Biomedical subjects

J Gnirs

Publications and source records attributed to J Gnirs.

26 records · Page 2Linked to original sources

PubMed1988

[Vascular abnormalities of the umbilical cord--incidence, significance and possibility for prenatal ultrasonic detection].

Vascular anomalies of the umbilical cord are amongst the most frequent congenital malformations, their incidence being 0.2% to 1.4%. As a result of the latter the risk of occurrence of other malformations and chromosomal anomalies is markedly elevated. Between January 1977 and July 1987 a total of 78 cases (0.51%) of umbilical cord vascular anomalies were recorded at the Department of Gynaecology of the University of Heidelberg. Malformations occurred in 37% of the foetuses involved. 28% showed retarded growth and 9% had an abnormal set of chromosomes. Anomalies of the urinary tract and malformations of the thoracic organs were very frequent. Total mortality after the 28th pregnancy was about 14%. Currently available high-resolution real-time ultrasound equipment can show up even prenatally pathological variations of the umbilical vascular pedicle (e.g. a single umbilical artery). Because of the manifold risk involved, routine ultrasound control is recommended. If this anomaly is diagnosed, the pregnancy should be classified and treated immediately as a high-risk pregnancy.

Abnormalities, Multiple↗

PubMed1985

Fetal behavioural states and controlled sound stimulation.

The aim of this study was to investigate responses of human fetuses near term (37-42 wks) (increase/decrease of fetal heart rate and/or fetal motility) to acoustic stimuli. The study group consisted of 43 patients and the control group of 27 patients. Polygraphic recordings of 5 different fetal variables were carried out synchronously for the categorization of the actual fetal behavioural state according to Nijhuis et al. (Nijhuis, J.G., Prechtl, H.F.R., Martin, C.B., Jr. and Bots, R.S.A.M. (1982): Early Hum. Dev., 6, 177-195). Controlled acoustic stimulation was performed either with sine wave tone (2 kHz, 120 dB and 5 s duration) or modulated sine wave tone (0.5-2 kHz, 'sawtooth' modulation, 120 dB and 5 s duration). An additional group of patients received 'sham' stimulation. Overall 84 acoustic stimulations have been carried out. In 26 out of 84 stimulations (30%) a fetal response could be observed within 5 s after acoustic stimulation. In general, there were far fewer fetal responses in sleep states than in states of wakefulness. Whereas in state 1 F only 1 out of 28 acoustic stimulations was followed by an immediate fetal response, more responses were observed in state 2 F. An obvious increase in fetal reactivity to acoustic stimulation was noted in states of wakefulness (states 3 F and 4 F). Comparison between the true and sham stimulations revealed a relatively high level of spontaneous fetal activity (high variation of fetal heart rate and fetal motility) present in states 2 F and 4 F. This must be taken into account in all assessments of fetal responses.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Stimulation↗

PubMedDate not supplied

[Total cervix occlusion--an efficient measure in prolapsed amniotic membranes in extreme prematurity?].

BACKGROUND: We analysed retrospectively whether the total cervix occlusion implicates efficient the prolongation of pregnancy in patients with bulging fetal membranes during extreme prematurity. PATIENTS AND METHODS: Between 1993 and 1999 nineteen pregnant women (17 singleton and 2 twin pregnancies) with cervical incompetence and bulging membranes at 20 to 27 weeks' gestation (mean 24 weeks) underwent total cervix occlusion (TCO) at the Department of Obstetrics at the Technische Universität of Munich after taking cervical cultures, prophylactic antibiotic treatment, tocolysis and induction of fetal lung maturity (after 33 weeks of gestational age). RESULTS: Eleven of nineteen pregnancies were carried beyond 32 weeks' gestation. 6 of 21 fetuses, included 2 twin pregnancies died. Considering the perinatal mortality the mean prolongation of pregnancy was 9.4 weeks after total cervix occlusion. 9 of 19 pregnant women were delivered beyond 37 weeks of gestational age. CONCLUSION: Taking the small number and the lack of a randomized trial into consideration, these results implicate the total cervix occlusion as an efficient method in cases of bulging membranes during extreme prematurity. Nevertheless a thorough postoperative control and screening of infectious complications are required.

Adult↗

PubMedDate not supplied

[Prenatal ultrasound diagnosis of children with dysmelia].

UNLABELLED: Since 1979 prenatal ultrasonography is a screening method in Germany. The examination of head, thorax and femur is now established as a routine method. AIM OF THE STUDY: The evaluation of the effectiveness and the consequences of an early prenatal diagnosis of foetal limb deficiencies. METHOD: From 1989-1994 we had 403 children with 207 minor or 196 major limb deficiencies. Questionnaires were sent to those 196 parents of children with major diseases 134 cases (68%) of children with limb deficiencies could be analysed. The average age of the mother at birth was 27.5 years and the age of the father was 30.5 years. RESULTS: 61 children had deficiencies of the upper limb. another 61 of the lower limbs and 12 had combined defects of the limbs. The mothers had 5.6 (1-15) prenatal ultrasounds examinations. In 63% (n = 82) these were performed by the obstetric practitioners, in 30% in departments of obstetrics and 7% in a university hospital. In 5.2% only, the limb deficiency was diagnosed antenataly. CONCLUSION: If there are any unclear findings the women should be sent to a centre of prenatal diagnostics. In cases of congenital deficiencies of the limbs there is the possibility] for the parents to combined to combined consultation of the obstetrician, the human genetic and the orthopaedic to plan the treatment and talk about all consequences.

