Problemen der Geburtshilfe. Progesteron entfaltet eine Vielzahl von Wirkungen auf Myometrium und Zervix, u. a. eine Hemmung der Myometriumkontraktion und eine zervixstabilisierende Wirkung durch Inhibition proinflammatorischer Zytokine und konsekutiv...
Article
Full-text available
The authors conclude that laparoscopy in experienced hands is safe even during pregnancy, with the recognized advantages of minimally invasive surgery, yet it carries a higher miscarriage rate than laparotomy, with a comparable preterm birth rate. Before surgery, patients should be thoroughly informed about the operation they are about to undergo...
Article
Full-text available
Preterm infants born before the 30th week of pregnancy are especially at risk of perinatal brain damage which is usually a result of cerebral ischemia or an ascending intrauterine infection. Prevention of preterm birth and early intervention given signs of imminent intrauterine infection can reduce the incidence of perinatal cerebral injury. It has...
Article
Objective: The aim of this study is to present the current state of neuroprotection for prematurely born infants.
Article
Full-text available
Background Premature rupture of the membranes (PROM) is most commonly diagnosed using physical examination; however, accurate decision making in ambiguous cases is a major challenge in current obstetric practice. As this may influence a woman’s subsequent management, a number of tests designed to assist with confirming a diagnosis of PROM are comme...
Article
Objective: To test a possible neuroprotective activity of 17β-estradiol in the neonatal rat brain exposed to hypoxic-ischemia (controlled hypoxia after unilateral carotid artery ligation). Methods: Seven-day-old Wistar rats underwent ligation of the left common carotid artery followed by 80 minutes hypoxia in 8% oxygen inducing an ipsilateral br...
Article
Full-text available
Intrauterine infection is suggested to cause perinatal brain white matter injury. In the current study, we evaluated whether S100B, a brain damage marker, may be also assessed in maternal bloodstream after white matter injury induced by fetal intravenous application of lypopolisaccharide (LPS) endotoxin. Fourteen fetal sheeps were chronically cathe...
Article
Full-text available
Periventricular leukomalacia (PVL) is a frequent complication of preterm delivery. Proinflammatory cytokines, such as interferon-gamma (IFN-gamma) and tumor necrosis factor alpha (TNF-alpha) released from astrocytes and microglia activated by infection or ischemia have previously been shown to impair survival and maturation of oligodendrocyte proge...
Chapter
Full-text available
There is a growing body of evidence from clinical and epidemiologic studies that in utero exposure to infection plays an important role in the genesis of fetal or neonatal injury leading to cerebral palsy and chronic lung disease. Thus, after chorioamnionitis the incidence of immature neonates with periventricular white matter damage and periventri...
Chapter
There is a growing body of evidence from clinical and epidemiologic studies that in utero exposure to infection plays an important role in the genesis of fetal or neonatal injury leading to cerebral palsy and chronic lung disease. Thus, after chorioamnionitis the incidence of immature neonates with periventricular white matter damage and periventri...
Article
Fragestellung: Intrauterine Infektionen sind mit einer hohen perinatalen Morbiditat und Mortalitat assoziiert. Klinische und experimentelle Untersuchungen weisen auf eine inflammatorische Schadigung der weisen Hirnsubstanz hin. Biochemische Indikatoren fur die Entwicklung einer Hirnschadigung bzw. einer neurologischen Auffalligkeit liegen nicht vor...
Article
To study endotoxin induced changes in pulmonary blood flow during normoxia and hypoxia and analyzed the role of nitric oxide (NO) and endothelin (ET) in this process. Twenty-seven fetal sheep were chronically instrumented at 107+/-1 days (term is 147 days). Experiments were performed 3 days after surgery. Fetuses were randomized into four groups. G...
Article
Intrauterine infection is suggested to cause perinatal brain white matter injury. The aim of the present study was to clarify, whether intravenous application of endotoxin results in neuropathological findings and increased blood levels of the S100B protein, which is a consolidated marker of brain injury. Twenty-one fetal sheep were chronically cat...
Article
Full-text available
To investigate the role of nitric oxide in the process of circulatory decentralization during fetal hypoxemia. Fifteen sheep with singleton pregnancies were chronically instrumented at 107 days of gestation (term is 147 days). Three days later, 8 of the fetuses received nitro-L-arginine methyl ester (L-NAME), an inhibitor of nitric oxide synthesis....
Article
Full-text available
In the present study we examined the effects of low-dose endotoxin (lipopolysaccharides, LPS) on continuously recorded umbilical blood flow. Twenty fetal sheep were catheterized at a gestational age of 107 +/- 1 days. A flow probe was placed around either the common umbilical artery or one single umbilical artery. Three days later fetuses received...
