P Berle

Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Hesse, Germany

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Publications (70)89.71 Total impact

  • T Hitschold · P Berle · M Gonser
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    ABSTRACT: We tried to evaluate, whether emergency operative closure of the cervix (EOCC) is a realistic option for prolongation of pregnancy in cases with early opening of the cervix and prolapse of the amniotic sac (PAS) into the vagina. We report on 16 patients with PAS between 15 + 3 and 28 + 1 weeks of gestation and cervix dilatation between 2 and 8 cm. After antibiotic and tocolytic treatment we performed EOCC in 7 cases and EOCC + Cerclage in 9 cases. Pregnancy follow up and fetal outcome were analysed retrospectively. Mean gestational age at delivery was 33 + 1 weeks (9 cases > 32 + 0 weeks, 2 cases between 28 + 0 and 31 + 6 weeks, 3 cases between 25 + 0 and 27 + 6 weeks, 1 case with rupture of membranes during operation and immediate cesarean section at 28 + 1 weeks, 1 miscarriage at 23 + 3 weeks). Time between EOCC and delivery was between 0 and 146 days (mean 56.3 days), 14 fetuses survived healthy. The best results were obtained after EOCC + cerclage. If antibiotic and tocolytic treatment was successful in stopping local infection and contractions, EOCC is an acceptable and mostly successful procedure to prolong pregnancy.
    No preview · Article · Feb 2001 · Zeitschrift für Geburtshilfe und Neonatologie
  • J Heimann · T Hitschold · K Müller · P Berle

    No preview · Article · Jan 2000 · Geburtshilfe und Frauenheilkunde
  • T. Hitschold · H. Müntefering · P. Berle
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    ABSTRACT: Purpose: To correlate fetal outcome and placental histology of fetuses with umbilical cord Doppler S/D-ratios below the 5th percentile. Design and Methods: Among a total of 4000 fetuses 180 showed an umbilical Doppler resistance index below the 5th percentile, 250 above the 95th percentile and 3,650 within the normal range. We obtained 1-4 individual measurements per case. Results: Among 180 fetuses with low fetoplacental impedance we found in 68 (38%) growth retardation, in 36 (20%) premature delivery and in 30 (17%) the need for Caesarean section for fetal asphyxia. In cases with elevated S/D-ratio these figures were 125 (50%), 98 (39%) and 50 (20%), respectively. These amounts differed significantly from the reference group. If low impedance was detected before the 28th week of gestation (66 cases), we observed growth retardation in 40 cases (60%), in 22 (30%) premature delivery and in 16 (25%) cesarean section for fetal asphyxia. In cases with elevated S/D-ratio before 28th week of gestation (n=40) these figures were 33 (80%), 22 (55%) and 20 (50%), respectively. If low impedance occurred later (114 cases), the figures were 28 (25%), 14 (12%) and 14 (12%), respectively. In cases with high impedance after the 28th week (210 cases) these figures were 93 (44%), 75 (36%) and 30 (14%), respectively. This was also statistically significant. From the placentamorphological point of view low fetoplacental impedance reflects accelerated villus maturation whereas high impedance represents retarded maturation of the villus tree. Conclusion: There is some evidence that strikingly low umbilical resistance indices, assumed to demonstrate a particularly good fetal blood supply, may also indicate a placental compensatory phenomenon due to imminent placental insufficiency with the need for more intensive fetal surveillance, especially if this flow pattern is observed before the 28th week of gestation.
    No preview · Article · Oct 1998 · Geburtshilfe und Frauenheilkunde
  • T. Hitschold · H. Müntefering · P. Berle

