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Biomedical subjects

A Rempen

Publications and source records attributed to A Rempen.

67 records · Page 4Linked to original sources
PubMedDate not supplied

[Sonographically diagnosed subependymal intraventricular hemorrhage in clinically inconspicuous newborn infants and their relation to perinatal factors].

With an intracranial ultrasound screening at the University Clinic of Obstetrics and Gynaecology, Wuerzburg, a subependymal/intraventricular haemorrhage (SEH/IVH) was observed in 37 cases (5.5%). Of the analyzed maternal, obstetric and neonatal variables as possible risk factors of SEH/IVH, SEH/IVH was significantly more frequent in male newborns, first- and secondborn children and in infants of very young mothers, whereas it was significantly less frequently found after rupture of the membranes with the cervix fully dilated and in large-fordates infants. Factors like mode of delivery, presentation, duration of labour, drugs sub partu, maternal injuries, oligohydramnios, meconium staining, coiling of the umbilical cord, birth weight and size, post-maturity, hypotrophy, umbilical cord blood gas analysis, and Apgar score did not show a significant correlation to SEH/IVH. Multivariate analysis only substantiated an independent association between gender and SEH/IVH. Newborns with an umbilical artery pH less than or equal to 7.19 together with an one-minute Apgar score less than or equal to 8 had a four times higher bleeding rate than infants with normal pH and/or Apgar score. The mentioned parameters, however, are not appropriate to predict SEH/IVH in asymptomatic newborns. The appearance of SEH/IVH is usually due to a combination of events rather than to a single factor. The role of raised head compression and intrapartual hypoxia in the causation of SEH/IVH in term newborns has to be clarified in further studies.

Apgar Score↗
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[Prenatal diagnosis and therapy of hydro-/chylothorax with fetal hydrops].

The prenatal diagnosis of a massive bilateral hydro-/chylothorax at 34 weeks of gestation is presented. It was associated with a marked hydrops which probably had resulted from protein depletion into the pleural cavity and/or elevation of intrathoracic pressure with subsequent obstruction of venous return. So the hydro-/chylothorax is to be considered a further cause of the congenital hydrops universalis. After induction of lung maturation with dexamethasone the infant was delivered by a primary cesarean section at 36 weeks of pregnancy. The immediately following intensive care guaranteed the circulatory function and ventilation. The pleural effusions were managed successfully by careful continuous intrapleural drainage and intravenous protein substitution. Last not least, the survival of the infant despite the massive findings is to be owed to the close cooperation of pediatricians and obstetricians.

Adult↗
PubMedDate not supplied

[Prenatal diagnosis of prune belly syndrome occurring in siblings in 2 consecutive pregnancies].

The present paper reports on the occurrence of Prune Belly syndrome in siblings. The mother, now 21, gave birth in 1981 to a boy with Prune Belly syndrome. In the second pregnancy the changes in the fetus were first diagnosed by sonography in the 26th week. An ovarian tumor was ruled out by transabdominal puncture of the tumor in the girl's lower abdomen; dilatation of the bladder was diagnosed by the subsequent sonographic check-up. At the same time amniotic fluid was taken in order to determine the fetal karyotype. As the quantity of amniotic fluid was normal, further treatment was put off: a vesicoamniotic shunt, which had been considered at one stage, was not constructed, even though the dilatory changes in the urinary tract increased. In the 37th week a girl was delivered by cesarean section. She had Prune Belly syndrome. Kidney function post part was normal; the prognosis for the infant is good, as it is for her brother who was not treated prenatally. The authors' observations, especially of the course of the second pregnancy, show that provided the quantity of amniotic fluid is normal, prenatal therapy with its attendant risks should only be considered with great reservation.

Adult↗
PubMedDate not supplied

[Value of sonography in extrauterine pregnancy].

Out of 106 treated cases of ectopic pregnancy (e.p.) at the woman's university hospital Würzburg from 1980 to 5/1984 ectopic gestation was strongly presumed in 40 patients (38%) after physical examination. Out of 71 patients additionally undergoing sonography with a clinical diagnosis of suspected e.p. in 25%, a solid-cystic tumor was described in 22 cases and an extrauterine gestational sac in four cases, thus providing a sonographic suspicion of e.p. in 37%. Totally the part of cases with presumed e.p. before operation was doubled to 51% (36 patients) by the combined use of physical and sonographic examinations. Generally interpretation of the sonographic image is only possible in relation to the clinical findings because the ultrasound appearance of e.p. is mostly non-specific and visualization of the extrauterine gestational sac with a pulsating fetal heart that solely produces evidence, is very rare. Equally the reliable exclusion of e.p. by ultrasound remains problematic. In 13 cases (18%) of the scanned group rupture of tubal pregnancy could not be avoided.