Article
Full-text available
Klinische und epidemiologische Studien weisen auf eine wichtige Rolle perinataler Infektionen in der Genese fetaler und neonataler Schädigungen hin. Eine Chorioamnionitis ist nicht nur von wesentlicher Bedeutung für die Entwicklung einer Frühgeburt, sondern erhöht auch das Risiko perinataler Hirnschäden. Im Vordergrund stehen neben der peri- und in...
Article
Fragestellung: Eine aszendierende intrauterine Infektion kann zu Schaden der weisen Hirnsubstanz unreifer Feten fuhren. So loste die Applikation der Zytokine INF-γ und TNF-α bei Oligodendrozyten-Vorlauferstufen Apoptose aus und beeintrachtigte die weitere Ausdifferenzierung dieser Zellen. Es sollte nun geklart werden, inwieweit diese Schaden durch...
Article
Fragestellung: Eine aszendierende intrauterine Infektion fuhrt uber die Freisetzung verschiedener Cytokine zu Schaden der weisen Hirnsubstanz unreifer Feten. In der vorliegenden Arbeit sollte deshalb der Einfluss von INF-γ und TNF-α auf das Uberleben und die Differenzierung von Oligodendrozyten-Vorlauferstufen untersucht werden. Methodik: Kulturen...
Article
There is strong evidence from recent clinical studies that ascending intrauterine infection is associated with an increased incidence of periventricular leukomalacia in very premature fetuses. Periventricular leukomalacia is characterized by disrupted myelination from a loss of oligodendrocyte progenitors. We investigated the effects of proinflamma...
Article
Full-text available
We tested the neuroprotective effects of creatine against hypoxic-ischemic injury in the immature brain. Hippocampal slices were prepared from fetal guinea pigs at 0.9 gestation and incubated in artificial cerebrospinal fluid (aCSF) equilibrated with carbogen. Slices were subjected to oxygen-glucose deprivation (OGD) for 30 or 40 minutes. Two hours...
Article
Full-text available
There is a growing body of evidence from clinical and epidemiologic studies that in utero exposure to infection plays an important role in the genesis of fetal or neonatal injury leading to cerebral palsy and chronic lung disease. Thus, after chorioamnionitis the incidence of immature neonates with periventricular white matter damage and periventri...
Article
Full-text available
Children undergoing perinatal brain injury often suffer from the dramatic consequences of this misfortune for the rest of their lives. Despite the severe clinical and socio-economic significance, no effective clinical strategies have yet been developed to counteract this condition. This review describes the pathophysiological mechanisms that are im...
Article
Full-text available
The role of nitric oxide in control of fetal cardiovascular functions and of cerebral blood flow during normoxia and acute hypoxia is only partially known. We studied the effects of nitric oxide synthase inhibition on the distribution of cardiac output in preterm sheep using N(omega)-nitro-L-arginine methyl ester (L-NAME). Thirteen fetal sheep were...
Article
Perinatal brain damage is associated not only with hypoxic-ischemic insults but also with intrauterine inflammation. A combination of antenatal inflammation and asphyxia increases the risk of cerebral palsy >70 times. The aim of the present study was to determine the effect of intracisternal (i.c.) administration of endotoxin [lipopolysaccharides (...
Article
Full-text available
Perinatal brain damage is associated not only with hypoxic-ischemic insults but also with intrauterine inflammation. A combination of antenatal inflammation and asphyxia increases the risk of cerebral palsy >70 times. The aim of the present study was to determine the effect of intracisternal (i.c.) administration of endotoxin [lipopolysaccharides (...
Chapter
Trotz weltweiter Anstrengungen ist die Frühgeburtlichkeit nach wie vor eines der herausragenden Themen der Perinatalmedizin. In Deutschland erleiden jährlich etwa 6—8% aller Schwangeren eine Frühgeburt. Obwohl die Anzahl der betroffenen Kinder zunächst gering erscheint, sind sie doch in hohem Maße von perinataler Mortalitätund Morbidität betroffen....
Article
Full-text available
Children who suffer from perinatal brain injury often deal with the dramatic consequences of this misfortune for the rest of their lives. Despite the severe clinical and socioeconomic significance, no effective clinical strategies have yet been developed to counteract this condition. As shown in recent studies, perinatal brain injury is usually bro...
Article
Children who suffer from perinatal brain injury often deal with the dramatic consequences of this misfortune for the rest of their lives. Despite the severe clinical and socioeconomic significance, no effective clinical strategies have yet been developed to counteract this condition. As shown in recent studies, perinatal brain injury is usually bro...