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Biomedical subjects

E Saling

Publications and source records attributed to E Saling.

206 records · Page 12Linked to original sources
PubMedDate not supplied

[Rise of fetal acidity due to the mother sub partu and its clinical consequences].

A rise in fetal acidity (FAS) occurs often but does not necessarily mean that the fetus is at risk. When an increase in acidity is due to maternal causes, a so-called maternogenous increase in acidity (MAS), the fetus has too much organic acid, but no O2 insufficiency. In order to avoid unnecessary operations in such cases, we asked ourselves how we could differentiate on a routine basis between maternogenous and fetogenous acidity increase, and which consequences can be drawn from this. We made observations on 858 neonates with a NApH actual less than 7.30, born between 1973 and 1980 at the Department of Obstetrics at Berlin- Neuk olln Hospital, to assess whether infants with MAS and NapH levels were less often clinically depressed than infants with FAS, and how often an MAS occurred corresponding to Saling 's definition (M/F delta pH qu40 less than or equal to 0.05) to Rooth 's definition (M/F delta pH actual less than or equal to 0.15) or a combination of Saling 's and Rooth 's definition. It was shown that MAS infants were significantly less often born in a clinically depresses state than FAS infants. Within the definition groups there were only very slight differences. With the aid of the Saling and the Rooth combination however, 45% could be recognized as MAS infants, whereas the MAS frequency according to Saling alone or Rooth alone amounted to only about 30%. For the subsequent assessments of the pH levels during labor therefore the combination of Saling and Rooth was used. From 288 labors it could be shown that the differentiation in MAS and FAS in FBA pH levels less than 7.30 led to a significant decrease in the number of operations without any increase in early morbidity in the infants. This leads to the assumption that the procedure described helps to prevent unnecessary operations.

Acidosis↗
PubMedDate not supplied

[Can fetal blood analysis be avoided during the expulsion period?].

The examinations described here were made in order to answer the question - how often, in spite of suspicious CTG patterns during the second stage of labor, were the fetal blood tests normal, and a spontaneous delivery or a further propulsion of the presenting part could be expected? The data of 201 patients formed the statistical basis for this survey; these patients were delivered at the Department of Obstetrics in Berlin- Neuk olln Hospital during the period from September 1975 to September 1976. Each patient had a suspicious Hammacher Score (greater than or equal to 3 points) during the second stage of labor, and due to this, the fetal acid-base balance had been examined. The course of 201 labors was divided up into those where the CTG first necessitated a fetal blood analysis in the mid-pelvic plane (n = 159) and those where the FBA was not necessary before the fetus was on the pelvic floor (n = 42). It was shown that with an increase in CTG score points the proportion of pH levels less than or equal to 7.24 increased. The peak of frequency division was at 4 points. In this group however, there was only a pH level of less than or equal to 7.24 in 4.2% of the infants. Acidotic pH levels were only present after greater than or equal to 5 score points. Here it was not possible with the CTG score to give definite evidence about the real risk to the fetus in a single case.(ABSTRACT TRUNCATED AT 250 WORDS)

Acidosis↗
PubMedDate not supplied

[Extracorporeal gas exchange--an alternative to ventilation of the premature newborn infant with respiratory insufficiency].

In spite of improvements in its prophylaxis and therapy the membrane syndrome is still one of the main causes of morbidity and mortality in newborns. In many perinatal centers in the United States extracorporeal gas exchange via an artificial lung is the ultimate step in therapy for this group of patients today. As a result of our own research work we are able to introduce an extracorporeal circulation system which is especially suited to the particular situation of the immature newborn and which enables a complete immobilization of the lung to avoid baro-trauma with alveolar oxygen diffusion and CO2-removal through the membrane lung. Using appropriate dimensions the system can be housed in a newborn incubator. With low total resistance the perfusion in the newborn is performed via an arterio-venous shunt of the umbilical vessels alternatively with and without a mechanical pump. We tested this perfusion system on premature lambs with a gestational age of 128 to 130 days. During a test period of from 6 to 8 hours at a low blood flow rate (200 ml/min) we achieved a sufficient CO2-removal via the membrane lung with enough oxygen supply through the non-ventilated lung. By means of suitable materials, and using CO2 gas priming procedure and employing prostacyclin analogons to inhibit thrombocyte aggregation, it was possible to lower the heparine dosage to a minimum.

Animals↗
PubMedDate not supplied

[Fetal heart-rate monitoring on the operating table in non-emergency cesarean sections].

At the Department of Obstetrics Berlin-Neukölln over a period of 4 years the fetal heart-rate was monitored on the operating table during 178 cesarean sections, which were indicated for arrest of labour in the pelvic inlet. After the induction of the anesthesia a clear influence on the oscillation pattern with lower oscillation frequency and amplitude - probably due to drugs - was seen in the cardiogram. The occurrence of pathological heart-rate patterns, such as decelerations and bradycardia were closely related to the depressed state and acidosis of the newborn. The cardiogram shows the danger of worsening in the infant's condition during anesthesia, and in these cases it permits a reduction in the induction-delivery-interval by changing the speed of the operation. Further, a retrospective interpretation of an unexpected clinical depression and acidosis in the newborn is possible, particularly in cases in which originally the fetus has not been at risk. For the above mentioned reasons it is recommended to carry out routine continuous registration of the fetal heart-rate on the operating table during cesarean sections.

