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E Saling

Publications and source records attributed to E Saling.

At least 19 recordsLinked to original sources
PubMed2005

[The lactobacilli-protection system of pregnant women--efficient prevention of premature births by early detection of disturbances].

BACKGROUND: The most frequent cause of preventable early premature births (< 32 + 0 gestational weeks) is urogenital tract infection (UTI). Screening for UTI and Chlamydia are now standard examinations. Detection of ascending genital infections, especially bacterial vaginosis, plays an ever-increasing role. Lactobacilli, which produce, e. g., lactic acid, H2O2, biosurfactants and coaggregation molecules, are particularly important for the vaginal biosystem. Some evaluations suggest that early diagnosis and therapy within this "lactobacilli-protection system" apparently leads to better results in the prevention of prematurity. Our screening recommendations for the pregnant patient comprise vaginal pH measurements both at the regular prenatal care visits and particularly the self measurement within the framework of our Self-Care Program. MATERIALS: 140 participating women were questioned for a second time. The data were compiled by the patients themselves. RESULTS: Due to elevated pH values, 21% of the women consulted their physician earlier than foreseen. Diagnoses: In 46% there was a disturbance of the vaginal milieu, in 4% bacterial vaginosis, in 33% Candida infection and in 21% "everything was OK". In spite of self-measured normal pH values in 25% of the patients the physician diagnosed the following: 25% disturbance of the vaginal milieu, 7% bacterial vaginosis, 32% infection with other bacteria (mainly Streptococci) and 50% Candida infection. CONCLUSION: Elevated pH values (measured by the patient) seem to indicate much more often a disturbance of vaginal milieu rather than an already existing bacterial vaginosis. Further investigations are necessary. The chances to treat vaginal disturbances--before a concrete infection is diagnosed--seem to be better for participants in the Self-Care Program.

Candidiasis, Vulvovaginal↗
PubMed2004

Efficient prematurity prevention is possible by pH-self measurement and immediate therapy of threatening ascending infection.

In two prospective investigations, the effectiveness of the self care programme for prematurity prevention, developed by Saling, was investigated. Pregnant women in Erfurt have been offered to perform self measurements of their vaginal pH by means of test gloves twice a week in order to screen for any disturbances in the vaginal milieu. The women were instructed to see their physician immediately, if abnormal pH > or = 4.7 or other risk factors were present, in order to get them confirmed and to start lactobacillus acidophilus therapy or in case of bacterial vaginosis to treat with clindamycin cream i. vag. Patients who were not interested in the programme served as a control group. Seventy-three out of 381 women in the intervention group have been identified as risk cases. Fifty-eight of them were treated with a lactobacillus preparation, and 24 with clindamycin cream, three patients refused to have any therapy. In this study, the prematurity rate was 8.1% in the self measurement/intervention group versus 12.3% in the control group (P < 0.05, n = 2341). 0.3% versus 3.3% of the neonates belonged to the group of very early prematures with a gestational age of <32 + 0 (P < 0.01). PROM was registered in 22.8% versus 30.8% (P < 0.001), respectively. Starting 1 March 2000, a similar statewide pH screening programme was initiated in order to reduce prematurity in the State of Thuringia. According to the study design, a significant decrease of prematurity was hypothetically expected for the second half of 2000. In Erfurt, an overall decrease of prematurity from 7.68 to 6.81% and a reduction of cases < or = 32 weeks from 3.22 to 2.39% was observed. Premature rupture of membranes was seen in 19 versus 0 pregnancies with early prematurity (n = 1600). Data from 16,276 women are available for the state of Thuringia. On this basis, a significant reduction of early prematurity from 1.58 to 0.99% was seen, respectively (P < 0.001). Comparing low birthweights a significant reduction of cases was achieved as well in all groups. On the basis of the data obtained we recommend the extension of the campaign in whole of Germany.

Administration, Intravaginal↗
PubMed2004

[Efficient prevention of prematurity - the Thuringian model].

