Werner Rath

Werner Rath
RWTH Aachen University · Department of Gynaecology and Obstetrics

MD, PhD

About

1,056
Publications
61,625
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9,406
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Introduction
Maternal mortality, venous thromboembolism and pregnancy, tocolysis, preterm birth, premature rupture of membranes, post partum haemorrhage, HELLP syndrome, outpatient management in risk pregnancies

Publications

Publications (1,056)
Article
Full-text available
Objectives With an increasing incidence of labor induction the socioeconomic costs are increasing and the burden on hospital capacities is rising. In addition, the worldwide SARS-CoV-2 pandemic asks for improvements in patient care during pregnancy and delivery while decreasing the patient-staff contact. Here, we are retrospectively analyzing and c...
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
Venous thromboembolism (VTE) is one of the leading causes of direct maternal deaths. It has been estimated that approximately 50% of these deaths are potentially preventable. The UK Confidential Enquiries into Maternal Deaths and the National Partnership for Maternal Safety have proposed strategies for the prevention of maternal deaths from VTE bas...
Article
There are currently no up-to-date evidence-based recommendations on the preferred method to induce labour after previous Caesarean section, especially for patients with unripe cervix, as randomised controlled studies are lacking. Intravenous oxytocin and misoprostol are contraindicated in these women because of the high risk of uterine rupture. In...
Article
Full-text available
Objectives Current international guidelines recommend tocolytic treatment by at least 48 hours to complete fetal lung maturation and to ensure in-utero transfer to a perinatal center before 34 weeks of gestation in patients with threatened preterm birth. According to the results of former surveys, significant differences between daily clinical prac...
Article
Full-text available
Purpose: This online survey looked at the experiences and general perceptions of midwives concerning induction of labour and the specific use of misoprostol. Methods: We published an online questionnaire with 24 questions in German on midwives’ experiences and perceptions of different methods of induction of labour. Results: The online survey wa...
Article
Full-text available
According to current guidelines, inpatient management until birth is considered standard in pregnant women with preterm premature rupture of membranes (PPROM). With the increasing burden on obstetric departments and the growing importance of satisfaction and right to self-determination in pregnant women, outpatient management in PPROM is a possible...
Article
Obejctives Worldwide, the overall cesarean section is rising. Trial of labor after cesarean (TOLAC) is an overall safe option with an immediate impact on neonatal and maternal short- and long-term health. Since the use of prostaglandins in cervical ripening is associated with an increased risk of uterine rupture, mechanical methods as balloon cathe...
Article
Full-text available
Subject While the synthetic prostaglandin E1 analogue misoprostol is the most effect labour induction agent, its use is off-label for the most part. For this reason, and in view of its potential adverse effects and varying approaches to its administration, the drug has recently once again become a focus of critical attention. The objective of this...
Article
Full-text available
Background Hormone Receptor (HR)-discordance between primary breast cancer and metastasis is a known biological phenomenon. Discordance studies usually comprise a heterogeneous group of HR-positive and negative patients and allow for the comparison of changes in HR-status from the primary to the recurrent disease. However, in a clinical setting, th...
Article
Rationale: To open new ways for MALDI-MS-based patient screening, blood serum is the most preferred specimen because of its richness in patho-physiological information and due to ease of collection. To overcome deleterious freeze/thaw cycles and to reduce high costs for shipping and storage, we sought to develop a procedure which enables MALDI-MS...
Chapter
Full-text available
Twin pregnancies are categorized according to three factors, zygosity, chorionicity and amnionicity. Dizygotic twins are always dichorionic and diamniotic, where each twin has its own chorionic and amniotic sac. Monozygotic twins account for 1/3 of twin pregnancies and show higher morbidity and mortality. In monozygotic twins, chorionicity and amni...
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...
