[Personal experience with surgical treatment of urinary incontinence in women].
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Female↗
Biomedical subjects
W Michels
Publications and source records attributed to W Michels.
Hormone analytical and carrier protein alternations following administration of mifepristone (RU 486) for termination of early pregnancy.
Outpatient terminations were performed on 50 biochemically confirmed pregnancies of 33 to 43 days amenorrhea with a single oral dose of 600 mg of mifepristone (RU 486). 37 women were randomly assigned to an additional endocrine investigation, comprising serum levels of beta hCG, progesterone (P), estradiol (E2), cortisol (C), sexual hormone binding globulin (SHBG), and cortisol binding globulin (CBG) on days 0 and 7 prior to and following the drug administration. Of these 37 patients, 30 experienced a complete expulsion of the uterine contents, 28 until day 7, 2 subjects on day 9 and 10, respectively. The remaining 7 women either showed an unaffected pregnancy or the symptoms of incomplete abortion, which made a surgical intervention necessary. In the successfully treated cases the levels of beta hCG, P and E2 decreased significantly, the nonresponders showed unchanged or even increasing hormone values. No significant changes of cortisol concentrations were found in the group of nonresponders, while the successful cases exhibited a slight elevation probably due to the abortion-associated processes. No considerable therapy-dependent differences were observed in the levels of SHBG. A small but significant decrease in the mean CBG value could be calculated in the group of responders.
Abortion, Spontaneous↗
[Pharmacokinetics of contraceptive steroids with reference to long-term administration].
Pharmacokinetic investigations (c0h, c2h, c6h, c24h, AUC24) were carried out both in the first and last four days of a treatment cycle in patients of different ages, who used oral contraceptives at least for 12 months. 57 women took the preparation Trisiston (three-step-formulation with the components 0.03 mg ethinylestradiol (EE2) + 0.05 mg levonorgestrel (LNG), 0.04 mg EE2 + 0.075 mg LNG, 0.03 mg EE2 + 0.125 mg LNG), 23 subjects used Gravistat (0.05 mg EE2 + 0.125 mg LNG) and 17 patients were under Certostat, a preparation still in clinical evaluation (0.05 mg EE2 + 2.0 mg Dienogest (DNG)). The levels of EE2, LNG and DNG were measured by means of radioimmunoassays. Between the concentrations obtained after administration of a first and single tablet (earlier investigations) and those determined in long-time users during the first 4 days following the tablet-free interval no qualitative and quantitative differences were observed. Between the levels of EE2 and LNG determined in the first and last days of the treatment cycle, marked differences were found in patients under the formulations Trisiston and Gravistat, but not in those taking Certostat. It is concluded that a cyclic and reversible cumulating effect emerges under the influence of LNG-containing contraceptives, the mechanism of which cannot be explained solely by the increase of carrier protein capacity. It seems possibly due to an alteration of steroid metabolism resulting from the interaction between both components.
Adolescent↗
[Serum and erythrocyte zinc, copper, magnesium and iron in women with normal pregnancies and pregnancy-at-risk (pregnancy-induced hypertension, fetal growth retardation and hepatosis)].
In women with normal pregnancy and with pathological pregnancy (pregnancy-induced hypertension, fetal growth retardation, hepatosis) trace elements concentrations (Fe++, Cu++, Zn++, Mg++) were determined in serum and erythrocytes. The concentrations were partly decreased or increased in both serum and erythrocytes, but these changes were not significant. Thus, the analyses of trace element concentrations can not be used as a marker of the investigated pathological events of pregnancy.
Copper↗
[Inter- and intra-individual variability of pharmacokinetic parameters for contraceptive steroids].
Serum levels of ethinylestradiol (E2) and levonorgestrel (LNG) have been determined in 10 volunteers of similar age after administration of 1 tablet of the oral contraceptives Gravistat and Ediwal, respectively, each containing 0.05 mg E2 and 0.125 mg LNG, using a cross over design. The studies were carried out at intervals of 4 weeks, within the follicular phase of the menstrual cycle and under standardized conditions. Wide variations were observed between the women in the calculated pharmacokinetic parameters, while there was a relatively close correspondence between the intra-individually obtained values, except for one case.
Adult↗
[Fetal movement and acceleration behavior in hypertension in pregnancy].