In two prospective projects, the effectiveness of the self-care programme for prematurity prevention developed by Saling was prevented. Pregnant women in Erfurt were shown how to perform self-measurements of their vaginal pH by means of test gloves twice a week in order to screen for any disturbances in the vaginal millieu. The women were instructed to see their physician immediately, if abnormal values (ph > or = 4.7) or other risk factors were present, in order to start Lactobacillus acidophilus therapy or, in cases of bacterial vaginosis, treatment with intravaginal clindamycin cream. Patients who were not interested in the programme, served as a control group. 73 out of 381 women in the intervention group were identified as risk cases. In this study, the prematurity rate was 8.1% in the self-measurement/intervention group versus 12.3% in the control group (p < 0.05, n = 2,341); 0.3 versus 3.3% of the neonates belonged to the group of very early prematures with a gestational age of <32 + 0 weeks (p < 0.01). Starting on March 1, 2000, a similar statewide pH screening programme was initiated in order to reduce prematurity in the State of Thuringia. According to the study design, a significant decrease in prematurity was hypothetically expected for the second half of 2000. Data from 16,276 women are available. On this basis, a significant reduction of early prematurity from 1.58 to 0.99% was seen (p < 0.001). Comparing low birth weights, a significant reduction of cases was also achieved in all groups. On the basis of data obtained, we recommend that the campaign should be extended to the whole of Germany. This recommendation is also supported by the observation that after the campaign had been discontinued the prematurity rates monitored in 2002 were as high as they had been prior to the introduction of the statewide programme.

Anti-Bacterial Agents↗
PubMed2001

A simple, efficient and inexpensive program for preventing prematurity.

Prevention of prematurity and of low birth weight is--because of the associated increased risk of mortality and morbidity--one of the most urgent tasks of perinatal medicine. Whereas the rate of prematures all over the world does not vary very much (5-10%), the rate of infants born with low birth weight lies between 3.6% and 10% in the industrial countries and between 9.8% and 43% in the developing countries, where the main cause of low birth weight is intrauterine malnutrition. As there are different causes for prematurity and low birth weight, but also because various countries have different resources and have therefore to set their priorities differently, there is no global solution. The situation in each country must be considered individually. However, as far as basic means are available for the majority--such as basic health care, monitoring the nutritional state of the mothers and acting to prevent infectious diseases (malaria in particular can cause prematurity)--determined prevention of prematurity should take the form of screening and the treatment of disturbances of the vaginal milieu or genital infections. This policy can be recommended because one of the most important avoidable causes of prematurity is ascending genital infection (mostly combined with bacterial vaginosis), which very frequently starts with a disturbance of the vaginal milieu and then often takes its course asymptomatically. Regular screening for signs of such a disturbance using vaginal pH-measurements (and if necessary further diagnostics and therapy) makes possible the detection of an "early marker" to prevent prematurity in an effective and inexpensive way. Our prematurity-prevention-program, which has been successful for many years, is based on an anamnestic assessment of prematurity risk, the early detection of warning signs (including regular measurement of the vaginal pH) and, if necessary, the appropriate therapeutic measures. In cases of disturbance of the vaginal milieu, the latter consists of a therapy with lactobacillus preparations or in a combination of lactobacillus preparation with an acidifying therapy which may lead to earlier normalization of the vaginal milieu. In cases of bacterial vaginosis local therapy, for example with metronidazol or clindamycin, is undertaken, and in other infections specific treatment. It is encouraging to note that particularly the rate of the very small prematures is reduced when pregnant patients take part in our self-care-program, measuring their own vaginal pH-value twice a week, and also searching for any other warning signs. In this way in our collective the rate of very small low birth weight infants could be reduced from 7.8% in the immediate previous pregnancy to 1.3%. In a prospective study performed in Erfurt the rate of very early premature births (< 32 + 0 gw) amounted to only 0.3% in contrast to 3.3% in a control group who had not taken part in the self-care activity. According to a differentiated classification of the control group the success of the self-care activity was even clearer: In patients who did not take part because their doctors did not support the self-care activity, the rate of very early premature births amounted to 4.1%. In patients who did not take part in the self-care activity, but who were in the care of doctors who were interested and had taken part in the prevention-program, the rate was 2.2%; in the group with active participation in the self-care activity it was only 0.3%. To date measurement of the vaginal pH-value was performed intravaginally using either indicator strips or pH-measuring test gloves. A short time ago we developed a panty liner coated with an indicator strip, which enables reading of the pH-value by just checking the indicator on the panty liner. First results with this panty liner are very promising.

Abortion, Spontaneous↗
PubMed1998

Basic aspects of prematurity prevention and results achieved by a suitable, simple program.