Article
Full-text available
As the number of labor inductions in high-income countries has steadily risen, hospital costs and the additional burden on obstetric staff have also increased. Outpatient induction of labor is therefore becoming increasingly important. It has been estimated that 20 – 50% of all pregnant women requiring induction would be eligible for outpatient ind...
Article
The prevalence of hypertensive disorders in pregnancy (HDP) is 6-8%. Blood pressure measurement (BPM) remains the cornerstone of diagnosis and should be performed in a standardised manner using automated devices. Office BPM represents only a spotty reading in an "artificial" environment failing to diagnose white coat hypertension (WCH). Ambulatory...
Chapter
Full-text available
Uterine fibroids have remarkably heterogeneous clinical characteristics with unknown exact etiology. The treatment of fibroids should be individualized based on their size, location, growth rate, the symptoms that they cause, the desire to have children and the age of the woman. Embolization is currently the most advanced non-surgical technique. Th...
Article
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Fetal growth restriction (FGR) affects about 3% to 8% of pregnancies, leading to higher perinatal mortality and morbidity. Current strategies for detecting fetal growth impairment are based on ultrasound inspections. However, antenatal detection rates are insufficient and critical in countries with substandard care. To overcome difficulties with de...
Article
Full-text available
HELLP syndrome and the less common acute fatty liver of pregnancy (AFL) are unpredictable, life-threatening complications of pregnancy. The similarities in their clinical and laboratory presentations are often challenging for the obstetrician when making a differential diagnosis. Both diseases are characterised by microvesicular steatosis of varyin...
Chapter
Full-text available
Deep vein thrombosis (DVT) of the lower limbs is a serious condition that can lead to pulmonary embolism (PE) in about 15–24% of cases. If it is not diagnosed/treated timely, nearly 15% of these PE are lethal. The relationship between travel and staying in the same position for a long time is well-known since World War II. Generally, it is more fre...
Book
This book is focused on the protection of female reproductive health. Artificial pregnancy termination is known to be associated with an increased risk of infertility, spontaneous pregnancy loss, and other gestational pathologies. Since family planning is a system for the prevention of unwanted pregnancy, the current situation of the spread of indu...
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
Zusammenfassung Einleitung Exzessive Gewichtszunahme (EGZ) stellt einen Risikofaktor in der Schwangerschaft dar. Da die EGZ ebenso wie Hypertensive Schwangerschaftserkrankungen (HES) und die intrauterine Wachstumsrestriktion (IUGR) mit veränderten Konzentrationen Apolipoprotein B- (ApoB) haltiger Lipoproteine einhergehen, wurde der Hypothese nachge...
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
Introduction Maintenance tocolysis, mostly defined as the continuation of tocolytic treatment beyond 48 h, remains a matter of debate. There is no sufficient evidence from randomized controlled trials, that maintenance tocolysis is able to prolong pregnancy significantly and to reduce severe neonatal morbidity and mortality. Hence, it is not recomm...
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....
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...
Article
Full-text available
The prevention and treatment of preterm birth remains one of the biggest challenges in obstetrics. Worldwide, 11% of all children are born prematurely with far-reaching consequences for the children concerned, their families and the health system. Experimental studies suggest that progesterone inhibits uterine contractions, stabilises the cervix an...
Article
Full-text available
Numerous experimental studies indicate that natural progesterone, through various mechanisms, exerts an inhibitory effect on uterine contractility and sensitises the myometrium for tocolytics. It was therefore appropriate to investigate the possible benefits of oral/vaginal progesterone and the synthetic progesterone derivative 17-α-hydroxyprogeste...
Article
Objective: Our study aimed to assess current practice related to thromboprophylaxis following cesarean section (c.s.) among obstetricians in Germany taking account of the German and international guidelines. Study design: A nation-wide survey using a structured 22-item questionnaire was conducted in Germany. The questionnaire was sent to head of al...
Article
Mass spectrometric profiling of intact serum proteins, i.e. determination of relative protein abundance differences, was performed using two different serum sample preparation methods: one with frozen and thawed serum, the other with at room temperature deposited and dried serum. Since in a typical clinical setting freezing of serum is difficult to...
