Search PubMed⌕ Search

Biomedical subjects

P Extermann

Publications and source records attributed to P Extermann.

32 records · Page 2Linked to original sources
PubMed1989

Ultrasound screening for congenital cardiac malformations in the fetus. Its importance for peri- and postnatal care.

Congenital cardiac malformations (CCM) are the commonest congenital anomalies. Using ultrasonography (US), the incidence of CCM in a selected group of fetuses and the impact of CCM on perinatal and postnatal care was evaluated. The indication for fetal echocardiography (F-ECHO) in 152 pregnancies was a positive family history in 61, fetal arrhythmias seen by routine obstetrical controls in 53, suspected CCM during obstetrical US in 9, growth retardation in 3 and contracted maternal factors in 6. Twenty pregnancies had no special indication. F-ECHO was performed between the 18th and the 39th gestational week. Twenty-seven cardiac malformations were found (18%), 10 of which were important; 3 succumbed at birth, 2 after surgical intervention, 1 was aborted and 4 needed intensive care at birth. Of 53 cases with arrhythmias, 3 needed special care during pregnancy: Digitalis in a case of atrial flutter, sick leave and bedrest in 2 with supraventricular tachycardia, premature delivery in 1 case with complete AV block due to an intraventricular tumor. The extremely high incidence of CCM in this group proves the need for careful fetal evaluation to detect malformations. Nowadays F-ECHO can and should be performed as early as in the 18th gestational week, allowing either to interrupt a pregnancy or to plan delivery in a well-equipped center which provides the necessary measures for these newborns.

Echocardiography↗
PubMed1989

[Chorionic villus sampling (CVS): level of activity and methods to resolve certain difficulties in interpretation].

As of December 1, 1988, we had, as part of our prenatal diagnostic service, studied 458 transcervical chorionic villus biopsies. Three-fourths of these samples were taken because of advanced maternal age (greater than or equal to 35 years), whereas nearly one fifth were done to alleviate parental anxiety. The remainder were performed because of a precedent chromosomal anomaly in child or parent, to determine fetal sex in the case of X-linked familial disorders, or to obtain DNA for molecular analyses. Among the cytogenetic anomalies detected after 24 to 48 hours of culture, eight involved classical trisomies. In four other instances the chromosomal abnormalities were more difficult to interpret (mosaic trisomies 10, 13 and 15, an apparently uniform trisomy 7). All four were revealed to be "false positives", since neither the amniocenteses nor the karyotypes of the normal newborns (one pregnancy is still ongoing) confirmed an abnormal karyotype. In the case of the trisomy 7 we were able, after birth of the baby, to study two placental biopsies, one of which revealed an abnormality distinct from that detected in the chorionic villi. The observations concerning a fifth false positive are more worrisome, as an apparently uniform trisomy 18, with a fetus showing growth retardation on ultrasound, could not be confirmed in the abortus. Otherwise, we have not encountered a false negative result. In this article we discuss the mechanisms potentially responsible for the cytogenetic discrepancies sometimes observed between fetal and placental tissues. Molecular analyses may help to establish whether a chromosomal anomaly present in fetal chorionic villi had its origin in the pre- or post-zygotic stage; in the latter case the aneuploidy may be uniquely extrafetal.

Chorionic Villi Sampling↗
PubMed1988

Trisomy 7 in chorionic villi: follow-up studies of pregnancy, normal child, and placental clonal anomalies.

Cytogenetic study of chorionic villi sampled because of advanced maternal age revealed, after overnight culture, an apparently non-mosaic trisomy 7. Amniocentesis showed exclusively normal mitoses, and the pregnancy continued normally. One hundred mitoses from cord blood of the normal newborn revealed a non-mosaic 46,XX complement. No cells with a proven trisomy 7 were found in cultures from either of two biopsies of the morphologically normal placenta, but the peripheral biopsy showed in multiple cultures an abnormal clone: 47,XX, +20, -2, -21, +t(2;21)(p13;q22). To our knowledge, this is the first case of non-mosaic trisomy 7 detected on CVS which has had follow-up studies of amniotic fluid, cord blood, and term placenta.

Adult↗
PubMed1987

[The contraction stress test by nipple stimulation: an alternative to the oxytocin test].

Breast stimulation as a "contraction stress test" has been proposed as an alternative test to oxytocin to check the well being of the fetus. 162 breast stimulation tests were carried out in 146 patients with an indication for a "contraction stress test". The stress rate was 66.6%. 8% of the tests showed hyperstimulation without any fetal complications. There was no difference between the types of patients where the test was successful, failed or resulted in hyperstimulation. Where the tests failed, oxytocin tests were carried out. The time needed for these was, on the whole, double that taken for the breast stimulation tests. The two techniques can be comparable, both from correlation of the results with the indication and the outcome for the infant. The mothers tolerated the breast stimulation test very well indeed.

Adult↗
PubMed1986

[Multicenter experiences with the intracervical administration of a new PGE2 gel in labor induction].

