Search PubMed⌕ Search

Biomedical subjects

E Saling

Publications and source records attributed to E Saling.

At least 199 records · Page 11Linked to original sources
PubMedDate not supplied

[Current aspects of the Thuringia prematurity prevention campaign 2000].

In two prospective investigations the effectiveness of the self- care program 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 (Careplan VpH) twice a week. The women were instructed to see their physician immediately, if abnormal values (pH > or = 4.7) or other risk factors were present. 73 out of 381 women in the intervention group have been identified as risk cases. 58 of them were treated with a lactobacillus preparation, and 24 with clindamycin cream for bacterial vaginosis, 3 patients refused to have any therapy. In this study the prematurity rate was 8.1 % in the self-measurement/intervention group vs. 12.3 % in the control group (N=2 341, P < 0.05); 0.3 % vs. 3.3 % of the neonates belonged to the group of early prematures with a gestational age of < 32 + 0 weeks (P < 0.01). PROM was registered in 22.8 % vs. 30.8 % (P < 0.001) respectively. Starting March 1, 2000 a similar statewide pH-screening program was initiated in Thuringia. According to the study design a significant decrease of prematurity was hypothetically expected for the second half of the year 2000. In Erfurt an overall decrease of prematurity from 7.68 to 6.81 % and a reduction of cases < 32 + 0 weeks from 3.22 to 2.39 % was observed (N=1,600). 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 the whole of Germany.

Female↗
PubMedDate not supplied

[Lung maturation during artificial placentation and mechanical lung distension].

An new method of lung maturation during artificial placentation was evaluated during a series of 15 animal experiments in premature lambs (gestational age 125-132 days). Perfusion circuit with interposition of a membrane lung was connected with the umbilical vessels. Extracorporeal CO2-removal (ECCO2-R) and apneic oxygenation were provided during lung distension. The ultramicroscopic pattern approved a maturation of the lung during the procedure showing development of lamellar bodies and surfactant secretion into the alveolar space. The biochemical analysis of the tracheal fluid showed a significant increase of both PC and PG concentrations (3.225 +/- 1.112 mg/100g to 24.228 +/- 3.36 mg/100 g respectively 0.249 +/- 0.11 mg/100 g of 0.622 +/- 0.09 mg/100 g. The biophysical function of the lung was also improved as was shown by a significant increase of the statistical compliance. We conclude that artificial placentation and lung distension might be a new mode of prophylaxis for respiratory distress syndrome in critically immature babies.

Animals↗
PubMedDate not supplied

[Initial results of the Erfurt Prevention of Prematurity Campaign].

OBJECTIVES: Genital infection particularly bacterial vaginosis (BV) increases the relative risk of prematurity. Detection of disturbances of vaginal milieu at an early stage and the use of suitable countermeasures such as intervention with antimicrobial substances, e.g. clindamycin, can reduce the preterm birth rate, provided the diagnosis is made early enough. STUDY DESIGN: Since October 1996 pregnant women being given prenatal care in 16 of the 29 outpatient offices in Erfurt, have been informed about the Prematurity Prevention Programme and have been offered to take part and to perform self-measurements of their vaginal pH twice a week in order to screen for any disturbances in the vaginal milieu. Special CarePlan-VpH gloves (Selfcare, Oberhaching) were used to identify patients a risk (pH > 4.7). The pregnant women taking part in the programme were instructed to see their physician immediately, if abnormal values were present, in order to get them confirmed and to start lactobacillus acidophilus therapy (Gynoflor, Nourypharma, Oberschleissheim) or, in case of BV, to treat with clindamycin cream (Sobelin, Upjohn, Erlangen) i.vag. Patients being given prenatal care in the 13 outpatient offices not participating and other pregnant women in Erfurt who were not interested in the programme served as control group. RESULTS: Up to now 59 out of 314 women in the intervention group have been identified as risk cases (p > or = 4.7). 52 of them were treated with a lactobacillus preparation, and 19 additionally with clindamycin cream, 3 patients refused to have any therapy. In this ongoing study the prematurity rate was 8.3% in the self-measurement/intervention group vs. 13.0% in the control group (n = 1,842); 0.3% vs. 3.3% of the neonates belonged to the group of very early prematures with a gestational age of < 32 + 0 weeks (p < 0.01). PROM was registered in 22.3% vs. 32.1% (p < 0.001) respectively. CONCLUSION: Self-measurement of vaginal pH at close intervals, as recommended by Saling, leads to the early identification of women at risk for prematurity. Earliest possible intervention by the obstetrician appears to result in reducing the rate of prematures and in particular of very early prematures (< 32 + 0 weeks).

Female↗
PubMedDate not supplied

[Further experiences with ovum lavage with respect to preventing premature labor].