An urgent task for modern obstetrics is to reduce the number of unwanted very early prematures. Long-term impairments of these infants still occur too frequently. Ascending genital infections, particularly before 32 gestational weeks, are the most significant cause of prematurity. The best chance of preventing early prematurity is to employ a prophylactic screening program, preferably including self-pH-measurement by all pregnant patients and paying attention to all other important risk factors. The results of this "Prenatal Care Self-Examination" program are encouraging. The rate of very small prematures, with a birth weight of less than 1,500 g, in all 1,120 multigravidae who have taken part in this program is clearly lower, at 1.3%, than in immediate previous pregnancies when it was 7.8%. The rate of extremely small infants of less than 1,000 g amounted to 0.9%, compared with 3.9% in previous pregnancies. Results from a prospective study recently presented confirm in a convincing way what can be achieved in an entire city. In Erfurt, with 208,000 inhabitants and about 1,500 deliveries per year, all in the one maternity department in this city, 16 practitioners taking care of the pregnant patients, i.e. nearly one half of them in Erfurt, motivated their patients to take part in our prematurity prevention program with its "Prenatal Care Self-Examination", where the patients themselves measured their vaginal pH twice a week. The results are very interesting. In the group of 1,842 patients without prenatal self-examination activity, the frequency of very early prematures--i.e. less than 32 weeks gest.--was 3.3% (n = 61). In the group of 314 patients who performed prenatal self-examinations, the corresponding frequency was only 0.3% (n = 1). This is an eleven-fold, and significantly lower rate. On account of such positive results, a definitive step has been made with regard to practicability and efficiency of prevention of very early premature birth.

Female↗
PubMed1997

Prevention of prematurity. A review of our activities during the last 25 years.

For 25 years we have been engaged in programs for prevention of prematurity. In the initial stages we tried to use lists which might indicate increased risk of prematurity to select groups with higher disposition in this direction, and to initiate more intensive care with these patients. The earlier results have been positive, but such programs required such high expenditure (of time, energy, and cost) that they could not permanently be maintained. Another supporting contribution for prematurity prevention was the introduction of vaginal disinfectant measures in cases of PROM. Historically, one of the most urgent tasks of obstetrics has been and is the reduction in the unwanted birth rate of very small prematures infants. Long-lasting impairments of these infants still occur too frequently. Ascending genital infections, particularly before 32 gestational weeks, are the most important cause of prematurity. This has been confirmed by the excellent results achieved after creating a complete barrier by an operative total cervical occlusion in cases with recurrent late abortions. It is difficult to realize programs for prematurity prevention based on socio-economic factors, because of the expense with the necessary increase in time and staff. Our new "Prematurity-Prevention-Program" is based mainly on the hypothesis that the ascension of genital infection directly affects prematurity. We found that in women with prematurity symptoms, signs of impairment of the immune system could be found, thus reinforcing the assumption that ascending infections are probably enhanced by such impairments. The best chance of preventing early prematurity is to employ a prophylactic screening program, preferably including self pH-measurement of all pregnant patients and paying additional attention to all other risk factors. The preliminary results of our "Prematurity-Prevention-Program" were encouraging. The rate of very small prematures with birth weight of less than 1.500 g in all participating pregnant patients is now clearly lower at 1.4% than in immediately previous pregnancies when the rate was 7.8%. The rate of extremely small infants of less than 1.000 g amounts now to 1.0%, compared to 4.0% previously. From another retrospective evaluation, we found that the earlier in the pregnancy the prematures are born, the more often their mothers have had pathologically elevated vaginal pH-levels upon admission. In premature births at less than 32 weeks of gestation, all fifteen of the mothers had increased pH-levels. For premature births of later gestation, the frequency was only 61%. Further, we noted that in 67% of all the nearly 700 pregnant patients evaluated, consistently normal pH-levels were present, while in 33% they were increased. In cases with increased vaginal pH-levels, lactobacillus acidophilus treatment was successful in more than 80% of the 75 patients after therapy of 5 +/- 3 days. By our program, we feel that a decisive step has been taken in achieving practical and efficient means of preventing premature births.

Abortion, Spontaneous↗
PubMed1996

Fetal fibronectin in vaginal specimens predicts preterm delivery and very-low-birth-weight infants.

OBJECTIVE: The purpose of this study was to evaluate the association of vaginal fetal fibronectin expression to risk of preterm delivery and delivery of very-low-birth-weight infants. STUDY DESIGN: Vaginal secretions were obtained from women between 22 and 35 weeks' pregnant with minimal cervical dilation (< or = 2 cm) and threatened preterm delivery. The secretions were analyzed for the presence of fetal fibronectin. Other clinical information including cervical dimensions, uterine activity, serum C-reactive protein concentration, vaginal pH, evidence of vaginal or systemic infection, and vaginal bleeding were also obtained. RESULTS: Of the 112 patients recruited, 40 (35.7%) were delivered prematurely (<37 weeks). For prediction of preterm delivery, the fetal fibronectin test result had a sensitivity, specificity, and positive and negative predictive values of 67.5, 90.3, 79.4, and 83.3%, respectively (odds ratio 19.3, p < 0.0001). Women with a positive fetal fibronectin test had a nearly 13-fold increased probability of being delivered of an infant weighing <1500 gm than did women with a negative fetal fibronectin test (32.4% vs 2.5%, p<0.0001). Categoric analysis and multiple logistic regression demonstrated that fetal fibronectin was an independent risk factor for prediction of preterm delivery and birth weight <1500 gm. CONCLUSION: Vaginal fetal fibronectin expression is an independent risk factor for preterm delivery and birth of very-low-birth-weight infants in symptomatic women with intact amniotic membranes and minimal cervical dilatation.