With the participation of four Swiss obstetric clinics, medically indicated inductions of birth (with living fetuses) were performed using a new, stable PGE2 gel, and documented according to a uniform protocol. The study was conducted to investigate the efficacy of 0.5 mg of PGE2, in 2.5 ml of a vehicle (Triacetin) not yet commercially available, for local cervical maturation (n = 41). Thirty-nine patients selected by prospective randomization, in whom birth was induced conventionally, served as a control group. The efficiency of the prostaglandin gel alone or respectively with additional administration of oxytocin was evaluated on the basis of the clear changes in the cervical findings observed within 12 or respectively 24 hours, the spontaneous births, or, in the case of cesarean deliveries, according to the pelvic score. Application of PGE2 alone led to impressive changes of the cervix score and, in 34 of the 41 cases, to regular contractions after an average time of 87 minutes. After 12 hours, prior to administration of oxytocin, 43% of the patients were already delivered. The combination of locally applied PGE2 gel with conventional oxytocin induction significantly increases the number of successful inductions. The percentage of unsuccessfully attempted inductions was reduced to 24% in the PGE2 gel group as compared to 44% in the control group.

Adolescent↗
PubMed1986

[Peridural anesthesia in obstetrics: impact on the lower urinary tract].

The results of non-invasive urodynamic examinations (urinary flow rates and ultrasound determination of residual urine in the bladder) and of urinary bacteriology were studied 4 or 5 days after delivery in 305 patients. The method of delivery and other clinical and obstetric parameters that could influence lower urinary tract function have been considered. The numbers of urines that contain bacteria in quantities of more than 10(5)/ml are significantly raised as compared with the control group after spontaneous delivery under continuous epidural analgesia (15% as compared with 4.5% - p less than 0.01). Continuous epidural anaesthesia increases the risk of urinary tract infection and is significantly associated with a prolongation of labour as well as an frequency of catheterisations as well as episodes of urinary retention. This compromises the likelihood of starting normal micturition after delivery.

Adult↗
PubMed1985

Antepartum nonstress fetal heart rate monitoring: systematic analysis of baseline patterns and decelerations as an adjunct to reactivity in the prediction of fetal risks.

A total of 1552 antepartum nonstress tests performed during the week before delivery are analyzed with respect to both reactivity and the presence of pathologic baseline patterns (tachycardia, bradycardia, diminished beat-to-beat variability) or decelerations. Correlation with mode of delivery and condition of the newborn infant shows that, irrespective of nonstress test reactivity, the presence of baseline anomalies and/or decelerations is associated with significantly increased perinatal morbidity and mortality. Nonstress test analysis, if systematic, that is, not restricted to reactivity alone, makes it possible to better detect fetuses at high perinatal risk, in which case closer surveillance would be indicated.

Apgar Score↗
PubMed1985

[Echographic measurement of post-micturition urine volume: description of a simplified method for use in gynecology and obstetrics].

A simple method of determining the quantity of urine after micturition in different clinical situations occurring in our specialty is described. There were three groups of patients studied: normal, women five days after delivery, and women who had been operated on for urinary incontinence (on the fifth post-operative day). The reliability of the method was confirmed in the case of women who were receiving bladder training after operation for urinary incontinence. The value for the practitioner of this method, which only depends on a simple ultrasound machine, is emphasized.

Female↗
PubMed1983

Are vaginal fluid concentrations of prolactin, alpha-fetoprotein and human placental lactogen useful for diagnosing ruptured membranes?

Vaginal fluid levels of prolactin (Prl), alpha-fetoprotein (AFP) and human placental lactogen (hPL) were assayed to investigate their usefulness in the diagnosis of ruptured membranes. Fifty-two patients at term were divided into those with intact membranes, and those with ruptured membranes. In patients with intact membranes the concentration of all three substances was low with few exceptions. The mean vaginal concentrations of the three proteins were significantly higher in patients with ruptured membranes, but low values were also found in this group. It is concluded, that because of the overlap between the values, Prl, AFP and hPL measurements in vaginal fluid do not represent a useful advance in the assessment of rupture of the membranes.

Body Fluids↗
PubMedDate not supplied

Crohn's disease as a risk factor for the outcome of pregnancy.

BACKGROUND/AIMS: To study the effects of Crohn's disease on the course of pregnancy and the influence of pregnancy on the activity of Crohn's disease. METHODOLOGY: The course of 35 pregnancies in 23 women with Crohn's disease were reviewed over a 12 years period. RESULTS: Nine pregnancies (25%) started when Crohn's disease was active. We observed 2 exacerbations among the 9 pregnancies with active disease and 7 exacerbations among the 26 pregnancies with quiescent disease: this represents a total exacerbation rate of 26% similar to non-pregnant women with Crohn's disease. The course of pregnancy was normal with a full-term delivery in 22 cases (63%). We observed 5 premature deliveries (14%), 5 spontaneous abortions (14%), 1 induced abortion (3%) and 2 liveborns with severe malformations (6%). Preterm delivery was significantly associated with reactivation of Crohn's disease during pregnancy (P = 0.009), whereas fetal loss was significantly associated with activity of Crohn's disease at the time of conception (P = 0.015). CONCLUSIONS: Pregnancy does not appear to influence the course of Crohn's disease. The relapse rate of Crohn's disease during pregnancy is similar to that of the general Crohn's disease population. Active Crohn's disease at the time of conception or reactivation during pregnancy are risk factors for abnormal pregnancy outcome.

Adult↗