Between January and December 1990, lavage of the ovum was performed in 64 gravidae with actual or potential symptoms of premature labour. Subsequently the lavage fluid was microbiologically examined. The present study discusses the indications for this new method, how it is performed and the results obtained. Microorganisms possibly necessitating treatment were detected in the lavage fluid of 30 (47%) of the gravidae at risk. Thirty-nine patients manifested actual symptoms of imminent premature birth, such as labour or critical cervical status. Results of fluid tests were positive in 23 (59%) of these patients, while according to the results of conventional cervical or vaginal smear tests performed simultaneously, treatment was necessary in only 13% of them. The majority of the microorganisms in the lavage fluid (coagulase-negative, haemolytic and group D streptococci were usually detected) are only facultatively pathogenic and are found in small quantities in cervical smears as normal "local flora". The mean delivery date was in gestational week (GW) 37/1, and for patients with antibiosis produced by a suitable antibiotic in GW 38/3 (10 weeks after lavage was performed). In view of the results of this study, bacteriological testing of ovum lavage fluid may be regarded as a useful complementary method for detecting ascending infections. It may advance pathogenetic research into late abortion and premature birth and further reduce the premature birth rate.

Bacteria↗
PubMedDate not supplied

[Vaginal pH self-monitoring by pregnant patients (in comparison with control measurements by the physician)].

Two methods of vaginal pH measurement have been compared. 100 pregnant women measured their vaginal pH by themselves using indicator paper strips and were afterwards controlled apparently by pH electrode. There was no significant difference between both methods, showing that pH indicator strip measurement is sufficiently reliable for pH determination by the pregnant woman herself.

False Positive Reactions↗
PubMedDate not supplied

[Prevention of late abortion and high risk premature labor--measures suited for routine practice].

Ascending infection is likely to be the main cause of late abortion and early delivery. In a retrospective evaluation performed at our hospital, evidence of infection was encountered in 76% of 195 pregnancies with premature infants having birth weights less than 2000 g. It may be assumed that the processes responsible for this development take place at the lower pole. It was against this background that we developed a programme designed to contribute to an effective prevention of late abortion and early delivery. The essential requirement is that measurements of vaginal pH enter into routine use during prenatal care. This simple procedure allows for the identification of many (not all) vaginal disorders that might occur in patients at risk. In the presence of other serious anamnestic or diagnostic evidence of imminent late abortion or early delivery, specific bacteriologic examinations including a check-up for chlamydia, vaginal ultrasonography of the cervix and testing for CRP should be carried out. Lower pole lavage, a procedure recently developed by the authors, facilitates the identification of pathogens in the upper part of the infected area, as compared to conventional vaginal and cervical smear. Following are the most important therapeutic measures: An early total blockage of the os uteri is desirable in patients with a clinical history of late abortion or premature infants with little chance of surviving. Acidifying local treatment with Lactobacillus acidophilus is recommended in the presence of abnormally high vaginal pH values (over 4.2). If pathogenic or potentially pathogenic micro-organisms are identified in the upper part of the infected area, local antibiotic therapy should be resorted to, if useful; otherwise systemic antibiotics should be given. If the patient shows definite symptoms of imminent late abortion or early delivery (e.g. critical cervical findings and/or premature labour and/or positive CRP values), systemic wide-spectrum antibiotics should be administered, even if no pathogens have been encountered. The first assessments of the effectiveness of this programme have shown that since its institution in 1989 and 1990, the incidence of underweight infants (birth weight below 1500 g) was significantly reduced at this hospital (by 30%) as compared to the years 1987 and 1988. On the other hand, the incidence of larger underweight infants having a birth weight of 1500 g and more was shown to rise slightly by 9%, while the total number of underweight infants remained unchanged (8.7%).(ABSTRACT TRUNCATED AT 400 WORDS)

Abortion, Septic↗
PubMedDate not supplied

[Endocrine parameters during artificial placentation and postnatal lung maturation].

During a experimental study in premature lamb the adaptation to a artificial placenta was evaluated by means of analysis of endocrine parameters. Performing cesarean section on day 125.-135.13 premature lambs were born and connected to a extracorporeal circuit providing CO2-Removal (ECCO2-R) during apnoic oxygenation over a period of 3 hours and 17 minutes mean duration. The intermittent analysis of 6 endocrine parameters was performed at the beginning of the experiment, after 1 hour and after 3 hours. TSH showed an statistical significant increase from a initial concentration of 0.638 +/- 0.051 microE/ml to 0.992 +/- 0.093 microE/ml after 1 hour (p 0.01). For T3 we found 0.273 +/- 0.074 nmol/l and 0.809 +/- 0.124 nmol/l. For RT3 we detected a decrease as the initial value was 4.304 +/- 0.474 ng/ml whereas after one hour we found 2.040 +/- 0.153 ng/ml. ACTH values increased from 543 +/- 109 pg/ml to 1150 +/- 194 pg/ml after 1 hour. Cortisol values increase from 39.6 +/- 7.5 ng/ml to 55.3 +/- 11.9 ng/ml. No significant change was found during the analysis of beta-endorphin concentrations. We conclude that the adaptation to artificial umbilical circulation is possible. Furthermore detected changes of endocrine parameters, namely cortisol and thyroxin levels, should provide a basis for postnatal organ maturation.

