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

Puerperal symphysis fundus distance: normal values

Aim: To measure puerperal symphysis fundus distance (SFD) by two manual methods and to calculate individual normal values. Study design: Prospective cohort study including women after single pregnancy without special problems in uterine involution. Methods: SFD was daily measured on the 1st-5th postpartum days by counting the number of midwife's fingers put horizontally on the mother's abdomen and by a paper tape, respectively. Linear mixed model analysis was performed to determine SFD normal values. Results: Independent variables determining the SFD on different days after delivery were the gestational age and the delivery mode (finger method) and the maternal age, body mass index (BMI), delivery mode and birth weight (tape method). Individual normal values were calculated by regression equation including the coefficients for the independent variables. Conclusion: Puerperal SFD values measured by tape have more independent variables than those measured by fingers and reflect better the actual situation of the patient. It should be verified whether values deviating from normal values of tape measurements may prevent postpartum complication

Puerperal symphysis fundus distance: normal values

Aim: To measure puerperal symphysis fundus distance (SFD) by two manual methods and to calculate individual normal values. Study design: Prospective cohort study including women after single pregnancy without special problems in uterine involution. Methods: SFD was daily measured on the 1st-5th postpartum days by counting the number of midwife's fingers put horizontally on the mother's abdomen and by a paper tape, respectively. Linear mixed model analysis was performed to determine SFD normal values. Results: Independent variables determining the SFD on different days after delivery were the gestational age and the delivery mode (finger method) and the maternal age, body mass index (BMI), delivery mode and birth weight (tape method). Individual normal values were calculated by regression equation including the coefficients for the independent variables. Conclusion: Puerperal SFD values measured by tape have more independent variables than those measured by fingers and reflect better the actual situation of the patient. It should be verified whether values deviating from normal values of tape measurements may prevent postpartum complication

Maternal and neonatal outcome of labour induction at term comparing two regimens of misoprostol

Aim: To compare the efficacy and safety of two misoprostol dosing regimens for induction of labour in primiparous (1P) and multiparous (>1P) women. Methods: Retrospective study of induction of labour using vaginal misoprostol 25 μg vs. 50 μg every 6 h in 942 women at a tertiary centre. The main outcome variables are induction-to-delivery interval, latency period duration, vaginal delivery within 24 h, and maternal and foetal safety outcome. Results: With the 50 μg regimen, induction-to-delivery intervals were significantly shorter: 18.4 h vs. 24.6 h (1P) and 14 h vs. 17.9 h (>1P), as was latency period duration (by 5.4 and 4 h, respectively). Vaginal delivery within 24 h was significantly more frequent, as were non-reassuring foetal heart rate (1P: 20% vs. 14%) and tachysystole (1P: 31% vs. 11%; >1P: 21% vs. 7%). No uterine rupture was reported. Neonatal outcomes were similar except for significantly more frequent infant referral to neonatal intensive care in the >1P group receiving the 50 μg regimen (11% vs. 4%). Conclusion: Vaginal misoprostol 25 μg seems to maintain efficacy with more acceptable maternal and neonatal safety. As induction of labour is an off-label use for misoprostol, safety should be prioritised with the lower dosage regimen despite the longer induction-to-delivery interva

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

International estimated fetal weight standards of the INTERGROWTH-21(st) Project.