Under standardized conditions, 26 pregnant women with pregnancy-related hypertension of different degrees were submitted to cardiogram-synchronous recording of fetal body and respiratory movements. The gestational age was between the completed 34th and 38th weeks. Of the 26 fetuses of the risk group, 20 were normotrophic and 6 hypotrophic. 40 normotrophic unimpaired fetuses of the same gestational age served as a control group. The average duration of the examination period was 70 minutes. The fetal movement and acceleration behaviours did not differ between the normotrophic fetuses of the risk group and those of the control group. The hypotrophic fetuses from the risk group, however, had significantly lower fetal body and respiratory activities than the normotrophic fetuses from this group. The same holds true for the degrees of heart rate activity. It can be concluded that pregnancy-related hypertension as the only pregnancy complication does not have a measurable influence on fetal movement and acceleration behaviours. This is true for both treated and untreated pregnancy-related hypertensions. The severity of pregnancy-related hypertension is not primarily reflected in changes of fetal movement and acceleration behaviours, either. This means that the parameters presented are not suited to prognosticate the effects of pregnancy-related hypertension on the fetus a priori. The situation becomes quite different if in addition to pregnancy-related hypertension some intrauterine fetal growth retardation develops. In this case, the fetus indicates its impairment by increasingly impaired movement and heart rate activities as a consequence of chronic oxygen deficiency.
Female↗
[Effects of various oxygen concentrations on metabolic performance of in vitro perfused human placentas].
The aim of the experiments was the in vitro-investigation of metabolic reactions of human placentae under different oxygen supply, particularly when oxygenation followed a period of hypoxia. A perfusion system was used with both circuits of a whole placenta being recirculated over 2 hours with blood-containing perfusate. In group A 17 placentae were perfused under normoxic conditions; in group B 10 perfusions were carried out under hypoxia. In group C 8 placentae were oxygenated after 60 minutes of hypoxic perfusion. (All results are given in mumol/g wet weight/h). In group B glucose uptake (2.95 +/- 1.11) was slightly increased compared to group A (2.59 +/- 1.68), while lactate production was markedly higher (7.69 +/- 1.04 versus 3.56 +/- 1.53 in group A). Oxygen consumption was smaller under hypoxia. Pyruvate showed no significant changes over the 2 hours in all groups. In group C the results of the first hour resembled those of group B. After reoxygenation these placentae showed a smaller oxygen consumption compared to group A, but the highest glucose uptake (4.35 +/- 0.72), whereas lactate production (5.26 +/- 1.86) was lowered compared to group B. The smaller oxygen consumption could be explained by a deterioration of mitochondriae and hence a decreased capacity of oxydative metabolism. The higher glucose uptake could reflect the ability of placental tissue to restore other energy-sources (e.g. proteins) which were affected under the previous hypoxia. Further investigations are required to answer questions of placental function and its disturbances.
Blood Glucose↗
[The extent of fetal heart rate accelerations associated with fetal body movements in relation to the duration of fetal body movement].
The temporal relations between fetal body movements and associated fetal heart rate accelerations were shown as the ratios of duration of acceleration or acceleration amplitude and the duration of associated fetal body movements in 44 normotrophic and 40 hypotrophic fetuses (body weights within the 6th to 10th percentiles, n = 19, and less than or equal to the 5th percentile, n = 21) between the 36th and 40th gestational weeks. Related to the duration of associated fetal body movements, hypotrophic fetuses proved to have gradually smaller heart rate accelerations than normotrophic fetuses. Moreover, the acceleration parameters duration and amplitude were dependent on the relative duration of fetal body movements. Short fetal body movements were accompanied by fetal heart rate accelerations of relatively highest degree and vice versa. As a consequence, no comparison is possible between temporally different fetal body movements and their associated heart rate accelerations. Of the two acceleration parameters duration and amplitude, the inclusion of the accelerations amplitude in the above mentioned ratio yielded the most obvious results. Taking into consideration that fetuses with intrauterine growth retardation are often in a state of chronic hypoxia, the ratios of acceleration amplitude and durations of associated fetal body movements indicated different degrees of this metabolic situation.
Adult↗
[Movement and heart acceleration behavior of eutrophic fetuses in the early and late dilatation period].
The degree of fetal respiratory and body movements as well as of fetal heart rate reactivity was checked by synchronous ultrasonic and cardiographic monitoring of 18 normotrophic fetuses in the early and late dilation period. Apart from the fetal respiratory movements, which could no longer be observed in the late dilatation period, the degree of fetal body movements remained unaffected during the birth process. In the late dilatation period, the mean amplitude of heart rate accelerations occurring in association with fetal body movements was significantly lower than in the early dilatation period. In the unimpaired normotrophic fetus, however, the reactivity of the fetal cardiovascular system increased during the birth process in relation to the ratio of the amplitude of heart rate accelerations and the duration of associated fetal body movements. Hence, a decrease in fetal heart rate reactivity signals intranatal disturbance of the materno-utero-placento-fetal entity.