    No preview · Article · Jan 1998 · Geburtshilfe und Frauenheilkunde
  • A. Klee · T. Hitschold · P. Berle
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    ABSTRACT: Over a period of about six months each, deliveries after premature rupture of membranes (PROM) and a confirmed gestational age of > 32 weeks were subjected to either of the following regimes: During the first 6 months induction was started 48 hours after PROM in the absence of spontaneous labour (Group 1). During the following 6 months labour was induced 12 hours after PROM in case of lacking labour-dependent cervical dilatation (Group 2). Progress of delivery and neonatal morbidity were analysed in both groups. 7.6% of the deliveries had to be induced in Group 1 compared with 25.7% in Group 2. No significant difference in the delivery rate after 48 hours and in the operative delivery rate could be observed (88.9% vs. 94.6% and 28.5% vs. 30.1%). Comparing both subgroups, which underwent induction, revealed an increased operative delivery rate in Group 2 (42% vs. 33%). The period of labour in this group was prolonged (15 hours vs 9 hours). Caesarean section because of an amnionic infection syndrome and transfer to the neonatal care unit were not found to be different in groups 1 and 2 as well as in the corresponding subgroups. Severe infections such as pneumonia or amnionic infection syndrome were observed in 3.8% (Group 1) and in 5.7% (Group 2). 7.4% of the newborn, delivered after induction of labour 12 hours following PROM, developed these infections, whereas no case arose when labour was induced after 48 hours. These data suggest no benefit for newborn delivered after induction of labour 12 hours following PROM, compared to newborn delivered after an expectant labour by induction after 48 hours.
    No preview · Article · Sep 1997
  • T Hitschold · P Berle
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    ABSTRACT: The diagnostic value and the complication rate of transabdominal chorionic villi and placental sampling was compared with standard amniocenteses. The method ist especially helpful in cases with conspicuous fetal sonographic findings. The results of 475 biopsies were retrospectively compared with 983 amniocenteses and chorionic villi samplings (CVS). 64% of chorionic villi samplings (CVS) were performed in the first, 30% in the second and 6% in the third trimester. The indications were advanced maternal age (45%) and psychological problems (14%) in the first trimester and conspicuous maternal serum markers (11%) or fetal ultrasound anomalies (12%) in the second and third trimester, respectively. 10 out of 20 aneuploid cytogenetic results were found in fetuses with sonographic anomalies. In 4 cases we found confined placental mosaicism, which was clarified by means of amniocentesis and cordocentesis. We had 8 miscarriages in a total of 475 CVS procedures; 6 in 304 before the 15th week of gestation (1.97%). The natural abortion rate in this gestational age is about 1%, the CVS-related abortion rate therefore is near 1%. Transabdominal CVS is a low risk method for rapid karyotyping during the entire pregnancy.
    No preview · Article · Jul 1997 · Ultraschall in der Medizin
  • T. Hitschold · P. Berle

    No preview · Article · Jun 1997 · Ultraschall in der Medizin
  • A. Klee · T. Hitschold · P. Berle

    No preview · Article · Jan 1997 · Geburtshilfe und Frauenheilkunde
  • S Ulrich · C Piper · M Kalder · P Berle
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    ABSTRACT: This report is on a severe case fo a HELLP-syndrome (H haemolysis, EL elevated liver enzymes, and LP low platelets). A 32-year old gravida developed severe preeclampsia with epigastric pain at 33 weeks' gestation. During a few hours post partum she showed disseminated intravascular coagulation (DIC) and required intensive care. The severe HELLP-syndrome was combined with a fast increasing acute respiratory distress syndrome (ARDS) and acute oligo-anuric renal failure. She was treated in the intensive-care unit for several days with artificial respiration, 10 acute haemodialyses, 4 plasma exchanges with fresh-frozen plasma and many blood and platelet transfusions. An early Caesarean section and treatment in the intensive care unit managed to turn the otherwise complicated progression of the disease. It is pointed out that plasma exchange with fresh-frozen plasma is a rarely employed treatment.
    No preview · Article · Sep 1996 · Geburtshilfe und Frauenheilkunde
  • S. Ulrich · C. Piper · M. Kalder · P. Berle