Chi-Square Distribution↗
PubMed1996

Comments on past and present situation of intensive monitoring of the fetus during labor.

Modern intensive monitoring of the fetus during labor affords the opportunity for the greatest possible safety to the infant, whilst at the same time dispensing with unnecessary operations to terminate labor which can be dangerous for the mother and her child. Developments over the past 28 years, since cardiotocography has been in clinical use, have unfortunately also been accompanied by confusion and mistakes. We think that there are two main reasons for this: I. Many who use cardiotocography have not assessed its efficiency correctly. Heart rate pattern with all their variations have too often been regarded as the only diagnostic criteria for the determination of fetal hypoxia. However this procedure only allows a rough selection of actually endangered fetuses. In more than 50% of the cases with a suspicious or pathologic cardiotocogram there is no concrete clinical evidence of manifest danger of hypoxia. II. Investigations concerning the practical importance of monitoring the fetus during labor were often not based on actual clinical indications. Attempts were made to prove that continuous electronic monitoring of the fetal heart rate could be replaced by simple traditional auscultation. Furthermore due to failure to appreciate the real efficiency of cardiotocography, this truly excellent method was in fact blamed for the faults arising from wrong interpretation, instead of underlining the lack of logic of the investigators concerned. After all, several prospective studies, that have examined the efficiency of various monitoring strategies, demonstrate the shortcomings of these techniques in the clinical setting and have shown them to have no relevance in every practice. Presently the most suitable way to monitor the fetus during labor is to combine cardiotocography with a biochemical method. At the moment fetal blood analysis is the most suitable test to be performed in cases where the cardiotocogram is not normal. Then the role of fetal blood analysis is to find out whether in fact a danger of hypoxia is threatened or not. Today the most urgent task when monitoring the fetus during labor is not so much to reduce the number of cases of cerebral palsy since these are seldom caused by intrapartum asphyxia. The major objective is now recognised to be to prevent early morbidity of the fetus, newborn, and the consequences that flow from this. The excellent results of combined intensive monitoring of the fetus during labor are particularly well illustrated by the intrapartum mortality in our hospital during different periods when monitoring practice has been progressively and methodically improved by stages. During the period when monitoring consisted of simple auscultation used on its own, the intrapartum mortality was 0.56%. After the introduction of fetal blood analysis--at that time cardiotocography did not yet exist--the mortality sank to 0.32%. During the first ten years of cardiotocography combined with fetal blood analysis the mortality reduced further to 0.17%, and during the following 13 years it reached to a minimal level of 0.4%. Finally, in this review, other aspects are commented on such as oximetry. Oximetry, presently used as pulse oximetry, as an additional biochemical method will possibly be incorporated as the third method of monitoring the fetus during labor. Oximetry could also be used as an automatic alarm system in the labor ward when fetal O2 levels drop below a particular limit to draw the attention of the staff to the case concerned. Up to now this has not been convincingly achieved with the use of cardiotocography.

Cardiotocography↗
PubMed1996

Fetal pulse oximetry during labor: issues and recommendations for clinical use.

Several centers are investigating the possible benefits arising from the introduction of pulse oximetry into intensive fetal monitoring during labor and delivery. 50 cases with abnormal cardiotocograms interesting under different clinical aspects were selected from 2000 cases from different countries which were additionally monitored by pulse oximetry. We have drawn the following conclusions with the help of now 36 years of experience with FBA: if fetal pulse oximetry is used in every case of abnormal cardiotocogram and SpO2-values, defined as normal are present, FBA and numerous operative interventions can be eliminated in a considerable number (more than one half) of cases. In cases with reduced SpO2-values as well as lengthy SpO2-registration gaps (limits of acceptability are described) it is urgently advised to use FBA for differential diagnosis so that even in these cases unnecessary operative interventions can be avoided.

Cardiotocography↗
PubMed1995

[Immune status of pregnant patients especially in possible premature labor].