Cardiotocography↗
[Synchronous cardiotocographic registration of fetal body and respiratory movements in placenta insufficiency].
The extent of fetal movements and their reflections in the cardiogramme were studied in 44 normotrophic and 39 hypotrophic fetuses under standardized conditions using real time ultrasound examination of fetal body and respiratory movements and synchronous registration of fetal cardiogrammes from a uterus without labour. Altogether, hypotrophic fetuses exhibited fewer movements than normotrophic fetuses did. Numbers and parameters of accelerations in fetal heart rate occurring in connection with fetal body movements were less marked, too. The acceleration amplitude was particularly significant. Further comparisons between fetuses born with pHa greater than or equal to 7.20 and less than 7.20 or 1- and 5-minute Apgar scores greater than or equal to 8 points and less than or equal to 7 points revealed statistically significant (alpha = 0.05) differences in the frequency of movements and movement-associated accelerations in fetal heart rate only in fetuses with a body weight less than or equal to the 5th weight percentile according to Kyank (n = 21). Fetuses with a body weight between the 6th and the 10th weight percentiles (n = 18) and normotrophic fetuses did not, or did only faintly, reveal these differences. A ratio calculated from the acceleration amplitudes and the durations of associated body movements differed significantly between impaired and unimpaired born fetuses during defined intervals of the duration of fetal body movements.
Acid-Base Equilibrium↗
[Treatment of symptomatic urinary incontinence in women].
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Benzilates↗
[Description of cardiogram potentials of fetal movements in labor].
Examples of cardiographic reflections of intranatal fetal movements (body movements) in 130 normotrophic and 26 hypotrophic fetuses (body weight less than or equal to 10th percentile) are presented. Labour-synchronous accelerations of fetal heart rate occurred in 95% associated with fetal body movements. About 83% of the body movements associated with fetal heart rate accelerations occurred periodically. Strikingly, labour with fetal body movements resulted in accelerations, whereas labour alone hardly ever produced medium-term heart rate changes or variable decelerations. In contrast to periodical accelerations with associated body movements, periodical accelerations without associated fetal body movements, which are mainly of hemodynamic origin, indicated potential fetal risk. Even with medium-degree or severe variable decelerations in the expulsive period, fetal body movements with associated heart rate accelerations indicated a good actual fetal condition. The importance of cardiogram synchronous real-time ultrasonic examination of intranatal fetal movements is discussed.
Cardiotocography↗
[Computerized automatic analysis of the cardiotocogram (results of an international multicenter study].
By means of an international multicentre study (SU, Socialist Republic of Poland, Socialist Republic of Czechoslovakia, GDR) 403 patients with computerized CTG-analysis and 393 patients with visual CTG-analysis in labour were investigated in relation to course of labour and neonatal outcome. The following results were fixed: The computerized CTG-analysis by help of the equipment "robotron-NATALI" is equal the statement of high qualified perinatologists. The computerized CTG-analysis led significantly more frequently in various stages of labour to the diagnosis "prepathological" CTG-pattern (warn signs) in relation to visual CTG-analysis with a significantly higher rate of fetal pH-measurements. That means, that the sensitivity of this method is greater. The safety in frame of electronic supervision of labour is improved. The number of "acut-tocolysis" in various stages of labour for both collectives wasn't significantly too. The rate of caesarean section and the rate of operative vaginally deliveries (forceps, vacuum-extraction) showed in both collectives no significantly differences. The neonatal morbidity (APGAR score, pHUA) matured analogous results in the collective with and without computerized CTG-analysis. A decline of "acidotic" morbidity in the collective with computerized CTG-analysis wasn't mentioned. One stillbirth was found in the collective with visual CTG-analysis. In spite of that computerized CTG-analysis showed no better results in perinatological centres in relation to visual CTG-analysis this method is the basis for very important perinatological aims how computer controlled infusion in connection with termination of labour as well as computer steered tocolysis.(ABSTRACT TRUNCATED AT 250 WORDS)
Apgar Score↗
[Prolactin stimulation using the metoclopramide test in females taking oral contraceptives].