Cross-Sectional Studies↗

PubMedDate not supplied

[Doppler sonography--effect of fetal position, site of the placenta and measurement site of the fetal aorta].

The influence of fetal position, the site of placenta and the site of measurement in the fetal aorta on doppler-flow parameters was investigated in patients with uncomplicated pregnancies. In 20 cases the S/D-ratio was obtained in three different regions of the descending aorta. Measurements superior the renal vessels showed comparable values (4.1-4.3). No differences were found between signals obtained cranial or caudal of the diaphragma. Measurements at the aortal bifurcation showed significantly increased median values (6.6, p less than 0.05). No differences could be obtained concerning the influence of fetal position or site of placenta on S/D-ratio. All median values of a total of 197 patients were in the range of 4.8. Therefore it may be concluded that the above mentioned parameters do not have significant influence on doppler flow parameters in fetal vessels. However, a proximal site of measurement in the descending aorta fetalis should be reassured.

Aorta↗

PubMedDate not supplied

[Prune belly syndrome. Prenatal diagnosis and obstetric procedure].

With an incidence of between 1 in 30,000 and 1 in 50,000 births, prune-belly syndrome (PBS) is a rare malformation syndrome. The phenotypical and pathoanatomic changes range from discrete expression to very severe malformation complexes with extremely poor prognosis. Malformations of the kidneys and the efferent urinary tract are common. In such cases, oligohydramnios often develops early in such fetuses, followed by Potter's sequence. This syndrome can generally be diagnosed by timely ultrasound investigations, i.e., before the end of the first half of pregnancy. Striking features in the fetus are often oligohydramnios and a greatly dilated urinary bladder, more rarely multicystic-dysplastic kidneys and other malformations of the urogenital tract. Diagnostic possibilities and obstetric procedure are described on the basis of ten cases seen between January 1984 and July 1987 at Heidelberg University Gynecological Clinic.

Abdominal Muscles↗

PubMedDate not supplied

[Controlled acoustic and photic stimulation of the fetus in the last pregnancy trimester].

The aim of the study communicated here was to check any fetal reactions occurring after external stimulation (light-optic and acoustic stimuli), depending on fetal behavioral status. The group studied (acoustic/light stimulation) comprised 85 patients with normal course of pregnancy at term (37th to 42nd week of gestation). They were compared with a control group of nonstimulated patients (n = 26), also with normal course of pregnancy and corresponding gestational age. Fetal heart frequencies and an external tokogram were recorded synchronously with the fetal respiration, body, limb and eye movements registered simultaneously by two independent observers and the fetal behavioral statuses were defined (Nijhuis, Prechtl et al. 1982; Boos and Schmidt 1984; van Vliet et al. 1985). The stimulation methods used were as follows: 1. Single-frequency pure tone (2 kHz, 120 dB, 5 sec) 2. Sawtooth-modulated pure tone (0.5-2.0 kHz, modulation frequency 10 Hz, 120 dB, 5 sec) 3. Low-frequency, sawtooth-modulated pure tone (with vibration effect), (0.1-0.3 kHz, modulation frequency 10 Hz, 120 dB, 5 sec) 4. Light stimulation: electronic photographic flash, luminous intensity 25 X 10(6) Lux/10(-3) sec, 8 flash sequences in 10 sec, distance from maternal abdomen 20 cm. In order to rule out purely coincidental changes in fetal attitude, both genuine and "sham" stimulations were performed in randomized sequence, in the latter case without any acoustic or light-optic signals. No differences in fetal reactions were found with the three different acoustic stimulation methods.(ABSTRACT TRUNCATED AT 250 WORDS)

Acoustic Stimulation↗

PubMedDate not supplied

[Fetal heart rate and Doppler flow parameters in fetal blood vessels--evaluation of 2,517 individual signals].

Analysis of more than 2500 doppler flow signals in three patients was performed to evaluate the influence of fetal heart rate (fhr) variation on S/D-ratio in fetal vessels. Little differences of S/D-ratio in fetal vessels (descending aorta, umbilical arteries) were detected within the physiological variations of fhr (120-160 bpm) (envelope of regression line -0.007, -0.006). Analysing inter- as well as intraindividual variation only minor effects of fhr alteration can be observed in clinical application of doppler flow velocimetry. Dopplersonographic measurements, however, should be performed for at least a three minute period (for each vessel) to avoid false-positive or false-negative interpretation of short term changes of doppler signals. This is especially important in distressed fetuses.

Adult↗