In this study it could be shown that pregnant women having a normal course of pregnancy had significantly higher levels of T-lymphocytes and T-helper cells compared with non-pregnant women. Also other parameters belonging to cellular immune defence showed a similar--in the sense of an improved immune function--trend (even though this was not statistically significant). In pregnant women with symptoms of threatened prematurity significantly lower levels for lymphocytes. T-lymphocytes and T-helper cells were measured than in women who had a normal course of pregnancy. The ratio was also clearly reduced--in those cases where later preterm labour did actually occur it was particularly low at 1.1. In the group of pregnant women with premature labor the number of those who found the situation "very stressful" amounted to 65% and in the group whose course of pregnancy was normal, the percentage was 26%. The results of this study point to the fact that in pregnant women with premature labor the immune function is often impaired and it can be assumed that this provides favourable conditions for ascending infections which then cause a higher risk of prematurity. Further studies should be made concerning the causal connections which we have postulated between physical and psychological overstrains and impairment of the immune function.

Arousal↗
PubMed1995

[Intensive monitoring of the fetus sub partu--value and false interpretation].

The past 30 years have seen dramatic advances concerning safety of the unborn child unsurpassed during 2400 years before, i.e. since the time of Hippocrates. Part of these advances is fetal monitoring during labor. It has recently been recognized that severe brain damage due to intrapartum fetal hypoxia is more rare than previously assumed. Legal consequences are to be expected. Expert opinion ought to investigate and judge the cause of possible intrapartum fetal damage more thoroughly and critically than it was customary. It is unfortunate that some authors in the framework of this development and for other reasons as well have come to the erroneous conclusion that the intensive intrapartum fetal monitoring is of less significance than previously believed. Such opinions are slanted and scientifically untenable. Intensive intrapartum fetal monitoring fulfills also the important task of reducing the early acidosis related to morbidity which has to be taken seriously since it may affect nearly all important organ systems of the fetus and the newborn. Intrapartum fetal monitoring has to (correction for o) be considered of great value regard to modern medical knowledge.

Asphyxia Neonatorum↗
PubMed1994

The influence of maternal oxygen administration on the fetus.

During the last few years opinions have been divided on the advantages and disadvantages of oxygen administration in pregnancy and during labor. We review the present knowledge regarding the influence of maternal oxygen inhalation on the fetus. We conclude that the fetus may benefit from oxygen therapy during pregnancy and labor.

Blood Flow Velocity↗
PubMed1994

Indications for operative termination of labor on cardiotocography and fetal blood analysis: the reliability of these methods.

In a retrospective study it was possible to show that of 110 cases with operative delivery, performed due to suspicious or pathological fetal blood acidity findings, 93.6% were justified. A pre-pathological or pathological umbilical cord artery pH of < 7.25 was taken as the basis for correct clinical management ("true" positive cases). There was a clear relationship between the pH of the umbilical artery blood and the clinical state of depression in the newborn. This study shows that, with the help of combined fetal supervision using cardiotocography (CTG) as a screening method and fetal blood analysis (FBA) as a method of differentiation, early stages of threatened fetal acidosis can be reliably detected without having too high a rate of operative deliveries, which must inevitably result when continuous CTG supervision is used on its own. Obstetricians should therefore try to prevent severe acidosis combined with a corresponding clinical state of depression of the newborn. This requires the use of modern monitoring (CTG and FBA) and prompt clinical measures (tocolysis or termination of labor) when the pH levels are reduced or are apparently falling.

Acidosis↗
PubMed1993

[External fetal version from breech to vertex presentation. Evaluation of 1,000 cases].

Results of 1000 external versions of foetuses from breech to vertex presentation under tocolysis were evaluated. The rate of success of the versions was 52%. The success rate improved with gestational age, with increasing parity, with increasing age of the mother and her increasing body weight. The location of the placenta did not play a decisive role. The success rate of the version was remarkably good, even, in cases with small-for-gestational age foetuses and large-for-gestational age foetuses as well as in cases with a previous Caesarean section. The frequency of typical complications and the resulting Caesarean rate of 2.3% are within the acceptable limit. Up to now, from a total of more than 1,500 versions performed at the Department of Obstetrics at the Women's Hospital, Berlin-Neukölln, no death of either mother or child has occurred, which could be related to this procedure. Of course, the prerequisite for a safe version is strict adherence to the essential guidelines. The fact, that versions are not practised in all obstetrical departments, is partly due to the embarrassing lack of expert knowledge on the part of some practitioners and clinicians. In numerous cases, a moderately difficult laparotomy--which Caesarean section is in principle--with all the inevitable risks and dangers, could have been prevented, if a version had been performed.

Adult↗