OBJECTIVE: Estimated fetal weight (EFW) and fetal biometry are complementary measures used to screen for fetal growth disturbances. Our aim was to provide international EFW standards to complement the INTERGROWTH-21(st) Fetal Growth Standards that are available for use worldwide. METHODS: Women with an accurate gestational-age assessment, who were enrolled in the prospective, international, multicenter, population-based Fetal Growth Longitudinal Study (FGLS) and INTERBIO-21(st) Fetal Study (FS), two components of the INTERGROWTH-21(st) Project, had ultrasound scans every 5 weeks from 9-14 weeks' until 40 weeks' gestation. At each visit, measurements of fetal head circumference (HC), biparietal diameter, occipitofrontal diameter, abdominal circumference (AC) and femur length (FL) were obtained blindly by dedicated research sonographers using standardized methods and identical ultrasound machines. Birth weight was measured within 12 h of delivery by dedicated research anthropometrists using standardized methods and identical electronic scales. Live babies without any congenital abnormality, who were born within 14 days of the last ultrasound scan, were selected for inclusion. As most births occurred at around 40 weeks' gestation, we constructed a bootstrap model selection and estimation procedure based on resampling of the complete dataset under an approximately uniform distribution of birth weight, thus enriching the sample size at extremes of fetal sizes, to achieve consistent estimates across the full range of fetal weight. We constructed reference centiles using second-degree fractional polynomial models. RESULTS: Of the overall population, 2404 babies were born within 14 days of the last ultrasound scan. Mean time between the last scan and birth was 7.7 (range, 0-14) days and was uniformly distributed. Birth weight was best estimated as a function of AC and HC (without FL) as log(EFW) = 5.084820 - 54.06633 × (AC/100)(3)  - 95.80076 × (AC/100)(3)  × log(AC/100) + 3.136370 × (HC/100), where EFW is in g and AC and HC are in cm. All other measures, gestational age, symphysis-fundus height, amniotic fluid indices and interactions between biometric measures and gestational age, were not retained in the selection process because they did not improve the prediction of EFW. Applying the formula to FGLS biometric data (n = 4231) enabled gestational age-specific EFW tables to be constructed. At term, the EFW centiles matched those of the INTERGROWTH-21(st) Newborn Size Standards but, at < 37 weeks' gestation, the EFW centiles were, as expected, higher than those of babies born preterm. Comparing EFW cross-sectional values with the INTERGROWTH-21(st) Preterm Postnatal Growth Standards confirmed that preterm postnatal growth is a different biological process from intrauterine growth. CONCLUSIONS: We provide an assessment of EFW, as an adjunct to routine ultrasound biometry, from 22 to 40 weeks' gestation. However, we strongly encourage clinicians to evaluate fetal growth using separate biometric measures such as HC and AC, as well as EFW, to avoid the minimalist approach of focusing on a single value

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

Evaluation of fetal anthropometric measures to predict the risk for shoulder dystocia

OBJECTIVE: To evaluate the quality of anthropometric measures to improve the prediction of shoulder dystocia by combining different sonographic biometric parameters. METHODS: This was a retrospective cohort study of 12 794 vaginal deliveries with complete sonographic biometry data obtained within 7 days before delivery. Receiver-operating characteristics (ROC) curves of various combinations of the biometric parameters, namely, biparietal diameter (BPD), occipitofrontal diameter (OFD), head circumference, abdominal diameter (AD), abdominal circumference (AC) and femur length were analyzed. The influences of independent risk factors were calculated and their combination used in a predictive model. RESULTS: The incidence of shoulder dystocia was 1.14%. Different combinations of sonographic parameters showed comparable ROC curves without advantage for a particular combination. The difference between AD and BPD (AD - BPD) (area under the curve (AUC) = 0.704) revealed a significant increase in risk (odds ratio (OR) 7.6 (95% CI 4.2-13.9), sensitivity 8.2%, specificity 98.8%) at a suggested cut-off ≥ 2.6 cm. However, the positive predictive value (PPV) was low (7.5%). The AC as a single parameter (AUC = 0.732) with a cut-off  ≥ 35 cm performed worse (OR 4.6 (95% CI 3.3-6.5), PPV 2.6%). BPD/OFD (a surrogate for fetal cranial shape) was not significantly different between those with and those without shoulder dystocia. The combination of estimated fetal weight, maternal diabetes, gender and AD - BPD provided a reasonable estimate of the individual risk. CONCLUSION: Sonographic fetal anthropometric measures appear not to be a useful tool to screen for the risk of shoulder dystocia due to a low PPV. However, AD - BPD appears to be a relevant risk factor. While risk stratification including different known risk factors may aid in counseling, shoulder dystocia cannot effectively be predicted