Adaptation, Physiological↗
PubMedDate not supplied

[Changes in lung compliance during extracorporeal gas exchange in the premature lamb].

Changes in the function of the lungs were investigated in 14 premature lambs during extracorporeal CO2 removal via membrane lungs with alveolar oxygen diffusion of the nonventilated lung by measuring the pressure volume curves at various moments after the start of perfusion via the endotracheal tube. During the course of the perfusion the static compliance clearly increases. In less than 6 hours the optimum of the "conditioning" appears to have been reached using this treatment.

Animals↗
PubMedDate not supplied

[Influences on decisions of pregnant patients with breech presentation for external fetal version or cesarean section--information status and anxiety pattern].

Within the framework of a retrospective and prospective analysis of 61 women with breech presentation in late pregnancy and with the help of a half-standardised questionnaire, we investigated the subjective reaction of these patients after they had been informed of their situation, as to what fears resulted and how well informed they were regarding the various obstetrical procedures in cases with breech presentation. The patients in the version group were clearly more anxious (n = 41). They were frightened of putting the child's well-being at risk, damaging personal health and having a cesarean section. The fear patterns were very varied in both groups. In the cesarean group (n = 20) the patients were not so afraid of the anesthesia and the risk of infection, whereas those in the version group were considerably more afraid; it was quite the reverse as regards the risk of permanent damage to the child due to the version--in the cesarean group this was rated as a high risk, whereas in the version group it was rated as a slight risk. The decision on the obstetrical procedure was mainly influenced by the doctor. In conclusion it can be said, that too little is known about the obstetrical procedure of cephalic version near to term and that it is tainted with unnecessary fears. We recommend that more intensive, specialised information should be given before undertaking obstetrical management of breech presentation.

Adult↗
PubMedDate not supplied

[Loop instrumentation for hemostasis during surgery of the cervical portio].

An easy to manipulate loop instrument for achieving haemostasis during surgery of the cervical portio is described. A wirenet loop that can be adjusted to any desired tension and arrested circularly around the portio vaginalis produces temporary ischaemia. Both application and release for removal are simple.

Cervix Uteri↗
PubMedDate not supplied

[Tocolysis with fenoterol suppositories--a comparison with oral administration of fenoterol tablets].

A new application form of fenoterol (Partusisten) as 15 mg suppositories from Boehringer Ingelheim was tested for its tocolytic effect, tolerance and the main side effects under usual clinical conditions in a prospective study in 50 pregnant patients with premature labour in 24-36th week of gestation. During one week's treatment 25 pregnant women received 3 to 4 15 mg fenoterol suppositories and 25 patients 6 to 8 5 mg fenoterol tablets. Beginning on the second day of treatment until the end of therapy in both groups a reduction of the uterine activity of at least 50 percent was achieved. The uterine relaxant effect was sufficient until 3 to 4 hours after the application of fenoterol tablets and 6 to 8 hours after the application of fenoterol suppositories. Side effects were mainly limited to cardiovascular complaints, restlessness and tremor, and we found no significant difference between tablets and suppositories. The maternal heart rate reached its highest level on the second day of treatment. Fenoterol suppositories can be recommended in all cases, where an oral tocolytic therapy is not possible e.g. in cases of vomiting or before operations. Here the application of fenoterol suppositories can replace in some cases the intravenous infusion of fenoterol.

Administration, Oral↗
PubMedDate not supplied

[Significance of Doppler blood flow studies in twin pregnancies].

Twin pregnancies are characterized by similar uteroplacental but different fetoplacental haemodynamics at the same gestational age. The aim of this study was to investigate the correlation between Doppler blood flow measurements of fetal vessels and the morphological findings of the placenta, fetal growth and signs of fetal hypoxia. The study group consists of 18 twin pregnancies with operative delivery. In all cases the placenta was examined morphologically. We found similar discordancies in the pulsatility index (PI) or the mean blood flow velocity (Vmean) of the fetal aorta (measurements less than 7 days before delivery) and the birth-weight. In twin pregnancies with operative delivery due to fetal indication in 11 out of 12 cases the twin with suspected hypoxia had a relatively lower Vmean and a higher PI value. The association of pathological blood flow velocity waveforms of the umbilical artery, the fetal aorta and the fetal common carotid artery and histomorphological findings of the placenta could be demonstrated.