    No preview · Article · Aug 1996 · Geburtshilfe und Frauenheilkunde
  • S Ulrich · M Kalder · T Hitschold · E Weiss · P Berle
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    ABSTRACT: We analysed 78 fetuses with absent or reverse endiastolic flow velocities (AREDFV) of the umbilical arteries with respect to fetal acidosis, resistance index of the middle cerebral artery (MCA) and abnormal neurological evaluations. A control group was matched for gestational age and normal umbilical artery flow velocity waveforms. Fetuses with AREDFV showed an increased incidence of fetal acidosis. The number of fetuses with abnormal neurological signs was significantly increased compared to the control group. Most of these fetuses (86%) showed abnormal blood flow velocity waveforms of the middle cerebral arteries called "brain-sparing effect". The combination of premature delivery in the 30th week of gestation, severe idiopathic respiratory distress syndrome, and a resistance index under the 10th percentile in the middle cerebral arteries seems to be a risk factor of the early neurological morbidity in fetus with AREDFV.
    No preview · Article · Feb 1996 · Zentralblatt für Gynäkologie
  • S Ulrich · E Weiss · M Kalder · T Hitschold · P Berle
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    ABSTRACT: Absent or reverse end-diastolic flow velocities (AREDFV) of the umbilical arteries are associated with fetal distress. We studied 74 fetuses with AREDFV with respect to the resistance index of the middle cerebral artery (MCA). The change in the resistance index of MCA was applied to the fetal outcome. The fetuses were retrospectively divided into 3 groups: 1) The fetuses in the first group did not show any changes in the course of observation of the MCA. 2) In the second group a drop followed by an increase in the resistance index of the MCA was confirmed. This is known in literature as "cerebral oedema". 3) The third group showed only a drop in the resistance index, described in literature as "brain-sparing-effect". The increase in the resistance index of the MCA points to a danger for the fetus, since the incidence of fetal acidosis, low birth weight, severe idiopathic respiratory distress syndrome in these fetuses was extremely high. In particular every second fetus in this group showed neurological complications. The change in the cerebral perfusion known as "cerebral oedema" which is extremely dangerous for the fetus has to be avoided.
    No preview · Article · Jan 1996 · Zeitschrift für Geburtshilfe und Neonatologie
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    ABSTRACT: Within a group of preeclamptic women we found severe histologic placental pathology with functional relevance when both the uteroplacental and fetoplacental flow velocity waveforms showed elevated resistance indices. These pathological findings were a reduced decidual area, infarction and villus maturation failures with a high rate of intrauterine growth retardation, acidosis and premature delivery. In cases with normal flow velocity waveforms these pathologic findings were much rarer although the patients were preeclamptic, too.
    No preview · Article · Jan 1995 · Zeitschrift für Geburtshilfe und Neonatologie
  • M Kalder · S Ulrich · T Hitschold · P Berle
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    ABSTRACT: During three and a half years we observed 83 single pregnancies all delivered by caesarean section. All of them had a mild (systolic blood pressure > 140, diastolic > 90 and proteinuria > 0.5 g/dl) or a severe preeclampsia (systolic blood pressure > 160, diastolic > 100 and proteinuria > 3.0 g/dl). We found significantly twice as many abnormal uteroplacental blood flow velocities in the severe preeclampsia group than in the mild one. These results draw us to the conclusion that possible pathological changing of the vessels is due to preeclampsia which does not need to correlate with a placental insufficiency and fetal growth retardation. An abnormal uteroplacental blood flow velocity connected with an abnormal umbilical blood flow velocity raises the fetal morbidity and the early childhood morbidity. Fetal outcome in mild compared to severe preeclampsia definitively shows a worse prognosis for those fetuses whose mother developed a prepartal severe preeclampsia. A distinctly increased rate of cerebral haemorrhages, abnormal neurological signs, acute respiratory distress syndromes and bronchopulmonary dysplasia was found. Finally we show an additional risk for fetal outcome in absent or reverse enddiastolic flow velocity (AREDFV) in the severe preeclampsia group. We observed in the AREDFV group with severe preeclampsia in comparison to a group of AREDFV without maternal preeclampsia more than twice as many cerebral haemorrhages, abnormal neurological signs and bronchopulmonary dysplasia.
    No preview · Article · Jan 1995 · Zeitschrift für Geburtshilfe und Neonatologie