Diagnosis, Differential↗
PubMedDate not supplied

[Kell antibodies in pregnancy].

The paper is concerned with a case presentation of a pregnancy complicated by Kell sensitization. A review of 14 own cases and the literature revealed that sensitization against Kell-antigens requires treatment similar to those with sensitization against D-antigens (Rh0). The diagnostic procedures include repeated amniocentesis, sonography, and titer controls of the Kell-antibodies.

Adult↗
PubMedDate not supplied

[Induced labor with prostaglandins: 0.5 mg PGE2 intracervical gel versus 3 mg PGE2 vaginal tablet].

For the induction of labour prostaglandin (PG) E2 has been recommended either as intracervical gel (0.5 mg) or as vaginal tablet (3 mg) depending on the Bishop score of the cervix. A prospective trial was conducted in 79, mainly postterm, pregnancies (59 with a Bishop score < 5), in whom either PG-E2 tablet or gel was given randomly without respect to the cervical score. In addition, 51 inductions in primiparous women (44 with a Bishop score < 5) were analysed retrospectively. In pregnancies with a Bishop score < 5 the rate of successful inductions, duration of labour or incidence of neonatal acidosis was not different in both groups. Similar results were obtained in the prospective trial for inductions with a cervical score > 4. These data suggest the lack of superiority of the intracervical over the vaginal route of PG-E2 administration for the induction of labour.

Administration, Intravaginal↗
PubMedDate not supplied

[Normal values of color Doppler ultrasound in pregnancy].

In addition to the flowmetrie of aorta fetalis and a. umbilicalis, color flow mapping enables the examination of the renal and middle cerebral arteries in the assessment of the fetal blood circulation. The resistance and pulsatility-indices of aorta fetalis, umbilical artery, renal artery and middle cerebral artery were calculated in a prospective examination of a normal study group of 123 pregnant women. Moreover, ratios were established from the pulsatility-indices of renal artery and aorta fetalis, renal artery and umbilical artery, middle cerebral artery and aorta fetalis, middle cerebral artery and umbilical artery. By the use of these ratios, we hope to detect more reliably changes in the fetal blood circulation.

Adult↗
PubMedDate not supplied

[Stress on the head of the fetus in spontaneous labor in relation to perinatal factors].

The pressure exerted on the fetal head during the second stage of labor was continuously measured in 42 spontaneous deliveries with a new instrument. The pressure values were correlated to various obstetric variables. Typically, the head pressure remained elevated beyond the end of the uterine contraction in primiparae, whereas it decreased simultaneously with the amniotic pressure in multiparae. On the average, the head pressure was higher in primiparae indicating, together with the longer lasting bearing down period, a higher resistance of the birth canal. Deliveries with pudendal block or peridural analgesia showed no differences, but these two groups differed in other factors which might have influenced the results. Infusion of oxytocin during the course of labor was associated with higher head pressure values that could not be deduced from the hormone administration per se, but from a higher resistance of the birth canal. Maternal age did not influence the head pressure. Within physiological limits, the head pressure was independent from the size of the child and the maternal pelvis.

Adult↗
PubMedDate not supplied

[Color Doppler sonography of peripheral and cerebral fetal vessels in comparison as prognostic criterion in predicting intrauterine distress].

Doppler sonography of the fetal descending aorta, renal artery, middle cerebral artery and umbilical artery in a population of 74 fetuses with a abdominal circumference below the fifth percentile of the reference limits were done. All fetuses were free from structural and chromosomal abnormalities. The pulsatility- and the resistance indices as well as the ratios between these indices from peripheral and cerebral vessels were calculated and correlated to the fetal distress. The measurement of the pulsatility index of the middle cerebral artery provided the best results in predicting the development of fetal distress. Better results were achieved by the use of ratios of pulsatility-indices of various vessels than by the examination of the vessels alone. Our results suggest the usefulness of the examination of the middle cerebral artery and their ratios compared to the renal artery.

Aorta, Thoracic↗
PubMedDate not supplied

[Meckel-Gruber syndrome].

The lethal Meckel-Gruber-Syndrome can be diagnosed prenatally during ultrasound screening between 16 and 20 weeks of pregnancy. Two case reports of Meckel-Gruber-Syndrome are given, which demonstrate the importance of a reliable ultrasound examination. The results supply the basis for an adequate counseling of the patient with the option of pregnancy termination in case of the lethal syndrome.

Abnormalities, Multiple↗