In 31 patients taking oral contraceptives (o.c.) for a period between 1 year to more than 3 years, basal serum prolactin levels and metoclopramide induced prolactin values were determined 30 and 60 minutes following an i.v. injection of 10 mg of metoclopramide. The basal prolactin levels were elevated in 7 women to more than 1,000 mU l. The 3 groups of patients taking o.c. with different estrogen doses showed higher drug induced increase of their prolactin levels than the controls. These differences were statistically significant between groups I and III and the control group. No differences could be found between the challenged values of the users groups. The prolactin increase challenged with 200 micrograms TRH in 5 women under o.c. was considerably smaller than that observed in the metoclopramide groups, but exceeded the TRH induced levels found in the controls. The significance of these findings is discussed with special reference to the promotion of prolactinomas.
Adult↗
[Fetal heart rate accelerations and fetal oxygen pressure sub partu].
By means of tcPO2 measurement, a total of 297 FHR accelerations from 55 oxygen cardiotocograms were analysed with regard to their association with changes in fetal oxygen pressure sub partu. It could be demonstrated that the transcutaneous oxygen pressure of 2.3 kPa (17.1 mmHg) with occasional accelerations was significantly (alpha less than 0.05) higher than that of 2.2 kPa (16.6 mmHg) with periodic accelerations. Oxygen pressure with occasional accelerations with "classical parameters" (amplitude greater than or equal to 15 bpm, duration greater than or equal to 15 sec) did not significantly differ from that with one or both parameters below these minimal values. Furthermore, our results suggest the production of periodic accelerations by pressorreceptor reflex due to intermittent disturbance in umbilico-placental perfusion.
Blood Gas Monitoring, Transcutaneous↗
[Use of a computer system in perinatal data collection].
We present a computer system for obstetrical and perinatological data collection. All deliveries of the years 1984, 1985, and 1986 have been collected with this data collection program, so that there is how a data base containing 7,975 data records. A relational data base was chosen for data collection and storage. Either off-line or on-line data collection is possible by medical users via menu monitoring. Various possibilities of use are described.
Birth Weight↗
[Significance of trial vacuum extraction in the framework of obstetric surgery in vertex presentation].
On the basis of a clinical study of 76 infants born by trial vacuum extraction from the pelvic inlet, 57 infants were examined retrospectively with regard to early and late morbidity after "successful" trial vacuum extraction. In 34 cases surgery was indicated because of fetal distress; in 23 children the operation was performed because of a standstill at the pelvic inlet. The results were compared with a group of infants delivered by vacuum and forceps extraction from the centre of the pelvis (or the pelvic floor) or cesarean section in consequence of fetal distress. The results indicate the high risk for children born by trial vacuum extraction, especially in cases of fetal distress. In addition to statistically significant lower Apgar scores and a statistically significant higher acidosis morbidity (p less than 0.05) as compared to other obstetric operations, there is also a statistically significant greater number of "striking" and "injured" children as opposed to those delivered by vacuum or forceps extraction from the centre of the pelvis (or the pelvic floor) or by cesarean section in consequence of fetal distress. These neurological deviations represent primarily the static-motoric and speech development, and are analogous to late morbidity after births from breech presentation. The findings confirm the clinical impression that trial vacuum extraction-especially in cases of fetal distress at the pelvic inlet-represent an additional risk to the child. In such cases cesarean section is the only alternative method of delivery.
Apgar Score↗
[Pattern changes in the framework of cesarean sections in 1980/83 as compared to 1974/76 in the University Women's Clinic in Jena].
In a comparative study on Caesarean section problems-based on investigations from 1974/76 and 1980/83-conducted at the Gynaecological and Obstetrical Hospital of Jena University, changes are apparent in the indication for Caesarean section and in maternal morbidity. The evident decrease in statistically uncorrected perinatal mortality as well as in uncorrected intra-and postnatal mortality during this period (difference statistically significant at p less than 0.05) was not due to a further increase in Caesarean sections from 8.23% (period 1974/76) to 9.27% (period 1980/83), but to other factors (improved medical care for pregnant women and improved neonatal check-up). In comparison with uncorrected intra-and postnatal mortality, perinatal Caesarean section lethality even showed a 2,46-fold relative increase. As late morbidity among high-risk children related to the immediate stage of labour is still poorly understood, "extended" indication for Caesarean section is maintained-in spite of high infection morbidity among mothers. General perioperative antibiotic prophylaxis for these women is recommended because of the statistically significant poor situation of secondary Caesarean sections as far as maternal morbidity is concerned.
Apgar Score↗