Article
Tocolysis is among the most common obstetric measures. The objective is to prolong the pregnancy by at least 48 hours to complete foetal lung maturation and for the in-utero transfer of the pregnant woman to a perinatal centre. The indication for tocolysis is regular, premature contractions (≥ 4/20 min) and a dynamic shortening of the cervical leng...
Conference Paper
Introduction Atherogenic lipid oxidation and cholesterol accumulation is increased in the placenta in IUGR. Both, hypoxic conditions and the formation of small molecules like oxysterols however are involved in cellular cholesterol homeostasis by regulating the cholesterol efflux ABC-transporter expression ABCA1 and ABCG1 via activating liver-X-rece...
Article
Full-text available
Purpose : Intrauterine growth restriction (IUGR), a major cause of fetal morbidity and mortality, is defined as a condition in which the fetus does not reach its genetically given growth potential. Screening for IUGR biomarkers in the mothers´ blood during pregnancy would be of great help for optimal pregnancy management and timing of delivery as w...
Article
Zusammenfassung Laut WHO ist die mütterliche Mortalitätsratio von 1990 bis 2015 weltweit um 44% gesunken, aber immer noch sterben mehr als 300 000 Mütter, davon 99% in den Entwicklungsländern. In einigen Industrieländern ist die Inzidenz mütterlicher Sterbefälle in den letzten 20 Jahren sogar angestiegen. Die führenden Ursachen direkter Müttersterb...
Article
Introduction: Recent studies have shown increased RBC aggregation and no difference in plasma viscosity in the presence of markedly lower hematocrit in women at term compared to non-pregnant women. Little is known about the outcome of blood rheological parameters and red blood cell (RBC) deformability particularly in the course of normal pregnancy...
Article
Full-text available
Purpose This is an official interdisciplinary guideline, published and coordinated by the German Society of Gynaecology and Obstetrics (DGGG), the Austrian Society of Gynaecology and Obstetrics (OEGGG) and the Swiss Society of Gynaecology and Obstetrics (SGGG). The guideline was developed for use in German-speaking countries and is backed by the Ge...
Chapter
Die knapp 40-jährige Frau ist dank einer erfolgreichen In-vitro-Fertilisation zum ersten Mal schwanger und jetzt am Beginn der 32. SSW. Zu Beginn der Schwangerschaft war sie bei 165 cm Körpergröße mit ca. 85 kg zwar etwas »mollig«, der Schwangerschaftsverlauf gestaltete sich aber bisher ohne Probleme. Allerdings ist der kleine Junge in den letzten...
Chapter
Der Entbindungstermin rückt näher, in knapp 3 Wochen soll es soweit sein. Die 33-jährige Mutter wünscht sich, dass ihr Kind dieses Mal wieder »auf natürlichem Weg« zur Welt kommen soll, ohne Kaiserschnitt. Vor 5 Jahren war ihre Tochter spontan, ohne Probleme zur Welt gekommen, vor 2 Jahren hatte man ihr bei Beckenendlage »aus Sicherheitsgründen« (w...
Chapter
Im Kreißsaal wird ein Zugang angekündigt, eine 37 Jahre alte Schwangere mit Placenta praevia, eingewiesen vom Frauenarzt zur primären Sectio; sie blutet nicht, hat keine Beschwerden, keine Blutungen in der letzten Zeit, keine Wehen – der Kaiserschnitt soll deshalb in Ruhe vorbereitet werden. Das CTG ist unauffällig, es gibt aber einen einmalig erhö...
Chapter
Der Notarzt wird zu einer Frau gerufen, die in der 34. Woche schwanger ist und Zuckungen am ganzen Körper hatte, bevor sie bewusstlos wurde. Als er eintrifft, ist sie wieder aufgewacht, fühlt sich aber sehr schläfrig und müde. Sie berichtet, dass sie in den letzten 2 Tagen starke Kopfschmerzen hatte, so, als hätte man ihr mit einem Hammer auf den K...