Aorta↗
PubMedDate not supplied

[Economy circuit of fetal circulation illustrated on the basis of personal quantitative Doppler blood flow parameters].

Percentile curves of the mean blood flow velocity and the mean blood flow volume of the fetal aorta were calculated from a normal study group comprised of 290 pregnant women. Additionally ratios of the mean blood flow velocity or blood flow volume of the fetal common carotid artery and the fetal aorta were established. In a high risk group with a loss of end-diastolic blood flow velocities in the umbilical artery and/or fetal aorta and subsequent primary caesarean section due to fetal distress (pathological CTG) we investigated the course of the above mentioned parameters. The ratio of the mean velocity or the mean blood flow volumes showed and increased in all 10 cases of the high risk group from the first to the last measurement. In all cases the final level before the delivery was far above the 95th centile. The underlying pathophysiological occurrence of the conserving adaptation of the fetal circulation is expressed by the ratios. This is why we consider these parameters to be of great importance in the supervision of high risk pregnancies in the future.

Aorta, Thoracic↗
PubMedDate not supplied

[Actocardiograph--an instrument for the diagnosis of fetal behavioral stages?].

The investigation of fetal behaviour are an important clinical tool for assessing fetal well-being. However, they are time-consuming and at least 2 real-time scanners must be employed. The aim of this study was to find out if fetal behavioural states can be diagnosed by using only the "actocardiograph". Thus we compared tracings of the actocardiograph with simultaneously registered tracings from "polygraphic monitorings" including real-time observations of fetal eye, breathing and body movements. We could demonstrate that state 1F and 4F can be recognised in 93% resp. 82%. Periods without a definite state cannot be diagnosed from actocardiographic tracings. This suggested that the combined recording of fetal movements and fetal heart rate with the actocardiograph might be useful for the registration of fetal movements and for the overall diagnosis of fetal behavioural states. However polygraphic monitorings including real-time observations give the only precise picture of neuromotoric coordination.

Embryonic and Fetal Development↗
PubMedDate not supplied

[Circulatory adaptation of the newborn infant immediately post partum by bilocal measurement of transcutaneous PCO2].

In addition to cardio-respirography, non-invasive intermittent blood pressure measurement, temperature measurement and transcutaneous oxygen partial pressure measurement, a further non-invasive method for monitoring the post partuant adaptation of the newborn has emerged with the development of an electrode for measuring the transcutaneous carbon dioxide partial pressure. In order to achieve the correct interpretation of measuring data in depressed newborns, a transcutaneous carbon dioxide partial pressure measurement was performed on 36 vigorous newborns directly post partum. The levels of the transcutaneous carbon dioxide measurement exceeded those from arterial PCO2 measurements. After using the Severinghaus corrective formula which takes into account a tissue factor as well as a temperature factor, the levels did correspond well with the results from arterial CO2 partial pressure determinations. In order to be able to investigate the adaptation of the circulation, we performed synchronous measurements of the tcPCO2 infraclavically and in the regio pubica. The significant difference between the measuring data of both electrodes up to an interval of 26 minutes post partum suggests that during the early adaptation phase of the vigorous newborn, there is a right to left shunt with venous admixture.

Adaptation, Physiological↗
PubMedDate not supplied

[Value of the Hammacher score and fetal blood analysis in subpartal monitoring of the child].

Although it has been documented in many studies that optimal monitoring of the fetus during labor is only achieved through a combination of cardiotocography (CTG) and fetal blood analysis, up to now no uniform guidelines exist as to when fetal blood analysis should be performed. Furthermore, there are still many obstetricians who decide on their delivery procedure entirely on the basis of CTG. We have therefore examined the question of how accurately intrauterine risk situations of the fetus can be recognized in individual cases by using the Hammacher score only from particular CTG patterns. The data from 407 patients formed the statistical basis. All these patients had been delivered between January and September 1979 at the Department of Obstetrics at the Women's Hospital in Berlin-Neukölln. In all cases, at least one fetal blood analysis had been performed on account of a suspicious CTG during the course of labor. All actual pH values were combined with the Hammacher score of the corresponding 30-min-interval, and in addition we recorded the CTG patterns seen. We observed that the CTG was at least suspicious (greater than or equal to 3 points) in 79,3%, while the fetal blood analyses performed immediately afterwards were normal in 78,1%; only in 11,7% it was reduced to 7,29-7,25 and in 10,2% it was less than or equal to 7,24 (incl. 3,9% less than or equal to 7,19). The probability that a high score was associated with a reduced pH increased from 2% at 0-2 points, to 26,3% at greater than or equal to 5 points.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