Der elektronische Mutterpass

Zusammenfassung: Durch das Führen einer elektronischen Krankengeschichte für Schwangerschaft, Geburt und Wochenbett wurde es uns möglich, die elektronisch gespeicherten Daten im PDF-Format auf einen USB-Stick zu übertragen. In der Ambulanz der Klinik für Geburtshilfe am Universitätsspital Zürich erhalten seit Herbst 2005 alle Schwangeren einen mit Drittmitteln der Industrie finanzierten elektronischen Mutterpass. Er beinhaltet alle über die Schwangere gespeicherten Daten der Krankenakte einschließlich (Ultraschall-)Bildern. Der Stick wird nach jeder Kontrolluntersuchung neu synchronisiert. Die ersten Rückmeldungen der Schwangeren sind sehr positi

Nomograms of Iranian fetal middle cerebral artery Doppler waveforms and uniformity of their pattern with other populations' nomograms

<p>Abstract</p> <p>Background</p> <p>Doppler flow velocity waveform analysis of fetal vessels is one of the main methods for evaluating fetus health before labor. Doppler waves of middle cerebral artery (MCA) can predict most of the at risk fetuses in high risk pregnancies. In this study, we tried to obtain normal values and their nomograms during pregnancy for Doppler flow velocity indices of MCA in 20 – 40 weeks of normal pregnancies in Iranian population and compare their pattern with other countries' nomograms.</p> <p>Methods</p> <p>During present descriptive cross-sectional study, 1037 normal pregnant women with 20^th–40^thweek gestational age were underwent MCA Doppler study. All cases were studied by gray scale ultrasonography initially and Doppler of MCA afterward. Resistive Index (RI), Pulsative Index (PI), Systolic/Diastolic ratio (S/D ratio), and Peak Systolic Velocity (PSV) values of MCA were determined for all of the subjects.</p> <p>Results</p> <p>Results of present study showed that RI, PI, S/D ratio values of MCA decreased with parabolic pattern and PSV value increased with simple pattern, as gestational age progressed. These changes were statistically significant (P = 0.000 for all of indices) and more characteristic during late weeks of pregnancy.</p> <p>Conclusion</p> <p>Values of RI, PI and S/D ratio indices reduced toward the end of pregnancy, but PSV increased. Despite the trivial difference, nomograms of various Doppler indices in present study have similar pattern with other studies.</p

Ultragarsine biometrija. I. Gestacinio amziaus nustatymas

Summary: One of the most important objectives of ultrasonographic fetal biometry is the accurate gestational age (GA) estimation. The crown – rump length greater than 10mm has the best correlation with GA at 8–12 gestational weeks. GA could be estimated at 5–7 gestational weeks, measuring the dimensions of the gestational sack. Biparietal diameter is the main parameter that can me measured in the second trimester for GA estimation, but fetal head circumference can be used as well applying the “ellipse” function. However, when fetal head appears to be dolichocephalic or brachicephalic, femur length could be additionally used for GA estimation. At the third trimester of pregnancy, GA estimation could be improved when measuring the length of fetal kidneys. The main failures of GA estimation occur due to the application of fetal abdominal parameters or rather out of date and adjusted for an inappropriate population standards. Key words: gestational age, ultrasonographic fetal biometry

Creating unbiased cross-sectional covariate-related reference ranges from serial correlated measurements

Cross-sectional covariate-related reference ranges are widely used in clinical medicine to put individual observations in the context of population values. Usually, such reference ranges are created from data sets of independent observations. If multiple measurements per individual are available, then ignoring the within-person correlation between repeats will lead to overestimation of centile precision. Furthermore, if abnormal measurements have triggered more frequent assessment, the data set will be biased thus producing biased centiles. Where multiple measures per individual exist, the methods commonly used are either randomly or systematically to select one observation per individual or to model individual trajectories and combine these. The first of these approaches may result in discarding a large proportion of the available data and may itself cause bias and the latter requires the form of the changes within individuals to be characterized. We have developed an approach to the modeling of the median, spread, and skew across individuals using maximum likelihood, which can incorporate correlations between dependent observations. Heavily biased data sets are simulated to illustrate how the methodology can eliminate the biases inherent in the data collection process and produce valid centiles plus estimates of the within-person correlations. The "select one per individual" approach is shown to be liable to bias and to produce less precise centiles. We recommend that the maximum likelihood method incorporating correlations be used with existing data sets. Furthermore, this is a potentially more efficient approach to be considered when planning the future collection of data solely for the purposes of creating cross-sectional covariate-related reference ranges

Physiological Uterine Involution in Primiparous and Multiparous Women: Ultrasound Study

Purpose. To examine the uterine involution period after uncomplicated delivery in primiparous and multiparous women. Methods. Longitudinal prospective study. Repeated parameters were measured and endometrial contents and diastolic notch were observed. Measurements of primiparous and multiparous women were carried out after labour on the 1st, 3rd, 10th, 30th, 42nd, and 60th postpartum days. The analysis was performed using SPSS version 21. Results. The median uterus parameters are bigger in multiparous group in physiological puerperium, but the decreasing trend is the same. The endometrial cavity on the 10th day was significantly wider in multiparous women and mainly echo-negative view of the uterine cavity was observed. The evaluation of the uterine angle deviation changes from an extremely retroverted position to a more anteverted position. RI of the uterine artery in both groups was low immediately after labour and significantly increased one month postpartum. Notching of the uterine artery undergoes changes, but diastolic notch does not appear in all postpartum women even after two months following labour. Conclusions. The puerperium period after normal vaginal delivery depends on parity. The trend of involution in primiparous and multiparous women follows a similar pattern, yet, it lasts longer in the multiparous women. Ultrasound of uterine is certainly a useful tool after labour and may be important in facilitating an early detection of postpartum uterine complications

Der elektronische Mutterpass

Zusammenfassung: Durch das Führen einer elektronischen Krankengeschichte für Schwangerschaft, Geburt und Wochenbett wurde es uns möglich, die elektronisch gespeicherten Daten im PDF-Format auf einen USB-Stick zu übertragen. In der Ambulanz der Klinik für Geburtshilfe am Universitätsspital Zürich erhalten seit Herbst 2005 alle Schwangeren einen mit Drittmitteln der Industrie finanzierten elektronischen Mutterpass. Er beinhaltet alle über die Schwangere gespeicherten Daten der Krankenakte einschließlich (Ultraschall-)Bildern. Der Stick wird nach jeder Kontrolluntersuchung neu synchronisiert. Die ersten Rückmeldungen der Schwangeren sind sehr positi

Newborn weight charts underestimate the incidence of low birthweight in preterm infants

OBJECTIVE: The objective of the study was to compare sonographic fetal weight estimates with newborn weight charts and analyze the predictive accuracy of the ponderal index (PI) in preterm infants. STUDY DESIGN: We generated sonographic reference curves for fetal weight and PI estimates from a database of fetal biometric records from 12,589 term deliveries. We then plotted sonographic and newborn weight and PI of 2406 preterm newborns on these curves and compared them with published newborn weight charts. RESULTS: The third centiles of sonographic and newborn weights diverged markedly between 25 and 36 weeks of gestation and by more than 400 g at 32-33 weeks. In contrast, sonographic and newborn PI values were similar despite uncertainties as to fetal length. CONCLUSION: We suggest using sonographic reference fetal weights to screen preterm newborns for low birthweight. Uncertainties in fetal length threaten the reliability of the PI