Chapter
Eine 39-jährige Schwangere freut sich auf ihr zweites Kind, nachdem ihr erstes vor knapp 12 Monaten in der 32. Woche mit Kaiserschnitt zur Welt gekommen ist. Auf ihren ausdrücklichen Wunsch soll die zweite Geburt auf natürlichem Weg erfolgen. Sie ist 10 Tage über dem errechneten Termin. Kurz vor der geplanten Geburtseinleitung bekommt sie krampfart...
Chapter
Erschöpft von einer langen, anstrengenden Geburt ahnt die 35-jährige Mutter nicht, was ihr noch bevorsteht. Soeben wurde ihr 4350 g schwerer Sohn geboren, spontan, wie sie es sich gewünscht hatte, nach kleinem Dammschnitt, den sie kaum verspürt hatte. Nach einem Abort vor 4 Jahren in der 12. SSW mit anschließender Kürettage und einem erneuten Abort...
Article
Full-text available
Objective The enzyme 11ß-dehydroxysteroid dehydrogenase 2 (11ß-HSD2) converts active cortisol (F) to inactive cortisone (E). A reduced 11ß-HSD2 activity in the placenta has been demonstrated for prematurity, low birth weight, and preeclampsia. We hypothesized that disturbed placental function rather than a maternal response contributes to decreased...
Article
Zusammenfassung Venöse Thromboembolien (VTE) gehören zu den häufigsten Ursachen direkter Müttersterbefälle in den Industrieländern. Ihre Inzidenz hat in den letzten 20 Jahren signifikant zugenommen. Das absolute Risiko für VTE liegt in der Schwangerschaft zwischen 0,6–2,2/1000 Geburten, im Vergleich zu Nichtschwangeren ist das tägliche Risiko für V...
Conference Paper
Introduction Atherogenic lipid oxidation and cholesterol accumulation is increased in the placenta in IUGR. Both, hypoxic conditions and the formation of small molecules like oxysterols however are involved in cellular cholesterol homeostasis by regulating the cholesterol efflux ABC-transporter expression ABCA1 and ABCG1 via activating liver-X-rece...
Conference Paper
Introduction Intrauterine growth restriction (IUGR) shows a typical drop of apolipoprotein E (ApoE) concentration levels in fetal blood. ApoE activates LDL receptor related proteins (LRP) thus greatly increases transplacental transport of lipoproteins such as LDL and VLDL. The origin of the fetal ApoE is still unknown but might be maternal. Object...
Conference Paper
Introduction and objective Increased oxidative stress and diminished oxidative capacity are distinctive features in the pregnancy-specific syndrome preeclampsia (PE). Activation of the nuclear factor erythroid 2-related factor 2 (Nrf2) initiates and enhances the transcription of many antioxidative enzymes such as heme oxygenase-1 (HO-1), which part...
Conference Paper
Introduction Excessive maternal gestational weight gain (GWG) is a risk factor for several maternal and fetal complications. Lipid metabolism like apo B is linked to obesity and maintenance of pregnancy via placental cholesterol uptake and steroid hormone production. Additionally, evidence is increasing that apo B containing lipoproteins directly i...
Conference Paper
Introduction and objectives Increased oxidative stress and intrauterine inflammation are etiological factors for intrauterine growth restriction (IUGR). The transcription of many antioxidative genes is mediated mainly through the transcription factor Nrf2. A link between Nrf2 and the vascular haemeostasis in preeclampsia has been discussed. The inf...
Article
Introduction: Increased oxidative stress and intrauterine inflammation are etiological factors for intrauterine growth restriction (IUGR). The transcription factor Nrf2 regulates the expression of multi antioxidative and detoxifying enzymes. The role of Nrf2 in the placental development is not well described. Here, we tested the effect of Nrf2-dele...