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    ABSTRACT: The purpose of this study is to determine the levels of brain type isoenzyme of creatine kinase (CK-BB) as a possible indicator of a pre-existing intrauterine brain-cell damage in cord blood sera of fetuses with preceding absent or reverse end-diastolic flow velocities of the umbilical arteries (AREDFV). CK-BB isoenzyme activities were determined in umbilical cord sera of 13 newborn infants with preceding AREDFV and in 14 fetuses with low end-diastolic flow velocities (LEDFV) of the umbilical arteries. 50 newborn infants with elective cesarean section and normal umbilical artery blood flow velocity waveforms were used as controls. Two-tailed Student's t-test and Fischer's exact test were used for statistical evaluation of the results. CK-BB isoenzyme activity did not depend on gestational age. Fetuses with AREDFV showed a significant increase in CK-BB values, whereas fetuses with LEDFV had CK-BB activities within the normal range of the controls. The elevated CK-BB values of the AREDFV group were not correlated with fetal acidosis at birth. Brain-cell injury with leakage of CK-BB isoenzyme might be present in fetuses with AREDFV even before (preterm) delivery.
    No preview · Article · Feb 1994 · Journal of Perinatal Medicine
  • S Ulrich · J P Ernst · M Kalder · E Weiss · P Berle
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    ABSTRACT: Absent or reverse enddiastolic flow velocities (AREDFV) of the umbilical arteries are associated with fetal distress and adverse fetal outcome. We studied 68 fetuses with AREDFV with respect to abnormal neurological evaluation up to two years. A control group was matched for gestational age and had normal umbilical artery flow velocity waveforms. Fetuses with AREDFV showed increased abnormal neurological signs, compared with the control group (31% vs. 12%). Our results confirm the significance of AREDFV in growth retarded infants with respect to neurological development in early childhood.
    No preview · Article · Jan 1994 · Zeitschrift für Geburtshilfe und Perinatologie
  • N. Vedder · E. Weiss · P. Berle
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    ABSTRACT: Ohne Zusammenfassung
    No preview · Article · Dec 1993 · Archives of Gynecology and Obstetrics
  • M. Queck · P. Berle
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    ABSTRACT: Ohne Zusammenfassung
    No preview · Article · Dec 1993 · Archives of Gynecology and Obstetrics
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    ABSTRACT: The placental vascular architecture of small-for-gestational-age fetuses seems to have an impact on the flow patterns in the umbilical arteries. Blood flow velocity waveforms of the umbilical arteries were measured by Doppler ultrasonography in nine small-for-gestational-age fetuses with elevated systolic/diastolic ratios of the umbilical arteries, seven small-for-gestational-age fetuses with normal flow patterns, and 14 appropriate-for-gestational-age fetuses with normal flow patterns. After delivery histomorphometric placental investigations were performed. Reduced end-diastolic flow velocities were significantly associated with both a reduction of vascularization within the terminal villi and adverse diffusion conditions, indicating insufficient functional maturity. The perfusion and diffusion capacity of small-for-gestational-age placentas with normal umbilical artery flow velocity waveforms was similar or even slightly better compared with the appropriate-for-gestational-age control values. These data suggest that Doppler flow velocimetry in the umbilical arteries is predictive of a vascular lesion within the placentas of small-for-gestational-age fetuses.
    No preview · Article · May 1993 · American Journal of Obstetrics and Gynecology
  • E Weiss · P Berle
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    ABSTRACT: In a retrospective study, the perinatal mortality between 1981 and 1989 in Hesse is analysed with the help of the Hessische Perinatalerhebung (Hessian Perinatal Study, HEPE). The frequencies of antepartum, subpartum, and neonatal death (< or = 7th day) are studied in relation to the birthweight of the newborn. For the first time in 1982, the neonatal mortality was below the rate of the stillborn foetuses. The subpartum mortality is remarkably low since 1985 (< 0.3%). The number of stillbirths with antepartum death is unchanged since 1985 and their relative amount increases as the neonatal mortality decreases further. The improvement in neonatal mortality concerns particularly the very low birthweight infants below 1500 g, and especially those below 1000 g. The survival of the born alive fetuses below 1000 g birthweight show an additional improvement, when they are born in a perinatal centre. The death of the stillborn babies occurs antepartum in 90% and concerns approx. 80% of fetuses with more than 1499 g and in nearly 50% fetuses weighing more than 2499 g. Lethal malformations are of no importance in antepartum mortality. An improvement in antepartum foetal losses seems to be possible in Hesse and could lead to a decrease in perinatal mortality to below 5% in the years to come.
    No preview · Article · May 1993 · Geburtshilfe und Frauenheilkunde

Publication Stats

236 Citations
89.71 Total Impact Points

Institutions

  • 1989-1996
    • Dr. Horst Schmidt Kliniken Wiesbaden
      Wiesbaden, Hesse, Germany
    • Akdeniz University
      • Department of Histology and Embryology
      Satalia, Antalya, Turkey
  • 1989-1995
    • Johannes Gutenberg-Universität Mainz
      • Department of Ecology
      Mayence, Rheinland-Pfalz, Germany