Acidosis↗
PubMedDate not supplied

[Total surgical cervical occlusion. Conclusions from data of several clinica, which use total surgical cervical occlusion].

Operative Total Cervix Occlusion (TCO), and in particular early TCO (ETCO), which we introduced in 1980, continues to be an important part of the prematurity prevention program. We were therefore especially interested in obtaining not only a general idea of where, on what scale and with what results TCO is being performed, but also information on the operative technique used, the complication rate associated with it, and preoperative procedure. From the data of the 11 departments which participated in this inquiry it was established that the overall success rate of all TCO procedures performed was over 80% (659 out of 819). TCO thus enabled to substantially increase the number of infants who survived. This result is also reflected in a comparison of the pregnancies preceding and following TCO. The infant survival rate was increased from below 21% to over 74%. One surprising result was that late occlusion was performed more frequently than early occlusion at more than 50% of the clinics participating in the inquiry. This is presumably due to difficulties in defining early and late occlusion in retrospective data evaluation, and probably also explains why, based on our experience, the success rate with late occlusions was too high. Two occlusions were performed in 43 patients and three or more in 9 (including current TCO). With 14 cases (1.7%) identified the rate of complications associated with TCO is very low.

Antibiotic Prophylaxis↗
PubMedDate not supplied

[Results of follow-up of mothers with previous surgical "total cervical cerclage" also with reference to neonatal data].

From August 16, 1993 until March 6, 1995 a study was conducted at the Department of Obstetrics at the Berlin-Neukoelln Womens Hospital to evaluate the status of patients who had previously undergone total cervical occlusion (TCO) for the prevention of late abortion and premature birth. Special consideration was given to the possible effects of TCO on the patients' gynecologic status, the psychological circumstances associated with TCO and the developmental status of the infants. Fifty-four women participated in the study, their ages ranging between 26 and 53 years. The mean time-span between the TCO procedure and the present study was five years and five months. In the 54 women undergoing TCO, a total of 73 such procedures were performed. An extensive early TCO was performed in 63% and an extensive late TCO in 20.5%. The gestational age at the time of delivery was > or = 37 + 0 weeks in 67.1% of the women. More than half of the patients (54.9%) experienced a normal spontaneous vaginal delivery. In total, 84.5% of the infants were delivered vaginally; thus the cesarean section rate was only 15.5%. Regarding the patients' medical histories, the majority of the patients had no pathological findings on routine pap smears and pelvic examinations and, similarly, they had no complaints of menstrual irregularities. Only 10 patients (18.5%) underwent gynecological surgery in the interim; in these patients, the most common reason for surgery (in four cases) was sterilisation. The findings during speculum examination were tabulated. The majority of the patients (96%) exhibited a normal multiparous cervical portio. In 55% of the patients there was no evidence of scarring of the cervical portio. In 25% of the patients there was minor cervical scarring, in 13.5% it was moderate and in 5.8% it was severe. Except for a single case, the patients showed no evidence of vaginitis. During bimanual palpation on pelvic examination, in 82.7% of the patients the cervix was found to be at least 2 cm in length, a closed external cervical os was palpated in 65.4%, and an anteflexed/anteverted uterus that was normal in size and form was noted in 46.2%. In 95.4% of the patients, original squamous epithelium was seen colposcopically. The psychosocial status of each patient was evaluated on an individual basis. After taking all of the psychosocial circumstances associated with such a high-risk pregnancy into consideration, all the patients giving birth to a living infant described that event as a positive experience. However, this was not the case in the two patients whose premature infants did not survive. In 74.1% of the patients, the relationship with their domestic partners was described as "unchanged" when compared to the status of their relationship during the preceding pregnancy without TCO. The patients undergoing TCO described their own psychological status as "frequently strained" (61.1%) and "disturbed" (9.3%) antepartum. Postpartum, 90.7% of the patients described their psychological status as "good". In total, there were 74 births in the 54 patients included in this follow-up study. Of these 51 (68.9%) were living term infants, one stillborn (1.4%) and 22 (29.7%) premature infants. One infant weighed less than 1.000 grams while 4 (5.3%) weighed between 1.000 and 1.499 grams. Postpartum, 45.5% of the premature infants and 19.6% of the term infants were hospitalized. The primary indications for the transfer of the premature neonates were intensive care, hyperbilirubinemia and adaptation problems. The physical, emotional and mental development was unimpaired in 91.4% of the children. A capability for good social integration was displayed in 95.7% of the children. Based on the current investigation, it may be concluded that the total cervical occlusion procedure has no significant long-term negative effects.

Abortion, Threatened↗